basic principles chemoteraphy martin

7/25/2019 Basic Principles Chemoteraphy Martin

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ChemotherapyChemotherapy


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BackgroundBackground

Chemotherapy (cytotoxic) drugsChemotherapy (cytotoxic) drugs

Infuence on the synthesis o DNA, RNA or proteinInfuence on the synthesis o DNA, RNA or protein

a!ority o drugs are not acti"e to resting ce##s ($a!ority o drugs are not acti"e to resting ce##s ($%%))

C#assi&cation'C#assi&cation'

hasespeci&c drugshasespeci&c drugs

Ce## cyc#especi&c drugs' e*ecti"e +hi#e ce##s are acti"e#y inCe## cyc#especi&c drugs' e*ecti"e +hi#e ce##s are acti"e#y in

cyc#ecyc#e

Ce## cyc#enon speci&c drugs' e*ecti"e +hether cancer ce##sCe## cyc#enon speci&c drugs' e*ecti"e +hether cancer ce##s

are in cyc#e or are restingare in cyc#e or are resting


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Cell cycle phase-specifc chemotherapeuticCell cycle phase-specifc chemotherapeutic

agentsagentsPhase oPhase o ClassClass TypeType Characteristic AgentsCharacteristic Agents

Greatest ActivityGreatest Activity

$ap ($)$ap ($) Natura# productNatura# product -n.yme-n.yme AsparaginaseAsparaginase

/ormone/ormone CorticosteroidCorticosteroid rednisonerednisone

$01 !unction$01 !unction Antimeta2o#iteAntimeta2o#ite urine ana#ogurine ana#og C#adri2ineC#adri2ine

DNA synthesis (1)DNA synthesis (1) Antimeta2o#iteAntimeta2o#ite yrimidine ana#ogyrimidine ana#og Cytara2ine, fuorouraci#, gemcita2ineCytara2ine, fuorouraci#, gemcita2ine

Antimeta2o#iteAntimeta2o#ite 3o#ic acid ana#og3o#ic acid ana#og ethotrexateethotrexate Antimeta2o#iteAntimeta2o#ite urine ana#ogurine ana#og

4hioguanine, fudara2ine4hioguanine, fudara2ine Natura# productNatura# product 4opoisomerase I4opoisomerase I 4opotecan4opotecaninhi2itorinhi2itor

isce##aneousisce##aneous 1u2stituted urea1u2stituted urea /ydroxyurea/ydroxyurea

$ap 5 ($5)$ap 5 ($5) Natura# productNatura# product Anti2ioticAnti2iotic 6#eomycin6#eomycin

Natura# productNatura# product 4opoisomerase II4opoisomerase II -toposide-toposide

inhi2itorinhi2itor

Natura# productNatura# product icrotu2u#eicrotu2u#e ac#itaxe#ac#itaxe#

po#ymeri.ation and sta2i#i.ationpo#ymeri.ation and sta2i#i.ation

itosis ()itosis ()Natura# productNatura# product itotic inhi2itoritotic inhi2itor 7in2#astine, "incristine,7in2#astine, "incristine, "indesine,"indesine,

"inore#2ine"inore#2ine


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Cell cycle-specifc and cell cycle-nonspecifcCell cycle-specifc and cell cycle-nonspecifc

chemotherapeutic agentschemotherapeutic agents

ClassClass TypeType Characteristic AgentsCharacteristic Agents

Cell cycle-specifcCell cycle-specifc

A#8y#ating agentA#8y#ating agent Nitrogen mustardNitrogen mustard Ch#oram2uci#, cyc#ophosphamide,Ch#oram2uci#, cyc#ophosphamide,

me#pha#anme#pha#an

A#8y# su#onateA#8y# su#onate 6usu#an6usu#an

4ria.ene4ria.ene Dacar2a.ineDacar2a.ine

eta# sa#teta# sa#t Cisp#atin, car2op#atinCisp#atin, car2op#atin

Natura# productNatura# product Anti2ioticAnti2iotic Dactinomycin, daunoru2icin,Dactinomycin, daunoru2icin,

doxoru2icin,doxoru2icin, idaru2icinidaru2icin

Cell cycle-nonspecifcCell cycle-nonspecifc

A#8y#ating agentA#8y#ating agent Nitrogen mustardNitrogen mustard ech#orethamineech#orethamine

