Transcript Chemotherapy Training - Essex Cancer Network

Chemotherapy Training
Level 1
Essex Cancer Network
October 2012
INTRODUCTION
Why?
Level One training is required for all staff who may come
across chemotherapy in their normal job, such as
dispensary technicians, assistants and aseptics staff.
Level Two training is for all staff involved in prescription
verification of SACT prescriptions.
Level Three training is for specialist oncology staff, who
work within the area of cancer for more than 50% of their
time, or are designated as a cancer specialist at their trust.
Principles for Level One
Training
Knowledge
• Basic background knowledge of cancer
Training
• One hour lunchtime session held each year.
Key elements of syllabus
• Health and safely/ safe handling
• Relevant protocols/SOPs to trust
• Labelling
• Counselling
• Where to go for further advice
• Background and principles of chemotherapy
Revalidation
• To be revalidated the individual must attend a yearly update in oncology
training session.
CANCER
Background knowledge of
cancer
• Cancer
– Abnormal growth of cells which tend to proliferate in an
uncontrolled way and may spread
– Derived from Greek word karkinos meaning crab
• Tumour
– Latin word meaning “abnormal swelling”
• Neoplasm
– “new growth” (benign or malignant)
• Benign
– Not cancer
– Does not invade surrounding tissue or spread to other parts
of the body.
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Background knowledge of
cancer
• Malignant
– Tending to be severe and become progressively worse
– Can invade and destroy nearby tissue and that may spread to
other parts of the body.
– Latin combination of "mal" meaning "bad" and "nascor"
meaning "to be born“ – literally means "born to be bad"
• Oncology
– Branch of medicine that deals with cancer, including study of
their development, diagnosis, treatment, and prevention
• Haematology
– Branch of medicine that specialises in study & treatment of
blood
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Cancer Treatment
Choices
Radiotherapy
Surgery
Systemic
therapy
• Can be used alone or in
combination – to enhance
local control & attack
potential sites of
metastases
• Systemic therapy
–
–
–
–
Chemotherapy
Hormone therapy
Biological therapy
Experimental chemotherapy
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CHEMOTHERAPY
Principles of
chemotherapy
“Normal cells obey strict rules.
Divide only when told.
Die rather than misbehave.”
• Normal cells have several systems for
interrupting the cell cycle if there is a problem
• These control systems are called
“checkpoints”
• Checkpoints are biological traffic lights telling
the cell when it can safely carry on to replicate
or when to stop and fix a problem
Principles of
chemotherapy
• In cancer cells, some or all of the usual
checkpoints fail leading to an over proliferation of
abnormal cells
• The faulty checkpoints make the cell unable to
check if the DNA replication was complete, if any
mutations needed to be repaired, if the DNA was
properly separated between the daughter cells,
or many other problems
• These cells are likely to become cancerous with
their multiple genomic problems
Whereas normal cells have functioning
checkpoints, abnormal cells checkpoints have been
lost or disabled
Aim of Systemic
Chemotherapy
• Cure
– Cancer / Tumour disappears and does not return
• Control
– If cure is not possible, the goal is to control the disease (stop
growth & spreading)
• Palliation
– For advanced cancer, where control is unlikely. Drugs used to
relieve symptoms  Improve QoL
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Why in ‘regimens’
• Combination chemotherapy is used to try and
improve rate and duration of response by
combining drugs with different mechanisms of
action:
–
–
–
–
–
helps to prevent resistance
known to be effective as single agents
different toxicity (toxicities don’t overlap)
try to use drugs with synergistic killing effect
no clinically important drug interactions between the
agents
Why in courses?
• Use pulsed intermittent therapy to allow
normal cells to recover
• Normal (bone marrow cells) cells recover
quicker from chemotherapy then cancer cells
• Normal tissues are inevitably damaged by
chemotherapy – bone marrow & epithelial
lining cells usually recover within 2-3 weeks
• On this basis, most chemotherapy given at 3 –
4 weekly intervals
Pulsed therapy
Bone Marrow
Cells
Tumour Cells
Course of treatment
Limit of
detection
Relapse
0
3
6
Time (Weeks)
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Common Side Effects
Mucositis
Nausea/vomiting
Diarrhea
Cystitis
Sterility
Neuropathy
Alopecia
Pulmonary fibrosis
Cardiotoxicity
Local reaction
Renal failure
Myelosuppression
ORAL CHEMOTHERAPY
NPSA RRR
Risks of incorrect dosing of oral
anti-cancer medicines – 22 January 2008
• Doctors, nurses, pharmacists and their staff
must be made aware that the
– Prescribing
– Dispensing, and
– Administration
of oral anti-cancer medicines should be
carried out and monitored to the same
standard as injected therapy.
NPSA RRR
Risks of incorrect dosing of oral
anti-cancer medicines – 22 January 2008
Oral anti-cancer medicine - incidents by type of
medication error
Wrong dose, strength,
frequency, quantity
23%
Wrong drug / medicine
51%
Omitted medicine
17%
9%
Other
Principles for Safe
Dispensing
• Prescriptions must be screened by an authorised
pharmacist
• All pharmacy staff involved with dispensing oral
anticancer agents must have access to full copies of
all relevant protocols (trial and non-trial)
• Dispensary staff must have ready access to specialist
oncology pharmacy advice
• Dispensary staff should work to detailed operational
procedures
• Label directions must be clear and unambiguous –
where relevant include treatment period, start and
stop dates and an indication of the need for safe
handling
Principles for Safe
Dispensing
• Patient information leaflets may be
supplemented with additional local
information
• For patients with swallowing difficulties, there
is a need to seek specialist advice (medicines
information or oncology pharmacist)
• General risk management issues such as
handling of wastage from patients,
inappropriate storage and risk to others,
especially young children should be given
HEALTH AND SAFETY
Health and safely
Chemotherapy is:
– Mutagenic
• induces mutations
– Teratogenic
• disturbs the growth of embryo/foetus
– Carcinogenic
• causes cancer, changes normal cells into cancerous cells
Routes of Absorption
• Inhalation
aerosols or evaporation
• Absorption
skin or mucous membranes
• Ingestion
hand to mouth contact
Methods of Exposure
• Direct contact with cytotoxics
Spillage
Splash
Needle-stick
Aerosol
Picking them up
Therefore made up in aseptics in ‘isolators’
Oral Chemotherapy
• Should not be touched by hand
• Use cytotoxic triangle to count - Do not use
medicines counter
• The tablet/capsule should be placed into a
medicine cup or spoon and taken by the patient
directly from the container without handling
• For patients with swallowing difficulties, there is
a need to seek specialist advice on crushing
tablets or opening capsules (medicines
information or oncology pharmacist)
NEED TO KNOWs
Relevant protocols/SOPs
to trust
• Please list for your trust
Labelling
• Label directions must be clear and
unambiguous – where relevant include
treatment period, start and stop dates and an
indication of the need for safe handling
• All labels for chemotherapy agents (not
TKIs/MABs) must have stated
– ‘Cytotoxic – handle with care’
Counselling
• Unless you have had specific training on
chemotherapy agents to level 2 or 3, you
should not counsel patients about taking their
chemotherapy agents.
• If you need further advise please contact your
specialist cancer pharmacist