The four you will be asked about firstEvery antineoplastic hits the fast-dividing tissues:
marrow, gut lining, hair follicles, and mucosa. That is why the classic four —
the nadir, nausea and vomiting, alopecia, and
extravasation — show up on every care plan. Three of them are predictable enough to
prevent; the fourth happens at your hands, at the bedside, and is judged by what you do in the first sixty seconds.
Toxicity is dose-limiting: the drug is not stopped because the tumor stops shrinking, it is stopped because the patient runs out of marrow, kidney, heart, or nerve. Protecting the healthy tissue is the cancer treatment.