Transcript Chapter 44

Chapter 44
Drugs Used for Cancer Treatment
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Lesson 44.1
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Objectives
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Identify common sites for cancer in men and
women and cite the goals of chemotherapy.
Cite the rationale for giving chemotherapeutic
drugs on a precise time schedule.
Describe the nursing assessments and
interventions needed for people experiencing
adverse effects from chemotherapy.
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Cancer and the Use of
Antineoplastic Agents
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Cancer: disorder of cellular growth
Occurs when a group of abnormal cells proliferates
more rapidly than normal cells, losing the ability to
perform specialized functions
They invade surrounding tissues, and develop
growths in other tissues distant to the original growth
(metastasis)
Treatment requires combination of surgery, radiation,
chemotherapy, and immunotherapy
Recent developments enhance role of antineoplastic
agents in therapy
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Cancer Cases and Deaths
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Audience Response Question 1
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Which type of cancer is the leading cause of
cancer-related death in women?
A.
B.
C.
D.
Breast
Colon
Lung
Ovary
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Phases of Cell Growth
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Mitosis: phase of cellular proliferation in which cells
divide into two equal daughters
 Cells either advance into nonproliferative stage (G0), or
advance to first gap phase (G1)
 Stimulation is needed to enter G1 phase
 Phase G1: presynthetic phase in which the cell
manufactures needed enzymes to prepare for DNA
synthesis
 Phase G2: postsynthetic phase in which the cell prepares for
mitosis by producing RNA, specialized proteins, and
foundations for the mitotic spindle apparatus needed for
mitosis
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Phases of Cell Growth (cont.)
 Phase G2 (cont.)
• Mitosis divides the cell into two G1 daughter cells
• G1 cells may advance again to S phase or pass into a
nonproliferative stage known as G0
 S phase: stage of active synthesis of two sets of
DNA
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Generation time: time required to complete a
cycle
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Cell Cycle and Effects of Drugs
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Cell cycle–specific
 Drug is selectively toxic when the cell is in a
specific phase of growth—schedule dependent
 Effective against malignancies that proliferate
rapidly
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Cell cycle–nonspecific
 Active throughout the cell cycle
 More effective against slowly proliferating
neoplastic tissue
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Audience Response Question 2
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By which method does cell cycle–specific
treatment therapy work?
A.
B.
C.
D.
Treating cancer cells at their vulnerable cell
reproductive stage
Affecting a cancer cell throughout its entire life
cycle
Inhibiting slowly growing cancer cells
Targeting key pathways that provide growth to
cancer cells
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Drug Therapy for Cancer
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Goals for chemotherapy
 Give a dose large enough to be lethal to cancer
cells but small enough to be tolerable for normal
cells
 Control of the disease (arresting of tumor)
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Goal for palliation: alleviation of symptoms if
cancer is beyond control
Goal for prophylaxis: prophylactic measures if
patient is a known risk for developing cancer
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Nursing Assessments
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History of risk factors
Dietary habits
Preexisting health problems
Adaptation to diagnosis
Psychomotor functions
Safety
Symptoms of pharmacologic adverse effects
Physical and sexual assessment
Pain
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Nursing Interventions
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Plan care based on assessment data and
individual needs of patient; monitor VS
Examine lab tests
Monitor for development of emergencies
Monitor hydration status
Report early signs of infection
Nausea and vomiting are common
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Preadminister antiemetic; report poor control,
monitor hydration and electrolyte status
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Nursing Interventions (cont.)
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Monitor for changes in bowel movements
Meticulous oral hygiene for stomatitis
Report bleeding
Give pain medications at intervals to maintain
maximum pain control
Nutritional needs
Encourage patient/family to discuss concerns
with support group; allow choices
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Nursing Interventions (cont.)
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Sexual needs: discuss birth control during
chemotherapy and/or sperm storage
Vascular access devices
Skin care to prevent skin breakdown
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Patient Education
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Neutropenia: discuss handwashing; avoiding
infected individuals; no fresh flowers,
vegetables, pets, items with free-standing
water, those receiving immunizations
Pain: report pain that is new or not controlled,
take medications at prescribed intervals to
obtain maximum relief
Anemia: space activities and rest
Thrombocytopenia: monitor for bleeding
episodes; avoid sharps, ASA, anticoagulants
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Audience Response Question 3
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A patient has developed thrombocytopenia
following a round of chemotherapy. The
nurse should instruct the patient to:
use an electric razor to shave.
