Drugs Used for Cancer Treatment Chapter 44 Drugs Used for Cancer Treatment Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 44 Lesson 44.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives Discuss the incidence of cancer Explain the normal cycle for cell replication and describe the effects of cell cycle-specific and cell cycle-nonspecific drugs within this process Cite the rationale for giving chemotherapeutic drugs on a precise time schedule Cite the goals of chemotherapy Describe the nursing assessments and interventions needed for people experiencing adverse effects from chemotherapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Cancer and the Use of Antineoplastic Agents Cancer: disorder of cellular growth Occurs when a group of abnormal cells proliferates more rapidly than normal cells, losing the ability to perform specialized functions They invade surrounding tissues, and develop growths in other tissues distant to the original growth (metastasis) Treatment requires combination of surgery, radiation, chemotherapy, and immunotherapy Recent developments enhance role of antineoplastic agents in therapy Many types of cancer cells lose the ability to die properly as part of their normal life cycle. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Phases of Cell Growth Mitosis: phase of cellular proliferation in which cells divide into two equal daughters Cells either advance into nonproliferative stage (G0), or advance to first gap phase (G1) Stimulation is needed to enter G1 phase Phase G1: presynthetic phase in which the cell manufactures needed enzymes to prepare for DNA synthesis Phase G2: postsynthetic phase in which the cell prepares for mitosis by producing RNA, specialized proteins, and foundations for the mitotic spindle apparatus needed for mitosis G0 is the largest variable in the cell cycle. During this resting phase, the cell is not actively replicating. Draw a diagram depicting the life cycle of a cell. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Phases of Cell Growth (cont’d) Phase G2 (cont’d) Mitosis divides the cell into two G1 daughter cells G1 cells may advance again to S phase or pass into a nonproliferative stage known as G0 S phase: stage of active synthesis of two sets of DNA Generation time: time required to complete a cycle Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Cell Cycle and Effects of Drugs Cell cycle-specific Drug is selectively toxic when the cell is in a specific phase of growth—schedule dependent Effective against malignancies that proliferate rapidly Cell cycle-nonspecific Active throughout the cell cycle More effective against slowly proliferating neoplastic tissue It is important to correlate the dosage schedule with the known cellular kinetics of that type of neoplasm. Drugs usually administered when the cell is most susceptible to the cytotoxic effects of the agent for a greater “kill rate.” Provide examples of specific drugs that are cell cycle-specific and cell cycle-nonspecific. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Therapy for Cancer Goals for chemotherapy Give a dose large enough to be lethal to cancer cells but small enough to be tolerable for normal cells Control of the disease (arresting of tumor) Goal for palliation: alleviation of symptoms if cancer is beyond control Goal for prophylaxis: prophylactic measures if patient is a known risk for developing cancer Combination therapy is superior in therapeutic effect than using a single agent alone. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Assessments History of risk factors Dietary habits Pre-existing health problems Adaptation to diagnosis Psychomotor functions Safety Symptoms of pharmacologic adverse effects Physical and sexual assessment Pain Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Interventions Contact between health care provider and family Help patient adapt emotionally as well as physically Often first to identify complications Patient education important part of treatment Encourage support groups and practice of stress reduction Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 44 Lesson 44.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives State which types of chemotherapeutic agents are cell cycle-specific and those that are cell cycle-nonspecific Describe the role of targeted anticancer agents in treating cancer Describe the role of chemoprotective agents in treating cancer Describe the role of bone marrow stimulants in treating cancer Develop patient education objectives for a patient receiving chemotherapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Alkylating Agents Actions Highly reactive chemical compounds that bond with DNA molecules, causing cross-linking of DNA strands; binding prevents separation of the double-coiled DNA molecules necessary for cellular division Uses Treat chronic lymphocytic leukemia, ovarian cancer, brain tumors, Hodgkin’s disease, non-Hodgkin’s lymphoma, multiple myeloma Serious adverse effects Bone marrow depression, nephrotoxicity For specific drugs, see Table 44-1. These agents are cell cycle-nonspecific, capable of combining with cellular components at any phase of the cell cycle. Common adverse effects: GI symptoms, anorexia, nausea, vomiting. