Devita, Hellman, and Rosenberg's Cancer

LWBK1006-44 LWW-Govindan-Review November 24, 2011 11:30

556 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

ANSWERS

Answer 44.1. The answer is B.

This lady likely has splenic rupture, a rare adverse event associated with

the use of filgrastim and pegfilgrastim. Allergic-type reactions and adult

respiratory distress syndrome have also been reported as rare, serious

adverse events associated with the administration of these agents.

Answer 44.2. The answer is D.

Primary prophylactic use of G-CSF is recommended in all of the above

scenarios as per the American Society of Clinical Oncology 2006 Guide-

lines.

Answer 44.3. The answer is D.

Patient with cancer has an increased risk of deep venous thrombosis. Fac-

tors that increase the risk of thrombosis in these patients include presence

of metastatic disease, primary site of cancer (pancreatic cancer, lung can-

cer), presence of indwelling central venous catheter, and certain treatments

such as bevacizumab and erythropoietin-stimulating agents.

Answer 44.4. The answer is C.

Multiple trials have shown that the prophylactic use of either warfarin

or low-molecular-weight heparin is effective in reducing symptomatic

catheter-related thrombosis. These rates are approximately 4% with some

possible increased bleeding complications in those on anticoagulation.

Current ACCP guidelines recommend against the use of routine antico-

agulation prophylaxis.

Answer 44.5. The answer is D.

Acute, delayed, and anticipatory nausea and vomiting make up the three

clinical syndromes of CINV. Acute CINV occurs within the first 24 hours

of chemotherapy administration, whereas delayed CINV occurs more

than 24 hours after chemotherapy administration. Anticipatory CINV

occurs as a conditioned response to stimuli that remind patients of previ-

ous episodes of nausea and vomiting.

Answer 44.6. The answer is C.

Patient-related factors that increase the risk of CINV include female gen-

der, younger age, CINV with previous chemotherapy treatment, history

of pregnancy-associated nausea and vomiting, and history of motion

sickness. A history of chronic alcohol consumption is associated with

a decrease in risk of CINV. Treatment-related factors that increase

the risk of CINV include the agent, dose, rate, and route of adminis-

tration.