Chemotherapy Treatment Visit Note
Cycle Details:
Cycle 3 of FOLFIRI + Bevacizumab regimen.
Drugs administered: Irinotecan (180 mg/m²), Leucovorin (400 mg/m²), 5-Fluorouracil (400 mg/m² bolus, 2400 mg/m² infusion over 46 hours), Bevacizumab (5 mg/kg).
Premedications: Ondansetron 8mg IV, Dexamethasone 8mg IV, Famotidine 20mg IV.
Infusion details: All drugs administered via central venous catheter with good venous return. No immediate infusion reactions observed.
Toxicity Review:
Nausea: Mild, controlled with prescribed antiemetics (ondansetron PRN).
Fatigue: Moderate, improved from last cycle, patient able to perform most daily activities with rest periods.
Neuropathy: Grade 1 sensory neuropathy (tingling in fingertips), no functional impairment.
Blood counts: Neutrophil count 2.1 x 10^9/L, Platelet count 180 x 10^9/L, Haemoglobin 11.2 g/dL. All within acceptable range for treatment continuation.
Performance status: ECOG 1.
Examination:
General: Alert and oriented, appears comfortable.
Cardiovascular: S1S2, no murmurs, rubs, or gallops. Regular rhythm. Peripheral pulses 2+ and symmetrical.
Respiratory: Lungs clear to auscultation bilaterally, no wheezes or crackles.
Abdominal: Soft, non-tender, no hepatosplenomegaly. No ascites.
Neurological: Cranial nerves intact, no focal deficits. Mild distal sensory deficit noted in upper extremities.
Investigations:
Laboratory results (dated 30 October 2024):
Full Blood Count: WCC 4.5 x 10^9/L, Neutrophils 2.1 x 10^9/L, Hb 11.2 g/dL, Platelets 180 x 10^9/L.
Liver Function Tests: ALT 30 U/L, AST 25 U/L, ALP 80 U/L, Bilirubin 0.6 mg/dL. All within normal limits.
Renal Function Tests: Creatinine 0.8 mg/dL, eGFR >90 mL/min/1.73m^2. Normal.
CT Abdomen/Pelvis (dated 25 October 2024): Stable disease with no new lesions and slight reduction in primary tumour size. No new evidence of metastatic disease.
Plan:
Ongoing chemo schedule: Continue FOLFIRI + Bevacizumab regimen as planned.
Dose modifications: No dose modifications required for this cycle.
Supportive care measures: Continue antiemetics as prescribed. Advised patient to continue hydrating well. Reviewed dietary recommendations for fatigue management. Discussed management strategies for peripheral neuropathy.
Next appointment: Next chemotherapy cycle scheduled for 15 November 2024. Follow-up consultation with Dr. Thomas Kelly on 13 November 2024 to review progress.
