After referral, oncology patients at times are co-managed by the University of Illinois Veterinary Teaching Hospital Oncology Service and the referring veterinarians. The information listed below was developed as general guidelines for managing a case on chemotherapy.
We feel strongly that successful case management relies heavily upon good communication between the referring veterinarian, the client, and the clinicians at the U of I. Please do not hesitate to contact the Oncology Service if further questions or concerns arise: (217) 333-5311.
Monitoring the Animal
A complete blood count should be performed 7 days after chemotherapy administration. A manual differential to obtain an accurate neutrophil count is critical.
- If the neutrophil count is < 2500 cells/ml, DO NOT GIVE CHEMOTHERAPY! Recheck CBC in 2 to 4 days.
- If the neutrophil count is < 1000 cells/ml and not febrile, begin oral cephalexin.
- If the neutrophil count is < 1000 cells/ml and FEBRILE, call the Oncology Service. Intravenous antibiotics and intensive care are needed.
- If platelet count is < 50,000 cells/ml, call the Oncology Service.
- If gross (measurable) disease is present, a rough assessment of size should be made before each treatment. In addition, (regional) lymph nodes should be carefully evaluated for metastatic disease.
Chemotherapy Handling and Waste Disposal
All chemotherapy drugs should be regarded as hazardous. We strongly recommend the use of a closed chemotherapy system (e.g. Equashield) for drug preparation and administration as well as the wearing of chemotherapy gowns and approved chemotherapy administration gloves when handling the drugs or items (catheters, needles, and syringes) contaminated with chemotherapy. For the gloves, double gloving with latex and/or nitrile exam gloves is a reasonable alternative. Most chemotherapy waste can be disposed of with biohazard waste. Local hospitals may allow you to dispose of chemotherapy waste at their facility.
When giving IV injections of chemotherapy, it is critical to use a cleanly placed (only one venipuncture attempt) indwelling IV catheter. Drugs such as vincristine, vinblastine, and doxorubicin (Adriamycin) among others are vesicants. Perivascular administration may result in severe local reaction and tissue slough. IV pumps should never be used for administration of these drugs.