1. Drugs Used for Cancer Treatment
Chapter 44
Drugs Used for Cancer Treatment
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2. Chapter 44
Lesson 44.1
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3. 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
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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. 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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6. 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
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7. 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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8. 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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9. 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
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10. 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
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11. Chapter 44
Lesson 44.2
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12. 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
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13. 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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14. 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.
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15. 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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16. 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.
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17. 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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18. 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.
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19. 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.
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20. 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.
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