1. Drugs Used for Cancer Treatment
Chapter 44
Drugs Used for Cancer Treatment
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2. Lesson 44.1
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3. Objectives
Identify common sites for cancer in men and women and cite the goals of chemotherapy.
Cite the rationale for giving chemotherapeutic drugs on a precise time schedule.
Describe the nursing assessments and interventions needed for people experiencing adverse effects from chemotherapy.
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4. 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.
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5. Cancer Cases and Deaths
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6. Audience Response Question 1
Which type of cancer is the leading cause of cancer-related death in women?
Breast
Colon
Lung
Ovary
Answer: C
Rationale: Breast cancer used to be the number-one cause of cancer deaths in women, but with the increase in women smoking, lung cancer has emerged as the primary cause of death from cancer in women (27%).
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7. 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.
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8. Phases of Cell Growth (cont.)
Phase G2 (cont.)
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
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9. 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.
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10. Audience Response Question 2
By which method does cell cycle–specific treatment therapy work?
Treating cancer cells at their vulnerable cell reproductive stage
Affecting a cancer cell throughout its entire life cycle
Inhibiting slowly growing cancer cells
Targeting key pathways that provide growth to cancer cells
Answer: A
Rationale: Cell cycle–specific treatment therapy is selectively toxic to cancer cells in specific phases of their growth cycle. The cancers most effectively treated in this way are those that proliferate or divide quickly.
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11. 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.
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12. Nursing Assessments 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
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13. Nursing Interventions
Plan care based on assessment data and individual needs of patient; monitor VS
Examine lab tests
Monitor for development of emergencies
Monitor hydration status
Report early signs of infection
Nausea and vomiting are common
Preadminister antiemetic; report poor control, monitor hydration and electrolyte status
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14. Nursing Interventions (cont.)
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
Encourage patient/family to discuss concerns with support group; allow choices
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15. Nursing Interventions (cont.)
Sexual needs: discuss birth control during chemotherapy and/or sperm storage
Vascular access devices
Skin care to prevent skin breakdown
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16. Patient Education
Neutropenia: discuss handwashing; 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
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.
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17. Audience Response Question 3
A patient has developed thrombocytopenia following a round of chemotherapy. The nurse should instruct the patient to:
use an electric razor to shave.
wash his hands frequently.
plan his activities to allow rest time.
report temperature elevations.
Answer: A
Rationale:  A patient who has thrombocytopenia has a decreased platelet count.  Platelets are involved with blood clotting and a lack of platelets causes bleeding episodes.  An appropriate intervention to decrease the likelihood of bleeding is to instruct the patient to use an electric razor to shave.  Washing hands frequently and monitoring for temperature elevations are interventions associated with disorders of the white blood cells.  Instructing a patient to alternate activity with rest is crucial for patients with disorders of red blood cells. 
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18. Lesson 44.2
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19. Objectives
Identify which types of chemotherapeutic agents are cell cycle–specific and which 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.
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20. 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.
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21. Audience Response Question 4
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:
jaundiced skin and sclera.
decreased urine output.
increased liver enzymes.
frequent bleeding episodes.
Answer: B
Rationale:  Decreased urine output is one indicator of impaired renal function, caused by a nephrotoxic drug.  Jaundiced skin and sclera and increased liver enzymes are indicators of impaired liver function.  Frequent bleeding episodes are associated with hematological disorders.
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22. 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 cycle–specific, killing cells during the S phase of cell maturation.
Common adverse effects: GI symptoms, anorexia, nausea, vomiting.
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23. 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.
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24. 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; Wilms’ 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.
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25. 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.
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26. Drug Therapy for Cancer
Targeted anticancer agents
Act on receptors to target key 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
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 are integral to the growth and spread of cancer.
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27. Drug Therapy for Cancer (cont.)
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
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28. Audience Response Question 5
Which bone marrow stimulant increases the production of white blood cells?
Filgrastim (Neupogen)
Epoetin alpha (Epogen)
Darbepoetin (Aranesp)
Oprelvekin (Neumega)
Answer: A
Rationale: Filgrastim stimulates the production of neutrophilic white blood cells. It is used to counteract the reduction of white blood cells resulting from bone marrow transplantation or bone marrow suppression in chemotherapy treatment.
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