Chemotherapy Considerations

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Agents such as adriamycin can affect cardiac function, and an assessment of functional status, a review of systems looking for decreased exercise tolerance, dyspnea, edema, orthopnea, etc., should be elicited. On physical examination, particular attention should be paid to signs of edema, tachycardia, or arrhythmias. At minimum, a 12-lead EKG should be done on any patient who has received adriamycin before undergoing a surgical procedure to look for conduction changes. An echocar-diogram for an evaluation of function should be done for any symptomatic patients before any major surgical procedure in patients who have received an adriamycin-based chemotherapy. An evaluation of respiratory symptoms should be elicited in patients who have undergone radiation to the thorax or treatment with bleomycin-based chemotherapy to evaluate for pulmonary fibrosis. Treatment with corticosteroids can lead to diabetes or adrenal insufficiency requiring monitoring of glucose levels postoperatively and potential treatment with stress dose steroids and the implications for glucose control perioperatively. Treatment with steroids can also lead to gastritis and gastrointestinal bleeding or mask symptoms of peritonitis, making evaluation of abdominal pain difficult. Chemotherapy can also affect the gastrointestinal tract, with bowel perforation having been reported in patients undergoing treatment with cytosine arabinoside, taxol, and interleukin 2. In addition it should be remembered that oncology patients will still succumb to and need to be treated for the same illnesses as nononcologic patients such as cholecystitis and appendicitis; however, treatment with steroids, or immuno-suppressive agents such as seen in patients after bone marrow transplantation, and the potential for neutropenic colitis in those undergoing chemotherapy can make evaluation of these more common diseases more difficult.57

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