Nursing interventions include scalp hypothermia (ice cap) and scalp tourniquet; both reduce the amount of drug reaching the hair follicle and may prevent hair loss. Antimetabolites are S phase-specific. You should not receive Prolia if you have low levels of calcium in your blood (hypocalcemia). And nurses and others who give your chemo and help take care of you afterwards wear protective clothing, such as 2 pairs of special gloves and a gown, and sometimes goggles or a face shield. How soon after therapy should blood tests be done to monitor bone marrow function? Home-based therapy can offer many patient advantages. It enables the patient to jot down the time the dose was taken, number of pills taken, and any experienced side effects. Genetic abnormalities are passed along daughter cells, eventually producing a tumor or neoplasm that has characteristics quite different from those of the original tissue. Compliance will also be influenced by each patient’s pre-existing beliefs and attitudes about health, disease, and medical treatments. Option B is for antimetabolites. The oncology nurse’s responsibilities include patient education, symptom management, and proactive follow-up. Some hormones are used to block the release of gonadotropic hormones in breast or prostate cancer if the tumors are responsive to gonadotropic hormones. Any necessary dose reduction is simply a customization of dose to that individual’s needs. These limitations might include limited sight and limited manual dexterity in handling pills. They would need extra support and comfort as body image problems, lack of energy, and risk for infection can isolate them. 'Cytotoxic' means that the drug destroys rapidly growing cancer cells. These can affect not only how the patient follows his or her drug schedule, but also what he or she is willing to report or discuss regarding complications and side effects. The patient needs to feel comfortable with his or her physician or nurse in asking questions and reporting side effects. We really are top-notch,” says … Prompts, such as a spouse, alarm clock, watch, or even hand-held computer such as a Palm Pilot, may be used to remind patients to take their medication. These drugs act on and kill altered human cells. Please visit using a browser with javascript enabled. Hormones and hormone modulators block or interfere with these receptor sites to prevent growth of the cancer and cause cell death. [ONCOLOGY 15(Suppl 2):37-40, 2001]. Paulo Hoff, MD: What you need are a television, a VCR, and a tape with instructions. allergies, drug history and possible drug interactions. Enter your mobile number or email address below and we'll send you a link to download the free Kindle App. Leonard Saltz, MD: In particular trials of parenteral medications we have actually had situations where a patient deliberately concealed toxicity that she was having because she was afraid that if she told us about the toxicity we would cut her dose and she thought that would be a terrible thing. Dispensing only a single cycle of an oral agent is common and perhaps helps avoid overdoses. Multiagent Regimens Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. Dr. Saltz: It really depends a lot on all the other factors-education, socioeconomic status, and so on. In her article in the January 2009 issue of the Oncology Nursing Forum, Debra Frye (2009) describes the nursing considerations associated with capecitabine-based combination chemotherapy. If side effects are left unreported, necessary dose adjustments may not be made, and serious consequences can occur that can impact their life and further therapy. Inhibiting DNA production in cells that depend on certain natural metabolites to produce their DNA. While their action is intended to target abnormal cells, normal cells are also affected. Chemotherapy precautions must be taken Administration considerations; Chemo certified nurses; Agents include: Busulfan; Cyclophosphamide; Melphalan; Nursing Points General Mitotic inhibitors alter the M phase of the cell cycle. Older patients are more susceptible to GI and CNS adverse effects of antineoplastic therapy, particularly those with hepatic and renal dysfunctions. The complexity of the regimen will also affect the patient’s ability to comply. This medication guide provides information about the Prolia brand of denosumab. Arrange for blood tests before, periodically during, and for at least 3 weeks after therapy to monitor bone marrow function to aid in determining the need for a change in dose or discontinuation of the drug. Option C can increase photosensitivity. Appropriate patient selection is central to the successful and safe administration of any chemotherapy. Works with hormones to stop stimulating growth of tumors. Also, older patients are more likely to be taking multiple oral medications, and the addition of oral chemotherapy to this patient’s regimen may not be feasible, either due to the increased complexity or potential drug interactions. This diary is given to the patient at the initial teaching session and can be reviewed at subsequent visits. Any condition that can prolong QT interval is a contraindication to the use of nilotinib. Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for. Option B can increase the risk for hepatotoxicity. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. These and other factors are outlined in Table 1. Hypercalcemia is encountered as the calcium is pulled out of the bones without estrogen activity to promote calcium deposition. The goal of antiemetic therapy is to prevent vomiting and minimise nausea both during and after the administration of chemotherapy. CHEMOTHERAPY: Risks and Nursing Implications Chemotherapy is used primarily to treat systemic disease May be combined with surgery or radiation therapy to reduce tumor size operatively destroy any remaining tumor cells postoperatively treat some forms of leukemia. CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness, GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity. Treatment of a variety of tumors and leukemias. Compliance is reflected in many aspects of patient behavior over and above compliance with the dose and schedule. For some patients, there is also an anxiety component associated with taking numerous pills. Follow-up visits after each cycle, even in the absence of reported toxicities, are useful to maintain close supervision of the patient and to permit early detection of clinical toxicities or deterioration. Therefore, they are commonly administered as part of combination therapy. Echinacea: increased risk of hepatotoxicity with antineoplastics. Normal cells are always spared from the effects of antineoplastic agents. There are over 200 types of cancer and more than 50 chemotherapy drugs currently licensed to treat the disease, either on their own or in combination. In more traditional antineoplastic chemotherapy, normal cells are also affected. Reacting chemically with portions of RNA, DNA, or other cellular proteins to produce their cytotoxic effects. oral anticoagulants). The traditional agent fluorouracil has been joined by new drugs, including capecitabine, irinotecan, oxaliplatin, and targeted agents such as bevacizumab and cetuximab. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. Either breaking up DNA links or preventing DNA synthesis. In this area, oral regimens pose new challenges to patients and providers. We have gloves, gowns, spill kits and closed system devices. He would be correct to state which drug as an example? In traditional parenteral chemotherapy, the healthcare provider has far greater control of dose and dose adjustments. Null Hypotheses . First and foremost, patients need to know the correct dose and administration schedule. • Assess platelet count. Arrange for proper head covering at extremes of temperature if alopecia occurs; a wig, scarf, or hat is important for maintaining body temperature. Also, this page requires javascript. to prevent any untoward complications. Precautions are used accordingly. Uncontrolled growth of neoplastic cells will lead to invasion of healthy tissues in the area and, Cancers can be divided into two groups: 1) solid tumors; and 2) hematological malignancies. Cameron[1] has identified several specific factors involved in promoting compliance with a therapeutic regimen. The primary focus must be to develop educational strategies to ensure patient understanding of medication administration, potential side effects, and self-care measures. Unfortunately, although the side-effect profiles of many oral chemotherapy agents are relatively favorable, serious systemic side effects can still occur, making early recognition with prompt intervention critical. Also, a monthly calendar can be used as a visual guideline in mapping out the overall treatment schedule. Perhaps more importantly, the patient must decide whether to withhold medication in the presence of more severe side effects, not knowing that failure to do so could result in substantial, and even life-threatening, toxicities. Menopause-associated effects: hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression. A student nurse was asked to give an example of an antimetabolite. You may notice special clothing and protective equipment being worn by the nurses and other members of your cancer care team. Lastly, bone marrow activity should be monitored carefully and dose should be adjusted carefully. Antineoplastic agents comprise one aspect of chemotherapy. baroreceptors, renin-angiotensin-aldosterone system, etc.) These roles are of vital importance in the management of ambulatory oral chemotherapy. Nurses caring for patients receiving capecitabine need to be aware of the drug's unique safety profile. These forms can indicate the patient’s height, weight, body-surface area, calculated dose per square meter, and actual total daily dose. drug allergies, hepatorenal impairment, bone marrow suppression, pregnancy and lactation, etc.) 2. Antineoplastic antibiotics can increase toxicity of drugs that are toxic to the heart and lungs. Managing these side-effects requires superior assessment skills and extensive knowledge of pharmacologic actions. GI: nausea, vomiting, anorexia, diarrhea, and mucous membrane deterioration, hepatic toxicity, GU: renal toxicity, potentially toxic increase in uric acid levels. Provide small, frequent meals, frequent mouth care, and