Chapter 22: Care of the Adult with Cancer

Frank is 57 years of age and was diagnosed with stage 3 colon cancer following a CT scan. Frank had to have bowel surgery to remove the cancer and after he recovered from surgery, he was given a course of chemotherapy (FOLFOX).

FOLFOX is a combination of leucovorin, 5-fluorouracil (5-FU) and oxaliplatin. Leucovorin is given with 5-flourouracil because it helps the anti-cancer effects of 5-flourouracil.

Frank was given his FOLFOX in a special pump that is programmed to infuse very slowly, just a few millilitres every hour, so it infuses over 46–48 hours. He lived a long journey from the cancer hospital so it was arranged by the outpatient oncology nurse that a community nurse would come to his house to disconnect the pump when all the drug has infused. The community nurse also did a head-to-toe assessment of Frank on her visit to his home and assessed for side effects and gave advice of self-care for expected side effects. She asked

The three most common side effects with 5-FU are diarrhoea, mouth sores, and skin issues/hand-foot syndrome. Robert was advised that he should make sure to have over-the-counter anti-diarrhoea medications in the house should he need them. The nurse also stressed that if he did experience diarrhoea that persisted, to take extra fluids to avoid dehydration. Robert was also advised that he would be more sensitive to the sun when on 5-FU and to avoid activities that increased risk of friction and heat exposure to his hands and feet. He was also asked about any pins and needles in his hands or feet.

Questions

  • Pins and needles in the hands and feet is common side effect of oxaliplatin. What is this known as?
  • What specific health promotion advice about skin protection should be given to patients who are on 5-FU?

Answers

  • Pins and needles and other symptoms of sensory changes is known as peripheral neuropathy (PN) symptoms that can often present during or shortly after the infusion. The symptoms are usually transient and mild. However, a cumulative sensory peripheral neuropathy may also develop with prolonged treatment with Oxaliplatin. This can result in superficial and deep sensory loss and functional impairment.
  • Cancer patients who are having 5-FU should avoid sun exposure and if they do go in the sun, they should wear a high sunblock because of photosensitivity.
  • They should modify their daily activities to decrease risk of friction and heat exposure to their hands and feet to prevent hand-foot syndrome, e.g. washing dishes. They should also keep their hands and feet moist with emollients.