Cancer Chemotherapy & Biotherapy

Cure

• Treatment that eliminates cancer

• 5 years disease free (remission, cancer signs and symptoms decrease/disappear)

Control

• Stop cancer growth

• Extension of life when a cure is unrealistic (helps patients live longer when a cure is not possible)

Palliation

• Provide comfort when cure or control is impossible

• Alleviation of symptoms while avoiding life threatening toxicities

  • Difficulty breathing

  • Pain

  • Tumor burden

How does chemotherapy work?

It targets rapidly dividing cells

Rapidly Dividing Cells

• Hair

• Oral mucosa (lining inside mouth)

• Lining of GI tract

• Blood cells

Nadir

• Lowest cell count

• Highest risk of bleeding

• Highest risk of infection

• Neutropenia precautions are important

Neutropenia

• ANC less than 1,500

• Severe neutropenia: ANC less than 500

ANC

• Blood test measurement that shows how many neutrophils are in blood

• Formula: (% neutrophils + % bands) x WBC / 100

Neutropenic Precautions

• Strict handwashing

• Limit visitors (especially under 12 years old)

• Sick visitors (wear masks/stay at home)

• Patient wear mask for transport (sometimes a sheet)

• Wash all fresh fruits and vegetables properly

• If it grows in soil = CAN’T HAVE IT (flowers, potted plants, etc)

• Provide fresh water, avoid standing water (sits still for a long time, allowing bacteria to grow)

• Promote good oral and daily hygiene

• Prevent constipation

• If in doubt, wear a mask

Common Routes

• PO

• Peripheral IV (PIV, through a small vein)

• Central venous catheter (CVC, tube inserted into a large vein)

  • Tunneled catheter

  • Port

  • PICC

• Intrathecal (IT, medication given into spinal fluid)

Filgrastim/Neupogen

• Stimulates WBC production

• Given Sub Q

• Given daily; results after 3rd day

• Shorten duration of neutropenia

• Decrease risk of infection

Side Effects of Filgrastim/Neupogen

• Cause bone pain

• Painful during injection

Nursing Considerations of Filgrastim/Neupogen

• Stored cold

• DO NOT shake

CINV (Chemotherapy Induced Nausea & Vomiting)

• Lorazepam: Anticipatory N/V

• Ondansetron: Acute N/V

• Granisetron: Delayed N/V

Off Label Management of Nausea & Vomiting

• Ben/Phen

• Dexamethasone

Appetite Stimulant

Megestrol

Drug Class of Cyclophosphamide (Cytoxan)

Alkylating agent

Cell Cycle of Cyclophosphamide (Cytoxan)

Non specific (can attack cancer cells at any stage of cell cycle, not just one specific stage)

Route of Cyclophosphamide (Cytoxan)

• PO

• IV

Use of Cyclophosphamide (Cytoxan)

Given in combination therapies with other chemotherapy medications

Side Effects of Cyclophosphamide (Cytoxan)

• Cardiomyopathy (heart muscle damage)

• SIADH (excessive water retention, causing low sodium levels)

• Myelosuppression (decreased blood cell production in bone marrow)

• Hemorrhagic Cystitis (inflammation and bleeding of the bladder)

• Nausea/vomiting

• Alopecia (hair loss)

Nursing Considerations of Cyclophosphamide (Cytoxan)

• Hydration (2-3 L per day)

• Encourage frequent urination

• UAs (urine test that checks health problems)

• Monitor urine output (UOP)

Drug Class of Methotrexate (MTX)

Antimetabolite

Route of Methotrexate (MTX)

• PO

• IM

• IV

• Intrathecal (IT)

Side Effects of Methotrexate (MTX)

• Mucositis (inflammation and sores of mouth/digestive lining).

• Photosensitivity (increased sensitivity to sunlight).

• Myelosuppression

Serious Risks of Methotrexate (MTX)

• Hepatotoxicity (liver damage)

• Nephrotoxicity (kidney damage)

Nursing Considerations of Methotrexate (MTX)

• Drug is light sensitive (can lose effectiveness when exposed to light)

• Drug interactions with:

  • Folic acid (only drug reducing side effects, beneficial)

  • NSAIDs

  • Sulfa medications

  • Aminoglycosides

  • Warfarin

  • Alcohol

High Dose Therapy of Methotrexate (MTX)

• Prior to and during, give sodium bicarbonate to keep urine pH >7

• Urine samples every 6 hours

• Give Leucovorin post therapy

• Monitor methotrexate blood levels daily until <0.1 mmol

Drug Class of Doxorubicin (Adriamycin)

Anthracycline

Cell Cycle of Doxorubicin (Adriamycin)

Non specific or specific depending on the cancer

Route of Doxorubicin (Adriamycin)

IV

Special Consideration of Doxorubicin (Adriamycin)

Vesicant (can damage tissue if medication leaks outside the vein)

Side Effects of Doxorubicin (Adriamycin)

• Nausea

• Vomiting

• Diarrhea

• Stomatitis (inflammation and sores in the mouth)

• Alopecia (100%)

• Photosensitivity

• Mucositis

Serious Risk of Doxorubicin (Adriamycin)

Cardiotoxicity (heart damage)

Nursing Considerations of Doxorubicin (Adriamycin)

• Cumulative lifetime dose 500 mg/m2

• Avoid sun exposure

• Encourage SPF

• Red/orange urine

• Body fluids may occur

• Reinforce oral care

Side Effects of Rituxan (Rituximab)

• Tumor Lysis Syndrome (TLS, rapid breakdown of cancer cells that releases harmful substances into the blood)

• Hypersensitivity

  • Risk decrease with each administration (risk of allergic reaction becomes lower with each dose)

Serious Risks of Tumor Lysis Syndrome (TLS)

• Oncology emergency (life threatening cancer related condition needing immediate treatment)

• Associated with large tumor burden

Nursing Considerations of Rituxan (Rituximab)

• Monitor labs

  • Potassium

  • Calcium

  • Phosphorus

  • Uric acid

• Premedicate with Tylenol and Benadryl

Administration of Rituxan (Rituximab)

• Titrate infusion (gradually adjust the IV medication rate as needed):

  • Start at 50 mg/hr for the initial dose

  • Increase by 50 mg/hr every 30 minutes

  • 400 mg/hr is the maximum rate

• If no reaction, additional doses at 100mg/hr

• Increase every 30 minutes