Transcript CARE OF THE PATIENT UNDERGOING CHEMOTHERAPY AND…

CARE OF THE PATIENT
UNDERGOING
CHEMOTHERAPY AND/OR
RADIOTHERAPY
SHARON HARVEY
23/02/04
LEARNING OUTCOMES
THE STUDENT SHOULD BE ABLE TO:
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EXPLAIN WHAT CANCER IS AND ITS EFFECTS ON THE
INDIVIDUAL
IDENTIFY THE DIFFERENT TYPES OF TUMOURS
DEFINE CHEMOTHERAPY
DISCUSS THE SIDE EFFECTS OF CHEMOTHERAPY
DISCUSS IMMUNOTHERAPY AND HORMONE THERAPY
DEFINE RADIOTHERAPY
DISCUSS THE SIDE EFFECTS OF RADIOTHERAPY
DISCUSS THE RIGHTS OF THE PATIENT TO REFUSE
TREATMENT
GIVE EXAMPLES OF SUPPORTIVE THERAPY
EXPLAIN THE ROLE OF THE MACMILLAN NURSES
SOME FACTS ABOUT CANCER
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THREE IN TEN PEOPLE WILL BE DIAGNOSED
WITH CANCER DURING THEIR LIFETIME
THERE ARE CURRENTLY MORE THAN 1.2
MILLION PEOPLE LIVING WITH CANCER IN THE
UK
THE RISK OF CANCER INCREASES WITH AGE
AROUND 65% OF ALL NEW CANCERS ARE
DIAGNOSED IN PEOPLE OVER THE AGE OF 65
WHAT IS CANCER?
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CANCER IS THE NAME GIVEN TO A
GROUP OF DISEASES THAT OCCUR IN
ANY ORGAN OF THE BODY
IT IS THE ABNORMAL OR
UNCONTROLLED GROWTH OF CELLS
EACH CELL IN THE BODY HAS GENES
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NORMAL CELLS
- replicate themselves
exactly
- stop reproducing
after they have
reproduced 50-60
times
- stick together in the
right place
- self destruct if they
are damaged
- become specialised
or “mature”
HOW DOES CANCER DEVELOP?
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THEY DEVELOP WHEN A
SINGLE CELL’S GENES
DEVELOP A FAULT AND
ARE UNABLE TO
REGULATE CELL
DIVISION
THE CELL BEGINS TO
DIVIDE
UNCONTROLLABLY
DEVELOPING INTO A
LUMP KNOWN AS A
TUMOUR
CANCER CELLS:
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CARRY ON REPRODUCING
IGNORE SIGNALS FROM OTHER CELLS
AROUND THEM
DO NOT STICK TOGETHER, SO THEY CAN
MOVE AROUND THE BODY
REMAIN IMMATURE
DO NOT DIE IF THEY MOVE TO ANOTHER
PART OF THE BODY
BENIGN TUMOURS
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DO NOT INVADE THE SURROUNDING
TISSUES OR SPREAD TO OTHER PARTS
OF THE BODY
USUALLY GROW SLOWLY
USUALLY HAVE A COVERING MADE UP OF
NORMAL CELLS
THEY ARE NOT CANCEROUS
BENIGN TUMOURS CAN CAUSE
PROBLEMS IF THEY:
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GROW VERY LARGE
BECOME UNCOMFORTABLE OR
UNSIGHTLY
PRESS ON BODY ORGANS
TAKE UP SPACE IN THE SKULL
RELEASE HORMONES THAT AFFECT HOW
THE BODY WORKS
MALIGNANT TUMOURS
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ARE CANCEROUS
HAVE THE ABILITY TO
SPREAD BEYOND THEIR
ORIGINAL SITE
MALIGNANT CELLS CAN
BREAKAWAY FROM
PRIMARY SOURCE AND
SPREAD TO OTHER
ORGANS VIA THE BLOOD
STREAM OR LYMPHATIC
SYSTEM
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PRIMARY CANCER IS
THE TERM USED TO
IDENTIFY WHERE
THE CANCER
ORIGINATED
SECONDARY CANCER
IS THE TERM USED
TO IDENTIFY A
SECOND SIGHT OF
THE CANCER
THE MEANING OF
CHEMOTHERAPY
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THE WORD CHEMOTHERAPY COMES
FROM TWO WORDS, CHEMICAL AND
THERAPY
IT LITERALLY MEANS DRUG TREATMENT
IN PRACTICE IT USUALLY REFERS TO
CYTOTOXIC DRUGS, CELL KILLING
DRUGS
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HOWEVER IT IS SLIGHTLY MORE COMPLEX,
NOT ALL CANCER KILLING DRUGS ARE
CLASSED AS CHEMOTHERAPY
SUCH AS INTERFERON AND MONOCLONAL
ANTIBODIES WHICH ARE CLASSED AS
IMMUNOTHERAPY
THERE ARE 60 TYPES OF CHEMOTHERAPY
CURRENTLY AVAILABLE AND NEW ONES BEING
DEVELOPED ALL THE TIME
HOW DO THE DRUGS WORK?
