CARE OF THE PATIENT UNDERGOING CHEMOTHERAPY AND/OR RADIOTHERAPY

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CARE OF THE PATIENT UNDERGOING CHEMOTHERAPY
AND/OR RADIOTHERAPY

• SHARON HARVEY
• 23/02/04

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LEARNING OUTCOMESTHE STUDENT SHOULD BE ABLE TO-

• EXPLAIN WHAT CANCER IS AND ITS EFFECTS ON THE
  INDIVIDUAL
• IDENTIFY THE DIFFERENT TYPES OF TUMOURS
• DEFINE CHEMOTHERAPY
• DISCUSS THE SIDE EFFECTS OF CHEMOTHERAPY
• DISCUSS IMMUNOTHERAPY AND HORMONE THERAPY
• DEFINE RADIOTHERAPY
• DISCUSS THE SIDE EFFECTS OF RADIOTHERAPY
• DISCUSS THE RIGHTS OF THE PATIENT TO REFUSE
  TREATMENT
• GIVE EXAMPLES OF SUPPORTIVE THERAPY
• EXPLAIN THE ROLE OF THE MACMILLAN NURSES

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SOME FACTS ABOUT CANCER

• THREE IN TEN PEOPLE WILL BE DIAGNOSED WITH CANCER
  DURING THEIR LIFETIME
• THERE ARE CURRENTLY MORE THAN 1.2 MILLION PEOPLE
  LIVING WITH CANCER IN THE UK
• THE RISK OF CANCER INCREASES WITH AGE
• AROUND 65 OF ALL NEW CANCERS ARE DIAGNOSED IN
  PEOPLE OVER THE AGE OF 65

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WHAT IS CANCER?

• CANCER IS THE NAME GIVEN TO A GROUP OF DISEASES
  THAT OCCUR IN ANY ORGAN OF THE BODY
• IT IS THE ABNORMAL OR UNCONTROLLED GROWTH OF
  CELLS
• EACH CELL IN THE BODY HAS GENES

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• NORMAL CELLS
• - replicate themselves exactly
• - stop reproducing after they have reproduced
  50-60 times
• - stick together in the right place
• - self destruct if they are damaged
• - become specialised or mature

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HOW DOES CANCER DEVELOP?

• THEY DEVELOP WHEN A SINGLE CELLS GENES DEVELOP A
  FAULT AND ARE UNABLE TO REGULATE CELL DIVISION
• THE CELL BEGINS TO DIVIDE UNCONTROLLABLY
• DEVELOPING INTO A LUMP KNOWN AS A TUMOUR

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CANCER CELLS

• CARRY ON REPRODUCING
• IGNORE SIGNALS FROM OTHER CELLS AROUND THEM
• DO NOT STICK TOGETHER, SO THEY CAN MOVE AROUND
  THE BODY
• REMAIN IMMATURE
• DO NOT DIE IF THEY MOVE TO ANOTHER PART OF THE
  BODY

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BENIGN TUMOURS

• DO NOT INVADE THE SURROUNDING TISSUES OR SPREAD
  TO OTHER PARTS OF THE BODY
• USUALLY GROW SLOWLY
• USUALLY HAVE A COVERING MADE UP OF NORMAL CELLS
• THEY ARE NOT CANCEROUS

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BENIGN TUMOURS CAN CAUSE PROBLEMS IF THEY-

• GROW VERY LARGE
• BECOME UNCOMFORTABLE OR UNSIGHTLY
• PRESS ON BODY ORGANS
• TAKE UP SPACE IN THE SKULL
• RELEASE HORMONES THAT AFFECT HOW THE BODY WORKS

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MALIGNANT TUMOURS

• ARE CANCEROUS
• HAVE THE ABILITY TO SPREAD BEYOND THEIR ORIGINAL
  SITE
• MALIGNANT CELLS CAN BREAKAWAY FROM PRIMARY SOURCE
  AND SPREAD TO OTHER ORGANS VIA THE BLOOD STREAM
  OR LYMPHATIC SYSTEM

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• PRIMARY CANCER IS THE TERM USED TO IDENTIFY WHERE
  THE CANCER ORIGINATED
• SECONDARY CANCER IS THE TERM USED TO IDENTIFY A
  SECOND SIGHT OF THE CANCER

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THE MEANING OF CHEMOTHERAPY

• THE WORD CHEMOTHERAPY COMES FROM TWO WORDS,
  CHEMICAL AND THERAPY
• IT LITERALLY MEANS DRUG TREATMENT
• IN PRACTICE IT USUALLY REFERS TO CYTOTOXIC DRUGS,
  CELL KILLING DRUGS

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• HOWEVER IT IS SLIGHTLY MORE COMPLEX, NOT ALL
  CANCER KILLING DRUGS ARE CLASSED AS CHEMOTHERAPY
• SUCH AS INTERFERON AND MONOCLONAL ANTIBODIES
  WHICH ARE CLASSED AS IMMUNOTHERAPY
• THERE ARE 60 TYPES OF CHEMOTHERAPY CURRENTLY
  AVAILABLE AND NEW ONES BEING DEVELOPED ALL THE
  TIME

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HOW DO THE DRUGS WORK?

