CARE OF THE PATIENT UNDERGOING CHEMOTHERAPY AND/OR RADIOTHERAPY SHARON HARVEY 23/02/04

LEARNING OUTCOMES THE STUDENT SHOULD BE ABLE TO:- EXPLAIN WHAT CANCER IS AND ITS EFFECTS ON THE INDIVIDUAL IDENTIFY THE DIFFERENT TYPES OF TUMOURS DEFINE CHEMOTHERAPY DISCUSS THE SIDE EFFECTS OF CHEMOTHERAPY DISCUSS IMMUNOTHERAPY AND HORMONE THERAPY DEFINE RADIOTHERAPY DISCUSS THE SIDE EFFECTS OF RADIOTHERAPY DISCUSS THE RIGHTS OF THE PATIENT TO REFUSE TREATMENT GIVE EXAMPLES OF SUPPORTIVE THERAPY EXPLAIN THE ROLE OF THE MACMILLAN NURSES

SOME FACTS ABOUT CANCER THREE IN TEN PEOPLE WILL BE DIAGNOSED WITH CANCER DURING THEIR LIFETIME THERE ARE CURRENTLY MORE THAN 1.2 MILLION PEOPLE LIVING WITH CANCER IN THE UK THE RISK OF CANCER INCREASES WITH AGE AROUND 65% OF ALL NEW CANCERS ARE DIAGNOSED IN PEOPLE OVER THE AGE OF 65

WHAT IS CANCER? CANCER IS THE NAME GIVEN TO A GROUP OF DISEASES THAT OCCUR IN ANY ORGAN OF THE BODY IT IS THE ABNORMAL OR UNCONTROLLED GROWTH OF CELLS EACH CELL IN THE BODY HAS GENES THESE GENES CONTAIN CODED INSTRUCTIONS TELLING THE CELL WHAT TYPE IT SHOULD BE, SUCH AS SKIN, BONE OR BLOOD AND WHEN TO DIVIDE AND REPLICATE.

NORMAL CELLS - replicate themselves exactly - stop reproducing after they have reproduced 50-60 times - stick together in the right place - self destruct if they are damaged - become specialised or “mature”

HOW DOES CANCER DEVELOP? THEY DEVELOP WHEN A SINGLE CELL’S GENES DEVELOP A FAULT AND ARE UNABLE TO REGULATE CELL DIVISION THE CELL BEGINS TO DIVIDE UNCONTROLLABLY DEVELOPING INTO A LUMP KNOWN AS A TUMOUR

CANCER CELLS: CARRY ON REPRODUCING IGNORE SIGNALS FROM OTHER CELLS AROUND THEM DO NOT STICK TOGETHER, SO THEY CAN MOVE AROUND THE BODY REMAIN IMMATURE DO NOT DIE IF THEY MOVE TO ANOTHER PART OF THE BODY

BENIGN TUMOURS DO NOT INVADE THE SURROUNDING TISSUES OR SPREAD TO OTHER PARTS OF THE BODY USUALLY GROW SLOWLY USUALLY HAVE A COVERING MADE UP OF NORMAL CELLS THEY ARE NOT CANCEROUS

BENIGN TUMOURS CAN CAUSE PROBLEMS IF THEY:- GROW VERY LARGE BECOME UNCOMFORTABLE OR UNSIGHTLY PRESS ON BODY ORGANS TAKE UP SPACE IN THE SKULL RELEASE HORMONES THAT AFFECT HOW THE BODY WORKS

MALIGNANT TUMOURS ARE CANCEROUS HAVE THE ABILITY TO SPREAD BEYOND THEIR ORIGINAL SITE MALIGNANT CELLS CAN BREAKAWAY FROM PRIMARY SOURCE AND SPREAD TO OTHER ORGANS VIA THE BLOOD STREAM OR LYMPHATIC SYSTEM

PRIMARY CANCER IS THE TERM USED TO IDENTIFY WHERE THE CANCER ORIGINATED SECONDARY CANCER IS THE TERM USED TO IDENTIFY A SECOND SIGHT OF THE CANCER

THE MEANING OF CHEMOTHERAPY THE WORD CHEMOTHERAPY COMES FROM TWO WORDS, CHEMICAL AND THERAPY IT LITERALLY MEANS DRUG TREATMENT IN PRACTICE IT USUALLY REFERS TO CYTOTOXIC DRUGS, CELL KILLING DRUGS