NitrosoureaNitrosourea Carmustine, #omustineCarmustine, #omustine


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ComplicationsComplications


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Time o occurence oTime o occurence o

complicationscomplications

Immediate onset (hours to days)'Immediate onset (hours to days)'

Naussea0"omiting, ph#e2itis, hyperuricemia, rena# ai#ure,Naussea0"omiting, ph#e2itis, hyperuricemia, rena# ai#ure,

anaphy#axis, s8in rash, teratogenicityanaphy#axis, s8in rash, teratogenicity

/emorrhagic cystitis (cytoxan)/emorrhagic cystitis (cytoxan)

3e"er0chi##s (2#eomycin)3e"er0chi##s (2#eomycin)

/ypertension (procar2a.ine)/ypertension (procar2a.ine)

/ypotension (etoposide)/ypotension (etoposide)


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-ar#y onset (days to +ee8s)'-ar#y onset (days to +ee8s)'

9eu8openia, throm2ocytopenia, a#opecia, stomatitis, diarrhea,9eu8openia, throm2ocytopenia, a#opecia, stomatitis, diarrhea,

mega#o2#astosismega#o2#astosis

ara#ytic i#eus ("incristine)ara#ytic i#eus ("incristine)

/yperca#cemia (estrogens, antiestrogens)/yperca#cemia (estrogens, antiestrogens)

/ypomagnesemia (cisp#atin)/ypomagnesemia (cisp#atin)

ancreatitis (9asparginase)ancreatitis (9asparginase)

3#uid retention (estrogen, steroid)3#uid retention (estrogen, steroid)

u#monary intrates (methotrexate, 2#eomycin)u#monary intrates (methotrexate, 2#eomycin)

:totoxicity (cisp#atin):totoxicity (cisp#atin)


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De#ayed onset (+ee8s to months)'De#ayed onset (+ee8s to months)'

Anemia, aspermia, hepatoce##u#ar damage, hyperpigmentation,Anemia, aspermia, hepatoce##u#ar damage, hyperpigmentation,

pu#monary &2rosispu#monary &2rosis

eriphera# neuropathy ("incristine, cisp#atin)eriphera# neuropathy ("incristine, cisp#atin)

Cardiac necrosis (Cardiac necrosis (anthracyc#inesanthracyc#ines, cyc#ophosphamide), cyc#ophosphamide)

1IAD/ (cyc#ophosphamide, "incristine)1IAD/ (cyc#ophosphamide, "incristine)

/emo#yticuremic syndrome (mitomycin C)/emo#yticuremic syndrome (mitomycin C)


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9ate onset (months to years)'9ate onset (months to years)'

1teri#ity, hypogonadism, premature menopause, second1teri#ity, hypogonadism, premature menopause, second

ma#ignancyma#ignancy

/epatic &2rosis0cirrhosis (methotrexate)/epatic &2rosis0cirrhosis (methotrexate)

-ncepha#opathy (methotrexate)-ncepha#opathy (methotrexate)

Cancer o the 2#adder (cyc#ophosphamide)Cancer o the 2#adder (cyc#ophosphamide)


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Acute reactions - ExtravasationAcute reactions - Extravasation

-xtra"asation' #ea8age or intration o drug into the-xtra"asation' #ea8age or intration o drug into the

su2cutaneous tissuessu2cutaneous tissues

7esicant drugs' tissue necrosis or s#oughing7esicant drugs' tissue necrosis or s#oughing

Irritant drugs' infammation or painIrritant drugs' infammation or pain

Incidence' ;


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Irritant chemotherapy agents inc#ude'Irritant chemotherapy agents inc#ude'

2#eomycin, car2op#atin, carmustine, cisp#atin, dacar2a.ine,2#eomycin, car2op#atin, carmustine, cisp#atin, dacar2a.ine,

deni#eu8in di&tox, doxoru2icin, doxoru2icin #iposome, etoposide,deni#eu8in di&tox, doxoru2icin, doxoru2icin #iposome, etoposide,

iosamide, strepto.ocin, teniposide, thiotepa, "inore#2ineiosamide, strepto.ocin, teniposide, thiotepa, "inore#2ine

