Consultation for Chemotherapy Administration Template

CHEMOTHERAPY ADMINISTRATION CONSULTATION: 2023-10-15 by Dr. Emily Carter, Dr. John Smith for Dr. Thomas Kelly.
Presentation:
The patient, a 7-year-old Golden Retriever named Max, presented with lethargy and weight loss over the past month.
Lymphoma history:
Diagnosis: Diffuse large B-cell lymphoma confirmed via biopsy.
Diagnostic method and findings: Biopsy showed large atypical lymphocytes.
Immunocytochemistry results: Positive for CD20.
Main diagnostic imaging findings with date:
Liver findings: Mild hepatomegaly noted on ultrasound (2023-09-20).
Spleen findings: Normal.
Kidney findings: Normal.
Lung findings: No metastasis observed.
Bone marrow findings: No infiltration.
Presence or absence of paraneoplastic pathology: None detected.
Protocol one: CHOP Protocol
Details: Cyclophosphamide, Doxorubicin, Vincristine, Prednisone for 8 weeks.
Clinical signs and onset during protocol: Initial response with reduced lymph node size.
Staging details and findings at end of protocol: Partial remission achieved.
Clinical signs and onset:
Protocol two: LOPP Protocol
Details: Lomustine, Vincristine, Procarbazine, Prednisone for maintenance.
Chemotherapy Protocol:
Goal: Achieve complete remission and maintain quality of life.
Name of protocol (list drugs intended): Cyclophosphamide, Doxorubicin, Vincristine
Pre-chemotherapy organ dysfunction:
Gastrointestinal:
Presence of clinical signs: Occasional vomiting.
Diagnostic test and date performed: Abdominal ultrasound on 2023-09-20.
Renal: Baseline creatinine normal.
Cardiac: Normal echocardiogram.
Hepatic:
Baseline ALT elevated.
Baseline AST normal.
Haematology:
Baseline WBC normal.
Baseline RBC slightly low.
Baseline platelet count normal.
Baseline test result and collection status: Complete.
Todays history:
History related to hyporexia/weight loss:
Appetite assessment: Decreased appetite.
Vomiting assessment: Occasional vomiting.
Diarrhoea assessment: None.
Weight assessment: 5% weight loss since last visit.
History related to medicating:
Medication 1 administration and response: Prednisone, good response.
Medication 2 administration status: Cyclophosphamide, ongoing.
Medication 3 administration status: Doxorubicin, completed.
General history:
Quality of life assessment: Fair.
Lethargy/fatigue assessment: Moderate lethargy.
Cough/dyspnoea assessment: None.
Owner concerns for tumour progression/relapse from remission: Owner reports decreased energy levels.
Additional owner concerns: None reported.
Current medications:
To use regularly:
Prednisone 20mg, once daily.
Cyclophosphamide 50mg, every other day.
Vincristine 0.5mg, weekly.
To use if required:
Metoclopramide 5mg, as needed for nausea.
Physical examination:
Haircoat assessment: Dull coat.
Weight: 30kg, down from 31.5kg last visit.
BCS: 4/9, previously 5/9.
MCS: Mild muscle wasting noted.
Rectal temperature: 38.5°C.
Peripheral lymph nodes:
Submandibular: Slightly enlarged.
Pre-scapular: Normal.
Popliteal: Normal.
Cardiorespiratory assessment: Pink mucous membranes, heart rate 100 bpm, no murmur, strong femoral pulse, respiratory rate 20 breaths/min, normal lung sounds.
Abdominal palpation: Mild hepatomegaly.
Urogenital examination: Normal.
Todays diagnostic tests & results:
Complete blood count:
Test location: In-house lab.
Neutropenia: Normal neutrophil count.
Thrombocytopenia: Normal platelet count.
Haemoglobin: Mild anaemia, haemoglobin 11 g/dL.
Todays therapeutics information:
Chemotherapy week: Week 5, Day 3.
Injecting nurse: Nurse Sarah Johnson.
Body weight: 30kg.
BSA: 1.2 m².
Drug 1: Cyclophosphamide
Route: Oral
Dosage: 50mg/m²
Dose: 60mg
Comment on administration: Administered with food to reduce gastrointestinal upset.