• THE DRUGS ENTER THE BLOODSTREAM AND REACH ALL
  PARTS OF THE BODY
• CYTOTOXIC DRUGS DESTROY CANCER CELLS BY DAMAGING
  THEM SO THAT THEY CANT DIVIDE AND GROW
• THE DRUGS CAN ALSO AFFECT NORMAL CELLS

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THE SUITABILITY OF CHEMOTHERAPY

• THIS DEPENDS ON-
• THE TYPE OF CANCER
• WHERE IN THE BODY IT STARTED
• WHAT THE CANCER LOOK LIKE UNDER THE MICROSCOPE
  (GRADE)
• WHETHER THE CANCER HAS SPREAD

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THE PATIENT MAY HAVE CHEMOTHERAPY-

• ON ITS OWN
• WITH RADIOTHERAPY
• WITH SURGERY
• WITH HORMONE THERAPY
• WITH IMMUNOTHERAPY
• WITH COMBINATION OF ALL OR SOME OF THESE
  TREATMENTS

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THE PATIENT MAY HAVE

• HIGH DOSE TREATMENT WITH AN INFUSION OF BONE
  MARROW CELLS AFTERWARDS
• THIS IS KNOWN AS A BONE MARROW TRANSPLANT OR STEM
  CELL TRANSPLANT

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SIDE EFFECTS OF CHEMOTHERAPY

• MOUTH PAIN OR ULCERS
• NAUSEA AND VOMITING
• SOME CAUSE HAIR LOSS
• SKIN THAT IS DRY, DISCOLOURED OR SENSITIVE TO
  SUNLIGHT
• NAILS MAY GROW SLOWLY AND DEVELOP WHITE OR DARK
  LINES
• ANAEMIA
• LOW WHITE BLOOD CELL COUNT

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WAYS OF GIVING CHEMOTHERAPY

• In order to damage and kill the cancer cells, the
  drugs must be absorbed into your blood and
  carried throughout your body.
• The way chemotherapy is given depends on
• The type of cancer
• The drugs (for example, some must be injected and
  some can be taken by mouth)

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WAYS OF GIVING CHEMOTHERAPY

• THE THREE MOST COMMON WAYS OF GIVING CHEMOTHERAPY
  ARE-
• INTRAVENOUS INJECTION
• ORALLY
• INTRAVENOUS INFUSION
• LESS OFTEN DRUGS CAN BE INJECTED-
• INTRAMUSCULARLY / SUBCUTANEOUSLY
• INTRATHECALLY
• INTRA-ARTERIAL
• INTRACAVITARY (INTRAVESICAL,INTRAPERITONEAL,
  INTRAPLEURAL)
• INTRATUMOURAL OR INTRALESIONAL

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IMMUNOTHERAPY

• Immunotherapy is the name given to cancer
  treatments that use the immune system to attack
  cancers.
• Sometimes immunotherapy drugs are called
  'Biological Response Modifiers' (BRM's) because
  they stimulate the body to respond biologically
  (or naturally) to cancer. Immunotherapy can be
  
• Local or systemic (treating the whole body) 
• Non-specific or targeted

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LOCAL IMMUNOTHERAPY

• LOCAL MEANS TREATING ONLY ONE PART OF THE BODY
• THE BEST EXAMPLE IS BLADDER CANCER. THE VACCINE
  BCG CAUSES INFLAMMATION IN THE BLADDER THAT
  FIGHTS THE CANCER CELLS

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SYSTEMIC IMMUNOTHERAPY

• GIVEN TO TREAT THE WHOLE BODY
• INTERFERON IS A SYSTEMIC IMMUNOTHERAPY DRUG
• CAN TREAT KIDNEY CANCER AND MALIGNANT MELANOMA

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NON SPECIFIC IMMUNOTHERAPY

• LOCAL AND SYSTEMIC IMMUNOTHERAPY ARE CLASSED AS
  NON SPECIFIC IMMUNOTHERAPY
• THEY ARE GIVEN TO BOOST THE IMMUNE SYSTEM TO
  FIGHT THE CANCER CELLS

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TARGETED IMMUNOTHERAPY

• THIS TARGETS CANCER CELLS AND HOPEFULLY LEAVES
  NORMAL CELLS UNTOUCHED
• INCLUDES MONOCLONAL ANTIBODIES AND CANCER VACCINES