7esicant chemotherapy agents inc#ude'7esicant chemotherapy agents inc#ude'

Dactinomycin, daunoru2icin, doxoru2icin, epiru2icin, idaru2icin,Dactinomycin, daunoru2icin, doxoru2icin, epiru2icin, idaru2icin,

mech#orethamine, mitomycin, mitoxantrone, pac#itaxe#,mech#orethamine, mitomycin, mitoxantrone, pac#itaxe#,strepto.ocin, tenoposide, "in2#astine, "incristine, "inore#2inestrepto.ocin, tenoposide, "in2#astine, "incristine, "inore#2ine


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Ris8 actors or periphera# extra"asation'Ris8 actors or periphera# extra"asation'

1ma##, ragi#e "eins1ma##, ragi#e "eins

7enipuncutre techni>ue7enipuncutre techni>ue

1ite o "enipuncutre1ite o "enipuncutre Drug administration techni>ueDrug administration techni>ue

-xcessi"e mo"ements-xcessi"e mo"ements


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anagement o periphera# extra"asation'anagement o periphera# extra"asation'

1top administration1top administration

9ea"e the need#e0catheter in p#ace9ea"e the need#e0catheter in p#ace

Immo2i#i.e the extremityImmo2i#i.e the extremity Attempt to aspirate any residua# drug in the tu2ing, need#e, orAttempt to aspirate any residua# drug in the tu2ing, need#e, or

suspected extra"asation sitesuspected extra"asation site

Administer the appropriate antidote, coo# or +arm compressAdminister the appropriate antidote, coo# or +arm compress

-#e"ate the site-#e"ate the site

:2ser"e or secondary comp#ications' inection, pain:2ser"e or secondary comp#ications' inection, pain


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anagement o centra# extra"asation'anagement o centra# extra"asation'

-xtra"asation in upper torso or nec8 area is di?cu#t to manage-xtra"asation in upper torso or nec8 area is di?cu#t to manage

rocedures are simi#ar to periphera# extra"asationrocedures are simi#ar to periphera# extra"asation


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Common vesicant and irritant drugCommon vesicant and irritant drug

and potential antidoteand potential antidote

ChemotherapyChemotherapy harmaco#ogicharmaco#ogic :ther:ther Administration o antidoteAdministration o antidote

agentagent antidoteantidote managementmanagement

Cisp#atinCisp#atin Nathiosu#ateNathiosu#ate NoneNone 3or #arge extra"asation on#y3or #arge extra"asation on#y (@5% m9 o cisp#atin(@5% m9 o cisp#atinso#utionso#ution +ith %B mg0m9) se 5 m9+ith %B mg0m9) se 5 m9

%< Nathiosu#ate so#ution or%< Nathiosu#ate so#ution or each %% mg cisp#atineach %% mg cisp#atin

Doxoru2icin,Doxoru2icin, NoneNone 4opica# coo#ing4opica# coo#ing Co#d pad +ith circu#ating iceCo#d pad +ith circu#ating ice

Daunoru2icinDaunoru2icin +ater or B5% min at #east x0d+ater or B5% min at #east x0d or &rst 5E hor &rst 5E h

Dimethy# su#oxide (D1:) FF


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ExtravasationExtravasation- Prevention- Prevention

4he preerred site or esta2#ishing an intra"enous or the4he preerred site or esta2#ishing an intra"enous or the

purposes o chemotherapy administration is'purposes o chemotherapy administration is'

A #arge super&cia# "ein on the orearm 2et+een the +rist andA #arge super&cia# "ein on the orearm 2et+een the +rist and

antecu2ita# ossaantecu2ita# ossa

A+ay rom areas o 2ruisingA+ay rom areas o 2ruising

roxima# to "enipuncture sites esta2#ished +ithin the precedingroxima# to "enipuncture sites esta2#ished +ithin the preceding

5 hours5 hours

A+ay rom !oints or tendonsA+ay rom !oints or tendons

7eins in #o+er extremities are used as a #ast resort +hen 2oth7eins in #o+er extremities are used as a #ast resort +hen 2oth

arms are contraindicatedarms are contraindicated


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ExtravasationExtravasation- Prevention- Prevention

