Cancer

chemotherapy
 “It is the use of antineoplastics agents to
attempt to kill tumor cell by interfering with
cellular functions and reproduction”
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.
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
Cell cycle
 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
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
Classification……………
According to chemical groups
Alkylating agents
Antimetabolites
Anti tumor antibiotics
Nitrosureas
Plant alkaloids
Hormonal agents
Miscellaneous agents
Alkylating agents
• Eg : Buzalfan ,Cyclophosphamide, Carboplatin

Antimetabolites

• Eg: Cladribine , Methotrexate Sodium, 5-

flurouracil

Antitumor antibiotics
• Eg: Bleomycin Sulfate, Dactinomycin , Epirubicin
Nitrosureas
• Eg: Carmustine, Lomustine, Semustine

Pant alkaloids /natural products

• Eg : Docetaxel, Etoposide, Pacltitaxel

Miscellaneous agents

• Eg: Altetramine, Amsrcrine, Asparaginase

 Concepts in
chemotherap
y

Combination chemotherapy
Adjuvant chemotherapy
(along with surgery and radiation) (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 )
 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
 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
 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
 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
 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
 Safe preparation, handling and
disposal…………
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…………
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
Contaminated syringes ,I.V tubing , butterfly clips
etc. should be disposed of intact to prevent aerosol
generation and injury
• Do not recap
• Labeled “cytotoxic waste only”
 Safe preparation, handling and
disposal…………
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
Waste disposal
Label for cytotoxic drugs
Safe preparation, handling and
disposal…………
• Exposure can be occur through
– Inhalation of aerosols
– Absorption through the skin
– Ingestion of contaminated material
 Safe handling of chemotherapy
drugs

Protect patient Protect Protect your

environment self

• Care should be taken to •Use Leur lock connection Minimize exposure

protect skin • use air inlet device for • by inhalation
• All connection b/w drug preparation of drugs • by skin contact
and patient should occur • discard gloves after each • by ingestion
away from patient skin use and wash hand
Extravasations…
 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
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
 Hypersensitivity reactions
– Dyspnea
– Tachycardia
– Chest tightness or pain
– Dizziness
– Pruritis
– Anxiety
– Inability to speak
– Nausea
– Abdominal pain
– Hypotension
– Cloudy sensorium
– Fused appearance and cyanosis
 Stop drug Maintain iv access Notify physician
administration with 0.9% NS

Maintain airway Administer Epinephrin,

( supine position Aminophylline, Diphenhydramine
with feet elevated)
Side effects of
chemotherapy….

• Myelosuppression
• Fatigue
• Nausea and vomiting
• Stomatitis and •Cardiotoxicity
mucositis •Alopecia
•Taste changes
• Pulmonary toxicity
•Skin changes :
• Renal toxicity Hyper Pigmentation,
• Neurotoxicity Nail Discoloration,
Dermatitis
• Gonadal suppression Fingertip Ulceration
and Photosensitivity
 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
 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 diarrhoea
– 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.
 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
 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 with help of support
gumps.ss
THANK YOU