Cancer chemotherapy

chemotherapy or cancer chemotherapy is the treatment modality used for the treatment of a tumor or cancerous disease this ppt give a detailed use of drugs used for the cancer and what all the pracuation can be taken while handling it and can be used as study material for bsc and gnm for their examination purpose as well as apply their knowledge in their clinical practice

1. Cancer chemotherapy department of medical surgical nursing

2. “It is the use of antineoplastics agents to attempt to kill tumor cell by interfering with cellular functions and reproduction”

3. Introduction The use of chemicals to treat cancer began in the early 1940’s The era of modern chemotherapy begun in 1948 with the introduction of nitrogen mustard It is only in the last 10 to 15 yrs, however , that chemotherapy has become a major treatment modality.

4. Objectives of chemotherapy….. To maximize the death of malignant tumor cells To cure the client with cancer Control the tumor growth when cure is not possible To extend the life span and improve the quality of life of client with cancer

5. Cell cycle

6. Chemotherapeutic drugs act through variety of mechanism….. Limiting DNA synthesis and expression Cross linking polymer DNA DNA double stand breaks Preventing formation of mitotic apparatus

7. Classification of chemotherapeutic drugs ….. According to activity on cell Cell cycle phase specific G1 phase : Bleomycin, Corticosteroids, Hormones G2 phase: Bleomycin, Etoposide, Topotecan, Taxol etc. S phase: Cytarabin, 5-fluorocil, Methotrexate M phase : Vinblastin, Vincristine, Paclitaxel Cell cycle phase non-specific Busulfan Cisplatin Cyclophosphamide

8. Classific a tio n According to chemical groups Alkylating agents Antimetabolites Anti tumor antibiotics Nitrosureas Plant alkaloids Hormonal agents Miscellaneous agents

9. Alkylating agents Eg : Buzalfan ,Cyclophosphamide, Carboplatin Antimetabolites Eg: Cladribine , Methotrexate Sodium, 5- flurouracil Antitumor antibiotics Eg: Bleomycin Sulfate, Dactinomycin , Epirubicin

10. Nitrosureas Eg: Carmustine, Lomustine, Semustine Pant alkaloids /natural products Eg : Docetaxel, Etoposide, Pacltitaxel Miscellaneous agents Eg: Altetramine, Amsrcrine, Asparaginase

11. Concepts in chemot h e r apy Combination chemotherapy ( use of cytotoxic drugs in combination Neoadjuvant chemotherapy ( initial use of chemotherapy to reduce the bulk and lower the stage of tumor , making it amenable to cure with subsequent local therapy ) Adjuvant chemotherapy ( along with surgery and radiation )

12. Chemotherapy Indications To cure certain malignancies To palliate symptoms Treat aggressive cancer in asymptomatic patients Adjuvant therapy

13. Chemotherapy Contraindications Lack of facilities to monitor response and side effects Expected survival shorter than required for reponse Asymptomatic pt with slow growing incurable tumor Expected survival shorter than required for benefit of chemotherapy

14. Administration of chemotherapy.. Planning drug doses and schedules Doses : drugs are measured in milligrams (mg) Doses are determined based on Body weight in kilograms Body surface area Schedule (cycles): Chemotherapy is generally given at regular intervals called cycles One dose followed by several days or weeks without treatment

15. Administration of chemotherapy.. Oral route Intravenous route Angiocatheter, PICC line, non tunneled catheters, tunneled catheters and port a-cath Subcutaneous routes Intraventricular/ Intrathecal route: ommaya reservoir Intra-arterial routes Intraperitoneal route Intravesicular route Intrapleural route

16. Safe preparation, handling and disposal………… Aseptic preparation of parenteral products should be followed Only properly trained personnel should handle cytotoxic drugs Safe preparation has been divided into 3 sections Steps A,B,C Steps D,E,F,G Steps H,I,J,K,L Step A All procedures involved in the preparation of cytotoxic drugs should be performed in a class 2 ,type A or type B Laminar flow biological safety cabinet

17. Safe preparation, handling and disposal………… Step B The work surface of the cabinet should be covered with plastic- backed absorbent paper Step C Personnel preparing the drugs should wear PPE ( Gloves ,gown , facial protection respiratory protection apparatus, caps and shoe covers) Gloves should be changed regularly and immediately if torn or punctured Skin contact : Thoroughly wash the area with soap and water do not abrade. Flush eye(s),while holding back the eyelid(s) with copious amount of water for at least 15 minutes. Then seek medical evaluation

18. Safe preparation, handling and disposal………… Step D Reconstitution should be done with a venting device using a 0.22 micron hydrophobic filter (reduce the probability of spraying and spillages) Step E If a chemotherapy dispensing pin is not used ,a sterile alcohol pad should be carefully placed around the needle and vial top during withdrawal from the septum

