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Frieda Wiley, PharmD, BCGP, is a writer and pharmacist.
A look at the comorbidities of solid tumors and the methods used to treat them.
Solid tumors are fairly common, claiming every spot on the list of top 10 cancers in the United States. The presence of these masses can erupt in a sequela of complications while enhancing the severity of pre-existing comorbidities. When the cancer spreads to areas beyond its point of origin, affected tissue and organs may become damaged and lose function.
Patients also face a variety of complications as a consequence of treatments. Those complications can affect virtually every tissue of every system, such as the cardiovascular, pulmonary, endocrine, and musculoskeletal systems.
The list of cardiopulmonary complications resulting from solid tumors treatment seems exhaustive. Among these are: cardiac tamponade, radiation pneumonitis, pleural effusion, super vena cava syndrome, pulmonary embolism, and pericardial effusion, along with numerous other complications secondary to chemotherapy.
Endocrine disorders such as hypercalcemia, Cushing’s disease, and syndrome of inappropriate antidiuretic hormone (SIADH) have been observed in patients who have solid tumors.
Equally important is the increased risk of infection associated with cancer and cancer treatment. Many of the treatments commonly used in this patient population result in immunosuppression.
Even the nature of a solid tumor (e.g., features such as its size, primary location, presence and location of metastases) can give rise to immunological challenges-sometimes simply by creating physical barriers or obstruction.
For example, the bronchoalveolar obstruction caused by either lung metastases or primary lung cancer can lead to post-obstructive pneumonia. Blockages caused by genitourinary and certain intra-abdominal cancers can result in urinary tract infections, pyelonephritis, and bacteremia. Patients may experience bacteremia, hepatic abscess, and cholangitis as a result of obstructed biliary flow brought on my hepatobiliary metastases or hepatobiliary cancers.
The surgical interventions and radiotherapy sometimes used to treat solid tumor increase the risk for infection by disrupting the barrier components of the innate immune system such as the skin and the mucocutaneous and intestinal barriers.
Bacteremia presents another important challenge in solid tumor, as such infections are not only potentially fatal, but they can delay chemotherapy. Not only is bacteremia becoming more prevalent in cancer, but the risks for such infections rises with age and increased incidents of cancer as a result of substantial population growth coupled with increased life expectancy.
Elderly patients are of particular concern due to immunosenescence, or age-related, collapse of the immune system. With both humoral and cell-mediated immunity compromised, these circumstances may increase the risk of poor outcomes in elderly patients who have solid tumors. A study published in the Journal of Geriatric Oncology in 2019 found that some infections, such as Streptococcus bovis and Listeria monocytogenes, were more common in elderly patients, although they had fewer incidents of coagulase-negative staphylococci. Geriatric patients also experienced more frequent infections-often a result of multi-drug-resistant organism; additionally, those who had lung tumors, neutropenia, and low-grade fever were more likely to die.
Patients who receive myelosuppressive chemotherapy are at risk for neutropenia. Not only does this condition hinder the patient’s ability to fight infections by weakening the immune system, but it increases the risk of infection and hospitalization. Healthcare providers should note that fever in neutropenic patients is cardinal sign that the patient may have developed an infection and should be evaluated for serious infections.