4ype and 1i.e o eriphera# I7 De"ice'4ype and 1i.e o eriphera# I7 De"ice'

A sma##er gauge need#e0catheter has the o##o+ing ad"antages'A sma##er gauge need#e0catheter has the o##o+ing ad"antages'

#ess #i8e#y to puncture the +a## o a sma##er "ein#ess #i8e#y to puncture the +a## o a sma##er "ein

#ess scar tissue ormed +ith re>uent "enipunctures#ess scar tissue ormed +ith re>uent "enipunctures

increased 2#ood fo+ around the need#e a##o+s or greater andincreased 2#ood fo+ around the need#e a##o+s or greater and

aster di#ution o chemotherapy drugsaster di#ution o chemotherapy drugs

may decrease mechanica# ph#e2itismay decrease mechanica# ph#e2itis

A need#e0catheter guage 2et+een H5 and H5B is theA need#e0catheter guage 2et+een H5 and H5B is the

preerred choice or chemotherapy administrationpreerred choice or chemotherapy administration


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e!uence o drug administratione!uence o drug administration

4he recommended practice is to administer "esicants &rst4he recommended practice is to administer "esicants &rst

"enous integrity is good"enous integrity is good

"ein is most sta2#e and #ess irritated"ein is most sta2#e and #ess irritated

assessment o "ein patency is most accurateassessment o "ein patency is most accurate #ess chance o compromised "ascu#ar integrity#ess chance o compromised "ascu#ar integrity


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Acute reaction " #ypersensitivity andAcute reaction " #ypersensitivity and

anaphylaxisanaphylaxis

/istory o a#ergy/istory o a#ergy

Administered under constant super"isionAdministered under constant super"ision

4he most common chemotherapyinduced reaction is type I4he most common chemotherapyinduced reaction is type I

hypersensti"ityhypersensti"ity

aniestation' urticaria, respiratory distress, 2ronchospasm,aniestation' urticaria, respiratory distress, 2ronchospasm,

hypotension, angioedema, fushing, chest and 2ac8 pain,hypotension, angioedema, fushing, chest and 2ac8 pain,

anxietyanxiety

4est doses or s8in test may 2e perormed i there is an4est doses or s8in test may 2e perormed i there is an

increased suspicion or hypersensiti"ityincreased suspicion or hypersensiti"ity


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Common#y used premedications'Common#y used premedications'

dexamethasone, diphenhydramine, /5histamine antagonistdexamethasone, diphenhydramine, /5histamine antagonist

(cimetidine, ranitidine, amotidine)(cimetidine, ranitidine, amotidine)

-mergency e>uipment shou#d 2e immediate#y accessi2#e-mergency e>uipment shou#d 2e immediate#y accessi2#e


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Drugs +ith the highest ris8 o immediate hypersensiti"ity'Drugs +ith the highest ris8 o immediate hypersensiti"ity'

Asparginase, murine monoc#ona# anti2odies (i2ritumoma2Asparginase, murine monoc#ona# anti2odies (i2ritumoma2

tiuxetan), pac#itaxe#tiuxetan), pac#itaxe#

Drugs +ith a #o+ to moderate ris8'Drugs +ith a #o+ to moderate ris8' Anthracyc#ines, 2#eomycin, cisp#atin, car2op#atin, docetaxe#, I7Anthracyc#ines, 2#eomycin, cisp#atin, car2op#atin, docetaxe#, I7

me#pha#an, etoposide, humani.ed monoc#ona# anti2odiesme#pha#an, etoposide, humani.ed monoc#ona# anti2odies

(trastu.uma2), chimeric monoc#ona# anti2odies (rituxima2)(trastu.uma2), chimeric monoc#ona# anti2odies (rituxima2)


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anagement'anagement'

1top inussion o chemotherapy agent1top inussion o chemotherapy agent

aintain I7 access +ith norma# sa#ine at 5%% m90h unti## 2#oodaintain I7 access +ith norma# sa#ine at 5%% m90h unti## 2#ood

pressure sta2i#i.espressure sta2i#i.es

Administer oxygen at 5 90min and measure pu#se oxymetryAdminister oxygen at 5 90min and measure pu#se oxymetry

