OncologyTier 2Topic

Pre-chemotherapy screening investigations

Purpose

Baseline investigations before starting chemotherapy assess organ function relevant to specific drug toxicities and identify factors that would change treatment choice, dosing, or supportive care needs
Required before essentially every chemotherapy regimen, tailored to the specific agents planned given their differing toxicity profiles

Chemotherapy toxicity is often organ- and drug-specific (cardiotoxicity with anthracyclines, nephrotoxicity with platinum agents, hepatotoxicity with several classes) - baseline assessment establishes a reference point and identifies pre-existing dysfunction that would preclude or require dose-modification of a specific agent

FBC - baseline counts and marrow reserve (chemotherapy is frequently myelosuppressive)
Renal and liver function - many agents are renally cleared or hepatically metabolised, requiring dose adjustment
Cardiac function (echocardiogram/MUGA) - baseline LVEF before anthracyclines or trastuzumab, both cardiotoxic
Hepatitis B/C serology - chemotherapy-induced immunosuppression can reactivate chronic hepatitis B specifically, requiring antiviral prophylaxis if positive
Fertility counselling and preservation options discussed before gonadotoxic treatment in patients of reproductive age
Pregnancy test in women of childbearing potential, given the teratogenic/fetotoxic risk of most cytotoxic agents

Abnormal baseline results can change the regimen (substituting a less cardiotoxic/nephrotoxic agent), require dose modification, or trigger prophylactic measures (antiviral therapy for hepatitis B reactivation risk, growth factor support for anticipated severe neutropenia)

Hepatitis B reactivation, anthracycline cardiotoxicity, chemotherapy-induced infertility, tumour lysis syndrome risk (in high-risk haematological malignancies specifically)

Missing a baseline hepatitis B screen before immunosuppressive chemotherapy is a recognised, preventable cause of fulminant hepatitis B reactivation - now a standard part of pre-chemotherapy workup for this reason

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