Extravasational toxicity of anticancer chemotherapy and its management

Introduction Anticancer drugs have a number of side effects, including toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea. Extravasational toxicity is a complication of anticancer drugs, unmentioned in the majority of clinical textbooks other than oncology, explaining why residents may be unaware of this preventable catastrophe. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that first line staff get acquainted to this complication and its management. After reading this paper, residents and clinicians will be more vigilant in anticancer drug infusion and management of extravasation. Conclusion Once extravasation occurs, tis-sue injury is inevitable but can be reduced with the proper antidote. A trained member of staff should ad-minister this, preferably from the on-cology department only. Introduction As the incidence of cancer is increasing, cancer management has become a team effort consisting of family members, physicians, surgeons, radiations and medical oncologists, psychiatrists and physiotherapists. The objective of this team is to provide a cure or palliation with minimal side effects and quality of life to the patient. Radiation therapy has become target-orientated to avoid injury to normal tissue but now chemoradiation is the preferred modality. In spite of giving promising results, these anticancer drugs have a number of side effects, which include toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea1. In India, the oncology department is overloaded with cancer patients; hence, anticancer drugs are being infused in the parent departments by nurses and residents. However, extravasational toxicity is one of the dreaded complications of anticancer drugs, which didnot find a place in the majority of clinical textbooks1–7 other than oncology, and hence many of the residents may be unaware of this preventable catastrophe8. The incidence of extravasations in adults is 0.1% to 6.5%9,10. Extravasation can occur in any centre and even in highly advanced oncology centres11, but these advanced centres have specially trained oncology-nursing staff. Commonly, chemotherapy is infused in clinical or parental departments of the patient, and work of infusion is left to a house surgeon or an intern, who may not have yet acquired a reasonable experience in venepuncture. Even the resident may not have adequate knowledge of the measures to be undertaken in case of extravasation due to absence of this complication and its management in the majority of clinical textbooks. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that the first line staff (residents/nurses) gets acquainted to this complication and its management. Classification based on mode of