Chapter 40 Agents Used in the Treatment of Cancer

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved 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

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Etiology of Cancer Remains a mystery  Could be:  Environment  Lifestyle  Occupation  Genetic and ethnic factors  Age- and sex-related differences

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Cell Growth Cycle Normal cells and cancer cells go through five distinct growth phase cycles 1. G o, resting phase 2. G 1, first growth 3. S, DNA synthesis phase 4. G 2, second growth phase 5. M, mitosis phase Cancer cells divide rapidly.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Treatment Considerations Growth fraction  The fraction of cells that are in active phases Mitotic index  Percentage of cells undergoing mitosis Antineoplastics most effective when the growth fraction and mitotic index are high (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Treatment Considerations Cancer stage when it is discovered Efficacy of the cancer treatment Development of drug resistance General health of the client (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antineoplastics Divided into two groups 1. Cell cycle nonspecific (CCNS) 2. Cell cycle specific (CCS) CCNS effective against slow-growing cancer cells CCS effective against fast-growing cancer cells

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Agents Used in the Treatment of Cancer Alkylating agents Antimetabolites Mitotic inhibitors Antibiotics Hormones (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Agents Used in the Treatment of Cancer Radioactive drugs Biologic-response modifiers Miscellaneous agents Combination therapy Adjuvant agents (continues) (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved 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 (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved 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  Myleosuppression  Nadir: lowest point for the bone marrow cells

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antineoplastics: Adverse/Side Effects Common  Fever, chills, headache, nausea, and vomiting Serious  Bronchospasm, dyspnea, hypotension, and angioedema

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved 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

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Adjuvant Agents Antiemetics  Ondansetron HCl (Zofran) Rescue agents  Mesna  Leucovorin Blood-forming agents  Epoetin alfa (Procrit)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nursing Implications During administration of the antineoplastic:  Provide significant hydration to prevent nephrotoxicity  Provide periodic monitoring of heart and lung function

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Legal and Ethical Principles To avoid errors  Standardized, preprinted order forms  Nurses  Physicians  Pharmacists