14 August, 2017
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For many patients, chemotherapy is an important part of cancer treatment and has improved the survival rates of a significant numbers of cancers. Since chemotherapy drugs have some short- and long-term side effects, physicians have to make sure that there are not conditions present in the patient with cancer that would make chemotherapy more dangerous or even life-threatening. There are certain contraindications to chemotherapy; the presence of these conditions suggests that chemotherapy treatment should be delayed or perhaps not given at all.
First Trimester Pregnancy
Because of the high potential of birth defects and other adverse events, the first trimester of pregnancy is generally a contraindication to chemotherapy drugs, according to a study published in the March 1992 issue of the "Archives of Internal Medicine." However, some types of chemotherapy drugs are safe to administer during the second and third trimester of pregnancy, although there is still an increased risk of stillbirth and intrauterine growth restriction. If the patient does not want to terminate the pregnancy, the doctor will generally wait until the second trimester to begin chemotherapy.
The presence of thrombocytopenia, or low platelet counts, and other types of low blood counts means that a physician should not start chemotherapy until those conditions have been corrected. Medications or transfusions may help increase blood cell levels. Chemotherapy drugs themselves can cause low blood counts, as well, so any pre-existing blood count issues need to be managed before treatment initiation, as noted in the 2005 textbook "Juta's Manual of Nursing."
Liver or Kidney Impairment
Since most chemotherapy drugs are metabolized by either the liver or kidneys, liver or kidney impairment or failure can be a contraindication to chemotherapy, "Juta's Manual of Nursing" reports. Severe impairment of function of either of these organs prohibits the use of chemotherapy. However, some drugs can be given in patients with decreased liver or kidney function, but the dosage needs to be adjusted for the amount of function that is present. If the liver or kidney failure is due to a temporary condition, the physician could manage the immediate causes and then begin chemotherapy.
Chemotherapy can interfere with the healing of any wounds, so generally recent surgery is a contraindication to chemotherapy. Once the surgical wound has healed, the physician can start to treat with chemotherapy, according to "Juta's Manual of Nursing."
Any ongoing infection is a contraindication to chemotherapy, as noted in "Juta's Manual of Nursing." Chemotherapy lowers blood cell counts so that the body would have a difficult time fighting the infection. Overwhelming sepsis could occur, which would pose a more immediate risk to the patient than the cancer. Once the infection is treated, the chemotherapy treatment can be started.
- Pre-Transplant Treatment for Hepatocellular Carcinoma
- Juta's Manual of Nursing; S. Mogotlane and Colleagues; 2005
- American Society of Clinical Oncology: Pregnancy and Cancer
- Journal of Clinical Oncology: Cancer During Pregnancy
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