HOWEVER IT IS SLIGHTLY MORE COMPLEX, NOT ALL CANCER KILLING DRUGS ARE CLASSED AS CHEMOTHERAPY SUCH AS INTERFERON AND MONOCLONAL ANTIBODIES WHICH ARE CLASSED AS IMMUNOTHERAPY THERE ARE 60 TYPES OF CHEMOTHERAPY CURRENTLY AVAILABLE AND NEW ONES BEING DEVELOPED ALL THE TIME

HOW DO THE DRUGS WORK? THE DRUGS ENTER THE BLOODSTREAM AND REACH ALL PARTS OF THE BODY CYTOTOXIC DRUGS DESTROY CANCER CELLS BY DAMAGING THEM SO THAT THEY CAN’T DIVIDE AND GROW THE DRUGS CAN ALSO AFFECT NORMAL CELLS

THE SUITABILITY OF CHEMOTHERAPY THIS DEPENDS ON:- THE TYPE OF CANCER WHERE IN THE BODY IT STARTED WHAT THE CANCER LOOK LIKE UNDER THE MICROSCOPE (GRADE) WHETHER THE CANCER HAS SPREAD

THE PATIENT MAY HAVE CHEMOTHERAPY:- ON ITS OWN WITH RADIOTHERAPY WITH SURGERY WITH HORMONE THERAPY WITH IMMUNOTHERAPY WITH COMBINATION OF ALL OR SOME OF THESE TREATMENTS

THE PATIENT MAY HAVE HIGH DOSE TREATMENT WITH AN INFUSION OF BONE MARROW CELLS AFTERWARDS THIS IS KNOWN AS A BONE MARROW TRANSPLANT OR STEM CELL TRANSPLANT

SIDE EFFECTS OF CHEMOTHERAPY MOUTH PAIN OR ULCERS NAUSEA AND VOMITING SOME CAUSE HAIR LOSS SKIN THAT IS DRY, DISCOLOURED OR SENSITIVE TO SUNLIGHT NAILS MAY GROW SLOWLY AND DEVELOP WHITE OR DARK LINES ANAEMIA LOW WHITE BLOOD CELL COUNT

WAYS OF GIVING CHEMOTHERAPY In order to damage and kill the cancer cells, the drugs must be absorbed into your blood and carried throughout your body. The way chemotherapy is given depends on The type of cancer The drugs (for example, some must be injected and some can be taken by mouth)

WAYS OF GIVING CHEMOTHERAPY THE THREE MOST COMMON WAYS OF GIVING CHEMOTHERAPY ARE:- INTRAVENOUS INJECTION ORALLY INTRAVENOUS INFUSION LESS OFTEN DRUGS CAN BE INJECTED:- INTRAMUSCULARLY / SUBCUTANEOUSLY INTRATHECALLY INTRA-ARTERIAL INTRACAVITARY (INTRAVESICAL,INTRAPERITONEAL, INTRAPLEURAL) INTRATUMOURAL OR INTRALESIONAL

IMMUNOTHERAPY Immunotherapy is the name given to cancer treatments that use the immune system to attack cancers. Sometimes immunotherapy drugs are called 'Biological Response Modifiers' (BRM's) because they stimulate the body to respond biologically (or naturally) to cancer. Immunotherapy can be Local or systemic (treating the whole body)  Non-specific or targeted

LOCAL IMMUNOTHERAPY LOCAL MEANS TREATING ONLY ONE PART OF THE BODY THE BEST EXAMPLE IS BLADDER CANCER. THE VACCINE BCG CAUSES INFLAMMATION IN THE BLADDER THAT FIGHTS THE CANCER CELLS

SYSTEMIC IMMUNOTHERAPY GIVEN TO TREAT THE WHOLE BODY INTERFERON IS A SYSTEMIC IMMUNOTHERAPY DRUG CAN TREAT KIDNEY CANCER AND MALIGNANT MELANOMA

NON SPECIFIC IMMUNOTHERAPY LOCAL AND SYSTEMIC IMMUNOTHERAPY ARE CLASSED AS NON SPECIFIC IMMUNOTHERAPY THEY ARE GIVEN TO BOOST THE IMMUNE SYSTEM TO FIGHT THE CANCER CELLS

TARGETED IMMUNOTHERAPY THIS TARGETS CANCER CELLS AND HOPEFULLY LEAVES NORMAL CELLS UNTOUCHED INCLUDES MONOCLONAL ANTIBODIES AND CANCER VACCINES

