Cancer Treatment | NURS211

Clayton Chapter 43

what is cancer?

diseases characterized by uncontrolled cellular growth, tissue invasion, and distant metastases (sites beyond the original growth site)

what are the main factors that contribute to the development of cancer?

1. the environment (based on socioeconomic, environmental hazard exposure, etc)

2. genetic

true or false: for most types of cancers, Black or African American population have the highest mortality rate than all other racial and ethnic groups

true

true or false: the incidence rates of colorectal, lung, and cervical cancer are higher for those who live in rural Appalachian areas compared to those who live in more urban areas (socioeconomic status played a HUGE factor!)

true

true or false: people with more education are less likely to die before the age of 65 than those with less education, regardless of their race or ethnicity

true

true or false: the rate of smoking and alcohol use (known carcinogens) are higher among LGBTQ youth than cisgender heterosexual young adults

true

true or false: cancer care disparities are exacerbated by a lack of diversity in clinical research participation

treatment for cancer is usually multi-model which means…

there are many ways of treating cancer

what is adjuvant therapy and when in the process of cancer treatment does it usually takes place?

additional treatment given after the initial/main treatment with surgery (usually after surgery) to reduce the risk of cancer recurrence by destroying leftover cells

1. chemo

2. radiation

3. etc

what is neoadjuvant therapy and when in the process of cancer treatment does it usually takes place?

initial treatment given to shrink the cancer before surgery (given before adjuvant therapy)

1. chemo

2. radiation

3. etc

what is salvage therapy and when in the process of cancer treatment does it usually takes place?

second line therapy administered/done when first-line therapy is unsuccessful (e.g., radical prostatectomy (surgical removal of the prostate) for recurrent prostate cancer after initial radiation)

what is targeted therapy and when in the process of cancer treatment does it usually takes place?

a type of treatment “targets” cancerous cells and spares normal cells that results in fewer systemic effects than a general type of treatment would

• usually more complex and more expensive

what is biologic therapy and when in the process of cancer treatment does it usually takes place?

a type of treatment used to enable the immune system to better target and kill cancerous cells

• Examples of biologic therapies for cancer include monoclonal antibodies, which target cancer cells, and cytokines, which boost the immune system to fight cancer.

what are the three phases in which cancer treatments usually proceed along?

1. induction - induce remission - frontline (main) therapy (e.g., chemo, radiation, surgery, etc) - may be the only phase required if the cancer are not as aggressive/widespread, etc

2. consolidation (AKA intensification or post-remission therapy) - eradication of remaining cells after remission

   → usually used for hematological cancers

3. Maintenance - prevent recurrance of cancer

   → cancer occur after induction or consolidation phase and is typically the longest phase (can takes years!) and is often about making sure the cancer do not reawake

each cell goes through ____ phases of mitosis before producing daughter cell

5

chemotherapy agents that causes the cancer cell death in all phases of mitosis are called _____________

cell cycle nonspecific medications

chemotherapy agent that are effective only in one phase of mitosis are called ____________

cell cycle specific medications

for combination cancer therapy, _______ nonspecific and cell-cycle specific medications will be use to eliminate cancer cells more completely

both

what is the MOA, indications, adversed effects, and nursing considerations for alkylating agents?

1. MOA: damage cancer cell DNA (cross-link/breaks it) → cells can’t divide

2. indications: broad used in cancer → leukemia, lymphoma, solid tumors (breast, ovarian, lung)

3. adverse effects: bone marrow suppression, GI upset (N, V), alopecia + symptoms specific to each drugs within the category

4. nursing consideration: monitor CBC (infection/bleeding risks), encourage hydrations, monitor kidney functions (this class can can be hepatotoxic/nephronotoxic)

what is the MOA, indications, adversed effects, and nursing considerations for antimetabolites?