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THE DRUGS ENTER THE BLOODSTREAM
AND REACH ALL PARTS OF THE BODY
CYTOTOXIC DRUGS DESTROY CANCER
CELLS BY DAMAGING THEM SO THAT
THEY CAN’T DIVIDE AND GROW
THE DRUGS CAN ALSO AFFECT NORMAL
CELLS
THE SUITABILITY OF
CHEMOTHERAPY
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THIS DEPENDS ON:THE TYPE OF CANCER
WHERE IN THE BODY IT STARTED
WHAT THE CANCER LOOK LIKE UNDER
THE MICROSCOPE (GRADE)
WHETHER THE CANCER HAS SPREAD
THE PATIENT MAY HAVE
CHEMOTHERAPY:
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ON ITS OWN
WITH RADIOTHERAPY
WITH SURGERY
WITH HORMONE THERAPY
WITH IMMUNOTHERAPY
WITH COMBINATION OF ALL OR SOME
OF THESE TREATMENTS
THE PATIENT MAY HAVE
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HIGH DOSE TREATMENT WITH AN
INFUSION OF BONE MARROW CELLS
AFTERWARDS
THIS IS KNOWN AS A BONE MARROW
TRANSPLANT OR STEM CELL
TRANSPLANT
SIDE EFFECTS OF CHEMOTHERAPY
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MOUTH PAIN OR ULCERS
NAUSEA AND VOMITING
SOME CAUSE HAIR LOSS
SKIN THAT IS DRY, DISCOLOURED OR
SENSITIVE TO SUNLIGHT
NAILS MAY GROW SLOWLY AND DEVELOP
WHITE OR DARK LINES
ANAEMIA
LOW WHITE BLOOD CELL COUNT
WAYS OF GIVING CHEMOTHERAPY
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In order to damage and kill the cancer cells, the
drugs must be absorbed into your blood and
carried throughout your body.
The way chemotherapy is given depends on
The type of cancer
The drugs (for example, some must be injected
and some can be taken by mouth)
WAYS OF GIVING CHEMOTHERAPY
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THE THREE MOST COMMON WAYS OF GIVING
CHEMOTHERAPY ARE:INTRAVENOUS INJECTION
ORALLY
INTRAVENOUS INFUSION
LESS OFTEN DRUGS CAN BE INJECTED:INTRAMUSCULARLY / SUBCUTANEOUSLY
INTRATHECALLY
INTRA-ARTERIAL
INTRACAVITARY (INTRAVESICAL,INTRAPERITONEAL,
INTRAPLEURAL)
INTRATUMOURAL OR INTRALESIONAL
IMMUNOTHERAPY
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Immunotherapy is the name given to cancer treatments
that use the immune system to attack cancers.
Sometimes immunotherapy drugs are called 'Biological
Response Modifiers' (BRM's) because they stimulate the
body to respond biologically (or naturally) to cancer.
Immunotherapy can be
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Local or systemic (treating the whole body)
Non-specific or targeted
LOCAL IMMUNOTHERAPY
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LOCAL MEANS TREATING ONLY ONE PART
OF THE BODY
THE BEST EXAMPLE IS BLADDER CANCER.