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HORMONE THERAPY

• ALTHOUGH HORMONES DO NOT USUALLY AFFECT CANCE
  CELLS, OESTROGEN AND PROGESTERONE AFFECT THE
  GROWTH OF SOME BREAST CANCERS, WHILE TESTOSTERONE
  AFFECTS THE GROWTH OF SOME PROSTATE CANCERS.
  THIS MEANS DRUGS THAT BLOCK THE EFFECTS OR LOWER
  THE LEVELS OF THESE HORMONES CAN BE USED TO TREAT
  SOME TYPES OF BREAST AND PROSTATE CANCER

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HORMONE THERAPY DRUGS FOR BREAST CANCER

• TAMOXIFEN IS A COMMON AND SUCCESSFUL ADJUVANT
  TREATMENT USUALLY GIVEN FOR FIVE YEARS AFTER
  SURGERY
• AROMATASE INHIBITORS BLOCK THE PRODUCTION OF
  OESTROGEN BY THE ADRENAL GLANDS IN POST
  MENOPAUSAL WOMEN
• PITUITARY DOWNREGULATORS ARE USED TO TREAT
  PREMENOPAUSAL WOMEN. THEY PREVENT THE OVARIES
  FROM WORKING UNTIL THERAPY IS DISCONTINUED.

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HORMONE THERAPY DRUGS FOR PROSTATE CANCERS

• PITUITARY DOWNREGULATORS MAY INITIALLY EXACERBATE
  SYMPTOMS, KNOWN AS TUMOUR FLARE, THIS CAN BE
  PREVENTED BY GIVING AN ANTI-ANDROGEN
• ANTI-ANDROGENS BLOCK THE EFFECTS OF TESTOSTERONE
• BOTH TYPES OF DRUGS TOGETHER ARE CALLED MAXIMAL
  ANDROGEN BLOCKADE (MAB)

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RADIOTHERAPY

• THIS USES IONISING RADIATION TO KILL CANCER CELLS
• IT IS USED TO TREAT BREAST, LUNG, HEAD, NECK,
  PROSTATE, COLORECTAL, BRAIN AND GYNAECOLOGICAL
  CANCERS
• AT LEAST 50 OF PEOPLE WITH CANCER RECEIVE
  RADIOTHERAPY

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DIFFERENT TYPES OF RADIOTHERAPY

• TELETHERAPY OR EXTERNAL BEAM RADIOTHERAPY USES
  X-RAY BEAMS OF VARIOUS ENERGIES
• BRACHYTHERAPY USES SEALED SOURCES OF RADIATION TO
  DELIVER A HIGH DOSE TO A TUMOUR AND CAN INVOLVE
  INTERSTITIAL THERAPY OR IMPLANTS OR INTRACAVITY
  TREATMENT

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SIDE EFFECTS OF RADIOTHERAPY DEPENDS ON-

• THE AREA OF THE BODY BEING TREATED AND
  TISSUES/ORGANS IN THAT AREA
• THE SIZE OF THE TREATMENT AREA
• THE DOSE OR AMOUNT OF RADIOTHERAPY GIVEN
• THE FRACTIONATION OF THE TREATMENT
• THE GENERAL HEALTH OF THE PATIENT
• PREVIOUS OR CONCURRENT CHEMOTHERAPY OR SURGERY

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SIDE EFFECTS OF RADIOTHERAPY

• SKIN REACTION
• HAIR LOSS
• DIARRHOEA
• MUCOSITIS
• STERILITY
• FREQUENCY OF PASSING URINE
• FATIGUE
• ANOREXIA
• PSYCHOLOGICAL EFFECTS
• NAUSEA AND VOMITING

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SUPPORTIVE CARE OF PATIENT WITH CANCER

• SYMPTOM CONTROL
• CARING FOR THEM IN THEIR OWN HOME IF THEY SO WISH
• SUPPORTING THEM IF THEY DECIDE TO REFUSE
  TREATMENT FOR THEIR CANCER
• EMOTIONAL SUPPORT
• PSYCHOSOCIAL SUPPORT

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MACMILLAN NURSES

• There are currently 2000 Macmillan nurses in the
  U.K
• They are registered nurses with at least 5 years
  post registration experience, 2 years have to be
  within cancer care or palliative care
• They have specialist knowledge, for example in
  breast or lung cancer, or in chemotherapy.
• Macmillan paediatric nurses help children with
  cancer and their families.

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• Macmillan community-based nurses play a vital
  role in helping people with cancer to stay at
  home with their families.
• Macmillan hospital-based nurses see people with
  cancer from the time they are diagnosed and right
  through their treatment.
• Macmillan lead cancer nurses are senior nurse
  managers, who help shape the future of cancer and
  palliative care services in their area.