1. MOA: mimic normal cell “building blocks” (like folic acid or nucleotides) - sneak into DNA/RNA synthesis and causes the cellto not being able to replicate (cell cycle specific to S-phase)

2. indications: leukemias, lymphomas, solid tumors (breast, colon, pancreatic)

3. adverse effects: bone marrow suppression, GI upset, alopecia + symptoms specific to each medication within this class

4. nursing consideration: monitor CBC (infection/bleeding), monitor liver/kidney functions

what is the MOA, indications, adversed effects, and nursing considerations for antitutmor?

1. MOA: bind to DNA → block RNA/DNA synthesis - causes DNA strand to breaks 

2. indications: wide range of cancers: leukemia, lymphoma, breast, ovarian, and lung

3. adverse effects: bone marrow suppression, GI upset, alopecia, cardiotoxicity, pulmonary toxicity

4. nursing consideration: monitor CBC (risk of infection/bleeding)

5. strictly monitor cardiac functions (ECG< echocardiogram) → this medication can increase risk for cardiomyopathy

6. monitor lung (can lead to pulmonary fibrosis

what is the MOA, indications, adversed effects, and nursing considerations for plant alkaloid?

1. MOA: interfere with mitotic spindle formation → stop cell division at metaphase → cell cycle-specific (M-phase)

2. indications: leukemia, lymphoma, breast cancer, testicular cancer, Kaposi’s sarcoma, lung cancer.

3. adverse effects: bone suppression, peripheral neurophathy (e.g., tingling, numbness, constipation), neurotoxicity (ataxia, seizures), alopecia, GI upset, and hypersensitivity reaction 

4. nursing consideration: monitor CBC (infection risk), assess neuro status, assess bowel function, monitor for hypersensitivity reaction, use central line if possible are these drugs are vesicants

what is the MOA, indications, adversed effects, and nursing considerations for taxanes?

1. MOA: stabilize microtubes → prevent them from breading down → cell stuck in mitosis → cell death

2. indications: breast cancer, ovarian cancer, lung cancer, prostate cancer, Kaposi’s sarcoma

3. adverse effects: bone marrow suppression, peripheral neuropathy, hypersensitivity, alopecia, mucositis, N/V/D, fluid retention

4. nursing consideration: monitor CBC, monitor neuro status, assess for edema and fluid overload

what is supportive therapies in term of cancer treatments?

what are the different ways chemotherapy can be administer?

1. oral

2. subcutaneous

3. intramuscular

4. intracavitaries (inside the cavity)

5. topically

6. intrathecally (inside the of the spinal column)

7. intracranially

chemotherapeutic agents are _________! (which mean they _____ cells!!!)

cytotoxic; kill

true or false: beside from being considered as cytotoxic, chemotherapeutic agent are also considered to be vesicant

true

what is vesicant in term of cancer treatment

vesicant medications are medications taht cause severe tissue damage if they leak from the vein

what is extravasate?

[stuff] leaking from the vein

what are the symptoms that occur when vesicant extravesate?

1. kill all of the surrounding tissues and cells that are exposed to the medications (necrosis)

2. pain

3. inflammation

4. blistering

if vesicant drugs kill surrounding tissue when they leak out of a vein, why don’t they destroy the vein itself when infused?

in the bloodstream, vesicants are quickly diluted and carried away by blood flow, and the endothelium is relatively resistant - but if they extravasate into surrounding tissue, the drug stays concentrated and stagnant, causing severe local necrosis

what should the nurse do when vesicant extravasate?

1. IMMEDIATELY stop the infusion

2. take an empty syrine and take as much of the medication from the IV in the affected vein as you can

3. elevate the extremities to restore blood flow and prevent the medicationf rom spreading further

true or false: when dealing with chemotherapy, the nurse would need to perform special donning and doffing procedure with specialized PPE

true

what are alkylating agent in term of cancer treatment?

a class of chemotherapy that damages the DNA of cancer cells by substituting an alkl group for a hydrogen atom on the DNA helix which create cross-links between the two strand an make it impossible for the cells to copy their DNA and reproduce (DNA nee to be able to separate

nitrogen mustards vs mustard gas in term of cancer treatment?

