Cancer Treatment Modalities and Their Signature Toxicities
What the exam tests
Surgery (curative, adjuvant, neoadjuvant, palliative, debulking), radiation, chemotherapy, hormonal therapy, targeted agents, immunotherapy, stem cell transplant, and cellular therapy - with each modality's characteristic toxicity and nursing teaching.
Radiation
External beam radiation does not make the patient radioactive; no precautions are needed. Brachytherapy (implanted or seeded sources) does: private room, time-distance-shielding, limited visit time, lead shielding for staff, and often an indwelling urinary catheter to reduce exposure from excreted isotope.
Chemotherapy
Nadir is typically 7–14 days after administration, with recovery by about 21–28 days. Teach neutropenic precautions, avoidance of rectal temperatures and suppositories, and immediate reporting of fever. Vesicants cause tissue necrosis if extravasated.
Immunotherapy and targeted therapy
Checkpoint inhibitors cause immune-related adverse events (irAEs): colitis, pneumonitis, hepatitis, thyroiditis, hypophysitis, dermatitis. These can appear weeks to months after the last dose and are managed by holding the drug and giving corticosteroids - not antibiotics. Targeted agents have their own profiles: EGFR inhibitors cause acneiform rash; VEGF inhibitors cause hypertension, bleeding, thrombosis, and impaired wound healing. CAR-T therapy causes cytokine release syndrome (fever, hypotension, hypoxia) and neurotoxicity.
Traps
"Radiation precautions after external beam" is a classic distractor. Others: assuming targeted therapy is side-effect free, and assuming an irAE means permanent discontinuation rather than hold-and-treat.
Rule of thumb
New organ-system symptoms (diarrhea, cough, jaundice, fatigue, confusion) in a patient who received an immune agent - even months ago - think irAE first and report it; do not wait for the next scheduled visit.