Administer methy#predniso#one 5B mg I7Administer methy#predniso#one 5B mg I7

Administer diphenhydramine B% mg I7Administer diphenhydramine B% mg I7

Continuous#y monitor "ita# signsContinuous#y monitor "ita# signs

I symptoms do not reso#"e or +orsen, administer ephinephrineI symptoms do not reso#"e or +orsen, administer ephinephrine


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$ausea and vomiting$ausea and vomiting

1hou#d 2e pre"ent1hou#d 2e pre"ent

4he goa# o therapy is to pre"ent phases o nausea and4he goa# o therapy is to pre"ent phases o nausea and

"omiting'"omiting'

6eore chemotherapy (anticipatory)6eore chemotherapy (anticipatory) Githin the &rst 5 h ater chemotherapy (acute)Githin the &rst 5 h ater chemotherapy (acute)

Ater 5 h ater chemotherapy (de#ayed)Ater 5 h ater chemotherapy (de#ayed)

Chemotherapy agents are grouped according to theirChemotherapy agents are grouped according to their

emetic potentia#emetic potentia#


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$ausea and vomiting$ausea and vomiting

Antiemetic drugs'Antiemetic drugs' Dopamine receptors antagonistsDopamine receptors antagonists

1erotonin (B/4) receptors antagonists1erotonin (B/4) receptors antagonists

Neuro8inintype (NJ) receptor antagonistsNeuro8inintype (NJ) receptor antagonists

CorticosteroidCorticosteroid

Com2ination antiemetic therapyCom2ination antiemetic therapy

1ho+n to 2e more e*ecti"e1ho+n to 2e more e*ecti"e

Nonpharmaco#ogic inter"entionNonpharmaco#ogic inter"ention

assage therapy, music therapy, se#hypnosis, acupressure,assage therapy, music therapy, se#hypnosis, acupressure,

acupuncture, 4-N1acupuncture, 4-N1

1ma##er, more re>uent mea#s o##o+ing chemotherapy1ma##er, more re>uent mea#s o##o+ing chemotherapy


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tomatitistomatitis

:ra# mucosa is "u#nera2#e to the e*ects o chemotherapy:ra# mucosa is "u#nera2#e to the e*ects o chemotherapy

Comp#ication' secondary inection, ma#nutritionComp#ication' secondary inection, ma#nutrition


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tomatitistomatitis

Causes'Causes'

Antimeta2o#ites' 4K, fuorouraci#, capecita2ine, cytara2ine,Antimeta2o#ites' 4K, fuorouraci#, capecita2ine, cytara2ine,

irinotecanirinotecan

Anti2iotics' doxoru2icin, idaru2icin, dactinomycin, mitomycin,Anti2iotics' doxoru2icin, idaru2icin, dactinomycin, mitomycin,

2#eomycin2#eomycin

#ant a#8a#oids' "incristine, "in2#astine, "inore#2ine#ant a#8a#oids' "incristine, "in2#astine, "inore#2ine

4axanes' docetaxe#, pac#itaxe#4axanes' docetaxe#, pac#itaxe#

A#8y#ating agents' high doses o 2usu#an, cyc#ophosphamideA#8y#ating agents' high doses o 2usu#an, cyc#ophosphamide 6io#ogic agents' inter#eu8ins, #ympho8ineacti"ated 8i##er ce##6io#ogic agents' inter#eu8ins, #ympho8ineacti"ated 8i##er ce##

therapytherapy


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tomatitistomatitis

Assessment o mucous mem2ranes'Assessment o mucous mem2ranes'

Co#or, intactness, u#ceration, 2#eeding, inectionCo#or, intactness, u#ceration, 2#eeding, inection

3unctiona# assessment' a2i#ity to eat and drin83unctiona# assessment' a2i#ity to eat and drin8

Degree o stomatitis'Degree o stomatitis'

$rade I' erythema o ora# mucosa$rade I' erythema o ora# mucosa

$rade II' iso#ated sma## u#ceration or +hite patches atient a2#e to$rade II' iso#ated sma## u#ceration or +hite patches atient a2#e to

eat and drin8eat and drin8

$rade III' confuent u#ceration or +hite patches co"ering @ 5B< o$rade III' confuent u#ceration or +hite patches co"ering @ 5B< o

ora# mucosa atient a2#e on#y to drin8 fuidsora# mucosa atient a2#e on#y to drin8 fuids

