prechemotherapy

Prechemotherapy refers to the period and activities before starting chemotherapy, focusing on evaluation, optimization, and planning to maximize safety and effectiveness of treatment.

Clinical assessment during this phase includes a comprehensive medical history, physical examination, performance status, existing comorbidities, current medications, pregnancy status, and any prior adverse reactions to chemotherapy or other cytotoxic therapies. The goal is to identify factors that may affect treatment tolerance and outcomes.

Baseline investigations are selected to assess organ function and overall health. Common tests include blood counts with differential, kidney and liver function, electrolytes, coagulation as appropriate, and infectious disease screening when indicated. Imaging studies help determine disease extent and guide treatment decisions. Cardiac assessment is often considered if regimens with potential cardiotoxicity are planned, such as an electrocardiogram or echocardiography. A pregnancy test is performed in women of childbearing potential when relevant.

Risk stratification and prophylaxis planning are central components. This includes evaluating the risk of infections (neutropenia) and organizing appropriate antiemetic therapy and supportive care. Growth factor support may be considered for patients at high risk of febrile neutropenia. Prophylaxis for tumor lysis syndrome is considered in high-risk cancers, and dental evaluation is often advised to reduce infectious complications during immunosuppression.

Medication management and optimization involve reviewing drug interactions, adjusting the planned chemotherapy dose for renal or hepatic impairment, and considering pharmacogenetic testing when indicated by the regimen (for example, TPMT testing for certain thiopurines or UGT1A1 testing for specific regimens).

Patient preparation and informed consent are essential, including discussions of benefits, risks, alternatives, and treatment goals, as well as plans for premedication, monitoring, and supportive care. Vaccination status should be updated as appropriate before immunosuppressive therapy.

Prechemotherapy is a preparatory phase tailored to the cancer type, regimen, and patient factors, with ongoing reassessment throughout treatment.