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Use of chemotherapy to treat cancer is generally guided by results from clinical trials in individual tumor types. The complexity of treating cancer has increased over the last decade as more drugs, including those with targeted mechanisms of action, have been approved by the US Food and Drug Administration (FDA) and introduced into general practice. Drug side effects and toxicities must be anticipated and carefully monitored. The short- and long-term toxicities of individual drugs are listed in Tables 39–3 and 39–13. Decisions on dose modifications for toxicities should be guided by the intent of therapy. In the palliative setting where the aim of therapy is to improve symptoms and quality of life, lowering doses to minimize toxicity is commonly done. However, when the goal of treatment is cure, dosing frequency and intensity should be maintained whenever possible.

Table 39–13.Commonly used supportive care agents.1

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