dietary consultation as appropriate to maintain nutrition when GI effects are severe. Oncology nurses who are involved with patients taking oral chemotherapy must understand what factors affect compliance and how identification of these factors can aid in the development of educational strategies that will help assure patient compliance. Acute pain related to GI, CNS, and skin effects of the drug, Disturbed body image related to alopecia, skin effects, and impaired fertility, Risk for infection related to bone marrow suppression. This article will outline the active role that nurses must play in the management of patients who are self-administering oral chemotherapy. Use has been somewhat limited because neoplastic cells rapidly develop resistance to these agents. Which is an absolute contraindication in patients receiving nilotinib, a cancer cell-specific agent? Antineoplastic agents are contraindicated to pregnant and nursing women. The oncology nurse may have to act as a liaison, not only with the patient, but with homecare providers, community pharmacists, and/or homecare nurses. Good luck! Two important safety features are important here. The quality of the patient-provider relationship also can profoundly affect compliance. It is critical that patients and their families leave the oncologist’s office realizing the importance of early recognition of side effects. Are caregivers in the home aware that they need to notice and inquire about side effects or clinical changes? 1. Genetic abnormalities are passed along daughter cells, eventually producing a tumor or neoplasm that has characteristics quite different from those of the original tissue. Specific prescription forms tailored to oral chemotherapy also can be developed by the caregivers. JAdv Nurs 24:244-250, 1996. Even under therapy, children must be allowed to explore and learn like any other children. Finally, many patients use a weekly pill dispenser to organize their daily doses. Continuing to take self-modulated dosing is another concern that is a little different than not appearing after taking 5 days of therapy. The occurrence of nausea and vomiting can seriously compromise the delivery of oral therapy. Patients do not experience the numerous adverse effects associated with antineoplastic chemotherapy. Implications for nursing practice: Antiemetics are administered regularly in the hospital and home to decrease chemotherapy-related nausea, vomiting, and retching. In clinical trials, drug accountability forms are often used for documentation of the total number of dispensed pills (Figure 2). These drugs have potentially adverse effects which limit their usefulness in patients with pre-existing disease and those who are debilitated. Option D is for hormones and hormone modulators. Self-administered oral chemotherapy greatly shifts responsibility for dose monitoring and adjustments from the provider to the patient. Option A can increase the effects of various estrogen hormones. Estrogen-receptor sites on the tumor react with circulating estrogen, and this reaction stimulates the tumor cells to grow and divide. Antimetabolites are drugs that have chemical structures similar to those of various natural metabolites that are necessary for growth and division of rapidly growing neoplastic cells and normal cells. All other options can shorten QT interval. In addition, the nutritional needs and hydration status of children should be included in the considerations for formulating a care plan. • •Assess for presence/history of specific type of cancer, bone marrow suppression, tumor cell infiltraton of bone marrow, recent chemotherapy or radiation. Click the drug name to learn how it works and common side effects. Oncology nurses are often responsible for the administration of chemotherapy drugs to patients, so they must attain in-depth knowledge and understanding of the mechanism of action and expected side effects of each treatment as it is their duty to ensure that patients receive their chemotherapy treatments safely. In some regimens, enough data support sequencing of agents, but in others, data are lacking. Interfering with the ability of the cell to divide by blocking or altering the M phase of the cell cycle. • Assess for presence/history of: • Specific neoplasia present • Decreased hepatic functioning • Decreased bone marrow or infiltration Administer medication according to scheduled protocol and in combination with other drugs as indicated to improve effectiveness. The physician and nurse determine the presence or absence of side effects at office visits, and make judgments about dose adjustments. ... 2020-2021 Oncology Nursing Drug Handbook. Eat high carbohydrate, low-fat foods and avoid spicy foods. Xgeva is another brand of denosumab used to prevent bone fractures and other skeletal conditions in people with tumors that have spread to the bone. Cameron C: Patient compliance: Recognition of factorsinvolved and suggestions for promoting compliance with therapeutic regimens. This was the first classification of an anti-cancer drug to be developed. As part of pre-operative preparation, a patient showing signs of problems with blood clotting should be asked about usage of which herb? Examination of drug containers during return visits can help ensure that patients have completed their therapy. In addition, a chemotherapy fact card for the specific drug can be developed. In the presence of renal failure this will not be accurate due to large amounts of hematuria. Some cancers are sensitive to estrogen stimulation. CINV can lead to complications of treatment and also cause significant emotional and physical distress, disruptions to activities of daily living and influence the quality of life of the patient. 