Chemotherapy

How chemotherapy works

Normally, cells live, grow and die in a predictable way
Cancer occurs when certain cells in the body keep dividing and forming more cells without the ability to stop
this process
Chemotherapy protocols involve destroying cancer cells
How is chemotherapy given
Oral chemo medications (taken by mouth)
encased in a protective coating
Sub-lingual chemo medications
Some medications cannot be given orally
2. Subcutaneous injection of chemo treatments

use of a short needle

used for some types of biologic response modifiers and chemotherapy support drugs

How is chemotherapy given

4. Intra-muscular chemo injections
medication is deposited in the muscle tissue
Rapid absorption
Avoided in patients with low platelet count
5. Intravenous chemo treatments

rapid entry into the body's circulation

How is chemotherapy given

6. Intravenous chemo treatments
rapid entry into the body's circulation

Doses can be given as an IV bolus

Portable pumps allow medication to be given at a slow continuous rate

Intravenous chemo treatments is given in a variety of methods

Intravenous chemo treatments is given in a variety of methods

How is chemotherapy given

7. Intraventricular/Intrathecal chemo treatments
used when drugs need to reach the cerebrospinal fluid (CSF), the fluid that is in the brain and spinal cord
8. Intraperitoneal chemo treatments
can be given directly into the abdominal cavity

patient is encouraged to change positions from side to side and lying on the back
9. Intra-arterial chemo treatments
drugs are given into the artery that is supplying the blood to the tumor
Temporary external catheter, implanted pump

10. Intravesicular chemo treatments

medications are given with the use of a urinary catheter directly into the bladder
11. Intrapleural chemo treatments
given into the pleural cavity

used to control malignant pleural effusions

How is chemotherapy given

12. Implantable chemotherapy treatments

The goal of this method of treatment is to kill tumor cells left behind after surgery
Gliadel wafer is a form of the chemotherapy medication carmustine that can be placed and left in the cavity
after surgical removal of a brain tumor, specifically glioblastoma multiforme
13. Topical chemo treatments
- chemotherapy creams are applied directly to the skin
The types of chemotherapy drugs are selected based on a variety of information and factors:
Research
- documented responses and conducted clinical trials comparing standard treatments to new treatments
Response rates
- refer to the number of people whose tumors will respond (shrink or disappear) to the drug or drugs given
- can be either complete or partial
- how long do the responses last
3. The Health of the Patient
- the potential risks versus benefits

How long is chemotherapy given

type of cancer
the extent of cancer
the types of drugs that are given
the expected toxicities of the drugs
the amount of time necessary to recover from these toxicities
Types of therapies
Adjuvant: given after surgery

Neo-Adjuvant therapy :Treatment as a first step to shrink a tumor before the main treatment.

Concurrent therapy: When two or more therapies are given together, such as chemotherapy and radiation.
Side Effects of Chemotherapy
Some side effects of chemotherapy are serious medical conditions that need to be treated.
Some side effects are inconvenient or upsetting but are not damaging to your health.

Side Effects: Nausea and Vomiting

Nausea is the conscious recognition of the subconscious excitation of an area of the medulla closely
associated with or part of the vomiting center
Nausea may cause the desire to vomit
Avoid eating or drinking prior to and after chemotherapy administration
Eat frequent small meals. Avoid greasy and fatty foods
antiemetics

Bone marrow depression

This can lead to:
- anemia
- bleeding due to throbocytopenia
- infection due to leukopenia
- neutropenia

Nursing action
Administer packed RBC
Monitor hematocrit and hemoglobin
Avoid activities with the greatest potential for injury
Use electric razor when shaving

Nursing action
Promote hydration to avoid constipation
Avoid enemas, harsh laxatives & use of rectal thermometers
Avoid sources of infection
Prevent trauma to skin and mucous membrane
Report s/s of infection to physician

alopecia
Explain hair loss is temporary and hair will grow when drug is stopped
Use a mild, protein based shampoo, hair conditioner every 4-7 days
Minimize the use of electric dryer
Avoid excessive combing and brushing of hair
Use a wide-toothed comb
Select a wig, scarf, cap, or turban before hair loss occurs
Keep head covered in summer to prevent sunburn
fatigue
Assess for possible causes of chronic pain, stress, depression and insufficient rest or nutritional intake
Conserve energy and rest when tired
Plan for gradual accomodation of activities

anorexia
Freshen up before meals
Avoid drinking fluids with meals
High protein diet
Monitor and record weight weekly, report weight loss

stomatitis
Symptoms occur 5-7 days after chemotherapy and persists up to 10 days
Continue brushing regularly with a soft tooth brush
Use non-irritant mouthwash
Avoid irritants to the mouth
Maintain good nutritional intake, eat soft or liquid foods high in protein

stomatitis
Follow prescribed medication schedule for oral candidiasis
Increase frequency of oral hygiene every 2 hours
Glycerin and lemon juice should never be used to clear the mouth or teeth
diarrhea
Monitor number, frequency and consistency of stools
Avoid eating high roughage, greasy, spicyfood, alcoholic beverages, tobacco and caffeine products
Avoid using milk products
Eat low residue diet high in protein and calories
Include food high in potassium

