Documenting an oncology review
Pre-treatment reviews with toxicity grades and dose decisions, letters to the GP and surgeon, and family updates.
A review before cycle four
Cycle four of twelve, adjuvant FOLFOX for stage III sigmoid cancer.
Neutrophils 1.6, platelets 142, Hb 118. Bili and ALT normal.
Grade 1 cold-induced tingling in the fingers, settles within a day, no functional problem. Grade 1 nausea, ondansetron is working.
No diarrhoea, no mouth ulcers. ECOG 0, weight steady at 71 kilos.
Proceed at full dose, oxaliplatin 85 per square metre. If the neuropathy is grade 2 and persists between cycles, drop oxaliplatin to 65.
CEA 2.1. Surveillance CT chest, abdomen and pelvis after cycle twelve.
Treatment
Adjuvant FOLFOX, cycle 4 of 12. Stage III sigmoid adenocarcinoma.
Bloods
Neutrophils 1.6, platelets 142, Hb 118. Bilirubin and ALT normal. CEA 2.1.
Toxicity (CTCAE)
- Peripheral sensory neuropathy grade 1, cold-induced, resolves within 24 h
- Nausea grade 1, controlled with ondansetron
- No diarrhoea or mucositis
Status
ECOG 0. Weight 71 kg, stable.
Plan
- Proceed, full dose (oxaliplatin 85 mg/m²)
- Reduce oxaliplatin to 65 mg/m² if persistent grade 2 neuropathy
- Surveillance CT chest/abdomen/pelvis after cycle 12
Between cycles
- Letter to the GP
- The cycle given, toxicity, any dose change and what to do if she is febrile: present to emergency, not the practice.
- Letter to the surgeon
- Progress through adjuvant treatment and the date of the surveillance CT.
- Family update
- With consent, in plain language, for the family member who comes to each cycle.