B. wash his hands frequently.
C. plan his activities to allow rest time.
D. report temperature elevations.
A.
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Lesson 44.2
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Objectives
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Identify which types of chemotherapeutic
agents are cell cycle–specific and which are
cell cycle–nonspecific.
Describe the role of targeted anticancer
agents in treating cancer.
Describe the role of chemoprotective agents
in treating cancer.
Describe the role of bone marrow stimulants
in treating cancer.
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Drug Class: Alkylating Agents
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Actions
 Highly reactive chemical compounds that bond with DNA
molecules, causing cross-linking of DNA strands; binding
prevents separation of the double-coiled DNA molecules
necessary for cellular division
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Uses
 Treat chronic lymphocytic leukemia, ovarian cancer, brain
tumors, Hodgkin’s disease, non-Hodgkin’s lymphoma,
multiple myeloma
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Serious adverse effects
 Bone marrow depression, nephrotoxicity
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Audience Response Question 4
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A patient has been taking an alkylating agent
for chemotherapy to treat ovarian cancer. The
care plan mentions observing for
nephrotoxicity during treatment. The nurse
should monitor for development of:
jaundiced skin and sclera.
B. decreased urine output.
C. increased liver enzymes.
D. frequent bleeding episodes.
A.
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Drug Class: Antimetabolites
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Actions
 Inhibit key enzymes in the biosynthetic pathways
of DNA and RNA synthesis
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Uses
 Treat breast cancer; colon cancer; hairy cell
leukemia, lymphomas, acute lymphocytic
leukemia, myelodysplastic syndromes
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Serious adverse effects
 Bone marrow depression, petechiae,
hepatotoxicity, dermatitis, stomatitis
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Drug Class: Natural Products
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Actions
 Cell cycle–specific agents block formation of the
mitotic spindle during mitosis, inhibiting cell
division
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Uses
 Treat Hodgkin's disease; non-Hodgkin’s
lymphoma; acute lymphocytic leukemia; Kaposi’s
sarcoma; ovarian, breast, testicular cancers
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Serious adverse effects
 Bone marrow depression, peripheral neuropathy,
hepatotoxicity
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Drug Class:
Antineoplastic Antibiotics
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Actions
 Bind to DNA, inhibiting DNA or RNA synthesis
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Uses
 Hodgkin’s disease, non-Hodgkin’s lymphoma;
squamous cell, head and neck, testicular cancers;
Wilms’ tumor; rhabdomyosarcoma; Ewing’s and
osteogenic sarcoma; acute lymphocytic leukemia;
acute myeloid leukemia
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Serious adverse effects
 Bone marrow depression, hepatotoxicity,
stomatitis, cardiotoxicity
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Drug Class: Hormones
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Actions
 Reduce edema secondary to radiation therapy
and act as palliative therapy; temporarily suppress
fever, diaphoresis, and pain
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Uses
 Estrogens and androgens used in malignancies of
sexual organs
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Serious adverse effects
 Gynecomastia, hot flashes, diarrhea, pelvic pain,
edema, hepatitis, thrombosis, hyperglycemia
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Drug Therapy for Cancer
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Targeted anticancer agents
 Act on receptors to target key pathways that
provide growth and survival advantages for cancer
cells
 Not associated with toxicities common with
cytotoxic chemotherapy
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Chemoprotective agents
 Reduce toxicity of chemotherapeutic agents to
normal cells
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Drug Therapy for Cancer (cont.)
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Bone marrow stimulants: trigger recovery of
bone marrow cells
 Davepoetin and epoetin stimulate bone marrow to
produce RBCs to treat anemia
 Filgrastim, pegfilgrastim stimulate production of
neutrophilic white blood cells
 Oprelvekin stimulates platelet production
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Audience Response Question 5
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Which bone marrow stimulant increases the
production of white blood cells?
A.
B.
C.
D.
Filgrastim (Neupogen)
Epoetin alpha (Epogen)
Darbepoetin (Aranesp)
Oprelvekin (Neumega)
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