1. both are alkylating agents & vesicant

2. mustard gas is a specific compoun

3. nitrogen mustard are a class of related compound

4. nitrogen mustard is the kind that is use for chemotherapy

5. nitrogen mustard is considered to be more immediately toxic

what are the three different types of alkylating agents?

1. nitrogen mustards

2. nitrosoureas

3. alkyl sulfonates

what is the method of action of cyclophospamide (Cytoxan)?

causes cross-linking of DNA during mitosis to cause nucleis acid chain breakage, resulting in cell destruction

what conditions is cyclophosphamide (Cytoxan)?

1. lymphomas

2. multiple myelomas

3. leukemia

4. ovarian an breast cancers

what are the adverse effects of cyclophosphamide (Cytoxan)?

1. myelosuppresion

2. sepsis

3. nephrotoxicity

4. pulmonary toxicity

5. cardiotoxicity

6. infertility

7. hyponatremia

8. hemorrhagic cystitis (mesna as a precaution

Do patient currently on cytoxan need to have their heart monitored?

YES! Due to the risk of cardiotoxicity, the patient’s heart would definitely need to be monitored

Do patient currently on Cytoxan need to have their kidney function monitored?

YES! Due to the risk of nephrontoxicity, the patient’s kidney would need to be closely monitored to prevent bladder and kidney damages

Do patient currently on Cytoxan need to have their pulmonary functions monitored?

YES!

When a patient is on a drug that can induce pulmonary toxicity, what are the signs the nurse would need to watch out for for drug-induced pulmonary toxicity?

1. shortness of breath

2. cough

3. fatigue

4. fever

NOTES: consider test like chest X-rays, CT scans, and pulmonary function test to assest the overall health of the lung

myelosuppresion

the bone marrow ability to produce red blood cell are reduced

hemmorhagic cystitis

the lining of the bladder starts to become inflammed and bleed → resulting in blood appearing in urine with pain and frequent urination due to irritation

what are the route of cyclophosphamide (Cytoxan)?

1. oral (tablet)

2. intravenous

3. infusion

what are antimetabolites in term of cancer treatment?

a substance that interferes with the normal metabolic processes within cells (inhibits it) by imitating metabolites but do the reversed function of metabolites

what are the three types of antimetabolites?

1. purine

2. pyrimidine

3. folic acid

what are the cancer conditions that antimetabolites can be used to treatment?

1. lymphoma

2. leukemia

3. cancer of the GI tract

4. cancer of the billiary tract

what are the common side effects of antimetabolites?

1. nausea

2. vomitting

3. diarrhea

4. anorexia

5. allopecia

6. myelosuppresion

how does the pyrimidine antimetabolites work?

designed to mimic the pyrimidine base of the DNA and RNA → enter cancer calls → interfere with DNA and RNA synthesis by being converted into faulty metabolites that either get incporporated into DNA, causing errors and halting its production or inhibit essential enzyme needed to create the thymine base for DNA

what is a common side-effects often seen with specifically pyrimidine antimetabolites?

hand-foot syndrome (palmar-plantar erythrodysthesia)

1. redness, swelling, pain, peeling, and cracking of the sole and palm

2. on a patient with lighter skin - the condition might manifest to look like a sunburn

3. on a patient with darker skin - the condition might manifest to look not abnormal but there might be swelling and warm to the touch and also pain too!

what are the methods of action, indications (conditions that it is used for), and adverse effects of carmustine?

what are the methods of action, indications (conditions that it is used for), and adverse effects of busulfan?

how does folate antimetabolites work?

how does purine antimetabolites work?

what is a common side-effects often seen with specifically folate antimetabolites?

what is a common side-effects often seen with specifically purine antimetabolites?

what is a common side-effects often seen with specifically folate antimetabolites?

what are the methods of action of methotrexate (MTX)?

they perform various function,s but the main one is that they prevent DNA synthesis by imitating folic acid - so instead of using folic acid for the cell cycles, the body instead uses methotrexate which prevents cell proliferation

what are the cancer types and conditions that methotrexate (MTX) can be used to treat?

