Oncology and Chemotherapy Overview

  • Overview of Oncology

    • Types of cancers discussed
    • Focus on risk factors and symptoms
    • Emphasis on targeted areas of risk for environmental exposure

  • Risk Factors for Cancer

    • Smoking is a major risk factor for various cancers, including bladder cancer
    • Bladder cancer identified as an unexpected result of smoking

  • Chemotherapy

    • Toxicity of Chemotherapy Agents
      • Chemotherapy agents destroy rapidly dividing cells
      • Can result in various complications and side effects
    • Uses of Chemotherapy
      • Not only for cancer but also for autoimmune disorders
      • Importance of inquiry regarding the use of chemotherapy drugs in patients without cancer
    • Common Side Effects of Chemotherapy
      • CIND: Chemotherapy Induced Nausea and Vomiting
      • Mucositis: problems in the mucosal layer (usually in the mouth)
      • CIPN: Chemotherapy Induced Peripheral Neuropathy
      • Myelosuppression: reduced blood cell production in the bone marrow
      • Alopecia: hair loss commonly associated with chemotherapy
      • Cognitive changes and bowel elimination issues
    • Dosing and Schedules
      • Chemotherapy administered in rounds (e.g., six rounds, five days each, followed by recovery time)
      • Importance of compliance with dosing and scheduling because of side effects
      • Toxicity concern: all body fluids may contain traces of chemotherapy agents for up to 48 hours post-treatment
    • Extravazation
      • Definition: release of chemotherapy agents into surrounding tissue instead of blood vessels
      • Can cause significant tissue damage, necessitating careful monitoring during infusion
      • Nurses should prevent extravasation by monitoring IV sites frequently
      • Vesicants and Irritants
      • Vesicants cause tissue damage upon contact, while irritants may cause pain at the injection site

  • Chemotherapy Induced Nausea and Vomiting (CIND)

    • Stages include:
      • Anticipatory: nausea before treatment due to anxiety
      • Acute: nausea within 24 hours post-treatment
      • Delayed: nausea after 24 hours post-treatment
      • Breakthrough: intermittent symptoms despite medication
    • Medications for CIND
      • Ondansetron (Zofran)
      • Neurokinin receptor antagonists (aprepitant)
      • Dexamethasone (corticosteroid)
      • Lorazepam (may assist with nausea)
    • Consequence: inability to tolerate chemotherapy due to severe nausea could lead to dosage reduction

  • Mucositis

    • Defined as painful ulcerations in the mouth and throat
    • May lead to increased risk of infections due to bacteria
    • Treatment requires preventive strategies and management

  • Peripheral Neuropathy (CIPN)

    • Damage to peripheral nerves can cause loss of sensation
    • Patients become at higher risk for falls due to lack of sensation
    • Similar to diabetic peripheral neuropathy but caused by chemotherapy

  • Pregnancy and Breastfeeding Implications

    • Chemotherapy is teratogenic and poses risk to fetuses
    • Chemotherapy agents can be excreted in breast milk, necessitating cessation of breastfeeding during treatment

  • Older Adult Considerations

    • Chemotherapy risks in older adults: lower physiological reserve and higher risks for complications (dehydration from nausea/vomiting)
    • Immediate contact with a healthcare provider if symptoms worsen

  • Administration of Chemotherapy

    • Only trained nurses should administer chemotherapy to ensure safety
    • Precautions necessary to avoid accidental exposure to toxic agents
    • Special disposal of chemotherapy waste to prevent environmental contamination

  • Routes of Chemotherapy Administration

    • Various routes including PO (oral), IV (intravenous), IM (intramuscular), subcutaneous, and intrathecal
    • Some agents may be used for non-cancerous conditions (e.g. methotrexate for autoimmune diseases)

  • Targeted Therapy

    • Focused approach to treatment, utilizing biological response modifiers (e.g., interleukins, interferons)
    • Colony stimulating factors important for stimulating blood production:
      • Epoetin alfa (stimulates red blood cell production)
      • Filgrastim (stimulates white blood cell production)

  • Radiation Therapy

    • Types of Radiation Therapy
      • External beam: Not radioactive after treatment
      • Internal (sealed implants): Patient is radioactive and poses risk to others
    • Patient Management
      • Limit contact with pregnant individuals and children
      • Patient care for those receiving radiation therapy involves monitoring for side effects

  • Oncologic Emergencies

    • Definition: urgent conditions requiring immediate medical attention
      • Focus on spinal cord compression, tumor lysis syndrome, and superior vena cava syndrome
    • Spinal Cord Compression
      • Symptoms include back pain, weakness, gait changes
      • Urgent treatment includes steroids and radiation therapy

  • Hypercalcemia

    • Symptoms include stones, groans, psychiatric overtones (nausea, vomiting, increased thirst)
    • Treatment includes hydration and diuretics (loop diuretics preferred)

  • Superior Vena Cava Syndrome

    • Caused by tumors obstructing vena cava
      • Symptoms include facial swelling, tight clothing around the neck, and dyspnea
      • Urgent treatment with corticosteroids and diuretics

  • Tumor Lysis Syndrome

    • Results from rapid destruction of tumor cells and can lead to dangerous electrolyte imbalances (e.g., hyperkalemia)
    • Key Interventions
      • Hydration and potentially dialysis for severe cases

  • Palliative Care vs. Hospice

    • Definition of palliative care as supportive, not solely end-of-life
    • Hospice care typically initiated when a prognosis is six months or less
    • Important discussions about end-of-life care, grief stages, and family communication

  • Cancer Screening Recommendations

    • ACS recommendations for screenings including specifics like Pap smears for cervical cancer
      • Women aged 21-29: Pap test every 3 years
      • Women 30-65 years old: Pap plus HPV test every 5 years

  • Bioterrorism and Biological Agents

    • Awareness of patterns with exposure to biological agents
    • Isolation precautions and environmental control measures critical

  • Chemical Weapons in Disasters

    • Types include nerve agents and blood agents, with treatment involving immediate decontamination and appropriate safety measures
    • Importance of rapid assessment of exposure to prevent spread of harmful agents

  • Conclusion

    • The complexities of cancer treatment and management highlight the importance of thorough understanding for nursing practice
    • Awareness of potential complications and the holistic treatment approach is necessary for comprehensive patient care.