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CHEMOTHERAPY
An Overview
Amy Sinacola. Haematology Macmillan Clinical Nurse Specialist
Aims of session
Understand Cell CycleChemotherapy and the cancer
cellSide effectsNursing implicationsAdministration & 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
A cell in mitosis
Normal Cell Characteristics:
Metabolism. Strictly controlled & predictable
Maturation & Specialisation. Occurrs before dividing. Strictly controlled.
Reproduction = Cell deathContact Inhibition. Mechanism for
switching off division when in contact with different cells
Recognition. Like cells stay together.
Cancer Cell Characteristics:
Unchecked & Uncontrolled GrowthLoss of contact inhibitionLoss of capacity to differentiateIncreased growth fractionChromosomal InstabilityCapacity to metastasiseAltered biochemical properties
Chemotherapy and Cancer Cells
Cell Cycle specific :Most active against cells in a specificphase therefore need prolonged exposureor repeated doses.
Cell Cycle Non-specific:Most effective against actively dividingcells but also effective in G0.
Chemotherapy
Chemotherapy may be used conventionally to:
Cure patientsProlong survivalPalliative care symptom control
Chemotherapy
Combination Therapy. Prevents resistance.Adjuvant Therapy. Administered after primary therapye.g.SurgeryNeo adjuvant Therapy: Given before surgery to reducetumour size.
Chemotherapy
Over 50 different chemotherapy drugs
Administered as an outpatient or inpatientdepending on toxicity
Modes of administration include: 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.
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.
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 andpoor immune response to infection. Predisposing factors include:NeutropeniaUnderlying diseaseChemotherapyVenous 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%
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 & VomitingDiarrhoea & constipationLoss of appetiteTaste ChangesMucositis
Side Effects
Example of Grade 4 Mucositis
Side Effects: Body Image
Hair LossWeight Loss/ Weight GainLong term central venous cathetersSkin changes (colour, rashes, sensitivity
to sunshine/chlorine, dry)
Side Effects: Other
Fatigue: Often multi-factorialPeripheral neuropathyAltered Kidney FunctionChanges in hearing (high dose Cisplatin)Cardiac Toxicity (Doxorubicin/
Idarubicin)Late Effects: Infertility, secondary
malignancy, growth retardation.
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 R-CHOP and requires a long term central venous catheter.
What would you include in your nursingassessment?
How can nurses help.
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
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.
Summary:
The potential benefit to the patient of treatment as an option must
always outweigh the toxic effects.