1. breast cancer

2. ALL (acute lymphoblastic leukemia)

3. non-Hodgkin lymphoma

4. refractory psoriasis

5. rheumatoid arthritis

6. osteosarcoma

7. eczema

8. sarcoidosis

why does patient using methotrexate might have folate deficiency?

because methotexate imitating folic acid and prevent the body from using those folic acid

what are the common adverse effects of methotrexate (MTX)?

1. anorexia

2. hepatotoxicity

3. folate deficiency

4. mucosal ulceration

5. alopecia

6. fatigue

7. fever

8. increase risk of infection

9. gastrointestinal bleeding (GIB)

10. pancreatitis

11. renal failure

what does it mean that methotrexate is considered to be pregnancy category X?

1. cannot be given to pregnant individual

2. people who are not pregnant but are having sex need to use double the amount of contraception

   → using both hormonal and physical contraceptive

anthracyclines is also known as ____________________

antitutmor antibiotics

what is anthracyclines class of antitumor antibiotic in term of cancer treatment?

1. it is also known as the antitumor antibiotic

2. it is a very strong vesicants

3. it work by inhibiting the ability of DNA strands to unwind and replicate by inhibiting topoisomerase (which is an enzyme that help unzip the DNA)

4. can lead to cardiotoxicity and red/orange urine

true or false: medication such as anthracyclines class of antitumor antibiotics have a maximum life-time limit to prevent adverse effect like cardiotoxicity

true

Do patient currently on athracyclines class of antitutmor antibiotics need to have their heart monitored?

YES! Due to a risk of cardiotoxicity, the patient’s heart would need to be closely monitor to prevent heart damages due to factors like drug accumulation

The patient would need to have an ejection fraction (of the heart) of ______% or more to receive medication that have a risk of cardiotoxicity like that of the anthracycline class of antitumor antibiotic

55; since the normal range is 40-60%, patient who is looking to be on these type of medication would need to have an EF on the higher ends of what is considered to be normal

What is the ejection fraction of the heart and what is the average/normal range?

the amount of blood pumped by the left ventricle of the heart per minutes; 40-60%

Do all antitumor antibiotics have a significant risk of cardiotoxicity?

No, only the anthracycline class of antitumor antibiotic such as doxorubicin have the significant risk of cardiotoxicity

is doxorubicin an anthracycline class of antitumor antibiotics?

YES!

what is the method of actions, indication (conditions it can be used to treat), side effects and adverse effect of doxorubicin?

1. a type of antitumor antibiotic

2. MOA: inhibits topoisomerase to prevent DNA replication and cause cell death

3. indication: breast & thyroid cancers, leukemia, lymphoma, sarcoma, wilms tumor

4. side effects: myelosuppression, alopecia, oral sores, hyperpigmentation of skin, nails, and red/orange/pink urine (just because the medication color is so red!)

5. adverse effects: cardiotoxicity, extravasation necrosis, secondary cancer

what is the differences between the side effects and adverse effect?

side effects are generally expected and less concerning while adverse reactions are unexpected and may pose significant health risks

which of the cancer medication that is often considered as ‘The Red Devil’?

doxorubicin

what are some implications that can occur when doxorubicin is being infused?

1. fever

2. chills

3. productive cough

4. chest pain

5. short of breath

6. breathing difficulties

these are all of the factors that should be monitored as they relates to cardiac functions

what are most common plant alkaloids?

vinca alkaloids (e.g., vincristine, vinbalstine)

what are the method of action, indication, side effect, and adverse effect of plant alkaloids?

