Neurologic complications of immunosuppressive cancer therapy

Current therapies for cancer treatment, organ transplantation, and many inflammatory diseases involve the use of a variety of immunosuppressive agents, including antineoplastics, steroids, and cyclosporine. Direct neurotoxicities associated with these drugs include central nervous system disorders such as encephalopathy, seizure, cerebellar dysfunction, ophthalmologic and ototoxicities, mental status changes, and peripheral neuropathies with sensory or motor dysfunction. The incidence and severity of these toxicities vary and often depend on the dosage and schedule of administration and the presence of associated risk factors. Many of these neurotoxicities are reversible upon dose reduction or discontinuation of therapy. Important nursing measures for patients at risk for or experiencing neurologic complications include patient/family teaching, baseline neurologic assessment, monitoring response to therapy, and providing psychosocial support and appropriate reassurance to family members. This article presents an overview of neurologic complications specific to common immunosuppressive agents associated with cancer therapy, predisposing risk factors, and clinical manifestations. Nursing assessment parameters and management strategies also are described.