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Antimetabolites Actions Inhibit key enzymes in the biosynthetic pathways of DNA and RNA synthesis Uses Treat breast cancer; colon cancer; hairy cell leukemia, lymphomas, acute lymphocytic leukemia, myelodysplastic syndromes Serious adverse effects Bone marrow depression, petechiae, hepatotoxicity, dermatitis, stomatitis For specific drugs, see Table 44-1. Antimetabolites are cell-specific, killing cells during the S phase of cell maturation. Common adverse effects: GI symptoms, anorexia, nausea, vomiting. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Natural Products Actions Cell cycle-specific agents block formation of the mitotic spindle during mitosis, inhibiting cell division Uses Treat Hodgkin's disease, non-Hodgkin’s lymphoma, acute lymphocytic leukemia, Kaposi’s sarcoma, ovarian, breast, testicular cancers Serious adverse effects Bone marrow depression, peripheral neuropathy, hepatotoxicity For specific drugs, see Table 44-1 The vinca alkaloids vincristine and vinblastine are natural derivatives of the periwinkle plant. Common adverse effects: nausea, vomiting, diarrhea. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Antineoplastic Antibiotics Actions Bind to DNA, inhibiting DNA or RNA synthesis Uses Hodgkin’s disease, non-Hodgkin’s lymphoma; squamous cell, head and neck, testicular cancers; Wilm’s tumor, rhabdomyosarcoma, Ewing’s and osteogenic sarcoma, acute lymphocytic leukemia, acute myeloid leukemia Serious adverse effects Bone marrow depression, hepatotoxicity, stomatitis, cardiotoxicity For specific drugs, see Table 44-1. Common adverse effects: nausea, vomiting, red urine, diarrhea, chills. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Hormones Actions Uses Serious adverse effects Reduce edema secondary to radiation therapy and act as palliative therapy; temporarily suppress fever, diaphoresis, and pain Uses Estrogens and androgens used in malignancies of sexual organs Serious adverse effects Gynecomastia, hot flashes, diarrhea, pelvic pain, edema, hepatitis, thrombosis, hyperglycemia For specific drugs, see Table 44-1. Edema is associated with radiation therapy because it is the inflammatory response to cellular death. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Therapy for Cancer Three new types of medications to fight cancer from different directions Targeted anticancer agents Noncytotoxic drugs that target key pathways providing growth and survival for cancer cells Chemoprotective agents Help reduce the toxicity of chemotherapeutic agents to normal cells Bone marrow stimulants Trigger the recovery of bone marrow cells For specific drugs, see Tables 44-2, 44-3, and 44-4. Targeted anticancer agents evolved from research indicating cell membrane receptors control cell proliferation, cell migration, angiogenesis, and cell death, which is integral to the growth and spread of cancer. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Therapy for Cancer (cont’d) Targeted anticancer agents Target key pathways that provide growth and survival advantages for cancer cells Bone marrow stimulants Change way the body responds to cancer or strengthens the body’s defense mechanisms against cancer Chemoprotective agents Help reduce the toxicity of chemotherapeutic agents to normal cells For specific drugs, see Tables 44-2, 44-3, and 44-4. Bone marrow stimulants assist with early recovery of the immune response and prevent infections from becoming pathologic. Blood counts must be assessed closely to determine the degree of bone marrow suppression. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Patient Education Medication administration Plan drug administration exactly at the time intervals prescribed Home care while on chemotherapy Review orders for premedication or hydration Schedule oral hygiene measures Chemotherapy administration performed only by qualified RNs or physicians Emphasize the prevention of complications through maintenance of nutrition and hydration and commitment of hygiene practices. Explain how to minimize the chance of infection when neutropenia is present. Encourage seeking pain relief. Home care includes washing soiled linens separately, washing twice, flushing the toilet after use two or three times. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.