General clinicians should monitor patients receiving cancer treatment and report toxicoses and adverse effects to the oncologist so dose adjustments or alternate therapy can be pursued as needed.
Transient bone marrow suppression is a common adverse effect of chemotherapy. Most chemotherapy-induced nadirs occur 7 to 10 days after a maximum-tolerated dose of chemotherapy but can vary.22
CBCs with slide reviews can help monitor RBCs, platelets, and leukocyte/neutrophil counts. A circulating neutrophil count <1,000/µL may indicate the immune system is inadequate to fight infection, and risk for sepsis may be increased.23-25 Prophylactic antibiotics and/or hospitalization may be needed.
Rectal temperature should be measured when obtaining CBC in chemotherapy patients. Hospitalization is recommended in febrile and neutropenic patients. The literature on antibiotic use in cancer patients should be reviewed to ensure judicial use.25,26
Rabacfosadine is FDA-approved for treatment of canine lymphoma and is an increasingly common chemotherapeutic for this cancer; dermatologic toxicoses can be an adverse effect. Dermatopathology manifests as areas of alopecia, hyperemia, moist dermatitis, and/or hyperpigmentation in the inguinal region, trunk, and/or ear canals of dogs that can be confused with routine acute moist dermatitis (ie, hot spots) and ear infections (Figure).27 Steroids should be administered and can be added to the chemotherapy protocol and the rabacfosadine dose reduced.