chemotherapy an overview amy sinacola. haematology macmillan clinical nurse specialist

CHEMOTHERAPY

An Overview

Amy Sinacola. Haematology Macmillan Clinical Nurse Specialist

Aims of session

Understand Cell CycleChemotherapy and the cancer

cellSide effectsNursing implicationsAdministration & safety

Definition:

Chemotherapy• The treatment of cancer using specific

chemical agents or drugs that are destructive to malignant cells and tissues. The term comes from two words that mean "chemical" and "treatment."

Cytotoxic• literally translated means ‘toxic to cells’.

The Cell Cycle

The Cell Cycle

Mitosis

Cell Biology: Mitosis

A cell in mitosis

Normal Cell Characteristics:

Metabolism. Strictly controlled & predictable

Maturation & Specialisation. Occurrs before dividing. Strictly controlled.

Reproduction = Cell deathContact Inhibition. Mechanism for

switching off division when in contact with different cells

Recognition. Like cells stay together.

Cancer Cell Characteristics:

Unchecked & Uncontrolled GrowthLoss of contact inhibitionLoss of capacity to differentiateIncreased growth fractionChromosomal InstabilityCapacity to metastasiseAltered biochemical properties

Chemotherapy and Cancer Cells

Cell Cycle specific :Most active against cells in a specificphase therefore need prolonged exposureor repeated doses.

Cell Cycle Non-specific:Most effective against actively dividingcells but also effective in G0.

Chemotherapy

Chemotherapy may be used conventionally to:

Cure patientsProlong survivalPalliative care symptom control

Chemotherapy

Combination Therapy. Prevents resistance.Adjuvant Therapy. Administered after primary therapye.g.SurgeryNeo adjuvant Therapy: Given before surgery to reducetumour size.

Chemotherapy

Over 50 different chemotherapy drugs

Administered as an outpatient or inpatientdepending on toxicity

Modes of administration include: Oral e.g. Methotrexate, Hydroxyurea IV: Canula/Indwelling Central Venous Catheter Sub cut Intracavity e.g pelvic cavity, bladder Intrathecal. Can be fatal if wrong drug administered!

Intrathecal Chemotherapy

Chemotherapy Side Effects

Chemotherapy targets cells which are dividing rapidly.

Chemotherapy cannot distinguish between normal cells and cancer cells

Healthy Cells which have a high rate of growth and multiplication include cells of the bone marrow, hair, GI mucosa and skin.

Chemotherapy Side effects contd…

Side effects may be drug specific e.g. anthracyclines and cardiotoxicity, vinca alkaloids and neuropathy/constipation, bleomycin and pulmonary fibrosis

Severity of side effects varies between drugs.

Side effects often occur 7-14 days post treatment.

Side Effects: Acute

Tumour Lysis Syndrome. A Metabolic Emergency.Occurrs due to rapid cell lysis (death) &

large amounts of cell metabolites in blood.

If untreated can lead to acute renal failure, cardiac arrest and death.

Side Effects: Acute

Neutropenic Sepsis:Occurs due to Bone Marrow Failure andpoor immune response to infection. Predisposing factors include:NeutropeniaUnderlying diseaseChemotherapyVenous access devices

Neutropenic Sepsis

Severe overwhelming infection where inadequate blood flow to the tissues results in cellular dysfunction and, if not reversed, eventual organ failure.

Most common micro organism is gram negative

Mortality rate 40-90%

Side Effects: Acute

Haemorrhage• Invading tumours e.g gastric MALT

lymphomas• Haemorrhagic Cystitis related to high

dose Cyclophosphomide

Anaphylactic Reaction

Side Effects:Bone Marrow

Neutropenia:

Increased risk of infection.

Anaemia:

Tiredness, lethargy & breathlessness

Thrombocytopenia:

Increased risk of bleeding

Side Effects: Gastro-Intestinal

Nausea & VomitingDiarrhoea & constipationLoss of appetiteTaste ChangesMucositis

Side Effects

Example of Grade 4 Mucositis

Side Effects: Body Image

Hair LossWeight Loss/ Weight GainLong term central venous cathetersSkin changes (colour, rashes, sensitivity

to sunshine/chlorine, dry)

Side Effects: Other

Fatigue: Often multi-factorialPeripheral neuropathyAltered Kidney FunctionChanges in hearing (high dose Cisplatin)Cardiac Toxicity (Doxorubicin/

Idarubicin)Late Effects: Infertility, secondary

malignancy, growth retardation.

Case Study

17 year old girl with Hodgkins disease. Has had 3 cycles of chemotherapy treatment and is halfway through the course. She is feeling sick up to 24 hours before coming to hospital for treatment and vomiting up to 48 hours after receiving chemotherapy. She has lost 1 stone in weight in 2 months, she feels tired and is not wanting to have any more treatment.

Case Study

36 year old lady just diagnosed with None Hodgkins Lymphoma. She works part time as a beauty therapist and has 2 small children under the age of 5. She is to receive outpatient chemotherapy of R-CHOP and requires a long term central venous catheter.

What would you include in your nursingassessment?

How can nurses help.

Information and Education. What to do if unwell. Infection is a big risk! Advice on Symptom Control Timely administration of drugs Regular assessment of side effects and

effectiveness of interventions e.g anti emetics, analgesia etc

Nutritional assessment and intervention

How can nurses help

Psychological Care: Body Image, Diagnosis of life threatening disease, Fear of dying

Involve Family members, talking to children about parents diagnosis etc

Consider Sexual advice needed Consider financial implications Direct to supportive services in their area eg

support groups, complementary therapies etc. Refer to Community Team if support at home

needed

Points about Administration: Staff

Must be administered by chemotherapy trained nurses only

Safe handling is essential. Cytotoxic drugs are carcinogenic, mutagenic and teratogenic.

Potential exposure occurs during: preparation, administration and changing lines, handling of body fluids e.g urine, handling of chemo waste products e.g lines, medication bottles, spillage / leakage of chemotherapy.

ALWAYS TAKE UNIVERSAL PRECAUTIONS

Key Points:

Chemotherapy is a major treatment in curing or prolonging survival in cancer patients

It has a wide range of side effects depending on the drugs given.

Nurses have a key role to play in caring for a patient receiving chemotherapy

Safety issues are paramount in administration.

Summary:

The potential benefit to the patient of treatment as an option must

always outweigh the toxic effects.