How can I effectively manage the side effects of chemotherapy in patients with cancer in a primary care setting?

Effective management of chemotherapy side effects in primary care requires systematic, proactive assessment and tailored interventions addressing physical and psychological symptoms throughout the cancer treatment trajectory. Primary care teams should regularly enquire about common chemotherapy-related symptoms such as nausea, vomiting, fatigue, pain, and psychological distress, rather than waiting for patients to report them spontaneously, and assess their impact on daily life including sleep and mood disturbances NICE CKS.

For nausea and vomiting, primary care can initiate pragmatic antiemetic treatment following specialist advice, using agents such as haloperidol, metoclopramide, or levomepromazine, with attention to potential side effects and routes of administration appropriate to the patient’s condition NICE CKS. Gastrointestinal irritation from concomitant medications should be managed by reviewing and adjusting offending drugs or adding gastroprotection NICE CKS. If hypercalcaemia is suspected as a cause of nausea, urgent hospital referral is warranted NICE CKS.

Fatigue, a frequent and debilitating side effect, should be assessed for treatable causes and managed with supportive measures including information provision and referral to exercise programmes where appropriate NICE CG81. Pain management should follow established protocols, with consideration of neuropathic and nociceptive components, and referral to specialist palliative care if pain is complex or refractory NICE CKS,NICE CKS.

Neutropenic sepsis is a critical complication; primary care must provide patients and carers with clear information on early signs and when to seek urgent care, and healthcare professionals should be trained to recognise and act promptly on suspected cases NICE CG151. Prophylactic measures such as fluoroquinolone use during neutropenia may be considered in line with specialist guidance, but routine G-CSF use is not recommended unless part of the chemotherapy regimen NICE CG151.

Psychological distress should be regularly assessed at key points during treatment, with prompt referral to specialist psychological services if significant distress is identified NICE CKS. Continuity of care is essential, ideally with a nominated key worker coordinating supportive care and facilitating communication between oncology specialists and primary care NICE CG81.

Remote real-time symptom monitoring during chemotherapy has been shown to improve symptom control and may be integrated into primary care follow-up to enhance early detection and management of side effects Maguire et al. 2021.

Overall, primary care management of chemotherapy side effects involves early, regular, and holistic assessment; initiation of straightforward symptom control measures; patient education; psychological support; and timely referral to specialist services when problems exceed primary care expertise NICE CKS,NICE CKS,NICE CG151.