Department of Internal Medicine V: Hematology, Oncology, Rheumatology, Heidelberg University Hospital; Department of Radiotherapy and Radiooncology, Vivantes Hospital Neukölln, Berlin; Medical Center Charité Vivantes Radiotherapy, Berlin; Department of Internal Medicine I, Westpfalz Hospital Kaiserslautern; Department of Medicine: Hematology, Oncology, and Tumor Immunology, Charité Campus Virchow Hospital, Berlin; Department of Internal Medicine IV: Hematology and Oncology, University of Halle-Wittenberg, Halle (Saale).
Dtsch Arztebl Int. 2017 Jul 10;114(27-28):481-487. doi: 10.3238/arztebl.2017.0481.
For the treatment of patients with cancer to be successful and well-tolerated, the complications and side effects of the disease and its treatment must be treated and limited as far as possible. Summarized recommendations based on the constantly increasing evidence in the area of supportive care must be defined, standardized, and communicated.
We systematically reviewed the literature on the topics of anemia, neutropenia, nausea/vomiting, diarrhea, oral mucositis, skin toxicity, and peripheral neurotoxicity induced by cancer treatment, as well as osseous complications, extravasation, and side effects of radiotherapy. Recommendations were approved in a moderated, formalized consensus procedure.
In patients suffering from chemotherapy-induced anemia, the administration of agents that stimulate erythropoiesis can be considered. This can potentially improve these patients' quality of life and lessen the frequency of blood transfusions, but it can also lead to thromboembolic complications and arterial hypertension. If only a single individual risk factor is present in a patient whose risk of febrile neutropenia is estimated at 10-20%, there is no obligatory indication for the administration of granulocyte-colony stimulating factor. Antiemetic treatment before carboplatin is given can consist of a neurokinin-1 receptor antagonist along with a setron and dexamethasone. Duloxetine is recommended for the treatment of neuropathic pain. Sensorimotor training is effective in the treatment of chemotherapy-induced peripheral neuropathy and can already be given at the same time as the chemotherapy. Women with bony metastases of breast cancer who have been taking zoledronate at four-week intervals for a year should take it at 12-week intervals from then onward in order to lessen the likelihood of osseus complications. There is no evidence for any effective prophylactic treatment of chemotherapy-induced diarrhea.
Supportive measures are an integral component of all oncological treatments. More research is needed to determine how side effects can be lessened and prevented.
为了使癌症患者的治疗成功且耐受良好，必须尽可能地治疗和限制疾病及其治疗的并发症和副作用。必须根据支持性护理领域不断增加的证据，总结和定义、标准化和传达建议。
我们系统地回顾了关于癌症治疗引起的贫血、中性粒细胞减少、恶心/呕吐、腹泻、口腔黏膜炎、皮肤毒性和周围神经毒性以及骨并发症、外渗和放射治疗副作用等主题的文献。建议在经过适度、正式的共识程序后获得批准。
在患有化疗引起的贫血的患者中，可以考虑使用刺激红细胞生成的药物。这可能会改善这些患者的生活质量并减少输血的频率，但也可能导致血栓栓塞并发症和动脉高血压。如果只有一个单一的个体危险因素存在于发热性中性粒细胞减少症风险估计为 10-20%的患者中，则没有强制性指示给予粒细胞集落刺激因子。在给予卡铂之前，可以使用神经激肽-1 受体拮抗剂联合 5-羟色胺受体拮抗剂和地塞米松进行止吐治疗。度洛西汀推荐用于治疗神经病理性疼痛。感觉运动训练对化疗引起的周围神经病有效，并且可以在化疗同时进行。接受唑来膦酸每 4 周治疗 1 年的乳腺癌骨转移女性应从那时起每 12 周接受一次治疗，以降低骨并发症的可能性。没有证据表明化疗引起的腹泻有任何有效的预防性治疗方法。
支持性措施是所有肿瘤治疗的一个组成部分。需要进一步研究以确定如何减轻和预防副作用。
