OCN cheat sheet

Primary prevention reduces exposure or susceptibility (HPV vaccination, tobacco cessation, sun protection); secondary prevention detects preclinical disease by screening; tertiary prevention limits disability from established disease.

USPSTF screening: breast mammography every 2 years ages 40 to 74; colorectal cancer screening ages 45 to 75; cervical screening ages 21 to 65; annual low-dose CT lung screening ages 50 to 80 with at least 20 pack-years and currently smoking or quit within 15 years.

Pack-years = (packs smoked per day) x (years smoked); 20 pack-years is the lung-screening threshold.

Mosteller formula: BSA in square meters = square root of [(height in cm x weight in kg) / 3600].

Hospice eligibility: prognosis of 6 months or less if the disease follows its usual course, plus election to forgo curative-intent treatment for the terminal diagnosis.

Palliative care is not prognosis-limited and may be delivered concurrently with curative or disease-directed therapy; hospice is a distinct insurance benefit with prognostic eligibility.

Survivorship care plan contents: treatment summary, surveillance schedule, late-effect screening, health promotion, and named responsibility for follow-up.

Care transitions (inpatient to outpatient, curative to palliative intent) carry high risk for medication error and missed follow-up; medication reconciliation is required at each handoff.

NCCN distress thermometer: 0 to 10 scale; a score of 4 or higher triggers further evaluation and referral.

Hazardous drug handling under USP <800>: closed-system transfer devices, two pairs of chemotherapy-tested gloves, impermeable gown, eye and face protection, plus independent double-check of drug, dose, rate, and route.

Extravasation sequence: stop the infusion, leave the cannula in place, aspirate residual drug, then give the agent-specific antidote per policy, elevate the limb, and apply the specified hot or cold compress.

Antidotes: dexrazoxane for anthracyclines; sodium thiosulfate for mechlorethamine; hyaluronidase for vinca alkaloids; dimethyl sulfoxide for mitomycin C.

Vesicants include anthracyclines, vinca alkaloids, mechlorethamine, and dactinomycin; irritants produce phlebitis without tissue necrosis.

Fever in neutropenia: single oral temperature of 38.3 C or higher, or 38.0 C sustained over 1 hour; draw blood cultures and give empiric broad-spectrum IV antibiotics within 60 minutes.

Neutropenic precautions: hand hygiene, avoid fresh flowers and standing water, no rectal temperatures or suppositories; a strict neutropenic diet has not been shown to reduce infection.

Central venous access: confirm tip location before infusing a vesicant; assess each shift for occlusion, infection, and thrombosis.

Verify BSA-based doses against protocol maximums; oral chemotherapy requires the same double-check and patient education as IV therapy.

Cell-cycle specificity: alkylating agents and nitrosoureas are cell-cycle nonspecific; antimetabolites act in S phase; vinca alkaloids and taxanes act in M phase.

Radiation dose: 1 gray (Gy) = 100 centigray (cGy); acute effects occur during or within weeks of therapy, late effects months to years later.

Checkpoint inhibitors (anti-PD-1, anti-PD-L1, anti-CTLA-4) cause immune-related adverse events that may appear weeks to months after initiation; corticosteroids are the mainstay for grade 2 or higher.

CAR-T toxicity: cytokine release syndrome (fever, hypotension, hypoxia) is treated with tocilizumab with or without corticosteroids; ICANS neurotoxicity is treated with corticosteroids.

Trastuzumab for HER2-positive disease can cause reversible LVEF decline; obtain baseline and serial ejection fractions and hold for significant dysfunction.

Tamoxifen increases venous thromboembolism and endometrial cancer risk; aromatase inhibitors accelerate bone loss and cause arthralgias.

Myelosuppression nadir typically occurs 7 to 14 days after chemotherapy, with recovery by about day 21.

Tumor lysis syndrome risk rises with high tumor burden, high-grade lymphoma or acute leukemia, elevated LDH, and renal impairment; prophylaxis uses hydration plus allopurinol, with rasburicase when uric acid is elevated.

