1. Antineoplastic Agents and Adjunct Drugs Used in Cancer Treatment

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 2

3. Etiology of Cancer  May be:  Environment  Lifestyle  Occupation  Genetic and ethnic factors  Age- and sex-related differences 3

4. Cell Growth Cycle  Normal cells and cancer cells go through five distinct growth phase cycles  -G0 -resting cycle  -G1 -first growth  -S –DNA synthesis phase  -G2 –second growth  -M1 -mitosis phase  Cancer cells divide rapidly 4

5. Treatment Considerations  Growth Fraction  -The fraction of cells that are in active  phases  Mitotic index  -Percentage of cell undergoing mitosis  Antineoplastics most effective when the growth fraction and mitotic index are high 5

6. Treatment Considerations  Cancer stage when it is discovered  Efficacy of the cancer treatment  Development of drug resistance  General health of the client 6

7. Antineoplastics  Divided into two groups  -Cell cycle nonspecific (CCNS)  -Cell cycle specific (CCS)  CCNS effective against slow-growing cancer cells  CCS effective against fast-growing cancer cells 7

8. Agents Used in the Treatment of Cancer  Alkylating agents  Antimetabolites  Mitotic inhibitors  Antibiotics  Hormones 8

9. Agents used in the Treatment of Cancer  Radioactive drugs  Biological response modifiers  Miscellaneous agents  Combination therapy  Adjuvant agents 9

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 10

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  Myelosuppression  Nadir: lowest point for the bone marrow cells, WBCs, platelets 11

12. Antineoplastics: Adverse/Side Effects  Common  Fever, chills, headache, nausea, and vomiting  Serious  Bronchospasm, dyspnea, hypotension, and angioedema 12

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 13

14. Adjuvant Agents  Antiemetics  Ondansetron HCl (Zofran)  Appetite Stimulants  Megace ES (megestrol acetate)  Marinol (THC)  Blood cell-forming agents  Epoetin alfa (Procrit)  Neulasta 14

15. Nursing Implications  During administration of the antineoplastic:  -Provide significant hydration to prevent nephrotoxicity  -Provide periodic monitoring of heart and lung function 15

16. Nursing Considerations  Obtain thorough health history and physical assessment  Assess support systems  Provide for expression of feelings  Provide education regarding illness and treatment regimen  Pain control  Assessment of the patient’s emotional status 16

17. Nursing considerations  Monitoring of labs, fluid and electrolyte balance  Nutritional evaluation  Address infection status and education  Provide for safety needs  Be alert for adverse effects of the drugs  Ongoing assessment is crucial 17

18. Adverse Effects: Chemotherapy  Risk for infection  Risk for bleeding  Risk for ineffective tissue perfusion  Nausea and vomiting  Risk for vesicant extravasation  Body image disturbances  Uric acid neuropathy  Hemorrhagic cystitis  Pain 18

19. Handling of Cytotoxic Drugs  Be familiar with institution policies and procedures  Use proper protective equipment  Do not handle if pregnant 19

20. Handling of Cytotoxic Drugs  Take all special precautions  Contaminated material must be disposed of properly  Spill kit  Follow proper procedures for exposure 20

21. Investigational Drugs  Written prescription  Signed consent  Drug information available  Follow research protocol  Keep thorough records 21

22. Patient Teaching  Provide education regarding cancer and treatment  Emphasize importance of following chemotherapy regimen  Teaching regarding central venous catheters  Education regarding signs and symptoms to report to provider  Address appropriateness of home care 22

23. Legal and Ethical Principles  To avoid errors  Standardized, preprinted order forms 23