CHEMOTHERAPY

DRUGS ACTING
ON GI CANCER

-NISHA TITUS
 INTRODUCTION

Chemotherapy the administration of

one or more cytotoxic drugs to

destroy or inhibit the growth and

division of malignant cells in the

treatment of cancer.
 WHAT IS CHEMOTHERAPY?

Chemotherapy is the use of drugs to

destroy cancer cells. It usually works
by keeping the cancer cells from
growing, dividing, and making more
cells.
ACTION OF CHEMOTHERAPY
CELL CYCLE
 WHAT IS ?

Adjuvant Chemotherapy ?

Neoadjuvant Chemotherapy ?

Induction Chemotherapy ?

Consolidation Chemotherapy ?
 WHAT IS ?

Maintenance Chemotherapy ?

First Line Chemotherapy ?

Second Line Chemotherapy ?

Palliative Chemotherapy ?
 OTHER MODALITIES

SURGICAL IMMUNO RADIATION

TREATMENT THERAPY THERAPY

TARGETED HORMONE STEM CELL

THERAPY THERAPY TRANSPLANT
 OTHER MODALITIES

PRECISION COMBINATION
MEDICINE THERAPY

SUPPORTIVE
THERAPY
 OBJECTIVES OF CHEMOTHERAPY

 To maximize the death of malignant tumour cells.

 To cure the client with cancer.

 Control the tumour growth when cure is not possible.

 To extent the life span and improve the quality of life

of client with cancer.

 SYMBOLS TO UNDERSTAND

BIOHAZARD
 ROUTES OF ADMINISTRATION

Oral Chemotherapy
Medications

Subcutaneous Injections

Intra-muscular Injections
Intravenous Injections
 Intra-thecal Injections

Intra-peritoneal Injections

Intra-arterial Injections
Intra-vesicular Injections

Intra-pleural Injections
 CLASSIFICATION OF CHEMOTHERAPEUTIC
DRUGS

1) PHASE SPECIFIC DRUGS: Agents that are most active against cells

in a specific phase of the cell cycle.

2) CELL CYCLE SPECIFIC DRUGS: Agents that are effective while cells

are actively in cycle but that are not dependent on the cell being in a
particular phase.

3) CELL CYCLE NONSPECIFIC DRUGS: A third group of drugs that

appear to be effective whether cancer cells are in cycle or are resting.

 SAFEHANDLING
CHEMOTHERAPEUTIC AGENTS

 Chemotherapeutic Drugs are hazardous drugs.

 A hazardous drug is defined as an agent that presents a danger to
healthcare personnel due to its inherent toxicity.
 They are carcinogenic
 They are mutagenic
 They are teratogenic
 PREPARING CHEMOTHERAPEUTIC DRUGS
GATHERING THE EQUIPMENT

Before preparing chemotherapeutic drugs, be sure to gather all the

necessary equipment, including:

– Patient’s medication order or record , Prescribed drugs , Appropriate

diluent (if necessary), Medication labels , Long-sleeved gown ,
Chemotherapy gloves, Face shield or goggles and face mask , 20G
needles, Hydrophobic filter or dispensing pin
-Syringes with luer-lock fittings and needles of various sizes
-IV tubing with luer-lock fittings
-70% alcohol
-Sterile gauze pads
-Plastic bags with “hazardous drug” labels
-Sharps disposal container
-Hazardous waste container
-Chemotherapy spill kit
 PREPARING CHEMOTHERAPEUTIC DRUGS CONT..
ORGANIZING DRUG PREPARATION AREAS
 Prepare chemotherapeutic drugs in well-ventilated workspace
 Perform all drug admixing or compounding within a Class II Biological Safety Cabinet or a “vertical”
laminar airflow hood with a HEPA filter, which is vented to the outside
 If a Class II Biological Safety Cabinet isn’t available, it is recommended to use a special respirator
 Have close access to a sink, alcohol pads, and gauze pads as well as Chemotherapy hazardous waste
containers, sharps containers, and chemotherapy spill kits
 Make sure that all hazardous waste containers are made of punctureproof, shatterproof, leakproof plastic
 Make sure that yellow biohazard labels are available for labeling all chemotherapy-contaminated IV bags,
tubings, filters, and syringes
 Make sure that red sharps containers are available for disposal of all contaminated sharps such as
needles.
BIOSAFETY CABINET
LAMINAR FLOW CABINET
 PREPARING CHEMOTHERAPEUTIC DRUGS CONT..

