Role of nurses in the assessment and management of chemotherapy-related side effects in cancer patients

Figures & data

Figure 1 United Kingdom Oncology Nursing Society triage tool published in 2013.

Note: Reproduced with permission from the United Kingdom Oncology Nursing Society (UKONS). http://www.ukons.org.

Table 1 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
	Mild	Moderate	Severe	Life-threatening
Neutrophils	<1.5 × 10^Citation9/L	<1.5–1.0 × 10^Citation9/L	<1.0–0.5 × 10^Citation9/L	<0.5 × 10^Citation9/L
Febrile neutropenia	–		ANC <1,000/mm^Citation3 with a single temperature of >38.3°C (101°F) or a sustained temperature of ≥38°C (100.4°F) for more than one hour	Life-threatening consequences, urgent intervention indicated

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviations: ANC, absolute neutrophil count; NCI, National Cancer Institute.

Table 2 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Nausea	Loss of appetite without alteration in eating habits	Oral intake decreased without significant weight loss dehydration or malnutrition	Inadequate oral calorific or fluid intake, IV fluids, tube feedings, or TPN indicated	Life-threatening consequences
Vomiting	One episode in 24 hours	2–5 episodes in 24 hours, IV fluids indicated	>6 episodes in 24 hours, IV fluids indicated or TPN	Life-threatening consequences

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviations: IV, intravenous; NCI, National Cancer Institute; TPN, total parenteral nutrition.

Table 3 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Diarrhea	Increase of <4 stools per day over baseline, mild increase in ostomy output compared with baseline	Increase of 4–6 stools per day over baseline IV fluids indicated, moderate increase in ostomy output compared with baseline not interfering with ADL	Increase of >7 stools per day over baseline, incontinence, IV fluids, hospitalization, severe increase in ostomy output compared with baseline, interfering with ADL	Life-threatening consequences, ie, hemodynamic collapse

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviations: ADL, activities of daily living; IV, intravenous; NCI, National Cancer Institute.

Table 4 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Hair loss	Thinning or patchy	Complete	–	–

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviation: NCI, National Cancer Institute.

Table 5 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Stomatitis	Erythema of the mucosa	Patchy ulcerations or pseudomembranes	Confluent ulcerations or pseudomembranes, bleeding with minor trauma	Tissue necrosis, significant spontaneous bleeding, life-threatening consequences

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviation: NCI, National Cancer Institute.

Table 6 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Fatigue	Fatigue relieved by rest	Fatigue not relieved by rest and limiting instrumental ADL	Fatigue not relieved by rest, limiting self-care ADL	–

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviations: ADL, activities of daily living; NCI, National Cancer Institute.

Table 7 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Allergic reaction	Transient flushing or rash, drug fever <38°C, intervention not indicated	Intervention or infusion interruption indicated responds promptly to symptomatic treatment, eg, antihistamines	Prolonged recurrence of symptoms following initial improvement, hospitalization required for clinical sequelae, ie, renal impairment	Life-threatening consequences, urgent intervention required
Anaphylaxis	–	–	Symptomatic bronchospasm with or without urticaria, parenteral intervention indicated, allergy-related edema, angioedema, hypotension	Life-threatening consequences, urgent intervention required

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviation: NCI, National Cancer Institute.

Table 8 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Peripheral motor neuropathy	Asymptomatic, clinical or diagnostic observations only, intervention not indicated	Moderate symptoms limiting instrumental ADL	Severe symptoms limiting self-care ADL, assistive device indicated	Life-threatening consequences, urgent intervention indicated
Peripheral sensory neuropathy	Asymptomatic, loss of deep tendon reflexes, or paresthesia	Moderate symptoms limiting instrumental ADL	Severe symptoms limiting self-care ADL	Life-threatening consequences, urgent intervention indicated

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviations: ADL, activities of daily living; NCI, National Cancer Institute.

Table 9 Common toxicity criteria (NCI 2012)

Grade	1	2	3	4
Extravasation		Erythema with associated symptoms (eg, edema, pain, induration, phlebitis)	Ulceration or necrosis, severe tissue damage, operative intervention indicated	Life-threatening consequences, urgent intervention indicated
Injection site reaction	Tenderness with or without associated symptoms (eg, warmth, erythema, itching)	Pain, lipodystrophy, edema, phlebitis	Ulceration or necrosis, severe tissue damage, operative intervention indicated	Life-threatening consequences, urgent intervention indicated

Note: Data from National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed February 2012.⁷⁹

Abbreviation: NCI, National Cancer Institute.

United Kingdom Oncology Nursing Society (UKONS). http://www.UKONS.org. [homepage on the Internet]. Accessed Sep 2013.

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