$rade I7' /emorrhagic u#ceration, u#ceration co"ering @ B%< o$rade I7' /emorrhagic u#ceration, u#ceration co"ering @ B%< o

ora# mucosa atient una2#e to drin8 fuids or eatora# mucosa atient una2#e to drin8 fuids or eat


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tomatitistomatitis

re"ention're"ention'

$ood ora# hygiene$ood ora# hygiene

$ood nutrtion$ood nutrtion

anagement'anagement' C#eansing agents, #u2ricating agents, ana#gesic agents,C#eansing agents, #u2ricating agents, ana#gesic agents,

pre"enti"e agentspre"enti"e agents

ainu# u#ceration'ainu# u#ceration'

1tomatitis mixture' Diphenhydramine e#ixir B m9 L antasid %1tomatitis mixture' Diphenhydramine e#ixir B m9 L antasid %

m9 L "iscous #idocaine B m9m9 L "iscous #idocaine B m9


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tomatitistomatitis

KerostomiaKerostomia

3o##o+s radiation therapy o head and nec83o##o+s radiation therapy o head and nec8

4reatment' arti&cia# sa#i"a or pi#ocarpine B% mg : tid 2eore4reatment' arti&cia# sa#i"a or pi#ocarpine B% mg : tid 2eore

mea#smea#s

6eore radiation'6eore radiation'

Denta# consu#tation to e"a#uate ora# hygiene, the state oDenta# consu#tation to e"a#uate ora# hygiene, the state o

repair o the teeth, the hea#th o the gumsrepair o the teeth, the hea#th o the gums


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tomatitistomatitis

1econdary ora# inections1econdary ora# inections

1hou#d 2e treated prompt#y and as accurate#y as possi2#e1hou#d 2e treated prompt#y and as accurate#y as possi2#e

3unga# inections' nystatin suspension, c#otrima.o#e troches,3unga# inections' nystatin suspension, c#otrima.o#e troches,

ora# fucona.o#eora# fucona.o#e

7ira# inections' ora# or I7 acyc#o"ir7ira# inections' ora# or I7 acyc#o"ir


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Agents or oral careAgents or oral care

AgentsAgents %ndications and comments%ndications and comments

C#eansing agentsC#eansing agents

Norma# sa#ine so#utionNorma# sa#ine so#ution -conomica#, nondamaging-conomica#, nondamaging

/ydrogen peroxide/ydrogen peroxide $ermicida#, de2riding$ermicida#, de2riding

1odium 2icar2onate1odium 2icar2onate Nonirritating, de2ridingNonirritating, de2riding

Ch#orhexidineCh#orhexidine ay decrease inectionay decrease inection

9u2ricating agents9u2ricating agents

1a#i"a su2stitutes1a#i"a su2stitutes Decreases drynessDecreases dryness

Gater2ased #u2ricantsGater2ased #u2ricants seu# emo##ientseu# emo##ient

re"ention agents hemato#ogic gro+th actorsre"ention agents hemato#ogic gro+th actors

3i#grastim, 1argramostim3i#grastim, 1argramostim 9ess se"ere mucositis experienced 2y patients9ess se"ere mucositis experienced 2y patients

recei"ing gro+th actorsrecei"ing gro+th actors


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Agents or oral careAgents or oral care

AgentsAgents %ndications and comments%ndications and commentsAna#gesic agentsAna#gesic agents

/ea#ing and coating agents/ea#ing and coating agents

1u#cra#ate1u#cra#ate 6inds to mucosa, orms protecti"e coating6inds to mucosa, orms protecti"e coating

7itamin -7itamin - rotection to mucosa, hea#ing propertiesrotection to mucosa, hea#ing properties

AntacidsAntacids -nhance comort, coat mucosa-nhance comort, coat mucosa

A##opurino#A##opurino# ay decrease intensity o mucositis +ith fuorouraci#ay decrease intensity o mucositis +ith fuorouraci#

4opica# anesthetics4opica# anesthetics

9idocaine "iscous9idocaine "iscous 4ransient pain re#ie, a2sor2ed systemica##y4ransient pain re#ie, a2sor2ed systemica##y