Current assessment of clinical remission status: Partial remission, based on lymph node size reduction and clinical signs.
Chronological imaging and/or diagnostics staging with results:
Date: 2023-09-20
Staging timepoint: Initial staging
Diagnostic test performed: Abdominal ultrasound
The pertinent findings were:
Liver findings: Mild hepatomegaly, no focal lesions.
Spleen findings: Normal.
Kidney findings: Normal.
Lung findings: No metastasis.
Sample collection details and diagnosis: Biopsy confirmed lymphoma.
Date: 2023-10-10
Staging rationale: Mid-treatment assessment
Diagnostic test performed: Ultrasound
The pertinent findings were:
Liver findings: Stable hepatomegaly.
Spleen findings: Normal.
Kidney findings: Normal.
Lung findings: No metastasis.
Sample collection status: Not required.
Staging status based on diagnostics performed: Stable disease.
Chronological chemotherapy & outcome:
Protocol one:
Cyclophosphamide and Doxorubicin
Date: 2023-09-01
Cyclophosphamide, 60mg, well tolerated.
Doxorubicin, 30mg, mild nausea post-administration.
Toxicity assessment: Mild gastrointestinal upset.
Date: 2023-09-15
Cyclophosphamide, 60mg, no adverse effects.
Doxorubicin, 30mg, mild lethargy.
Toxicity assessment: Mild lethargy.
Vincristine and Doxorubicin
Date: 2023-09-29
Vincristine, 0.5mg, no adverse effects.
Doxorubicin, 30mg, mild nausea.
Toxicity assessment and timepoint: Mild nausea, managed with antiemetics.
Date: 2023-10-13
Vincristine, 0.5mg, no adverse effects.
Toxicity assessment: None.
Protocol two:
Lomustine and Vincristine
Date: 2023-10-20
Lomustine, 50mg, no adverse effects.
Vincristine, 0.5mg, no adverse effects.
Up to date problem list:
Final diagnosis: Diffuse large B-cell lymphoma, partial remission based on imaging and clinical response.
Current problems:
Lymphoma
Mild anaemia
Mild hepatomegaly
Second issue: Weight loss
Finding 1: 5% weight loss
Finding 2: Decreased appetite
Finding 3: Occasional vomiting
Finding 4: Mild muscle wasting
Finding 5: Dull coat
Tertiary issue: Mild anaemia, likely secondary to chronic disease.
Abdominal imaging findings (2023-10-10):
Liver findings: Stable hepatomegaly.
Spleen findings: Normal.
Kidney findings: Normal.
Blood findings:
Date: 2023-10-15
Finding and assessment: Mild anaemia, haemoglobin 11 g/dL.
Assessment of problem list:
1. Lymphoma
Staging details, findings, and interpretation: Partial remission, stable disease.
Response to treatment and interpretation: Good response to CHOP protocol.
Monitoring plan and rationale: Continue current protocol, re-evaluate in 4 weeks.
Current assessment and basis: Partial remission based on imaging and clinical signs.
2. Weight loss
Finding 1 and interpretation: 5% weight loss, likely due to decreased appetite.
Management recommendations: Dietary modification and appetite stimulants.
3. Mild anaemia
Diagnostic uncertainty and rationale: Likely secondary to chronic disease.
Monitoring options and owner preference: Monitor CBC monthly.
Monitoring plan and timepoint: Recheck CBC in 4 weeks.
Updated medications:
To use regularly:
Prednisone 20mg, once daily, continue for 4 weeks.
Cyclophosphamide 50mg, every other day, continue for 4 weeks.
Vincristine 0.5mg, weekly, continue for 4 weeks.
To use if required:
Metoclopramide 5mg, as needed for nausea.
Planned bloods and tests:
Planned clinicopathological tests:
Date: 2023-11-15, CBC and liver function tests.
Planned chemotherapy:
Date: 2023-11-01, Vincristine administration.
Short-term plan:
Cyclophosphamide 50mg, every other day.
CBC and liver function tests in 4 weeks.
Long-term plan:
Re-evaluate lymphoma status in 4 weeks.
Management plan if clinical sign persists: Adjust chemotherapy protocol if no improvement.