J Korean Med Assoc.  2023 Feb;66(2):92-104. 10.5124/jkma.2023.66.2.92.

Managing the adverse effects of cytotoxic chemotherapy at the level of primary healthcare

• Hong JH

• KMID: 2539904
• DOI: http://doi.org/10.5124/jkma.2023.66.2.92

Abstract

Background
Despite the increased incidence of cancer, more effective cancer drugs are being developed and cancer patient survival expectancy has been prolonged. Here, we discuss the contribution of primary healthcare clinics to managing the side effects of cytotoxic chemotherapy and provide a compilation of what is currently being used in this field.
Current Concepts
Loperamide is recommended for active use when diarrhea occurs. In severe cases, octreotide can help control diarrhea by reducing small bowel fluid secretion. Mouthwash mixed with salt and sodium bicarbonate is helpful for controlling mucositis, and transdermal fentanyl patches can be used for severe pain. Limited evidence suggests that pilocarpine may be helpful for xerostomia. Neurokinin-1 receptor antagonists, serotonin receptor antagonists, glucocorticoids, metoclopramide, and olanzapine are used for nausea and vomiting. Opioid-related constipation can be relieved without counteracting the analgesic effect of opioids via peripherally acting μ-opioid receptor antagonists. Granulocyte colony-stimulating factor is recommended to treat neutropenic fever. In cases with neutropenia but no fever, the decision to use it should be based on the patient’s condition. Minoxidil can be used for hair loss, and scalp cooling can also be considered, but its practical applications are limited. Topical steroid ointments are used to treat hand-foot syndrome. Selective serotonin re uptake inhibitors are recommended for depression in cancer patients because they have little interaction with other drugs and are well tolerated.
Discussion and Conclusion
Due to an increased cancer patient management burden and limited medical resources, primary healthcare practitioners should know these management strategies for cancer patients receiving cytotoxic chemotherapy.

Keyword

Cancer chemotherapy; Antineoplastic agents; Adverse effect; Primary healthcare; 항암요법; 항암제; 부작용; 일차진료