1. MOA: cause misalignment of chromosomes which can causes cell dealth (apotosis)

2. indication: is used often in form of chemotherapy for leukemia, lymphoma, rhadomyosarcoma, neuroblastoma, wilm’s tumor

3. side effect: nausea, vomitting, fatigue, numbness, or tinging

4. adverse effect: neurologic symptoms

what are the most common type of plant alkaloids and what are some of the prominent example of this class of plant alkaloid?

vinca alkaloids

1. vincristine

2. vinblastine

what is the methods of action, indication, side effects, and adverse effects of vincristine (Oncovin)?

1. a type of plant alkaloid

2. MOA: causes chromosal link errors leading to apoptosis of cancerous cells

3. indication: lymphoma, leukemia, Kaposi sarcoma, squamous cell carcinoma, lung cancer, and bladder cancer

4. side effects: myelosuppression, alopecia, oral sores, constipation

5. adverse effects: neuropathy, paralytic ileus (decreased GI bowel sound), hearing loss

vincisterine are known to have interaction with which food?

grapefruit

what are the route of administration for vincristine (Oncovin)?

must be administered IV only!

why is vincristine (Oncovin) only administered only administered through the IV and must be diluted in a small drip bag and not an IV push?

it is because the medication is incredibly toxic (hence the need to dilute it) and if mistakenly administered any other route like intrathecally than it can cause ascending paralysis

what is the one food that have the biggest interaction with a lot of different type of drugs?

GRAPEFRUIT/GRAPEFRUIT JUICE!

what is the drug class taxanes (what are they? what cancer can they be use to treat? side effects?)?

1. drugs that develped from the bark of the yew tree - all of the drugs will have the taxo prefix

2. includes docetaxel (taxotere), paclitaxel (taxol)

3. this drug can be use to treat breast, ovarian, prostate, gastric, esophageal, and pancreatic cancer

4. can be use as a combo or monotherapy

5. side effects: fluid retention, myelosuppression, alopecia, nausea, vomitting, diarrhea

6. adverse effectL cardiotoxicity, hepatotoxicity , peripheral neuropathy

true or false": when administering drugs from the drug class taxanes, the patient’s liver and heart should be monitored

yes!

taxanes is often administered after the patient being premediated with ____________ because of the hypersensitiy that the taxanes causes

diphenhydramine or a histamine receptor antagonist

true or false: supportive care with other pharmalogic agents is often required for how complex chemotherapy regiments can be

true because prevent and mitigating side effects or adverse effects is crucial

__________, ___________, ___________, are most commonly managed with supportive therapies

myelosuppression, nausea, vomitting

review the nursing implication slides

what are the chemo classess that commonly causes peripheral neuropathy?

1. plant alkaloid → specifically the vinca alkaloids

2. taxanes

part a: what is the hallmark adverse effect of cyclophosphamide?

part b: what is the priority nursing intervention for a patient receiving cyclophosphamide?

a. hemorrhagic cystitis (bloody urine, bladder irritation)

b. encourage hydration, monitor urine for blood, may give mesna for bladder protection

what is the hallmark adverse effect of methotrexate?

1. bone marrow suppression

2. mucositis

3. stomatitis

part a: what is the hallmark adverse effect of doxorubicin?

part b: what baseline tesr should be done before giiving doxorubicin?

part c: a patient on doxorubicin develops SOB, edema, and irregular HR, what is the priority nursing action?

a. cardiotoxicity (HF, arrythmias)

b. ECG and echocardiogram (cardiac function check)

c. stop the infusion and notify the provider (signs of cardiotoxicity)

part a: what is the hallmark adverse effect of vincristine?

part b: why is vincristine unique compared to most chemo drugs?

part c: a patient on vincristine reports difficulty walking and food drop…what is the best nursing intervention?

a. peripheral neuropathy (numbess, tingling, weakness)

b. dose-limiting toxicity is neuropathy, not bone marrow suppression

c. fall precautions, assistive devices, and notfy the provider

review the cram tips for the four medications needed to know for cancer…

• Cyclophosphamide → Bladder (cystitis)

• Methotrexate → Bone marrow + Mouth (mucositis)

• Doxorubicin → Heart (cardiotoxicity)

• Vincristine → Nerves (neuropathy)