Dic#onime hydroch#orideDic#onime hydroch#oride 4ransient pain re#ie4ransient pain re#ie

6en.ocaine6en.ocaine 4ransient pain re#ie4ransient pain re#ie

1ystemic ana#gesics1ystemic ana#gesics

N1AIDs, Narcotic ana#gesicN1AIDs, Narcotic ana#gesic 4a8e 2eore mea#s and as needed4a8e 2eore mea#s and as needed


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&iarrhea&iarrhea

Causes'Causes'

Chemotherapy, radiotherapy, the cancer itse#, medications,Chemotherapy, radiotherapy, the cancer itse#, medications,

supp#ementa# eedings, anxiety, inectionssupp#ementa# eedings, anxiety, inections

Chemotherapy agents'Chemotherapy agents'

Antimeta2o#ites' fuorouraci#, capecita2ine, 4K, cytara2ine,Antimeta2o#ites' fuorouraci#, capecita2ine, 4K, cytara2ine,

irinotecan, dactinomycin, hydroxyurea, pac#itaxe#irinotecan, dactinomycin, hydroxyurea, pac#itaxe#

Comp#ications'Comp#ications' Discomort, se"ere e#ectro#yte im2a#ances, dehydration, poorDiscomort, se"ere e#ectro#yte im2a#ances, dehydration, poor

>ua#ity o #ie>ua#ity o #ie


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&iarrhea&iarrhea

anagementanagement

-"a#uation o stoo# samp#es or inection-"a#uation o stoo# samp#es or inection

In the a2sence o inection'In the a2sence o inection'

:pioids (#operamide, diphenoxy#ate, codeine:pioids (#operamide, diphenoxy#ate, codeine

Anticho#inergics (atropine, scopo#amine)Anticho#inergics (atropine, scopo#amine)

9o+residue diet and increase fuids9o+residue diet and increase fuids

I7 hydration to pre"ent serious hypo"o#emia, e#ectro#yteI7 hydration to pre"ent serious hypo"o#emia, e#ectro#yte

distur2ance and shoc8distur2ance and shoc8


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ConstipationConstipation

anagementanagement

-"a#uation o stoo# samp#es or inection-"a#uation o stoo# samp#es or inection

In the a2sence o inection'In the a2sence o inection'

:pioids (#operamide, diphenoxy#ate, codeine:pioids (#operamide, diphenoxy#ate, codeine

Anticho#inergics (atropine, scopo#amine)Anticho#inergics (atropine, scopo#amine)

9o+residue diet and increase fuids9o+residue diet and increase fuids

I7 hydration to pre"ent serious hypo"o#emia, e#ectro#yteI7 hydration to pre"ent serious hypo"o#emia, e#ectro#yte

distur2ance and shoc8distur2ance and shoc8


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Bone marro' depressionBone marro' depression

Dose#imiting toxicityDose#imiting toxicity

4emporari#y in!u4emporari#y in!urered 2y chemotherapyd 2y chemotherapy

Chemotherapy does not a*ect circu#ating, mature 2#oodChemotherapy does not a*ect circu#ating, mature 2#ood

ce##s (no #onger di"iding)ce##s (no #onger di"iding)

Chemotherapy damages stem ce##s, decreasing 2oneChemotherapy damages stem ce##s, decreasing 2one

marro+Ms a2i#ity to rep#ace the 2odyMs used 2#ood ce##marro+Ms a2i#ity to rep#ace the 2odyMs used 2#ood ce##

e#ementse#ements


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6#ood ce##s ha"e a &xed #ie span (G6C ; hours, p#ate#ets %6#ood ce##s ha"e a &xed #ie span (G6C ; hours, p#ate#ets %

days, R6C 5% days)days, R6C 5% days)

4he e*ect in #o+ering 2#ood counts occurs at a predicta2#e4he e*ect in #o+ering 2#ood counts occurs at a predicta2#e

time ater chemotherapy, usua##y days depending ontime ater chemotherapy, usua##y days depending onthe speci&c drugthe speci&c drug

4he #o+est point reached in the periphera# 2#ood count ater4he #o+est point reached in the periphera# 2#ood count ater

chemotherapy is administered is ca##ed the nadirchemotherapy is administered is ca##ed the nadir