WEAR PROTECTIVE CLOTHING

 Essential protective clothing includes a cuffed gown, gloves, and a face shield or goggles and
a face mask.
 Gowns should be disposable, water-resistant, and lint-free with long sleeves, knitted cuffs,
and a closed front.
 Gloves should be disposable, powder-free, and made of thick latex or thick nonlatex material.
 Double gloving is an option when the gloves aren’t of the best quality.
CLOTHING
 SAFETY MEASURES GENERAL MEASURES

 At the local level, most health care facilities require nurses and pharmacists involved in the
preparation and delivery of chemotherapeutic drugs and care of the patient with cancer.
 Take care to protect staff, patients and the environment from unnecessary exposure to
chemotherapeutic drugs.
 Make sure your facility’s protocols for spills are available in all areas where chemotherapeutic
drugs are handled, including patient-care areas.
 Refrain from eating, drinking, smoking or applying cosmetics in the drug-preparation area
 ACCIDENTAL EXPOSURE

 If a chemotherapeutic drug comes in contact with your skin, wash the area thoroughly with
soap and water to prevent drug absorption into the skin
 If the drug comes in contact with your eye, immediately flush the eye with water or isotonic
eyewash for at least 5 minutes, while holding the eyelid open
 After an accidental exposure, notify your supervisor immediately
 WASTE DISPOSAL

 Place all contaminated needles in the sharps container; don’t recap needles
 Use only syringes and IV sets that have a luer-lock fitting
 Label all chemotherapeutic drugs with a yellow biohazard label
 Transport the prepared chemotherapeutic drugs in a sealable plastic bag that’s prominently
labeled with a yellow chemotherapy biohazard label
 Don’t leave the drug-preparation area while wearing the protective gear you wore during
drug preparation
 CHEMOTHERAPY SPILL

 Put on protective garments, if you aren’t already wearing them

 Isolate the area and contain the spill with absorbent materials from a chemotherapy spill kit
 Use the disposable dustpan and scraper to collect broken glass or desiccant absorbing
powder
 Carefully place the dustpan, scraper and collected spill in a leakproof, punctureproof,
chemotherapy-designated hazardous waste container
 Prevent aerosolization of the drug at all times
 Clean the spill area with a detergent or bleach solution
 ADMINISTERING CHEMOTHERAPEUTIC DRUGS

Gathering the equipment

– Prescribed drugs
– IV access supplies
– Sterile PNSS
– IV syringes and tubings with luer lock
–Leakproof chemical waste container
–Chemotherapy gloves
–Chemotherapy spill kit
– Extravasation kit
 ADMINISTERING CHEMOTHERAPEUTIC DRUGS
Preventing Infiltration
 Use a low-pressure infusion pump to administer vesicants through a peripheral vein, to
decrease the risk of extravasation
 Use a central venous catheter for continuous vesicant infusions

Guidelines in giving vesicants

 Use a distal vein that allows successive proximal venipunctures
 Avoid using the hand, antecubital space, damaged areas, or areas with compromised
circulation
 Don’t probe or “fish” for veins
 Place a transparent dressing over the site
 ADMINISTERING CHEMOTHERAPEUTIC DRUGS
Cont…
 Start the push delivery or the infusion with normal saline solution
 Inspect the site for swelling and erythema
 Tell the patient to report burning, stinging, pain, pruritus, or temperature changes near the
site
 After drug administration, flush the line with 20mL of NS
 Dispose of all used needles and contaminated sharps in the orange sharps container
 Dispose of PPE’s in yellow chemotherapeutic waste container
 Dispose of unused medications, considered hazardous waste, according to your facility’s
policy
 ADMINISTERING CHEMOTHERAPEUTIC DRUGS