WHO analgesic ladder: non-opioid, then weak opioid, then strong opioid, with adjuvants at any step; reassess and titrate to effect.

Equianalgesic doses: oral morphine 30 mg equals parenteral morphine 10 mg, oral oxycodone 20 mg, or oral hydromorphone 7.5 mg; reduce the calculated dose 25 to 50 percent for incomplete cross-tolerance when rotating.

Opioid-induced constipation: start a stimulant laxative such as senna prophylactically with any opioid; add an osmotic agent if needed; methylnaltrexone for refractory cases.

Highly emetogenic chemotherapy prophylaxis: 5-HT3 antagonist plus dexamethasone plus NK1 antagonist (aprepitant), with olanzapine as an effective add-on; add olanzapine or metoclopramide for breakthrough nausea.

Oral mucositis: oral cryotherapy for bolus 5-fluorouracil; saline or bicarbonate rinses; avoid alcohol-based mouthwashes; palifermin for high-dose conditioning regimens.

Dyspnea: low-dose opioids reduce air hunger; supplemental oxygen benefits only patients who are hypoxemic.

Delirium: nonpharmacologic measures first (orientation, sleep hygiene, glasses and hearing aids); haloperidol is first-line pharmacologic treatment.

Malignant bowel obstruction: octreotide to reduce secretions, dexamethasone, and nasogastric decompression for vomiting; avoid aggressive prokinetics in complete obstruction.

Palliative sedation is reserved for refractory symptoms in the imminently dying, after interdisciplinary agreement and family preparation.

Febrile neutropenia: temperature of 38.3 C once or 38.0 C sustained for 1 hour with ANC below 500 cells per microliter; cultures then empiric IV antibiotics within 60 minutes.

Spinal cord compression: back pain, motor weakness, sensory level, and bladder or bowel dysfunction; give dexamethasone 10 mg IV immediately, then obtain urgent MRI of the entire spine.

SVC syndrome: facial and upper limb edema, distended neck veins, dyspnea, and cough; elevate the head of the bed, avoid IV access in the affected arm, obtain CT, and treat with stent or radiation.

Hypercalcemia of malignancy: IV isotonic fluids, then a bisphosphonate or denosumab; calcitonin for rapid but transient control; loop diuretics only after volume repletion.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia; treat with aggressive hydration and rasburicase when uric acid is elevated.

Cardiac tamponade: hypotension, distended neck veins, and muffled heart sounds; urgent pericardiocentesis in unstable patients.

Anaphylaxis to chemotherapy or monoclonal antibodies: stop the infusion, give IM epinephrine, oxygen, IV fluids, and antihistamines; do not restart the drug.

Leukostasis: WBC above 100,000 per microliter with pulmonary or neurologic symptoms; urgent cytoreduction, and avoid transfusing to a high hematocrit.

SIADH-related hyponatremia in cancer: fluid restriction and slow correction to avoid osmotic demyelination.

Distress thermometer: 0 to 10 scale; a score of 4 or higher triggers further evaluation; distress is treated as a sixth vital sign.

SPIKES for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary.

Depression screening: PHQ-2 followed by PHQ-9; treat at moderate or greater severity and distinguish from grief, fatigue, and delirium.

Fertility preservation: offer sperm banking, oocyte or embryo cryopreservation before gonadotoxic therapy; referral should not delay urgent treatment.

Caregiver burden is screened independently of patient distress; caregivers have higher rates of anxiety and depression than the general population.

Anticipatory grief before an expected death is normal and does not necessarily predict a poor bereavement outcome.

Sexual health: address body image, dyspareunia, and erectile dysfunction; refer to specialist services rather than waiting for the patient to ask.

Health literacy: use plain language and teach-back; interpreter services and cultural humility improve shared decision-making.

Fear of recurrence is common in survivors; meaning-focused and mindfulness-based interventions reduce distress.