Drugs Used for Cancer Treatment Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 44-1

 Treatment requires combination of surgery, radiation, chemotherapy, and immunotherapy  Recent developments enhance role of antineoplastic agents in therapy Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Cancer and the Use of Antineoplastic Agents

Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Cancer Cases and Deaths

 Mitosis: phase of cellular proliferation in which cells divide into two equal daughters Cells are either in the non-proliferative stage (G0), or in the first gap phase (G1) Phase G1: pre-synthetic phase in which the cell manufactures needed enzymes to prepare for DNA synthesis Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Phases of Cell Growth

Phase G2: post-synthetic phase in which the cell prepares for mitosis by producing RNA and specialized proteins  Mitosis divides the cell into two G1 daughter cells  G1 cells may advance again to S phase or pass into a non-proliferative stage (G0)  S phase: stage of active synthesis of two sets of DNA Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Phases of Cell Growth (cont.)

Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Phases of Cell Growth (cont.)

 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 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Cell Cycle and Effects of Drugs

 Goals for chemotherapy : administering 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 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Therapy for Cancer

 History of risk factors  Dietary habits  Preexisting health problems  Adaptation to diagnosis  Psychomotor functions  Safety  Symptoms of pharmacologic adverse effects  Physical and sexual assessment  Pain Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Nursing Assessments

Care plan is based on assessment data and individual needs of patient:  Monitor VS  Examine lab tests  Monitor for development of emergencies  Monitor hydration and electrolyte status  Report early signs of infection  Nausea and vomiting are common Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Nursing Interventions

 Pre-administer antiemetic; report poor control,  Monitor for changes in bowel movements  Meticulous oral hygiene for stomatitis  Report bleeding  Give pain medications at intervals to maintain maximum pain control  Nutritional needs Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Nursing Interventions (cont.)

 Encourage patient/family to discuss concerns with support group  Allow patient to make choices on her/his care  Sexual needs: discuss birth control during chemotherapy and/or sperm storage  Vascular access devices  Skin care to prevent skin breakdown Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Nursing Interventions (cont.)

 Neutropenia: discuss hand washing; avoiding infected individuals; no fresh flowers, vegetables, pets, items with free-standing water, those receiving immunizations  Pain: report pain that is new or not controlled, take medications at prescribed intervals to obtain maximum relief  Anemia: space activities and rest  Thrombocytopenia: monitor for bleeding episodes; avoid sharps, ASA, anticoagulants Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Patient Education

 Actions: Highly reactive chemical compounds that bond with DNA molecules, preventing separation of the double-coiled DNA molecules which are necessary for cellular division  Uses: Treatment of chronic lymphocytic leukemia, ovarian cancer, brain tumors, multiple myeloma, Hodgkin’s disease, Non-Hodgkin’s lymphoma,  Serious adverse effects: Bone marrow depression, nephrotoxicity Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Class: Alkylating Agents

 Actions: Inhibit key enzymes in the biosynthetic pathways of DNA and RNA synthesis  Uses: Treatment of breast cancer; colon cancer; hairy cell leukemia, lymphomas, acute lymphocytic leukemia, myelodysplastic syndromes  Serious adverse effects: Bone marrow depression, petechiae, hepatotoxicity, dermatitis, stomatitis Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Class: Antimetabolites

 Actions: Cell cycle – specific agents block formation of the mitotic spindle during mitosis, inhibiting cell division  Uses: Treatment of 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 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Class: Natural Products

 Actions: Bind to DNA, inhibiting DNA or RNA synthesis  Uses: Hodgkin’s disease, non-Hodgkin’s lymphoma; squamous cell, head and neck, testicular cancers; Wilms’ tumor; rhabdomyosarcoma; Ewing’s and osteogenic sarcoma; acute lymphocytic leukemia; acute myeloid leukemia  Serious adverse effects: Bone marrow depression, hepatotoxicity, stomatitis, cardio toxicity Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Class: Antineoplastic Antibiotics

 Actions: 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 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Class: Hormones

 Targeted anticancer agents  Act on pathways that provide growth and survival advantages for cancer cells  Not associated with toxicities common with cytotoxic chemotherapy  Chemoprotective agents  Reduce toxicity of chemotherapeutic agents to normal cells Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Therapy for Cancer

 Bone marrow stimulants: trigger recovery of bone marrow cells  Davepoetin and epoetin stimulate bone marrow to produce RBCs to treat anemia  Filgrastim, pegfilgrastim stimulate production of neutrophilic white blood cells  Oprelvekin stimulates platelet production Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Drug Therapy for Cancer (cont.)

 By which method does cell cycle – specific treatment therapy work? A.Treating cancer cells at their vulnerable cell reproductive stage B.Affecting a cancer cell throughout its entire life cycle C.Inhibiting slowly growing cancer cells D.Targeting key pathways that provide growth to cancer cells Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Audience Response Question-1

 Which bone marrow stimulant increases the production of white blood cells? A.Filgrastim (Neupogen) B.Epoetin alpha (Epogen) C.Darbepoetin (Aranesp) D.Oprelvekin (Neumega) Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Audience Response Question-2

 A patient has developed thrombocytopenia following a round of chemotherapy. The nurse should instruct the patient to: A.use an electric razor to shave. B.wash his hands frequently. C.plan his activities to allow rest time. D.report temperature elevations. Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Audience Response Question 3

 A patient has been taking an alkylating agent for chemotherapy to treat ovarian cancer. The care plan mentions observing for nephrotoxicity during treatment. The nurse should monitor for development of: A.jaundiced skin and sclera. B.decreased urine output. C.increased liver enzymes. D.frequent bleeding episodes. Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Audience Response Question 4

 Which type of cancer is the leading cause of cancer- related death in women? A.Breast B.Colon C.Lung D.Ovary Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc Audience Response Question 5