A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations would account for her symptoms?
A. The symptoms may be the result of anemia caused by chemotherapy.
B. The patient may be immunosuppressed.
C. The patient may be depressed.
D. The patient may be dehydrated.
Correct Answer: A. The symptoms may be the result of anemia caused by chemotherapy.
Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression. The side effects of cancer chemotherapy can be acute or prolonged, and may need monitoring. It would require multi-disciplinary monitoring as certain patient populations may be at higher risk for complications. Interventions like exercise, optimizing sleep quality, and behavioral therapies such as relaxation can help fatigue.
Option B: There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression. Common toxicities associated with such agents include myelosuppression, nausea, vomiting, GI side effects, mucositis, alopecia, sterility, infertility, and infusion reactions. Furthermore, there is an increased risk of infections due to immunosuppression.
Option C: Patients undergoing chemotherapy usually need strong emotional support, and they are going through anxiety, depression, and anticipatory grief from the expected side effects of the drugs. Multidisciplinary and interprofessional interventions at various stages of their treatment regimen can promote mental health. However, it is not indicated in this stem.
Option D: The information given does not indicate that dehydration is a cause of her symptoms. Chemotherapy-induced nausea and vomiting treatment options include prochlorperazine, haloperidol, metoclopramide, lorazepam, dexamethasone, ondansetron, granisetron, dolasetron, palonosetron, dronabinol, aprepitant, fosaprepitant, netupitant. palonosetron has a longer half-life, better efficacy, and higher binding affinity than granisetron.