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Chemotherapy

Cancer Therapy
Patient Receiving Chemotherapy
Today’s Class:
 Chapter 16 Pg. 381-386
 Goals of chemotherapy
 Agents & drug classifications
 Methods of administration
 Side effects (assessment/management)
 Nursing care, management &
interventions
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
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.
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
QoL.
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
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.
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.
Major Chemo Classifications
 Cell Cycle Specific:  Cell cycle Non Specific:
 Antimetabolites-  Alkyating- alter DNA
interfere DNA (nitrogen mustard,
synthesis, S Phase busulfan)
(5FU, MTX ,folic acid)  Antitumor Antibodies
 Vinca Alkaloids- DNA & RNA distort
inhibits spindle ( Bleomycin)
formation during  Hormonal Agents-
mitosis bind to receptor sites
(Vincristine) that promote growth
(Tomoxifen)
Factors to consider when choosing
patient’s chemo. treatment

 Type of cancer
 Stage of Cancer (TNM System)
 Patient’s Age
 General State of Health
 Other health problems (liver, renal )
 Types of anticancer treatments in the
past
Methods to Administer Chemo:

 Oral Intrapleural
 Topical Intraperitoneal
 IV Intravesical
 IM Intralesional
 SC
 Intra-arterial
 Intrathecal
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 didn’t
know what the acceptable limit was???
Chemotherapeutic Agents

 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

 Normal Cells
Affected:
– bone marrow
– mouth
– stomach
– intestine
– hair follicles
– reproductive
system
Side Effects of Chemo: RBC Decrease

RBC Decrease : Anemia


Fatigue
SOB
Cold
Pale
Irritable
Dizzy
Weakness
Tingling
Anemia

 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.
 Without enough oxygen, other tissues
are unable to perform their functions.
Female 120-160 g/L & Male 140-180 g/L
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.<80
Side Effects of Chemo.
 Platelets Decrease: bruises
petechiae
bleeding gums
blood urine/stool
Thrombocytopenia

 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


 unexplained bruising
 blood in stools(black) or emesis (coffee)
 usually heavy menstrual bleeding
 red to pink urine
Nursing Interventions:
Thrombocytopenia

 Avoid use straight-edged razor


 Avoid aspirin & NSAID’s
 Avoid IM’s
 avoid rectal temps. and suppositories
 Use lotions and lubricants on skin & lips
 Ensure BM’s soft
 Soft toothbrush
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
Side effects of Chemo:
Neutropenia
Neutropenia: abnormally low WBC’s 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
Nursing Interventions:
Decreased 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
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)
Radioprotector

 Pilocarpine
administered orally
decreases the
chance of mucositis,
fungi, infections and
ulcers of the mouth.
Managing Peri-rectal
Complications

 Scrupluous peri-care
 Clean front to back(F)
 Sitz baths
 Stool softners
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
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
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)
 begin:prior to chemo & end ~ 48hrs. Post
completion chemo
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, IV’s, blades
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 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
 Chapter 13 Pain Next Class