2. If this activity does not load, try refreshing your browser. With oral chemotherapy, "good patient behavior" takes on a new dimension. Compliance is affected by the patient’s knowledge and understanding of the specific regimen. Our hottest nursing game is out now in the App Store. Consequently, original cell characteristics are lost. Chemotherapy is strong medicine, so it is safest for people without cancer to avoid direct contact with the drugs. Chemotherapy medications put nurses at risk for occupational exposure, a key nursing safety concern. A diary with a symptom management log (Figure 1) is an effective tool to help promote compliance and safe administration. If you leave this page, your progress will be lost. Proliferation of abnormally-dividing cells starts the pathologic process. Oncology nurses can play an active role in the identification of appropriately motivated patients for these self-administered therapies. Chemotherapy is often given as a combination of drugs. Inhibit thymidylate synthase, DNA polymerase, or folic acid reductase, all of which are needed for DNA synthesis. Women of childbearing age should use barrier contraceptives when these drugs are being taken. The important thing is to stress to the patient that it is important to call his/her physician or nurse at any sign of a symptom or side effect. Compliance may be variable over time, with motivation and actual compliance potentially diminishing with the increasing duration of a patient’s illness. Learn more about: All rights reserved. It can develop at any age. Nurses have always played a key role in the education and symptom management of patients undergoing chemotherapy. These roles are of vital importance in the management of ambulatory oral chemotherapy. Hospitals such as those in the Cleveland Clinic healthcare system have procedures to mitigate those risks. You have not finished your quiz. The goal of cancer chemotherapy is to decrease the size of neoplasm so that the human immune system can deal with it. Finally, patients often have a lack of appreciation for the potential seriousness of not reporting toxicities that develop. Gefitinib: potentially severe interstitial lung disease and various eye symptoms, Pazopanib: some bone marrow depression, diarrhea, hypertension, and liver impairment, change in hair color, Lapatinib: diarrhea, liver impairment, altered heart function, Erlotinib and bortezomib: cardiovascular events, pulmonary toxicity, Bortezomib: peripheral neuropathy, liver and kidney impairment, Any drug that has potential for hepatic or renal toxicity, Adversely affect drugs metabolized in the liver (e.g. Imatinib: GI upset, muscle cramps, heart failure, fluid retention, skin rash. A last consideration in patient selection is simply the patient’s ability to tolerate an oral medication. The guidelines, as shown in this article, include an overview on the pharmakinetics, dosage, preparation, administration, side-effects and nursing considerations … Drugs that kill cells as the process of mitosis begins. Treatment of various types of cancer, particularly those with rapidly-dividing nature. Skip Navigation. “Cleveland Clinic has policies, procedures, education and equipment to enhance the safety of nurses who administer chemotherapy drugs. H01 :There will be no significant difference between the pretest and posttest knowledge and practice scores of nursing students on chemotherapy for cancer patients. Education, support, and referrals to appropriate specialists are important. Treatment of prostatic cancers that are sensitive to hormone manipulation. This causes a mutant DNA molecule, leading to cell death. © 2021 MJH Life Sciences and Cancer Network. To stay logged in, please refresh the page or, if you are working on a form, click on the submit button to save your work. Assess for the mentioned cautions and contraindications (e.g. In our institution, we will be doing an in-service on oral chemotherapy. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. They interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain. Once you are finished, click the button below. Treatment of breast cancer in postmenopausal women or in other women without ovarian function. Your user session will expire in 2 minutes. They do this by inserting themselves between base pairs in the DNA chain. Monitor for adverse effects (bone marrow suppression, GI toxicity, neurotoxicity, and alopecia, renal or hepatic dysfunction). All the chemotherapy drug information you need in the palm of your hand! 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Decrease off trial in promoting compliance with a symptom management log ( Figure 1 ) is absolute!