drugs used for cancer treatment mosby items and derived items © 2013, 2010, 2007, 2004 by mosby,...

Drugs Used for Cancer Treatment

Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

44-1

Treatment requires combination of surgery, radiation, chemotherapy, and immunotherapy

Recent developments enhance role of antineoplastic agents in therapy


44-2

Cancer and the Use of Antineoplastic Agents


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Cancer Cases and Deaths

Mitosis: phase of cellular proliferation in which cells divide into two equal daughtersCells are either in the non-proliferative stage (G0), or in the first gap phase (G1)

Phase G1: pre-synthetic phase in which the cell manufactures needed enzymes to prepare for DNA synthesis


44-4

Phases of Cell Growth

Phase G2: post-synthetic phase in which the cell prepares for mitosis by producing RNA and specialized proteins Mitosis divides the cell into two G1 daughter cellsG1 cells may advance again to S phase or pass into a non-proliferative stage (G0)

S phase: stage of active synthesis of two sets of DNA


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Phases of Cell Growth (cont.)

http://www.youtube.com/watch?v=Q6ucKWIIFmg


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Phases of Cell Growth (cont.)

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 tissueMosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

44-7

Cell Cycle and Effects of Drugs

Goals for chemotherapy : administering 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


44-8

Drug Therapy for Cancer

History of risk factors Dietary habits Preexisting health problems Adaptation to diagnosis Psychomotor functions Safety Symptoms of pharmacologic adverse effects Physical and sexual assessment Pain


44-9

Nursing Assessments

Care plan is based on assessment data and individual needs of patient:Monitor VSExamine lab tests Monitor for development of emergenciesMonitor hydration and electrolyte statusReport early signs of infectionNausea and vomiting are common


44-10

Nursing Interventions

Pre-administer antiemetic; report poor control,

Monitor for changes in bowel movements Meticulous oral hygiene for stomatitis Report bleeding Give pain medications at intervals to

maintain maximum pain control Nutritional needs


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Nursing Interventions (cont.)

Encourage patient/family to discuss concerns with support group

Allow patient to make choices on her/his care

Sexual needs: discuss birth control during chemotherapy and/or sperm storage

Vascular access devices Skin care to prevent skin breakdown


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Nursing Interventions (cont.)

Neutropenia: discuss hand washing; avoiding infected individuals; no fresh flowers, vegetables, pets, items with free-standing water, those receiving immunizations

Pain: report pain that is new or not controlled, take medications at prescribed intervals to obtain maximum relief

Anemia: space activities and rest Thrombocytopenia: monitor for bleeding

episodes; avoid sharps, ASA, anticoagulants


44-13

Patient Education

Actions: Highly reactive chemical compounds that bond with DNA molecules, preventing separation of the double-coiled DNA molecules which are necessary for cellular division

Uses: Treatment of chronic lymphocytic leukemia, ovarian cancer, brain tumors, multiple myeloma, Hodgkin’s disease, Non-Hodgkin’s lymphoma,

Serious adverse effects: Bone marrow depression, nephrotoxicity


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Drug Class: Alkylating Agents

Actions: Inhibit key enzymes in the biosynthetic pathways of DNA and RNA synthesis

Uses: Treatment of breast cancer; colon cancer; hairy cell leukemia, lymphomas, acute lymphocytic leukemia, myelodysplastic syndromes

Serious adverse effects: Bone marrow depression, petechiae, hepatotoxicity, dermatitis, stomatitis


44-15

Drug Class: Antimetabolites

Actions: Cell cycle–specific agents block formation of the mitotic spindle during mitosis, inhibiting cell division

Uses: Treatment of 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


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Drug Class: Natural Products

Actions: Bind to DNA, inhibiting DNA or RNA synthesis

Uses: Hodgkin’s disease, non-Hodgkin’s lymphoma; squamous cell, head and neck, testicular cancers; Wilms’ tumor; rhabdomyosarcoma; Ewing’s and osteogenic sarcoma; acute lymphocytic leukemia; acute myeloid leukemia

Serious adverse effects: Bone marrow depression, hepatotoxicity, stomatitis, cardio toxicity


44-17

Drug Class: Antineoplastic Antibiotics

Actions: 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


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Drug Class: Hormones

Targeted anticancer agents Act on pathways that provide growth and

survival advantages for cancer cells Not associated with toxicities common with

cytotoxic chemotherapy Chemoprotective agents

Reduce toxicity of chemotherapeutic agents to normal cells


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Drug Therapy for Cancer

Bone marrow stimulants: trigger recovery of bone marrow cells Davepoetin and epoetin stimulate bone

marrow to produce RBCs to treat anemia Filgrastim, pegfilgrastim stimulate

production of neutrophilic white blood cells Oprelvekin stimulates platelet production


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Drug Therapy for Cancer (cont.)

By which method does cell cycle–specific treatment therapy work?A. Treating cancer cells at their vulnerable cell

reproductive stageB. Affecting a cancer cell throughout its entire

life cycleC. Inhibiting slowly growing cancer cellsD. Targeting key pathways that provide growth

to cancer cellsMosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

44-21

Audience Response Question-1

Which bone marrow stimulant increases the production of white blood cells?A. Filgrastim (Neupogen)B. Epoetin alpha (Epogen)C. Darbepoetin (Aranesp)D. Oprelvekin (Neumega)


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Audience Response Question-2

A patient has developed thrombocytopenia following a round of chemotherapy. The nurse should instruct the patient to:

A. use an electric razor to shave.B. wash his hands frequently.C. plan his activities to allow rest time.D. report temperature elevations.


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Audience Response Question 3

A patient has been taking an alkylating agent for chemotherapy to treat ovarian cancer. The care plan mentions observing for nephrotoxicity during treatment. The nurse should monitor for development of:

A. jaundiced skin and sclera.B. decreased urine output.C. increased liver enzymes.D. frequent bleeding episodes.


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Which type of cancer is the leading cause of cancer-related death in women? A. BreastB. ColonC. LungD. Ovary


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