1. Chemo in the home

Chemo101

1. Chemotherapy in the Home Continuing Education

2. Identify classifications of chemotherapy . Discuss side effects and toxicities of chemotherapy . Verbalize an understanding of safe chemotherapy handling in the home . Discuss safe administration of chemotherapy in the home . Identify patient teaching points relating to home chemotherapy. Learning Objectives

3. Chemotherapy is a category of cancer treatment that uses chemical substances that are given as part of a regimen. Most often, the treatment plan will also include surgery and/or radiation. Chemotherapy may be given with the following intent: Curing the Cancer Slowing the cancer’s growth Preventing the cancer from spreading Relieving symptoms caused by cancer Introduction to Chemotherapy

4. The chemotherapy treatment plan is most often given in cycles, which is determined by the physician. The cycle will vary depending on the type of cancer and type of chemotherapy agent used. There is usually a rest period in between the cycles to allow the body and blood counts to recover before the next dose of chemotherapy is given. Introduction to Chemotherapy

5. Depending on the type of cancer and where it is found, chemotherapy may be given via different routes including the following: Oral Subcutaneous Intravenous Intra-arterial Intrathecal/Intraventricular Intraperitoneal Intrapleural Intravesicular Intralesional Introduction to Chemotherapy

6. Some treatment regimes may include the chemotherapy to be administered via multiple routes simultaneously. When the route of chemotherapy is not specified or unclear, clarification of the order is necessary to prevent a medication error. When chemotherapy is given via intravenous route for an extended period of time, a vascular access device will be placed. The following are examples of the types of catheters placed for chemotherapy: Mediport Peripherally Inserted Central Catheter (PICC) Central Venous Catheter (Tunneled or Non-tunneled) Introduction to Chemotherapy

7. Chemotherapy can be administered in the hospital, out-patient oncology clinic or in the patient’s home. The setting will be determined by the type of chemotherapy agent used, physician preference, patient’s insurance and safety profiles of the chemotherapy agents needing to be administered. Introduction to Chemotherapy

8. Besides being classified as cell cycle-specific (chemotherapy kills cells that are in a specific phase and actively dividing) or non-specific agents, cytotoxic drugs are also classified based on their biochemical structure and mechanism of action. Classifications of cytotoxic drugs include the following: Alkylating Agents Antimetabolites Antitumor Antibiotics Plant Alkaloids Hormone Therapy Biological Cancer Therapies Chemotherapy Drug Classifications

9. Interfere with DNA replication to prevent cancer cells from reproducing Most alkylating agents are cell cycle non-specific Alkylating agents can produce major toxicities affecting the hematopoietic, gastrointestinal and reproductive systems These drugs are active against chronic leukemia, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, multiple myeloma and some cancers of the lung, breast and ovary Examples of alkylating agents include the following: carboplatin, cisplatin and ifosfamide Alkylating Agents

10. Interfere with DNA and RNA growth. Most antimetabolites are cell cycle specific. Antimetabolites can produce major toxicities affecting the hematopoietic and gastrointestinal systems. Antimetabolites are used to treat chronic leukemias as well as tumors of the breast, ovary and gastrointestinal tract Examples of antimetabolites include the following: 5-fluorouracil, capecitabine and methotrexate Antimetabolites

11. Interfere with DNA by stopping enzymes needed for cell division or by altering the membranes that surround cells. Antitumor Antibiotics are cell cycle non-specific. Antitumor Antibiotics can produce major toxicities affecting the hematopoietic, gastrointestinal, reproductive, and cardiovascular systems. Examples of antitumor antibiotics include the following: mitomycin-C, doxorubicin and daunorubicin Antitumor Antibiotics

12. Inhibit cancer cell growth by preventing cellular mitosis or division. Most plant alkaloids are cell cycle specific Plant Alkaloids can produce major toxicities affecting the hematopoietic, integumentary, neurologic and reproductive systems. Examples of plant alkaloids include the following: vincristine, vinblastine, and vinorelbine. Plant Alkaloids

13. A systemic therapy that works to add, block or remove hormones from the body to slow or stop the growth of cancer cells. There are two types of hormonal agents: corticosteroids and sex hormones Corticosteroids are used to treat leukemia, multiple myeloma and lymphoma and are used to reduce swelling around tumors of the brain and spinal cord. Ex: Prednisone & Dexamethosone Sex hormones are used to control the growth of breast, uterine and prostate cancer. Ex: Tamoxifen & Leuprolide Can have a range of side effects depending on type of cancer involved (hot flashes, decreased sex drive, mood changes, joint/muscle pain and osteoporosis). Hormone Therapy

14. Strengthen the body’s immune system to fight the growth of cancer . Various biological response modifiers include monoclonal antibodies, immunotherapy, oncolytic viral therapy, cytokines. These drugs are active against breast cancer, non-Hodgkin’s lymphoma, leukemia, renal cell carcinoma and malignant melanoma. The side effects can often include the following: flu-like symptoms (chills, fever, muscle aches, weakness), loss of appetite, nausea, vomiting and diarrhea. Some patients develop a rash and some bleed or bruise easily. Examples include Herceptin, Avastin, Erbitux and Rituxan. Biological Therapies