Transcript CHEMOTHERAPY - Central Manchester University Hospitals

CHEMOTHERAPY
An Overview
Amy Sinacola.
Haematology Macmillan Clinical Nurse Specialist
Aims of session
 Understand
Cell Cycle
 Chemotherapy and the cancer
cell
 Side effects
 Nursing implications
 Administration & safety
Definition:
Chemotherapy
• The treatment of cancer using specific
chemical agents or drugs that are
destructive to malignant cells and tissues.
The term comes from two words that mean
"chemical" and "treatment."
Cytotoxic
• literally translated means ‘toxic to cells’.
The Cell Cycle
The Cell Cycle
Mitosis
Cell Biology: Mitosis
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A cell in mitosis
Normal Cell Characteristics:
Metabolism. Strictly controlled &
predictable
 Maturation & Specialisation. Occurrs
before dividing. Strictly controlled.
 Reproduction = Cell death
 Contact Inhibition. Mechanism for
switching off division when in contact
with different cells
 Recognition. Like cells stay together.
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Cancer Cell Characteristics:
Unchecked & Uncontrolled Growth
 Loss of contact inhibition
 Loss of capacity to differentiate
 Increased growth fraction
 Chromosomal Instability
 Capacity to metastasise
 Altered biochemical properties
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Chemotherapy and Cancer Cells
Cell Cycle specific :
Most active against cells in a specific
phase therefore need prolonged exposure
or repeated doses.
Cell Cycle Non-specific:
Most effective against actively dividing
cells but also effective in G0.
Chemotherapy
Chemotherapy may be used
conventionally to:
 Cure patients
 Prolong survival
 Palliative care symptom control
Chemotherapy
Combination Therapy.
Prevents resistance.
Adjuvant Therapy.
Administered after primary therapy
e.g.Surgery
Neo adjuvant Therapy:
Given before surgery to reduce
tumour size.
Chemotherapy
Over 50 different chemotherapy drugs
Administered as an outpatient or inpatient
depending on toxicity
Modes of administration include:
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Oral e.g. Methotrexate, Hydroxyurea
IV: Canula/Indwelling Central Venous Catheter
Sub cut
 Intracavity e.g pelvic cavity, bladder
 Intrathecal. Can be fatal if wrong drug
administered!
Intrathecal Chemotherapy
Chemotherapy Side Effects
Chemotherapy targets cells which are
dividing rapidly.
 Chemotherapy cannot distinguish
between normal cells and cancer cells
 Healthy Cells which have a high rate of
growth and multiplication include cells of
the bone marrow, hair, GI mucosa and
skin.
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Chemotherapy Side effects contd…
Side effects may be drug specific e.g.
anthracyclines and cardiotoxicity, vinca
alkaloids and neuropathy/constipation,
bleomycin and pulmonary fibrosis
 Severity of side effects varies between
drugs.
 Side effects often occur 7-14 days post
treatment.
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Side Effects: Acute
Tumour Lysis Syndrome.
 A Metabolic Emergency.
 Occurrs due to rapid cell lysis (death) &
large amounts of cell metabolites in
blood.
 If untreated can lead to acute renal
failure, cardiac arrest and death.
Side Effects: Acute
Neutropenic Sepsis:
Occurs due to Bone Marrow Failure and
poor immune response to infection.
Predisposing factors include:
Neutropenia
Underlying disease
Chemotherapy
Venous access devices
Neutropenic Sepsis
Severe overwhelming infection where
inadequate blood flow to the tissues
results in cellular dysfunction and, if not
reversed, eventual organ failure.
 Most common micro organism is gram
negative
 Mortality rate 40-90%
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Side Effects: Acute
Haemorrhage
• Invading tumours e.g gastric MALT
lymphomas
• Haemorrhagic Cystitis related to high
dose Cyclophosphomide
Anaphylactic Reaction
Side Effects:Bone Marrow
Neutropenia:
Increased risk of infection.
Anaemia:
Tiredness, lethargy & breathlessness
Thrombocytopenia:
Increased risk of bleeding
Side Effects: Gastro-Intestinal
Nausea & Vomiting
 Diarrhoea & constipation
 Loss of appetite
 Taste Changes
 Mucositis
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Side Effects
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Example of Grade 4 Mucositis
Side Effects: Body Image
Hair Loss
 Weight Loss/ Weight Gain
 Long term central venous catheters
 Skin changes (colour, rashes, sensitivity
to sunshine/chlorine, dry)
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Side Effects: Other
Fatigue: Often multi-factorial
 Peripheral neuropathy
 Altered Kidney Function
 Changes in hearing (high dose Cisplatin)
 Cardiac Toxicity (Doxorubicin/ Idarubicin)
 Late Effects: Infertility, secondary
malignancy, growth retardation.
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Case Study

17 year old girl with Hodgkins disease. Has
had 3 cycles of chemotherapy treatment and is
halfway through the course. She is feeling sick
up to 24 hours before coming to hospital for
treatment and vomiting up to 48 hours after
receiving chemotherapy. She has lost 1 stone
in weight in 2 months, she feels tired and is
not wanting to have any more treatment.
Case Study
36 year old lady just diagnosed with
None Hodgkins Lymphoma. She works
part time as a beauty therapist and has 2
small children under the age of 5. She is
to receive outpatient chemotherapy of RCHOP and requires a long term central
venous catheter.
What would you include in your nursing
assessment?
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How can nurses help.
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Information and Education.
What to do if unwell. Infection is a big risk!
Advice on Symptom Control
Timely administration of drugs
Regular assessment of side effects and
effectiveness of interventions e.g anti emetics,
analgesia etc
Nutritional assessment and intervention
How can nurses help
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Psychological Care: Body Image, Diagnosis of
life threatening disease, Fear of dying
Involve Family members, talking to children
about parents diagnosis etc
Consider Sexual advice needed
Consider financial implications
Direct to supportive services in their area eg
support groups, complementary therapies etc.
Refer to Community Team if support at home
needed
Points about Administration: Staff

Must be administered by chemotherapy
trained nurses only
 Safe handling is essential. Cytotoxic drugs are
carcinogenic, mutagenic and teratogenic.
 Potential exposure occurs during: preparation,
administration and changing lines, handling of
body fluids e.g urine, handling of chemo
waste products e.g lines, medication bottles,
spillage / leakage of chemotherapy.
 ALWAYS TAKE UNIVERSAL PRECAUTIONS
Key Points:
Chemotherapy is a major treatment in
curing or prolonging survival in cancer
patients
 It has a wide range of side effects
depending on the drugs given.
 Nurses have a key role to play in caring
for a patient receiving chemotherapy
 Safety issues are paramount in
administration.
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Summary:
The potential benefit to the patient
of treatment as an option must
always outweigh the toxic effects.