NURSING CARE OF PATIENTS RECEIVING CHEMOTHERAPY

Chemotherapy is the use of chemicals to treat disease. Paul Erlich, considered to be the father of chemotherapy, coined this word to describe a specific chemical utilized in the treatment of parasites

Today the term chemotherapy while technically describing drug therapy for any disease , is most frequently used in reference to the treatment of cancer

Chemotherapy administration flow

There are four ways chemotherapy may be used: 1. Adjuvant therapy- A course of chemotherapy used in conjunction with another treatment modality. 2. Neoadjuvant chemotherapy- Administration of chemotherapy to shrink the tumor prior to surgical removal of the tumor. 3. Primary therapy- The treatment of patients with localized cancer for which there is an alternative but less than completely effective treatment. 4. Induction chemotherapy- The drug therapy is given as the primary treatment for patients with cancer for which no alternative treatment exists. 5. Combination chemotherapy- Administration of two or more chemotherapeutic agents in the treatment of cancer, allowing each medication to enhance the action of the other or act synergistically with it. e.g. MOPP regimen for Hodgkins disease.

Just as the word cancer represents many different types of malignant disease, the word chemotherapy represents many different types of chemotherapeutic agents. The drugs used in cancer treatment vary in their chemical structure , biological side effects and toxicities. Some are effective in treating one specific types of cancer while others are utilized in the treatment of wide variety of malignancies. The methods of administration also vary according to the chemotherapeutic and new techniques for safer and more effective administration.

The process of learning about chemotherapy is indeed a challenge. Nursing management of the patient receiving chemotherapy requires knowledge about the treatment , skill in assessment, technical expertise, ability and desire to support the client physically and emotionally. The reward in meeting this is to be able to provide the care this clients need in order to survive their disease and its treatment and hopefully to go on with their lives with as few physical and emotional scars as possible.

Nursing care begins with a thorough understanding of the patients condition; goal of therapy , drug dose, route, schedule, administration principles; and potential side effects.

Additional nursing management includes monitoring responses to the therapy, reassessing and documenting signs and symptoms, and communicating pertinent information to other members of the health care team.

Medical staff in Developing countries

shortage (sometimes dramatic) of support staff in hospitals and health centres, both in large cities and in rural areas Doctors too often choose to practice in towns

Lack of in-service training for both medical and support staff

Training Issues in Cancer

Although the training of medical personnel is a priority, training for support staff at the bedside is not sufficiently recognised as a necessary tool in the fight against cancer

Nurses Cancer Training

In most developing countries, training is inadequate, unsuitable, and does not include cancer care

Just one way to learn: with the help of doctors who have trained in developed countries

Many obstacles for Nurses

Shortage of medical staff Lack of sufficient resources No cancer training Cancer is a low health priority in most countries Cancer: a cultural tragedy for the people

Responsibilities of nurses for patient-centred care

Nursing role in Cancer Care

Responsibilities of nurses for patient-centred care

Coordination of care and treatment with the oncologist Good knowledge of malignant diseases Management of: Chemotherapy and its side effects Pain control Nursing care Palliative care Information for patients and families about treatment

Training Program
In developing countries, the major requirements are: Prevention and early diagnosis Chemotherapy, pain management Palliative Care and End of Life

Requirements for ASCO/ONS Chemotherapy Administration standards

Chemotherapy knowledge
Objectives Looking after patients with cancer coming back from Europe or USA

Nursing implications and side effects

Evaluation of pain and pain control

Palliative Care
Nurses need a professional approach and total quality control to look after patients when often there is:
- No money - No medicines - No hope - Abandonment of cancer patients

Improving cancer nursing

Promote initial training in nursing colleges and faculties of medicine Improve in-service training Recognise the work of the paramedical staff Encourage working in partnership with European and American centres and agencies for cancer control

Key elements of nurses education

Based on learning needs Interactive process Involves doctors/nurses/individuals responsible for patients continuing care Collaborative and interdisciplinary Consistent across continuum of care

An example with Palliative Care Training

Developing Nurses education and support Materials: working pathways suggested like Palliative Care Journals E-Newsletters Distance Learning Programs

Common definitions for ASCO/ONS chemotherapy administration safety standards

ROLE OF A NURSE
Prior to chemotherapy administration 1 Review - The chemotherapy drugs prescription which should have - Name of anti-neoplastic agent. - Dosage - Route of administration - Date and time that each agent to be administered. 2. Accurately identify the client 3.Medications to be administered in conjunction with the chemotherapy e.g antiemetics, sedatives etc.

4. Assess the clients condition including - Most recent report of blood counts including hemoglobin ,hematocrit, white blood cells and platelets. - Presence of any complicating condition which could contraindicate chemotherapeutic agent administration i.e. infection, severe stomatitis , decreased deep tendon reflexes, or bleeding -Physical status -Level of anxiety -Psychological status.

5. Prepare for potential complications Review the policy and have medication and supplies available for immediate intervention the event of extravasation. Review the procedure and have medication available for possible anaphylaxis 6. Assure accurate preparation of the agent -Accuracy of dosage calculation -Expiry date of the drug to be checked -Procedure for correct reconstitution and -Recommended procedures for administration 7. Assessment of patients understanding of the chemotherapeutic agents and administration procedures.

Chemotherapy offers patients with cancer a great deal of hope for a cure or a means of control cancer for a long period of time. Hope and optimism are vital ingredients in care plan

Cancers: attributable share

Reproduc. 6%

Infections 15%

Food 25%

Tobacco 33%

Alcohol 10%

Tobacco Alcohol Food Infections Reproduc. Work related Pollution Radiation Iatrogenic