Chapter 24
Care of Patients with
Cancer
Mrs. M. Kreisel MSN, RN
NU130 Adult Health 1
Summer 2011
General Disease-Related Consequences of
Cancer: Nursing Diagnosis
• Impaired immune and bloodproducing function
• Altered GI structure and
function
• Motor and sensory deficits
• Decreased respiratory function
Surgery as Cancer Treatment
• Oldest form of cancer treatment used
for:
• Prophylaxis
• Diagnosis
• Cure
• Control
• Palliation
• Second-look surgery
• Reconstruction or rehabilitation
Resection of Pancreatic Tumor
Radiation Therapy for Cancer
• Purpose—to destroy cancer cells with
minimal exposure of the normal cells to the
damaging actions of radiation
• Teletherapy: radiation source outside the
body
• Brachytherapy: (opposite of teletheraphy)
the use of implants of radioactive materials
such as radium, cesium, iridium or gold at
the cancer site
Radiation Therapy
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Side Effects of Radiation Therapy
• Vary according to the site
• Local skin changes and hair loss that will likely be
permanent depending on the total absorbed dose
• Altered taste sensations
• Fatigue related to increased energy demands
• Inflammatory responses that cause tissue fibrosis
and scarring
Nursing Care of Patients Undergoing
Radiation Therapy
• Teach accurate objective facts to help
patient cope.
• Do not remove markings.
• Administer skin care.
• Avoid direct exposure of the skin to the
sun.
• Care for xerostomia (dry mouth).
• Bone exposed to radiation is more
vulnerable to fracture.
• Do not use lotions or ointments.
Chemotherapy
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Treating cancer with chemical agents
Major role in cancer therapy
Used to cure and increase survival time
Some selectivity for killing cancer cells
over normal cells
• Normal cells most affected—the skin,
hair, intestinal tissues, spermatocytes,
and blood-forming cells
Chemotherapy
Chemotherapy Drugs
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Antimetabolites
Antitumor antibodies
Antimitotic agents
Alkylating agents
Topoisomerase inhibitors
Miscellaneous chemotherapeutic agents
Combination chemotherapy
Treatment Issues
• Drug dosage
• Drug schedule
• Drug administration:
• Extravasation: The escape of fluids into
the surrounding tissue
• Vesicants: blistering
Side Effects of Chemotherapy
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Anemia, neutropenia, thrombocytopenia
Alopecia or hair loss
Nausea and vomiting
Mucositis in the entire GI tract
Skin changes
Anxiety, sleep disturbance
Altered bowel elimination
Changes in cognitive function
Chemotherapy Patient-Centered
Nursing Care
• Infection risk
• Chemotherapy-induced nausea and
vomiting (CIN)
• Mucositis
• Alopecia
• Changes in cognitive function
• Peripheral neuropathy
Hormonal Manipulation
• Some hormones make hormone-sensitive
tumors grow more rapidly.
• Some tumors actually require specific
hormones to divide. Therefore decreasing
the amount of these hormones to
hormone-sensitive tumors can slow the
cancer growth rate.
Side Effects of Hormone Therapy
• Androgens (substances that produce male
characteristics) and antiestrogen receptor drugs
cause masculinizing effects in women.
• For men and women receiving androgens, acne may
develop, hypercalcemia is common, and liver
dysfunction may occur with prolonged therapy.
• Feminine manifestations often appear in men who
take estrogens, progestins, or antiandrogen receptor
drugs.
• Gynecomastia.
Gynecomastia
Photodynamic Therapy
• Selective destruction of cancer cells
through a chemical reaction triggered by
different types of laser light
• Patient teaching
• General sensitivity to light for up to 12
weeks after the photosensitizing drug is
injected
Immunotherapy: Biological
Response Modifiers (BRMs)
• Drugs that modify the patient’s biological responses to tumor
cells
• Cytokines—enhance the immune system they include
Interleukins & interferons (they release proteins and other cell
responses to try and prevent the unwanted cell from growing)
• Side effects—generalized and sometimes severe
inflammatory reactions, peripheral neuropathy, skin rashes
Gene Therapy
• Experimental as a cancer treatment
• Renders tumor cells more susceptible to
damage or death by other treatments
• Injection into tumor cells, enabling the
immune system to better recognize cancer
cells as foreign and kill them
• Human leukocyte antigen (HLA)
• Cytokines, IL-2
Targeted Therapy
• Combination of gene therapy and
immunotherapy
• Side effects:
• Allergic reaction
• Skin, mucous membranes, GI tract
lining
Oncologic Emergencies
• Sepsis and disseminated intravascular
coagulation
• Collaborative management includes:
• Prevention (the best measure)
• IV antibiotic therapy
• Anticoagulants, cryoprecipitated clotting
factors
Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)
• Water is reabsorbed to excess by the
kidney and put into system circulation.
• SIADH is most commonly found in
carcinoma of the lung.
• Collaborative care:
• Patient safety
• Restore normal fluid balance
• Provide supportive care
Spinal Cord Compression
Spinal Cord Compression
(Cont’d)
• Collaborative management includes:
• Early recognition and treatment
• Palliative
• High-dose corticosteroids
• High-dose radiation
• Surgery
• External back or neck braces to reduce
pressure in the spinal cord
Hypercalcemia
• Occurs most often in patients with bone metastasis
• Fatigue, loss of appetite, nausea and vomiting, constipation,
polyuria, severe muscle weakness, loss of deep tendon
reflexes, paralytic ileus, dehydration, electrocardiographic
changes
• Collaborative management includes:
• Oral hydration
• Normal saline IV
• Drug therapy
• Dialysis
Superior Vena Cava Syndrome
• Superior vena cava is compressed or
obstructed by tumor growth.
• Condition can lead to a painful, lifethreatening emergency.
• Signs include edema of face, Stokes’ sign,
edema of arms and hands, dyspnea,
erythema, and epistaxis.
Superior Vena Cava Syndrome
(Cont’d)
Collaborative Care: SVC
Syndrome
• High-dose radiation therapy
• Metal stent in the vena cava
Tumor Lysis Syndrome
• Large numbers of tumor cells are
destroyed rapidly, resulting in intracellular
contents being released into the
bloodstream faster than the body can
eliminate them.
• Collaborative management includes:
• Prevention
• Hydration
• Drug therapy
Tumor Lysis Syndrome (Cont’d)
NCLEX TIME
Question 1
In affluent countries, what percentage of
people diagnosed with cancer each year
are cured of their disease?
A.
B.
C.
D.
25%
40%
50%
65%
Question 2
What is the expected outcome related to hair
loss for the patient who is undergoing
chemotherapy?
A. Hair loss may be permanent.
B. Hair regrowth usually begins about 1
month after completion of chemotherapy.
C. New hair growth will likely be identical to
previous hair growth in color and texture.
D. Viable treatments exist for the prevention
of alopecia.
Question 3
A patient who is receiving radiation therapy
for breast cancer would experience which
side effect?
A.
B.
C.
D.
Severe fatigue
Mucositis
Hair loss
Nausea and vomiting
Question 4
The nurse is assessing for tumor lysis
syndrome in a patient who has been
receiving chemotherapy. Which
findings are possible for tumor lysis
syndrome?
A. Hypercalcemia
B. Edema of the face, progressing later to
arms and hands
C. Dyspnea and epistaxis
D. Hyperkalemia and hyperuricemia
Question 5
True or False: The goal of therapy with erythropoiesis
stimulating drugs, such as darbepoetin alfa (Aranesp)
and epoetin alfa (Epogen and Procrit), is to return hemoglobin
or hematocrit levels to normal levels after
chemotherapy.
A. True
B. False