Chemotherapy

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Chemotherapy

• Cancer Therapy

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Patient Receiving Chemotherapy
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Todays Class

• Chapter 16 Pg. 381-386
• Goals of chemotherapy
• Agents drug classifications
• Methods of administration
• Side effects (assessment/management)
• Nursing care, management interventions

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Chemotherapy Class Objectives

• Discuss the goals of chemotherapy.
• Describe the agents used in chemotherapy,
  including classification, methods of
  administration and side effects.
• Describe the nursing assessment and management of
  side effects of chemotherapy

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Chemotherapy

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

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Goals of Chemotherapy

• 1) Cure tumor or cancer disappears and doesnt
  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 QoL.

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Goals of Chemotherapy

• 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

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Potential Patient Responses

• 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.

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Chemotherapeutic Agents

• Cell Cycle Specific mostly affect the S phase
  some the M phase. Administered in minimal
  concentrations by continuous dosing routes.
• Cell Cycle Non-Specific affects dividing and
  resting cells in all phases of the cell cycle.
  Administered in single bolus injection.
• 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.

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Major Chemo Classifications

• Cell cycle Non Specific
• Alkyating- alter DNA (nitrogen mustard, busulfan)
• Antitumor Antibodies DNA RNA distort
• ( Bleomycin)
• Hormonal Agents-
• bind to receptor sites that promote growth
• (Tomoxifen)

• Cell Cycle Specific
• Antimetabolites-interfere DNA synthesis, S Phase
  (5FU, MTX ,folic acid)
• Vinca Alkaloids- inhibits spindle formation
  during mitosis (Vincristine)
  

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Factors to consider when choosing patients
chemo. treatment

• Type of cancer
• Stage of Cancer (TNM System)
• Patients Age
• General State of Health
• Other health problems (liver, renal )
• Types of anticancer treatments in the past

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Methods to Administer Chemo

• Oral Intrapleural
• Topical Intraperitoneal
• IV Intravesical
• IM Intralesional
• SC
• Intra-arterial
• Intrathecal

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Chemotherapeutic Agents

• 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 didnt know what
  the acceptable limit was???

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Chemotherapeutic Agents

• The resulting reduction in the bodys 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)

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Chemotherapy Side Effects

• Normal Cells Affected
• bone marrow
• mouth
• stomach
  
• intestine
  
• hair follicles
• reproductive system

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Side Effects of Chemo RBC Decrease

• RBC Decrease Anemia
  Fatigue
  SOB Cold Pale Irritable
  Dizzy Weakness Tingling

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Anemia

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

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Female 120-160 g/L Male 140-180 g/L
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Anemia Nursing Interventions

• 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.lt80

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Side Effects of Chemo.

• Platelets Decrease bruises
  petechiae bleeding gums
  blood urine/stool

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Thrombocytopenia

• Platelet count in healthy individual ranges
  150,000-350,000 per micro liter of blood.
• Thrombocytopenia occurs when the plt. Count
  lt100,000
• b/t 50,000-74,000 the condition is considered
  moderate.
• lt50,000 risk bruising and bleeding increases
• lt20,000 plt. transfussion

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Symptoms of Thrombocytopenia

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

Assess, report
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Nursing Interventions Thrombocytopenia

• Avoid use straight-edged razor
• Avoid aspirin NSAIDs
• Avoid IMs
• avoid rectal temps. and suppositories
• Use lotions and lubricants on skin lips
• Ensure BMs soft
• Soft toothbrush

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Nursing Interventions Thrombocytopenia

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

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Side effects of Chemo Neutropenia

• Neutropenia abnormally low WBCs which increases
  risk of infection.
• WBC decrease therefore increase susceptiability
  to INFECTIONS
• Symptoms
• Fever, sore throat, cough, SOB,Nasal congestion,
  burning urination, shaking
• chills, redness, swelling and warmth of an injury

Assess, know significance report
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Nursing InterventionsDecreased WBC

• 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

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Managing Mucositis

• 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)

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Radioprotector

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

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Managing Peri-rectal Complications

• Scrupluous peri-care
• Clean front to back(F)
• Sitz baths
• Stool softners

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Alopecia

• 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

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Caring for Scalp Hair during Chemo

• 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

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Safe handling of Chemo

• 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)
• beginprior to chemo end 48hrs. Post
  completion chemo

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Cytotoxic Precautions Protective Equiptment

• 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, IVs, blades

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Chemo. Administration

• Remember
• to always spike chemo. bag at waste level
• to water proof tape at all connections
• to remove protective equipment prior to leaving
  pts room
• know signs symptoms of side effects chemo
• adhere to hospital policies procedures
  regarding chemo. Be certified to give chemo
• Two RNs always check chemo

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• Chapter 13 Pain Next Class