Fatigue
0
None
1
Increased but not altering normal activities
2
Moderate, difficulty performing some activities
3
Severe, cannot perform some activities
4
Bedridden or disabling
Nausea
0
None
1
Able to eat
2
Oral intake significantly decreased
3
No significant intake, intravenous nutrition
4
–
Vomiting
0
None
1
1/day
2
2–5/day
3
≥6/day
4
Requiring parenteral nutrition or intensive care
Stomatitis
0
None
1
Painless erythema
2
Painful erythema or ulcers but can eat
3
Requiring intravenous hydration
4
Requiring parenteral or enteral nutrition
Diarrhoea
0
None
1
1–3/day
2
4–6/day
3
>6/day
4
Requiring intensive care
Constipation
0
None
1
Requiring stool softener
2
Requiring laxatives
3
Requiring enema
4
Obstruction or toxic megacolon
Dermatological manifestations
0
None
1
Redness
2
Ulcerations/blisters, pain
3
Extensive ulcerations/blisters
4
Generalised exfoliative or ulcerative dermatitis
Neuropathy, sensory
0
None
1
Paraesthesia or loss of tendon reflexes
2
Objective sensory loss or paraesthesia interfering with function
3
Sensory loss or paraesthesia interfering with daily living
4
Permanent sensory loss interfering with function
Neuropathy, motor
0
Normal
1
Subjective weakness
2
Mild objective weakness
3
Objective weakness interfering with daily living
4
Paralysis
According to another classification, neurological side effects are graded as 1–2 for sensory and grades 3–4 for motor manifestations.
Measures to Prevent or Treat Nausea/Vomiting and Stomatitis
Nausea and vomiting shall be prevented. Most effective prevention and treatment is obtained by various modifications of 5-HT3 receptor blockers. Sometimes merely changes of eating habits are of great value. Relaxing measures can reduce nausea and vomiting particularly in patients where the symptoms are conditioned. Acupressure and acupuncture have also been reported to be beneficial. Careful hygiene of the oral cavity, e.g. by regular rinsing, is of value to prevent stomatitis. Cryotherapy during 30 min before chemotherapy is reported to decrease the mucositis.
Adjuvant and Chemotherapeutic Agents in Rectal Cancer
Fluorouracil. Fluorouracil is a common cause of nausea and vomiting (1/10–1/100 of treated patients). This drug can also cause cerebral ataxia (1/10–1/100), confusion or nystagmus (1/1,000–1/10,000). It is stated that alopecia occurs after treatment with fluorouracil in 1/10–1/100 patients. Fluorouracil causes stomatitis in 40–60 % (1/10–1/100) which often is the first sign of toxicity, and it will cause leucopenia quite often (1/10–1/100). It is sometimes associated with changes in ECG (1/10–1/100) but more seldom with arrhythmia and coronary angina (1/100–1/1,000) or heart failure/myocardial infarction (1/1,000–1/10,000). Increased secretion of tears, pathological visual changes, or hypersensitivity for light is reported after treatment with fluorouracil (1/1,000–1/10,000).