Chapter 40
Agents Used in the
Treatment of Cancer
Cancer
Broad term
A group of diseases characterized by
uncontrolled cellular growth
Invasion into surrounding tissue
Metastasis
Cancer spreads to other areas in the body
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Etiology of Cancer
Remains a mystery
Could be:
Environment
Lifestyle
Occupation
Genetic and ethnic factors
Age- and sex-related differences
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Cell Growth Cycle
Normal cells and cancer cells go through
five distinct growth phase cycles
1.
2.
3.
4.
5.
Go, resting phase
G1, first growth
S, DNA synthesis phase
G2, second growth phase
M, mitosis phase
Cancer cells divide rapidly.
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Treatment Considerations
Growth fraction
The fraction of cells that are in active
phases
Mitotic index
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Percentage of cells undergoing mitosis
Antineoplastics most effective when the
growth fraction and mitotic index are
high
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(continued)
Treatment Considerations
Cancer stage when it is discovered
Efficacy of the cancer treatment
Development of drug resistance
General health of the client
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Antineoplastics
Divided into two groups
1.
2.
Cell cycle nonspecific (CCNS)
Cell cycle specific (CCS)
CCNS effective against slow-growing
cancer cells
CCS effective against fast-growing
cancer cells
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Agents Used in the
Treatment of Cancer
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Alkylating agents
Antimetabolites
Mitotic inhibitors
Antibiotics
Hormones
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(continued)
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Agents Used in the
Treatment of Cancer
Radioactive drugs
Biologic-response modifiers
Miscellaneous agents
Combination therapy
Adjuvant agents
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(continued)
Agents Used in the
Treatment of Cancer
Alkylating agents: cell cycle nonspecific
Antimetabolites: cell cycle specific in the
S phase
Mitotic inhibitors: cell cycle specific in
the M phase
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Antineoplastic Agents
Affect all cells, both healthy and sick
Dose-limiting effects
Hair falls out
Cells in the gastrointestinal tract die
Nausea and vomiting occur; emetic
potential
Myleosuppression
Nadir: lowest point for the bone marrow cells
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Antineoplastics: Adverse/Side
Effects
Common
Fever, chills, headache, nausea, and
vomiting
Serious
Bronchospasm, dyspnea, hypotension, and
angioedema
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Combination Therapy
Use of several antineoplastic agents at
the same time
Proven effectiveness
Rationale of using combination therapy
Have a more beneficial effect than when
used alone
Each agent exhibits different actions and
toxicities
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Adjuvant Agents
Antiemetics
Rescue agents
Ondansetron HCl (Zofran)
Mesna
Leucovorin
Blood-forming agents
Epoetin alfa (Procrit)
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Nursing Implications
During administration of the
antineoplastic:
Provide significant hydration to prevent
nephrotoxicity
Provide periodic monitoring of heart and
lung function
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Legal and Ethical Principles
To avoid errors
Standardized, preprinted order forms
Nurses
Physicians
Pharmacists
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