HORMONE THERAPY ALTHOUGH HORMONES DO NOT USUALLY AFFECT CANCE CELLS, OESTROGEN AND PROGESTERONE AFFECT THE GROWTH OF SOME BREAST CANCERS, WHILE TESTOSTERONE AFFECTS THE GROWTH OF SOME PROSTATE CANCERS. THIS MEANS DRUGS THAT BLOCK THE EFFECTS OR LOWER THE LEVELS OF THESE HORMONES CAN BE USED TO TREAT SOME TYPES OF BREAST AND PROSTATE CANCER

HORMONE THERAPY DRUGS FOR BREAST CANCER TAMOXIFEN IS A COMMON AND SUCCESSFUL ADJUVANT TREATMENT USUALLY GIVEN FOR FIVE YEARS AFTER SURGERY AROMATASE INHIBITORS BLOCK THE PRODUCTION OF OESTROGEN BY THE ADRENAL GLANDS IN POST MENOPAUSAL WOMEN PITUITARY DOWNREGULATORS ARE USED TO TREAT PREMENOPAUSAL WOMEN. THEY PREVENT THE OVARIES FROM WORKING UNTIL THERAPY IS DISCONTINUED.

HORMONE THERAPY DRUGS FOR PROSTATE CANCERS PITUITARY DOWNREGULATORS MAY INITIALLY EXACERBATE SYMPTOMS, KNOWN AS TUMOUR FLARE, THIS CAN BE PREVENTED BY GIVING AN ANTI-ANDROGEN ANTI-ANDROGENS BLOCK THE EFFECTS OF TESTOSTERONE BOTH TYPES OF DRUGS TOGETHER ARE CALLED MAXIMAL ANDROGEN BLOCKADE (MAB)

RADIOTHERAPY THIS USES IONISING RADIATION TO KILL CANCER CELLS IT IS USED TO TREAT BREAST, LUNG, HEAD, NECK, PROSTATE, COLORECTAL, BRAIN AND GYNAECOLOGICAL CANCERS AT LEAST 50% OF PEOPLE WITH CANCER RECEIVE RADIOTHERAPY

DIFFERENT TYPES OF RADIOTHERAPY TELETHERAPY OR EXTERNAL BEAM RADIOTHERAPY USES X-RAY BEAMS OF VARIOUS ENERGIES BRACHYTHERAPY USES SEALED SOURCES OF RADIATION TO DELIVER A HIGH DOSE TO A TUMOUR AND CAN INVOLVE INTERSTITIAL THERAPY OR IMPLANTS OR INTRACAVITY TREATMENT

SIDE EFFECTS OF RADIOTHERAPY DEPENDS ON:- THE AREA OF THE BODY BEING TREATED AND TISSUES/ORGANS IN THAT AREA THE SIZE OF THE TREATMENT AREA THE DOSE OR AMOUNT OF RADIOTHERAPY GIVEN THE FRACTIONATION OF THE TREATMENT THE GENERAL HEALTH OF THE PATIENT PREVIOUS OR CONCURRENT CHEMOTHERAPY OR SURGERY

SIDE EFFECTS OF RADIOTHERAPY SKIN REACTION HAIR LOSS DIARRHOEA MUCOSITIS STERILITY FREQUENCY OF PASSING URINE FATIGUE ANOREXIA PSYCHOLOGICAL EFFECTS NAUSEA AND VOMITING

SUPPORTIVE CARE OF PATIENT WITH CANCER SYMPTOM CONTROL CARING FOR THEM IN THEIR OWN HOME IF THEY SO WISH SUPPORTING THEM IF THEY DECIDE TO REFUSE TREATMENT FOR THEIR CANCER EMOTIONAL SUPPORT PSYCHOSOCIAL SUPPORT PAIN NAUSEA AND VOMITING EATING PROBLEMS FATIGUE TREATABLE COMPLICATIONS

MACMILLAN NURSES There are currently 2000 Macmillan nurses in the U.K They are registered nurses with at least 5 years post registration experience, 2 years have to be within cancer care or palliative care They have specialist knowledge, for example in breast or lung cancer, or in chemotherapy. Macmillan paediatric nurses help children with cancer and their families.

Macmillan community-based nurses play a vital role in helping people with cancer to stay at home with their families. Macmillan hospital-based nurses see people with cancer from the time they are diagnosed and right through their treatment. Macmillan lead cancer nurses are senior nurse managers, who help shape the future of cancer and palliative care services in their area.