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BB%< stem ce##s in 2one marro+ are in the $BB%< stem ce##s in 2one marro+ are in the $%%(resting(resting

stage), so they can escape rom ce## cyc#e phasespeci&cstage), so they can escape rom ce## cyc#e phasespeci&c

agentsagents

In com2ination chemotherapy, a drug +ith an ear#y nadirIn com2ination chemotherapy, a drug +ith an ear#y nadirand reco"ery in 55E days can 2e administered e"ery and reco"ery in 55E days can 2e administered e"ery

+ee8s+ee8s

Drugs +ith de#ayed 2one marro+ depression, +hich can 2eDrugs +ith de#ayed 2one marro+ depression, +hich can 2e

administered e"ery ;E +ee8sadministered e"ery ;E +ee8s


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7incristine, 2#eomycin, cisp#atin in moderate doses, 97incristine, 2#eomycin, cisp#atin in moderate doses, 9

asparginase, steroid hormones do not cause signi&cantasparginase, steroid hormones do not cause signi&cant

2one marro+ depression2one marro+ depression

4he degree o 2one marro+ depression is a#so infuenced 2y4he degree o 2one marro+ depression is a#so infuenced 2yother host actors' age, drug dose, nutritiona# state, 2oneother host actors' age, drug dose, nutritiona# state, 2one

marro+ reser"e, a2i#ity to meta2o#i.e drug, prior treatmentmarro+ reser"e, a2i#ity to meta2o#i.e drug, prior treatment


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Age' ad"anced age is oten associated +ith reducedAge' ad"anced age is oten associated +ith reduced

unctiona# 2one marro+ reser"es, reco"ery may 2e de#ayedunctiona# 2one marro+ reser"es, reco"ery may 2e de#ayed

roteinca#orie ma#nutrition may reduce the a2i#ity to repairroteinca#orie ma#nutrition may reduce the a2i#ity to repair

norma# ce##s damaged 2y chemotherapynorma# ce##s damaged 2y chemotherapy 6one marro+ reser"e' reduced in signi&cant a#coho# a2use6one marro+ reser"e' reduced in signi&cant a#coho# a2use

(atty marro+) and those +ith tumor in"asion o the 2one(atty marro+) and those +ith tumor in"asion o the 2one

marro+marro+


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De#ay treatment or reduce drug dosageDe#ay treatment or reduce drug dosage

Rena# and hepatic dysunction resu#t in pro#onged, e#e"atedRena# and hepatic dysunction resu#t in pro#onged, e#e"ated

circu#ating #e"e#s o drug +ith increased toxicitycircu#ating #e"e#s o drug +ith increased toxicity

Radiation to sites o 2one marro+ production may causeRadiation to sites o 2one marro+ production may cause2one marro+ atrophy or &2rosis and decreased 2one2one marro+ atrophy or &2rosis and decreased 2one

marro+ reser"esmarro+ reser"es


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Comp#ication' inection is the most re>uentComp#ication' inection is the most re>uent

A2so#ute neutrophi# count (ANC)'A2so#ute neutrophi# count (ANC)'

ANC B%%5%%%0mm' no signi&cant ris8ANC B%%5%%%0mm' no signi&cant ris8

ANC %%%B%%0mm' minima# ris8ANC %%%B%%0mm' minima# ris8

ANC B%%%%%0mm' moderate ris8ANC B%%%%%0mm' moderate ris8

ANC OB%%0mm' se"ere ris8ANC OB%%0mm' se"ere ris8

ANC O%%0mm' ris8 %%


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Prevention o inectionPrevention o inection

aintaining intact s8in and mucous mem2rane 2arriersaintaining intact s8in and mucous mem2rane 2arriers

-#iminating exposure to inecting organism (hands o hea#th-#iminating exposure to inecting organism (hands o hea#th

care +or8ers)care +or8ers)

aintaining a +e##nourished stateaintaining a +e##nourished state Restoration o an ade>uate neutrophi# count to pre"entRestoration o an ade>uate neutrophi# count to pre"ent

e2ri#e neutropenia can 2e induced 2y $C13 and $C13e2ri#e neutropenia can 2e induced 2y $C13 and $C13


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4/ANJ P:4/ANJ P:

basic principles chemoteraphy martin

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