Cancer Chemotherapy and Treatment

Dianne Brundage

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

1. Describe the etiology of cancer.

2. Define the tumor, nodes, metastases (TNM) system of cancer staging.

3. Classify each drug used in the treatment of cancer, and compare and contrast the mechanisms of action, uses, and side effects.

4. Outline actions for all health care providers to prevent medication errors with cancer treatments.

5. Describe the role of the health care practitioner in the care of cancer patients.

key concepts

The word cancer covers a diverse array of tumor types that affect a significant number of Americans and are a significant cause of mortality.

Numerous cellular changes occur in the genetic material of the cancer cell so that programmed cell death, or apoptosis, does not occur. Proliferation of cancer cells goes unregulated.

Many tumors are staged according to the tumor, nodes, metastases (TNM) system. Metastases are cancer cells that have spread to sites distant from the primary tumor site and have started to grow. The most frequently-occurring sites of metastases of solid tumors are the brain, bone, liver, and lungs.

Each category of chemotherapy drugs has some similar side effects, usually on the most rapidly-growing cells of the body. However, there are unique toxicities of various pharmacologic categories of antineoplastic agents. Anthracyclines cause cardiac toxicity, which is related to the cumulative dose. Tubulin-interactive agents are associated with neuropathy and ileus. Alkylating agents are associated with secondary malignancies.

Because of the severe toxicities associated with many of the chemotherapy agents, safety precautions must be in place to prevent chemotherapy errors, accidental chemotherapy exposures, and overdosages.

Clinicians should play a role in chemotherapy safety, patient education, and monitoring patient response to therapy. For example, cumulative doses of anthracyc-lines should be monitored along with signs and symptoms of heart failure. Clinicians also should monitor for drug interactions between other current medications and chemotherapy agents.

epidemiology

© The word cancer covers a diverse array of tumors types that affect a significant number of Americans and are a significant cause of mortality. The term cancer actually refers to more than 100 diseases. What is common to all cancers is that the cancerous cell has uncontrolled growth so that it invades tissues and spreads to other parts of the body, called metastases. In 2008, it was projected that over 1.4 million Americans will be diagnosed with cancer, and more than 565,000 Americans will die from the cancer.1 Figure 88-1 describes cancers by gender, new cases, and deaths.

A cancer patient may encounter many different health care professionals: phle-botomists, pathologists, surgeons, medical and radiation oncologists, physician assistants, pharmacists, nurses, counselors, dieticians, social workers, and chaplains all may be involved with a single patient. The pharmacist's role may include recommendations of various pharmacologic agents, education of patients and family members, education of staff about new agents and safety issues, preparation of therapies, resolution of reimbursement issues, development of order sets, and participation in clinical trials. Each patient should have access to an interdisciplinary team to assist him or her during treatment.

Cancer treatments have exploded due to advances in technology in the last couple of decades. The fields of radiat ion therapy, surgery, and pharmaceuticals have had numerous developments, so patients are receiving not only less toxic treatments but also treatments that have improved outcomes over those of 15 years ago. Supportive-care therapies have improved, so patients may be at less risk for toxicity and have a better quality of life than patients 10 to 15 years ago. In the early 1990s, most patients received chemotherapy in the hospital because of side effects. Today, most patients receive chemotherapy in the clinic and/or are taking oral agents at home.

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10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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