Cancer therapy complications and supportive care

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Target exams

Red flags

• A child on chemotherapy with a single oral temperature at or above 38.3 degrees, or at or above 38.0 degrees sustained for an hour, has febrile neutropenia when the absolute neutrophil count is under 500, and needs cultures and an empiric broad-spectrum antipseudomonal beta-lactam within one hour
• A child receiving an anthracycline who develops a gallop, a rising heart rate, breathlessness, or a falling ejection fraction has anthracycline cardiotoxicity and needs urgent echocardiography and cardiology review
• A child with high tumour burden starting therapy who develops a rising potassium, phosphate, or uric acid with a falling urine output has tumour lysis syndrome and needs aggressive hydration and rasburicase
• Severe oral mucositis of WHO grade 3 or 4 that stops a child eating or drinking risks dehydration, secondary sepsis, and opioid need, and warrants analgesia, nutritional support, and infection surveillance
• A chemotherapy drug that extravasates outside the vein causes local tissue necrosis, and anthracycline extravasation needs prompt dexrazoxane treatment within six hours rather than waiting for the lesion to declare itself
• Uncontrolled acute chemotherapy-induced nausea and vomiting on day one predicts refractory nausea through the whole cycle, so prophylaxis is matched to the emetogenic risk of the regimen before the first dose

Life stages

Care settings

Clinical exam formats

Board mappings

• Risk-stratifies chemotherapy regimens by emetogenic potential and matches the antiemetic combination to the risk
• Grades oral mucositis on the WHO scale and gives cryotherapy, oral care, and analgesia for prevention and treatment
• Recognises that a febrile child on chemotherapy needs cultures and an empiric antipseudomonal beta-lactam within one hour
• Explains how anticancer agents injure tissue through free-radical and cytokine pathways, producing nausea, mucosal breakdown, cardiomyocyte death, and tumour lysis
• Coordinates dexrazoxane cardioprotection and echocardiographic surveillance across the anthracycline exposure and into survivorship
• Appraises the Dupuis pediatric antiemetic guideline, the MASCC and ISOO mucositis guideline, the dexrazoxane harmonisation and Chow studies, and the Cairo-Bishop tumour lysis classification
• High emetogenic regimens such as cisplatin and high-dose cyclophosphamide receive a 5-HT3 antagonist plus dexamethasone plus aprepitant
• Febrile neutropenia is a single temperature at or above 38.3 degrees with an absolute neutrophil count under 500, treated with empiric antibiotics within one hour
• Anthracycline cardiotoxicity risk is dose-dependent and reduced by dexrazoxane at a ten-to-one ratio with the doxorubicin dose
• Leads the supportive-care bundle for a child receiving high-dose conditioning for transplant, linking mucositis, neutropenia, and nutrition
• Builds the tumour lysis prevention plan for a child with high tumour burden, choosing rasburicase over allopurinol after excluding G6PD deficiency
• Counsels a family on the long-term cardiac surveillance that follows anthracycline exposure through childhood into survivorship
• Level 1: Recognition of the unwell child on chemotherapy and the need to escalate for fever, dehydration, or cardiac signs
• Level 2: Applies the febrile neutropenia pathway, the antiemetic risk stratification, and the mucositis grading at the bedside
• Level 3: Coordinates the multidisciplinary supportive-care and survivorship plan across anthracycline cardioprotection and tumour lysis prevention
• The emetogenic risk categories and the matching antiemetic combinations for each
• The WHO mucositis grading scale and the evidence-based preventive interventions of cryotherapy, photobiomodulation, and palifermin
• The Cairo-Bishop classification of tumour lysis syndrome and the role of rasburicase for high-risk patients
• Structured assessment of the child on chemotherapy presenting with fever, oral pain, vomiting, breathlessness, or reduced urine output
• Communication with the family about the predictable side effects of a regimen and the supportive plan that manages each one
• Recognition of the red flags of febrile neutropenia, anthracycline cardiotoxicity, and tumour lysis syndrome at the bedside
• Chemotherapy-induced nausea and vomiting risk stratification and the three-drug prophylaxis for high emetogenic regimens
• Dexrazoxane for anthracycline cardioprotection and echocardiographic surveillance in survivors
• Empiric antipseudomonal beta-lactam for febrile neutropenia and the definition of the low-risk child eligible for oral therapy
• Recognition of the major toxicity classes of anticancer therapy and the supportive intervention for each
• Application of the Dupuis and MASCC antiemetic, MASCC and ISOO mucositis, dexrazoxane, and fever-and-neutropenia guidelines
• Avoidance of harm from delayed antibiotics in febrile neutropenia, from urinary alkalinisation in tumour lysis, and from unrecognised extravasation
• Canadian approach to febrile neutropenia with the IPSG criteria for low-risk oral management
• Dexrazoxane cardioprotection and the long-term cardiac follow-up of the childhood cancer survivor
• The supportive-care bundle that keeps the child on chemotherapy safe from nausea, mucositis, cardiotoxicity, and tumour lysis