19. Step F The external surface contaminated with a drug should be wiped clean with an alcohol swab prior to transfer or transport Step G for glass ampule, wrap it and then snap it at the break point using an alcohol pad to reduce the possibility of injury and to contain aerosol produced Step H syringes and I.V bottles containing cytotoxic drug should be labeled and dated Safe preparation, handling and disposal…………

20. Step I After completing the preparation process, wipe down the interior of the safety cabinet with water (for injection or irrigation) followed by 70% alcohol using disposable towels Step J Co n t a min a ted sy r i n ges ,I.V t u b i ng , bu t te r f l y cl i ps etc. should be disposed of intact to prevent aerosol generation and injury Do not recap Labeled “cytotoxic waste only” Safe preparation, handling and disposal…………

21. Step K Hand should be washed between glove changes and after glove removal Step L Cytotoxic drugs are categorized regulated wastes and therefore, should be disposed of according to National, state and local requirements Safe preparation, handling and disposal…………

22. Waste disposal

23. Label for cytotoxic drugs

24. Safe preparation, handling and disposal………… Exposure can be occur through Inhalation of aerosols Absorption through the skin Ingestion of contaminated material

25. Safe handling of chemotherapy drugs Protect patient Protect envi r o n ment Protect your self Care should be taken to protect skin All connection b/w drug and patient should occur away from patient skin Use Leur lock connection use air inlet device for preparation of drugs discard gloves after each use and wash hand Minimize exposure by inhalation by skin contact by ingestion

26. Extravasations …

27. Extravasations … Treatment:- Stop administration Aspirate any residual drug and blood in IV tubing , needle, and infiltration site. Instill IV antidote Apply cold or warm pack for 24 hrs Alkylating agent - sodium thiosulfate Antitumor antibiotics - hydrocortisone Plant alkaloids - hyalouronidase

28. Hypersensitivity reactions HSR are rare ,can be serious and life threatening The antineoplastics agents L-asperginase Carboplatin Bleomycin Cisplatin and Teniposide Precutions to ensue client safety .. Obtain allergy history Test dose Be with the client Emergency equipments and drugs Baseline vital signs

29. Hypersensitivity reactions Dyspnea Tachycardia Chest tightness or pain Dizziness Pruritis Anxiety Inability to speak Nausea Abdominal pain Hypotension Cloudy sensorium Fused appearance and cyanosis

30. Stop drug ad m in i st r at i on Maintain iv access with 0.9% NS Notify physician Maintain airway ( supine position with feet elevated) Administer Epinephrin, Aminophylline, Diphenhydramine

31. Side effects of chemotherapy…. Myelosuppression Fatigue Nausea and vomiting Stomatitis and mucositis Pulmonary toxicity Renal toxicity Neurotoxicity Gonadal suppression Cardiotoxicity Alopecia Taste changes Skin changes : Hyper Pigmentation, Nail Discoloration, Dermatitis Fingertip Ulceration and Photosensitivity

32. Nursing management of patient undergoing chemotherapy… Patient should be protected from infections Wash hands regularly with antibacterial agent Avoid crowd with cold, flu or infections Avoid raw fruits and vegetables Help the patient to identify period of more fatigue and activeness Patient should take rest prior to an activity Maintain good nutritional status and hydration status by taking balanced diet Antiemetics should be administered one hr prior to chemotherapy Patient should take light meal of non irritating food before treatment Ensure adequate fluid intake being consumed & retained

33. Nursing management of patient undergoing chemotherapy… Low fiber and residue diet ( Eg. fresh fruits, vegetables , seeds and nuts) should be recommended to patient as these food can cause less diarrhoea chances Fried food should be avoided as they produce gas Patient should be taught to maintain a record of episodes of diarrhoea &foods that cause diarrhoea Rectal area of patient should be kept clean &dry to maintain skin integrity.

34. Nursing management of patient undergoing chemotherapy… For oral mucositis : patient should be taught to do oral assessment and characteristics of saliva & ability to swallow Patient should be taught to do tooth brushing & flossing before and after each meal and bed time Patient should feed with soft non irritating high protein and high calorie foods Tobacco and alcohol should be avoided Body weight should be measured at least twice a week. If patient is malnourished, give parenteral nutrition For alopecia : patient should be addressed to use turban, cap or wig as hair loss is very stressful to patient. Advice the patient that hair will grow after the chemotherapy treatment

35. Nursing management of patient undergoing chemotherapy… Patient should be carefully assessed for pulmonary side effects (pulmonary edema ) & cardiovascular effects (ventricular dysfunction & heart failure) Patient should be taught about management of adverse effects and interventions are planned so patient can self manage the illness and facilitate coping strategies with help of support gumps.

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