Chemotherapy
Chemotherapy
Prepared by:
JEFFREY A. GALLO, RN, MSN
Chemotherapy
Primary focus:
prevent cancer cells from multiplying, invading adjacent
tissues, or developing metastasis
Provides systematic treatment for cure, control, or palliation
of cancer
Definition:
the use of cytotoxic drugs in the treatment of cancer
CHEMOTHERAPY
Adjuvant therapy:
a course of chemotherapy in conjunction with another treatment modality aimed
at treating metastasis
Neoadjuvant:
administration of chemotherapy to shrink a tumor before it is surgically removed
Primary therapy
: the treatment for patients who have localized cancer for which an alternative but
less than completely effective treatment is available
Induction:
drug therapy given as the primary treatment for patients who have cancer for
which no other alternative exists
Combination Chemotherapy:
administration of two or more chemotherapeutic agents to treat cancer; this
allows each medication to enhance the action of the other or to act synergistically
Myeloblative therapy:
dose-intensive therapy used in preparation for peripheral blood stem cell
transplantation
CHEMOTHERAPY
Historcial perspective
1900s
Paul Ehlrich used rodent models of infectious diseases to
develop antibiotics
Further developments led to the use of rodents to test
potential cancer chemotherapeutic agents
World War I and II
Servicemen exposure to mustard gas
led to effects of alkylating agents
1940
1946
1950s
1970s
CHEMOTHERAPY
Principles of Chemotherapy
Cell generation cycle
Tumor growth
Blood-brain Barrier
Made up of cellular structures that can inhibit certain
substances from entering the brain or CNS and acts as a
screening device , thereby protecting the brain and CSF from
harmful agents.
Formed by continuous supporting cells
Astrocytres and endothelial cells
Chemoprevention
Refers to the concept of reducing cancer risk in indivuals
who are highly susceptible to certain cancers by prescribing
certain natural or chemical synthetic products or
chemotherapeutic agents that may reduce or suppress the
process of carcinogenesis
Seeks to arrest the process of carcinogenesis before tumor
develops
Selective Estrogen Receptor Modulator
Aromatase inhibitors
Finasteride
Cytoprotectants
Are used to prevent or decrease specific system effects
related to certain drug therapies
These drugs selectively protect normal tissues from the
cytotoxic effects of drugs or irradiation while preserving their
antitumor effects
Usual administration and monitoring guidelines:
Follow specific manufacturers guidelines related to..
Administer the cytoprotectant 30 to 60 minutes before the
chemotherapy and radiation therapy
Side effects:
n/v, hypotension, warm flushed feeling, diarrhea and joint
pain
Cytoprotectants
Carvedilol(Coreg)
anthracycline associated cardiotoxicity
Dextrazoxane(Zinecard)
doxorubicin associated cadiotoxicity
Mesna(Mesnex)
hemorrhagic cystitis induced by ifosfamide or
cyclophosfamide(Cytoxan)
Amifostine(Ethyol)
Pancytoprotectant and decreases cumulative renal toxicity
associated with repeated administration of Cisplatin
Liposomes
Radiosensitizers
Enhances sensitivity of tumors to the effects of radiation, but
not to normal tissues
Allows better control of micrometastases
Examples:
Amifostine
Cisplatin
Docetaxel
Fludarabine
5-flourouracil
Gemcitabine
Hydroxyurea
placlitaxel
Chemotherapy administration
Body Surface area (m2)
Nomogram
Nurse responsibility:
Ensure accurate patient height and weight
The drug dose is ordered in mg per square meter
All drug calculations must be verified by a second person
Drug Reconstitution
Class II Biologic Safety
when drugs are prepared and reconstituted, aseptic
technique must be used in accordance with the
manufacturers current recommendations
All syringes of reconstituted drugs are immediately labeled
with the name of the drug
Administration Guidelines
Oral:
Emphasize importance of the patients complying with the
prescribed schedule
Plan for the drugs with emetic potential to be taken with
meals
Drugs that require hydration must be taken early in the
morning
Administration Guidelines
Subcutaneous and intramuscular
Injections sites must be rotated for each dose and a log kept
of the drug dosing schedule
Demonstration and return demonstration may be needed if
patient is giving self injection
Administration Guidelines
Intraarterial
Throughout the infusion, monitor:
vital signs,
color and temperature of the extremity,
and the site for potential bleeding
Administration Guidelines
Topical Administration
Cover surface area with a thin film of medication
Instruct the patient to wear loose-ftting cotton clothing
Wear gloves
Wash hands thoroughly after the procedure
Caution the patient not to touch the patient
Administration Guidelines
Intracavity
Follow prescribed medication dosage to minimize irritation
Administration Guidelines
Intraperitoneal
Tenckhoff catheter
Use dry heat to warm the infusate solution to body
temperature before administration
Monitor patient for:
Abdominal pressure
Pain
Fever
Electrolyte imbalance
Measure abdominal girth
Administration Guidelines
Intravenous
Are given through:
central venous catheter
peripheral venous access
Methods:
IV push
Piggyback
Continuous infusion
Administration Guidelines
Vein selection and venipuncture (Basilic, cephalic,
metacarpal veins)
Sites must be changed on a planned basis every 48 hours
to reduce phlebitis or infiltration
Peripheral sites must be changed daily for administration of
vesicants
veins suitable for venipuncture should:
feel smooth and pliable
Large enough to allow adequate blood flow
Use distal veins first,
Should be above areas of flexion
Subsequent changes should be done proximal to previous
sites
Trade name
Dactinomycin
Actinomycin
Daunorubicin
Cerubidine, Daunomycin
Doxorubicin
Adriamycin
epirubicin
Pharmorubicin
Esorubicin
4-deoxydorubicin
Idarubicin
Idamycin
Mecholrethamine
Mitomycin
Mutamycin
Menogaril
Tomosar
Anaphylaxis
Emergency medications and supplies for managing
anaphylaxis:
Injectable aminophylline, dyphenhydramine HCL, Dopamine,
epinephrine, heparin, hydrocortisone
Oxygen set-up, tubing cannula, or mask and airway device
Suction equipment
IV fluids
IV tubings and supplies for venous access
Anaphylaxis
Signs and symptoms
Anxiety
Hypotension
Urticaria
Cyanosis
Respiratory distress
Abdominal cramping
Flushed appearance
chills
Anaphylaxis
Management
1. immediately stop the infusion
2. Maintain an IV line with Isotonic saline
3. Position the patient for comfort and to promote perfusion to vital
organs
4. Notify the physician, nursing agency, or emergency department
5. Maintain the airway, and anticipate the need for cardiopulmonary
resuscitation
6. monitor vital signs according to agency policy
7. Administer appropriate medications with an aproved physicians
order
8. follow the nursing agencys protocol for follow-up care
9. Document
Follow-up care and provide health education to patient and SO