Chemotherapy Cancer Therapy Patient Receiving Chemotherapy Todays Class

Chemotherapy Cancer Therapy

Patient Receiving Chemotherapy

Today’s Class: Chapter 16 Pg. 381 -386 n Goals of chemotherapy n Agents & drug classifications n Methods of administration n Side effects (assessment/management) n Nursing care, management & interventions n

Chemotherapy Class Objectives: Discuss the goals of chemotherapy. n Describe the agents used in chemotherapy, including classification, methods of administration and side effects. n Describe the nursing assessment and management of side effects of chemotherapy n

Chemotherapy n Is the use of drugs (antineoplastic agents) to kill tumor cells by interfering with cellular functions and reproduction. n Systemic treatment rather than a localized therapy such as surgery and radiation therapy.

Goals of Chemotherapy: 1) Cure: tumor or cancer disappears and doesn’t return. 2) Control: stop the cancer from growing and spreading. 3)Palliation: when cure and control are not possible the goal is to relieve symptoms caused by cancer, improve Qo. L.

Goals of Chemotherapy n n n Must be realistic because they will define the meds to be used & aggressiveness of treatment. The primary focus of chemotherapy is preventing cancer cells from multiplying, invading adjacent tissue or developing metastasis. Objective of chemo : Destroy all malignant cells without excessive destruction of normal cells

Potential Patient Responses n n Complete response (CR) – complete disappearance of the disease. No disease is evident on examination, scans or other tests. Partial response (PR) – some disease remaining in body, but there has a been a decrease in size or number of the lesions by 30% or more. Stable disease (SD) – disease has remained virtually unchanged in size and number of lesions. Generally, a less than 50% decrease or a slight increase in size would be described as stable disease. Progressive disease (PD) – Disease has increased in size or number on treatment.

Chemotherapeutic Agents : n Cell Cycle Specific: mostly affect the S phase & some the M phase. Administered in minimal concentrations by continuous dosing routes. n Cell Cycle Non-Specific: affects dividing and resting cells in all phases of the cell cycle. Administered in single bolus injection. n Combination: agents that differ in both cell cycle specificity & their toxicities are combined to maximize tumor cell kill with minimal toxicity. Administered in repeated courses.

Major Chemo Classifications n n n Cell Cycle Specific: Antimetabolitesinterfere DNA synthesis, S Phase (5 FU, MTX , folic acid) Vinca Alkaloidsinhibits spindle formation during mitosis (Vincristine) n n Cell cycle Non Specific: Alkyating- alter DNA (nitrogen mustard, busulfan) Antitumor Antibodies DNA & RNA distort ( Bleomycin) Hormonal Agentsbind to receptor sites that promote growth (Tomoxifen)

Factors to consider when choosing patient’s chemo. treatment Type of cancer n Stage of Cancer (TNM System) n Patient’s Age n General State of Health n Other health problems (liver, renal ) n Types of anticancer treatments in the past n

Methods to Administer Chemo: Oral n Topical n IV n IM n SC n Intra-arterial n Intrathecal n Intrapleural Intraperitoneal Intravesical Intralesional

Chemotherapeutic Agents n n n Chemotherapeutic agents are apt to impair or damage cells in the marrow than other normal cells in the body (myelosuppression). myelosuppression is the depression of bone marrow function; decreased production of blood cells Only actively dividing cells in the bone marrow are affected (i. e. stem cells). Cells with shorter life span are more affected (white vs. red blood cell) The damage to the bone marrow is directly porportional to the drug dosage. Thus, the damage to these tissues is dose limiting. (Monitor CBC regularly) What would happen if the nurse didn’t know what the acceptable limit was? ? ?

Chemotherapeutic Agents n The resulting reduction in the body’s RBC, WBC and platelets limits the next dose of chemotherapy that may be safely given or causes postponement of further drug treatment of cancer until the patient recovers from the toxic effects. (Recovery)

Chemotherapy: Side Effects n Normal Cells Affected: – bone marrow – mouth – stomach – intestine – hair follicles – reproductive system

Side Effects of Chemo: RBC Decrease : Anemia Fatigue SOB Cold Pale Irritable Dizzy Weakness Tingling

