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Chapter 39

Antineoplastic Agents and Adjunct Drugs Used in Cancer Treatment. Chapter 39. 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. Etiology of Cancer. May be:

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Chapter 39

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  1. Antineoplastic Agents and Adjunct Drugs Used in Cancer Treatment Chapter 39

  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. Etiology of Cancer • May be: • Environment • Lifestyle • Occupation • Genetic and ethnic factors • Age- and sex-related differences

  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

  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

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

  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

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

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

  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

  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

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

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

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

  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

  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

  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

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

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

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

  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

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

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