1. Chapter 40 Agents Used in the Treatment of Cancer

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 2 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

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 3 Etiology of Cancer Remains a mystery  Could be:  Environment  Lifestyle  Occupation  Genetic and ethnic factors  Age- and sex-related differences

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 4 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.

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 5 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)

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 6 Treatment Considerations Cancer stage when it is discovered Efficacy of the cancer treatment Development of drug resistance General health of the client (continued)

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 7 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

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 8 Agents Used in the Treatment of Cancer Alkylating agents Antimetabolites Mitotic inhibitors Antibiotics Hormones (continues)

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 9 Agents Used in the Treatment of Cancer Radioactive drugs Biologic-response modifiers Miscellaneous agents Combination therapy Adjuvant agents (continues) (continued)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 10 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)

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 11 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

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 12 Antineoplastics: Adverse/Side Effects Common  Fever, chills, headache, nausea, and vomiting Serious  Bronchospasm, dyspnea, hypotension, and angioedema

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 13 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

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 14 Adjuvant Agents Antiemetics  Ondansetron HCl (Zofran) Rescue agents  Mesna  Leucovorin Blood-forming agents  Epoetin alfa (Procrit)

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 15 Nursing Implications During administration of the antineoplastic:  Provide significant hydration to prevent nephrotoxicity  Provide periodic monitoring of heart and lung function

16. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 40 - 16 Legal and Ethical Principles To avoid errors  Standardized, preprinted order forms  Nurses  Physicians  Pharmacists