Transcript Supportive Therapies

Supportive Therapies
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Cell boosters
Cell protectants
Blood and blood products
CTR Constipation
Integumentary support
Infection control
Colony Stimulating Factors
(CSFs / cell boosters)
• A substance that stimulates the bone
marrow to produce blood cells
– granulocyte colony-stimulating factor (GCSF),
– granulocyte-macrophage colony-stimulating
factor (GM-CSF),
– Promegapoietin - platelets
Usually not given for patients with hematopoetic
malignancies
CSF
Abbreviations
Cells primarily stimulated
Erythropoeitin
Epo
red blood cells
Granulocyte CSF
G-CSF
white blood cells (neutrophils)
Neupogen; Neulasta (Filgastrim)
Granulocyte
Macrophage CSF
GM-CSF
white blood cells (neutrophils,
macrophages, eosinophils); Leukine
(Sagramostin)
interleukin-11
IL-11
Platelets; Neumega (oprelvekin)
Interleukin-3
IL-3
white blood cells
(neutrophils,macrophages, eosinophils),
and platelets
Interleukin-6
IL-6
platelets
Stem cell factor
SCF, c-kit ligand, steel
factor, mast cell growth
factor stem
ligandcells which produce white blood
cells, red blood cells and platelets
GM-CSF and
Interleukin-3
PIXY321
white blood cells (neutrophils,
macrophages, eosinophils), red blood
cells and platelets
http://www.bmtinfonet.org/newsletters/issue14/colony.html
CSFs
• Stimulates bone marrow to
produce blood cells
• Produced by the body
• Also available as SC injection
• Given 1-3 days post chemo
• Refrigerate for storage but give
at room temp.
• Uses:
– pts with neutropenia at risk
for infections
– Bone marrow
transplantation pts
JAMA, 2006
Common Side Effects CSFs
Rash
Bone Pain
Muscle Pain
Weakness
Fever
Headache
Chills
redness and swelling at injection site
Usually managed with premedication and
symtomatically with Tylenol
Adverse Effects
• Signs and symptoms of allergic reactions
– Swelling
– Difficulty of breathing
– Chest tightness
– Rash
Usually managed with Benadryl
Chemoprotectants
• increase tumor kill while inflicting minimal
injury to normal tissue
• reduce the effects of therapy on normal
cells while maintaining tumor sensitivity to
the therapy
– Amifostine (Ethyol)
Amifostine (Ethyol)
• Uses:
– protect the kidneys against the harmful effects
of the cancer-fighting drug cisplatin in patients
with ovarian cancer or lung cancer
– reduce the severe dry mouth caused by
radiation treatment after surgery for head and
neck cancer
Administration
• Given IV
• Have patient lying down, on their
back
• Have crash cart readily available
• Frequently check VS – BP
tendency to bottom out
administer IV fluids
Side-effects
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nausea
vomiting
flushing (feeling of warmth)
chills ( feeling of coldness)
fever
dizziness or lightheadedness
drowsiness
sneezing
hiccups
Allergic reactions
Blood and Blood Products
• Whole blood
– Anemia
– Blood loss
– Surgery
• Packed Red Blood Cells
– Anemia
• Fresh Frozen Plasma
– Thrombocytopenia
– DIC
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Platelets
White Blood Cells
Cryoprecipitate – blood clotting factors
Granulocyte/neutrophil
Reasons
• Disease-related
– Anemia due to chronic bleeding (CRC)
– Hematological malignancies
– Anemia of chronic disease
• Treatment-related
– Blood loss from surgery
– Bone marrow suppression
• Chemotherapy
• RT
• Bone Marrow Transplantation
Side-Effects
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Transfusion reactions
noncardiogenic pulmonary edema
Alloimmunization
Hypervolemia leading to cardiac failure
Infection
– CMV
– hepatitis
– HIV
Infection Control
• Infection is the leading cause of morbidity
and mortality in cancer patients during the
treatment phase.
• Risk Factors:
– Therapy-related immunosuppression
– Decreased nutritional levels
Infection Control
• essential component of any health care
delivery.
• Infection control measures
– Simple hand washing
– Dressing changes
– Good venipuncture procedures
– High-level disinfection of surgical instruments
– Prophylactic use of antibiotics
Environmental control
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Handwashing and hygiene habits
Thoroughly cook foods
No fresh flowers or plants
Protect from insect bites, moldy areas, pets
Clean eating utensils and equipments
Avoiding crowds
Vaccinations ???
Clean environment
– Clothes
– Home – check for presence of molds
Patient education
• Healthy hygiene habits
• Home cooked foods vs. vendor food
• How to take temperature
– What to do if there is fever
• Outside activities
– Avoidance of crowds
– Use of masks
– Gardening
Complementary therapy
integrative medicine; holistic healing
• Additional forms of treatment given along with
traditional cancer therapies
• Recognized and approved by HCP
• NOT designed to cure but rather to alleviate the
treatment side-effects, pain and anxiety
Alternative Therapies
• Includes non-approved, non-tested
treatments that can be harmful
• “miracle cures”
Sensory
• Works with the 5 senses as well as the body’s
energy
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Aromatherapy
Landscape therapy
Music therapy: listening to or playing
Massage
Therapeutic touch
Reiki
Reflexology
Acupuncture
Massage - Precautions
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Signs of infection
Risk of developing blood clots
Skin exposed to radiation
Presence of pancytopenia
Presence of bone metastasis or
osteoporosis
• Provided by a licensed massage
therapist
Cognitive
• Promotes mind-body healing through the
power of positive thinking
– Guided imagery; visualization
– Hypnotherapy
– Prayer
– Meditation
– Relaxation/deep breathing
– Biofeedback
Expressive
• Patients expresses their thoughts
• Alleviate anxiety by allowing patients to
release fear and frustration in a positive,
creative way
– Journaling, blogging
– Writing poems, composing music
– Painting, sculpting
Psychotherapy and Counseling
• Support groups
– Live meetings with a therapist or leader
– Web groups
– “sisterhood” or “brotherhood”
• Volunteering i.e. Reach to Recovery
• Individual counseling
Physical
• Physical exercise
– walking
• Yoga
– stretching
• Tai Chi
– Meditation in motion
• Qi Gong
– Calming, breathing techniques
Advantages
• Weight control
• Relaxation, anxiety reduction
• Strength development
Medical systems
• Other non-traditional medicines
– Naturopathy
– Western herbalism
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Vitamin B12
Vitamin E
Echinacea
Fish Oil
Flaxseed oil
Saw Palmetto
– Chinese herbalism
– Department of Health approved alternative
complementary therapies
doh
Nurses Role
• Investigate appropriateness for the patient
• Explain benefits, disadvantages and
precautions
• DO NOT prescribe and be very careful
when suggesting
Patient teaching
• Consult physician and nurse before using any
complementary therapies
– Vigorous exercise
– Medications or any concoctions
• Tell HCP any complementary tx being used
• Do not stop taking prescribed medications
without consulting HCP
• Inform complementary therapist about the
prescribed medications being taken
• See physician if symptoms persist or worsen
~ What is now proved was only once
imagined
Sian Keogh
Thank you / Salamat po!!!!!