diarrhea
Drink 3000 ml of fluid daily
Eat small frequent meals; eat slowly and chew all food thoroughly
Administer antidiarrheal agents

depression
Assess for changes in mood and affect
Set small goals that are achievable daily
Participate in music, readings, outings
Share feelings
Reassurance
Support group
cystitis
Inflammation of the bladder caused by an infection
Sterile cystitis can be a side effect of radiation therapy or due to cyclophosphamide administration. The
metabolites are excreted through the kidneys
Fluid intake of 3000 ml daily
Empty the bladder as soon as the urge to void is experienced
cystitis
Empty bladder every 2-4hours
Urinate at bedtime to avoid prolonged exposure of the bladder wall to the effects of cytotoxan while sleeping
Ensure dilute urine by increasing fluid intake
Avoid foods and beverages that may cause irritation to the bladder (alcohol, coffee, strong tea, carbonated
beverages)
Side Effects

Effects on reproductive system:

Decrease sperm count
Decrease menstruation
Sperm banking
contraception

Chemotherapy offers patients with cancer a great deal of hope for a cure or a means to control cancer for a long
period of time. Hope and optimism are vital ingredients in the care plan.
Chemotherapeutic Agents
Cell Cycle Specific Drugs:

Antimetabolites
Bleomycin peptide antibiotics
Vinca alkaloids

Cell Cycle non-Specific Drugs:

Alkylating agents
Antibiotics (Dactinomycin)
Cisplatin
Chemotherapeutic Agents
Alkylating agents:
Produce cytotoxic effects on DNA
Use: leukemias, multiple myeloma, neuroblastoma, ovarian, breast, lung
Adverse effects: gonadal suppression, hemorrhagic cystitis
Major Toxicity: bone marrow suppression
Nursing implications:
a. Force fluids
b. Assess for s/s of bleeding
c. Leukocyte count
d. Monitor cbc, uric acid & renal function
e. Report hematuria/dysuria
Chemotherapeutic Agents
Antimetabolites:

Folic Acid Analogs

Methotrexate
inhibitor of dihydrofolate reductase, the enzyme that catalyzes conversion of folic acid to tetrahydrofolate.
Pyrimidine Analogs
Two pyrimidine analogs, 5-fluorouracil and cytarabine, are commonly used. 5-Fluorouracil must be
converted to an active 5-fluoro2-deoxyuridine-5-phosphate form to bind the enzyme thymidylate
synthetase and block or inhibit DNA and RNA synthesis.
This drug is considered S phase-specific.
Cytarabine (cytosine arabinoside) is an analog of 2-deoxycytidine and must be activated by conversion to a
5-monophosphate nucleotide. The nucleotide analog, AraCTP, inhibits DNA synthesis by substitution of
arabinose for deoxyribose in the sugar moiety of DNA; cytarabine may also inhibit DNA repair enzymes.
This drug is S phase-specific
Purine Analogs
Two purine analogs, 6-mercaptopurine (6-MP) and 6-thioguanine (6-TG), are used occasionally. 6-MP is a
sulfhydryl-substituted analog of hypoxanthine that must be converted to an active form by hypoxanthineguanine phosphoribosyltransferase (HGPRT). The active drug inhibits synthesis and metabolism of purine
nucleotides and thus disrupts synthesis and function of DNA and RNA. This S phase-specific drug
Chemotherapeutic Agents
3. Microtubule Inhibitors:
These are plant-derived substances .
Cause cytotoxicity by affecting the equilibrium between the polymerized and depolymerized forms of the
microtubules.
Vinca alkaloids inhibit microtubule polymerization and increase microtubule disassembly. The mitotic spindle
apparatus is disrupted, and segregation of chromosomes in metaphase is arrested.
Use: acute leukemia,cancer of brain, breast, testes, cervix

Chemotherapeutic agents: Vinca alkaloids

Adverse effects:
a. peripheral neuropathy
b. loss of deep tendon reflex
c. Jaw pain
d. Cramps, muscle weakness
e. Constipation, nausea, vomiting
f. Stomatitis
g. Alopecia
h. Hyponatremia
i. photosensitivity
Vinca alkaloids
Nursing implications
1. do not give IM/ SQ
2. monitor bowel function
3. frequent neuro checks
4. monitor CBC and platelets
5. avoid exposure to sun
Chemotherapeutic Agents
4. Antineoplastic Antibiotics:

Interacts with DNA, leading to disruption of DNA function

Do not give IM/SQ
Do not mix with other drugs
Monitor IV site
Monitor cbc, serum uric acid level, weight
Mouth care
Fluids
Wigs/hair coverings
Chemotherapeutic Agents

5. Hormonal Agents:
Commonly involves the use of glucocorticoids
Hormonal therapy keeps cancer cells in resting phase
Glucocorticoids can inhibit mitosis, RNA synthesis, and protein synthesis in sensitive lymphocytes

Considered cell-cycle nonspecific