THE VACCINE BCG CAUSES
INFLAMMATION IN THE BLADDER THAT
FIGHTS THE CANCER CELLS
SYSTEMIC IMMUNOTHERAPY
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GIVEN TO TREAT THE WHOLE BODY
INTERFERON IS A SYSTEMIC
IMMUNOTHERAPY DRUG
CAN TREAT KIDNEY CANCER AND
MALIGNANT MELANOMA
NON SPECIFIC IMMUNOTHERAPY
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LOCAL AND SYSTEMIC IMMUNOTHERAPY
ARE CLASSED AS NON SPECIFIC
IMMUNOTHERAPY
THEY ARE GIVEN TO BOOST THE
IMMUNE SYSTEM TO FIGHT THE CANCER
CELLS
TARGETED IMMUNOTHERAPY
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THIS TARGETS CANCER CELLS AND
HOPEFULLY LEAVES NORMAL CELLS
UNTOUCHED
INCLUDES MONOCLONAL ANTIBODIES
AND CANCER VACCINES
HORMONE THERAPY
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ALTHOUGH HORMONES DO NOT USUALLY
AFFECT CANCE CELLS, OESTROGEN AND
PROGESTERONE AFFECT THE GROWTH OF
SOME BREAST CANCERS, WHILE
TESTOSTERONE AFFECTS THE GROWTH OF
SOME PROSTATE CANCERS. THIS MEANS
DRUGS THAT BLOCK THE EFFECTS OR LOWER
THE LEVELS OF THESE HORMONES CAN BE
USED TO TREAT SOME TYPES OF BREAST AND
PROSTATE CANCER
HORMONE THERAPY DRUGS FOR
BREAST CANCER
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TAMOXIFEN IS A COMMON AND SUCCESSFUL
ADJUVANT TREATMENT USUALLY GIVEN FOR
FIVE YEARS AFTER SURGERY
AROMATASE INHIBITORS BLOCK THE
PRODUCTION OF OESTROGEN BY THE
ADRENAL GLANDS IN POST MENOPAUSAL
WOMEN
PITUITARY DOWNREGULATORS ARE USED TO
TREAT PREMENOPAUSAL WOMEN. THEY
PREVENT THE OVARIES FROM WORKING UNTIL
THERAPY IS DISCONTINUED.
HORMONE THERAPY DRUGS FOR
PROSTATE CANCERS
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PITUITARY DOWNREGULATORS MAY INITIALLY
EXACERBATE SYMPTOMS, KNOWN AS TUMOUR
FLARE, THIS CAN BE PREVENTED BY GIVING
AN ANTI-ANDROGEN
ANTI-ANDROGENS BLOCK THE EFFECTS OF
TESTOSTERONE
BOTH TYPES OF DRUGS TOGETHER ARE
CALLED MAXIMAL ANDROGEN BLOCKADE (MAB)
RADIOTHERAPY
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THIS USES IONISING RADIATION TO KILL
CANCER CELLS
IT IS USED TO TREAT BREAST, LUNG,
HEAD, NECK, PROSTATE, COLORECTAL,
BRAIN AND GYNAECOLOGICAL CANCERS
AT LEAST 50% OF PEOPLE WITH CANCER
RECEIVE RADIOTHERAPY
DIFFERENT TYPES OF
RADIOTHERAPY
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TELETHERAPY OR EXTERNAL BEAM
RADIOTHERAPY USES X-RAY BEAMS OF
VARIOUS ENERGIES
BRACHYTHERAPY USES SEALED SOURCES
OF RADIATION TO DELIVER A HIGH DOSE
TO A TUMOUR AND CAN INVOLVE
INTERSTITIAL THERAPY OR IMPLANTS
OR INTRACAVITY TREATMENT
SIDE EFFECTS OF RADIOTHERAPY
DEPENDS ON:
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THE AREA OF THE BODY BEING TREATED AND
TISSUES/ORGANS IN THAT AREA
THE SIZE OF THE TREATMENT AREA
THE DOSE OR AMOUNT OF RADIOTHERAPY
GIVEN
THE FRACTIONATION OF THE TREATMENT
THE GENERAL HEALTH OF THE PATIENT
PREVIOUS OR CONCURRENT CHEMOTHERAPY
OR SURGERY
SIDE EFFECTS OF RADIOTHERAPY
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SKIN REACTION
HAIR LOSS
DIARRHOEA
MUCOSITIS
STERILITY
FREQUENCY OF PASSING URINE
FATIGUE
ANOREXIA
PSYCHOLOGICAL EFFECTS
NAUSEA AND VOMITING
SUPPORTIVE CARE OF PATIENT
WITH CANCER
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SYMPTOM CONTROL
CARING FOR THEM IN THEIR OWN HOME
IF THEY SO WISH
SUPPORTING THEM IF THEY DECIDE TO
REFUSE TREATMENT FOR THEIR CANCER
EMOTIONAL SUPPORT
PSYCHOSOCIAL SUPPORT
MACMILLAN NURSES
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There are currently 2000 Macmillan nurses
in the U.K
They are registered nurses with at least 5
years post registration experience, 2 years
have to be within cancer care or palliative
care
They have specialist knowledge, for
example in breast or lung cancer, or in
chemotherapy.
Macmillan paediatric nurses help children
with cancer and their families.
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Macmillan community-based nurses play a
vital role in helping people with cancer to
stay at home with their families.
Macmillan hospital-based nurses see
people with cancer from the time they are
diagnosed and right through their
treatment.
Macmillan lead cancer nurses are senior
nurse managers, who help shape the
future of cancer and palliative care
services in their area.