Anemia n RBC’s transport oxygen to all parts of the body are produced in the bone marrow. Sometimes chemo can reduce the bone marrow’s ability to produce these cells, resulting in too few RBC’s to carry oxygen to other body tissues. n Without enough oxygen, other tissues are unable to perform their functions. n

Female 120 -160 g/L & Male 140 -180 g/L

Anemia Nursing Interventions n n n Assist pt. to conserve energy sit on bedside prior to ambulating oxygen administered as ordered small frequent meals nutritional meals communicate feelings of frustration & anger are normal when fatigued obtain order to administer blood when hgb. <80

Side Effects of Chemo. n Platelets Decrease: bruises petechiae bleeding gums blood urine/stool

Thrombocytopenia n n n Platelet count in healthy individual ranges 150, 000 -350, 000 per micro liter of blood. Thrombocytopenia occurs when the plt. Count <100, 000 b/t 50, 000 -74, 000 the condition is considered moderate. <50, 000 risk bruising and bleeding increases <20, 000 plt. transfussion

Symptoms of Thrombocytopenia Small red or purple spots on the skin n unexplained bruising n blood in stools(black) or emesis (coffee) n usually heavy menstrual bleeding n red to pink urine n

Nursing Interventions: Thrombocytopenia Avoid use straight-edged razor n Avoid aspirin & NSAID’s n Avoid IM’s n avoid rectal temps. and suppositories n Use lotions and lubricants on skin & lips n Ensure BM’s soft n Soft toothbrush n

Nursing Interventions: Thrombocytopenia Notify/educate for signs of bleeding n Notify physician of hypertension n Apply pressure to injection site, venipuncture, biopsy site for 4 -5 minutes post-procedure n Avoid indwelling catheters n May use birth control pill temporarily to prevent/arrest menses n

Side effects of Chemo: Neutropenia: abnormally low WBC’s which increases risk of infection. WBC decrease therefore increase susceptiability to INFECTIONS n Symptoms: n Fever, sore throat, cough, SOB, Nasal congestion, burning urination, shaking n chills, redness, swelling and warmth of an injury

Nursing Interventions: Decreased WBC n n n n good handwashing b/t pts. monitor v/s (esp. T) monitor lab values monitor signs inf. (resp, urinary oral, skin) maintain good patient hygiene no mouthwashes (drying) avoid people with colds balanced diet

Managing Mucositis n n n Through buccal cavity assessment oral hygiene: soft toothbrush, freq. Rinses, keep moist no commercial mouthwashes or lemon/glycerine swabs use saline, club soda or saline & baking soda meds as chlorhexidine rinses (may discolor teeth)

Radioprotector n Pilocarpine administered orally decreases the chance of mucositis, fungi, infections and ulcers of the mouth.

Managing Peri-rectal Complications Scrupluous peri-care n Clean front to back(F) n Sitz baths n Stool softners n

Alopecia n n n Unavoidable side effect of some chemo which is individual. The life cycle of the cell that produces a hair shaft is ~ one day. Rapid rate of cell growth & reproduction makes hair follicles sensitive to effects of chemo. B/t 7 &14 days post chemo hair thinning & loss begin (not permanent) hair may grow back a new color or texture

Caring for Scalp & Hair during Chemo n n n n Do not use hair coloring/permanent treatments Do not use brush type rollers use mild shampoos avoid blow drying use soft brushes use a sun block with most or all hair loss to protect scalp from sun use hat, scarf or turban

Safe handling of Chemo n n n Three routes of accidental exposure: 1). Absorption through skin 2). Inhalation 3). Ingestion (food, gum) Cytotoxic Precautions: protective practices whereby all excreta from pt. on chemo. may contain metabolized or cytotoxins. (urine & feces highest concentration) begin: prior to chemo & end ~ 48 hrs. Post completion chemo

Cytotoxic Precautions: Protective Equiptment n n n n Gown: protective, non absorbent, disposable Gloves: Non-powdered latex made for chemo Goggles: not regular glasses Masks: potential risk of droplet (topical chemo) Cytotoxic Caution Signs: foot of bed Spill Kits: commercially developed Sharps Container: needles, IV’s, blades

Chemo. Administration n n n Remember: to always spike chemo. bag at waste level to water proof tape at all connections to remove protective equipment prior to leaving pt’s room know signs & symptoms of side effects chemo adhere to hospital policies & procedures regarding chemo. Be certified to give chemo Two RN’s always check chemo

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