DefinitionThis section has been translated automatically.
Therapeutic measures that avoid, mitigate or treat the side effects of a different tumor therapy.
General informationThis section has been translated automatically.
Different dermatological tumor diseases are treated with different therapeutic modalities, often also multimodal procedures. If chemotherapeutic treatment modalities are necessary, these should always be supported or supplemented by symptom-oriented supportive therapy. Chemotherapy, radiotherapy or immunotherapy are not conceivable without supportive therapy.
OccurrenceThis section has been translated automatically.
- Antiemetic therapy:
- Chemotherapy-induced nausea (acute: 1-3 h after application of chemotherapeutic drugs; delayed: 26-24 h after application of chemotherapeutic drugs) and vomiting are among the most common and most feared side effects in antitumoral therapy. Triggered mainly by cisplatin, carboplatin, doxorubicin and anthracyclines. By correct application of antiemetics, 70-80% of these side effects can be avoided. A distinction is made between:
- Anticipatory (or psychological) vomiting: Therapy: Dopamine receptor antagonists such as metoclopramide (e.g. MCP-Ratiopharm 10-20 mg p.o. every 6-8 hours in higher dosage 2 mg/kg bw every 2 hours), benzodiazepines (e.g. lorazepam 1-2 mg p.o. every 12 hours) or neuroleptics (e.g. haloperidol 1-2 mg p.o. every 8-12 hours).
- Chemotherapeutic vomiting: Therapy: 5-HT3-antagonists like ondansetron (e.g. Zofran 8 mg i.v.) or dolasetron (e.g. Anemet 100 mg i.v. about 30 min. before chemotherapy), glucocorticoids (e.g. dexamethasone 20 mg i.v.), neurokinin-1 antagonists such as aprepitant (e.g. Emend 125 mg p.o. 1 hour before application of the chemotherapeutic drugs).
Notice! Preventive antiemetic therapy is more effective than treatment for nausea or vomiting.
- Therapy and prophylaxis of myelodepression (see Common Toxicity Criteria below):
- Anemia: Targeted clarification of the cause. In principle, there is an indication for the application of erythropoiesis-stimulating substances at an HB of < 10 g/dl with the aim of achieving values between 10 and 13 g/dl. Initial dosage of Erythropoietin alfa (e.g. Erypo FS) 40,000 IU s.c. once/week. Alternatively: Darbepoetin alfa (Aranesp) 2.25 µg/kg bw once a week s.c. or 500 µg s.c. every 3 weeks.
- Neutropenia: Targeted clarification of the cause. A neutropenia WHO grade IV with leukocyte count < 1000/ul (see Common Toxicity Criteria below ) should be treated with G-CSF like Filgrastim ( e.g. Neupogen 5 ug/kg bw/day s.c.) under consideration of further risk factors (age > 65 years, high risk of febrile neutrophilic leukopenia). Neutropenia WHO grade IV in combination with fever and signs of infection requires additional high-dose antibiotic therapy.
- Thrombocytopenia: Currently, the application of platelet concentrates is the only treatment option. The indication is given in case of thrombopenia < 10.000-20.000/µl with or without bleeding, in case of thrombopenia < 10.000-20.000/µl if further risk factors such as brain metases are present, in case of thrombopenia between 20.000-50.000/µl with heavy bleeding or in case of planned surgical intervention.
- Cancer related fatique (CRF):
- Dosed physical exercise, glucocorticoids in low dosage (e.g. prednisolone 5.0-10.0 mg/day p.o.). There are currently no therapy recommendations for amphetamines or antidepressants, but they can be tried in individual cases.
- Pain therapy: see below Pain therapy, drug therapy.
Note(s)This section has been translated automatically.
- Most often, supportive measures are needed in the palliative care of tumor patients. In the terminal phase they are often the only and therefore most important treatment for patients.
- Accordingly, supportive oncological therapy can be divided into different areas of responsibility:
- Antiemetic therapy for chemotherapy and radiotherapy
- Prophylaxis and therapy of bone marrow insufficiency (e.g. with growth factors of granulopoiesis or erythropoesis)
- Prophylaxis and therapy of exhaustion and tiredness (fatigue)
- Pain therapy
- Nutrition
- Skin and mucous membrane care (cytoprotection) during radiation or chemotherapy (see below mucositis, oral)
- Psychosocial support
- Rehabilitation.
Prof. Dr. med. Peter Altmeyer