Chapter 39

Antineoplastic Agents and Adjunct Drugs Used in Cancer Treatment

Cancer

Broad term A group of diseases characterized by uncontrolled cellular growth

Invasion into surrounding tissue Metastasis

Cancer spreads to other areas in the body

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Etiology of Cancer

May be:EnvironmentLifestyleOccupationGenetic and ethnic factors

Age- and sex-related differences

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Cell Growth Cycle

Normal cells and cancer cells go through five distinct growth phase cycles

-G0 -resting cycle -G1 -first growth -S –DNA synthesis phase -G2 –second growth -M1 -mitosis phase Cancer cells divide rapidly

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Treatment Considerations

Growth Fraction -The fraction of cells that are in active phases Mitotic index -Percentage of cell undergoing

mitosis Antineoplastics most effective when

the growth fraction and mitotic index are high

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Treatment Considerations

Cancer stage when it is discovered

Efficacy of the cancer treatment

Development of drug resistance

General health of the client6

Antineoplastics

Divided into two groups -Cell cycle nonspecific (CCNS) -Cell cycle specific (CCS) CCNS effective against slow-

growing cancer cells CCS effective against fast-

growing cancer cells

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Agents Used in the Treatment of Cancer Alkylating agents Antimetabolites Mitotic inhibitors Antibiotics Hormones

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Agents used in the Treatment of Cancer

Radioactive drugs Biological response modifiers Miscellaneous agents Combination therapy Adjuvant agents

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Agents Used in the Treatment of Cancer Alkylating agents: cell cycle

nonspecific Antimetabolites: cell cycle

specific in the S phase Mitotic inhibitors: cell cycle

specific in the M phase

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Antineoplastic Agents

Affect all cells, both healthy and sick

Dose-limiting effects Hair falls out Cells in the gastrointestinal tract

die Nausea and vomiting occur;

emetic potential Myelosuppression

Nadir: lowest point for the bone marrow cells, WBCs, platelets

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Antineoplastics: Adverse/Side Effects Common

Fever, chills, headache, nausea, and vomiting

Serious Bronchospasm, dyspnea, hypotension, and angioedema

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Combination Therapy

Use of several antineoplastic agents at the same time

Proven effectiveness Rationale of using combination

therapy Have a more beneficial effect than when used alone

Each agent exhibits different actions and toxicities 13

Adjuvant Agents

Antiemetics Ondansetron HCl (Zofran)

Appetite Stimulants Megace ES (megestrol acetate) Marinol (THC)

Blood cell-forming agents Epoetin alfa (Procrit) Neulasta

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Nursing Implications

During administration of the antineoplastic:

-Provide significant hydration to prevent nephrotoxicity

-Provide periodic monitoring of heart and lung function

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Nursing Considerations

Obtain thorough health history and physical assessment

Assess support systems Provide for expression of feelings Provide education regarding illness

and treatment regimen Pain control Assessment of the patient’s

emotional status

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Nursing considerations

Monitoring of labs, fluid and electrolyte balance

Nutritional evaluation Address infection status and

education Provide for safety needs Be alert for adverse effects of the

drugs Ongoing assessment is crucial

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Adverse Effects: Chemotherapy Risk for infection

Risk for bleeding Risk for ineffective tissue perfusion Nausea and vomiting Risk for vesicant extravasation Body image disturbances Uric acid neuropathy Hemorrhagic cystitis Pain

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Handling of Cytotoxic Drugs

Be familiar with institution policies and procedures

Use proper protective equipment

Do not handle if pregnant

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Handling of Cytotoxic Drugs Take all special precautions Contaminated material must

be disposed of properly Spill kit Follow proper procedures for

exposure

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Investigational Drugs

Written prescription

Signed consent Drug information

available Follow research

protocol Keep thorough

records

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Patient Teaching Provide education regarding cancer

and treatment Emphasize importance of following

chemotherapy regimen Teaching regarding central venous

catheters Education regarding signs and

symptoms to report to provider Address appropriateness of home

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Legal and Ethical Principles

To avoid errors Standardized, preprinted

order forms

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