Cont…
 Start the Wash hands thoroughly
 Document the sequence in which the drugs were administered
 site accessed, the gauge and length of the catheter, and the number of attempts
 name, dose, and route of the administered drugs
 Type and volume of the IV solutions and adverse reactions and nursing interventions
 According to facility policy, wear protective clothing when handling body fluids from the
patient for 48 hours after giving chemotherapy.
 MANAGING COMPLICATIONS OF CHEMOTHERAPY

1. ALOPECIA
 Hair loss that occurs as chemotherapeutic drugs destroy the rapidly growing cells of hair
follicles
 May be minimal or severe
 Occurs 2-3 weeks after treatment begins
 Almost always temporary Signs and Symptoms
 Hair loss that may include eyebrows, lashes and body hair
Nursing Interventions
 Minimize shock and distress by warning the patient of this possibility
 Discuss with the patient why it occurs
 Describe to the patient how much hair loss to expect
 Emphasize to the patient the need for appropriate head protection against sunburn
 Inform the patient that new hair may be a different texture or color
 Give the patient sufficient time to decide whether to order a wig
 Inform the patient that his scalp will become sore at times due to follicles swelling
Prevention measures
 For patients with long hair, suggest cutting hair shorter before treatment because washing
and brushing cause more hair loss
2. ANEMIA
 Occurs as chemo drugs destroy healthy cells and cancer cells
 RBCs are destroyed and can’t be replaced by the bone marrow Signs and symptoms
 Dizziness, fatigue, pallor, and shortness of breath after minimal exertion
 Low hemoglobin level and hematocrit
 May develop slowly over several courses of treatment
Nursing Interventions

 Monitor hemoglobin level, hematocrit, RBC count; report dropping values

 Be prepared to administer a blood transfusion or erythropoietin Prevention Measures
 Instruct the patient to take frequent rests, increase his intake of iron-rich foods, and take a
multivitamin with iron as prescribed
 If the patient has been prescribed a drug such as epoetin, make sure he understands how to
take the drug and what adverse effects he should watch for and report
MANAGING COMPLICATIONS OF CHEMOTHERAPY
3. DIARRHEA
 Occurs because the rapidly dividing cells of the intestinal mucosa are killed
 Complications include weight loss, F&E imbalance, and malnutrition Signs and symptoms
 An increase in the volume of stool compared with the patient’s normal bowel habits.

Nursing Interventions
 Assess frequency, color, and consistency of stool
 Encourage fluids, give IV fluids and potassium supplements as ordered Prevention measures
 Use dietary adjustments and antidiarrheal meds
 Provide good perianal skin care
MANAGING COMPLICATIONS OF CHEMOTHERAPY

4. EXTRAVASATION
 The inadvertent leakage of a vesicant solution into the surrounding tissue Signs and
Symptoms
 Initial signs and symptoms may resemble those of infiltration – blanching, pain, swelling
 Symptoms possibly progressing to blisters; to skin, muscle, tissue and fat necrosis; and to
tissue sloughing Blood return is an INCONCLUSIVE test and shouldn’t be used to determine if
IV catheter is correctly seated in the peripheral vein.
 To assess peripheral IV placement, flush the vein with NS and observe site for swelling.
Extravasation of Doxorubicin
Nursing Interventions
 Stop the infusion
 Check your facility’s policy to determine if the IV catheter is to be removed or left in place to
infuse corticosteroids or a specific antidote.
 Notify the physician
 Instill the appropriate antidote according to facility policy. Usually, you’ll give the antidote for
extravasation either by instilling it through the existing IV catheter or by using a 1 mL syringe
to inject small amounts subcutaneously in a circle around the extravasated area
 After the antidote has been given, remove the IV catheter
5. INFILTRATION
 The inadvertent leakage of a nonvesicant solution or medication into the surrounding tissue
 Infusion-site related Signs and symptoms
 Blanching
 Change in IV flow rate
 Numbness and tingling in swollen area due to nerve compression injury leading to
compartment syndrome
 Swelling around IV site (the swollen area will be cool to touch)
Nursing Interventions
 Remove the IV catheter
 Insert a new IV catheter in a different location Prevention Measures
 Check for infiltration before, during, and after the infusion by flushing the vein with normal
saline solution.
6. LEUKOPENIA
 Reduced leukocytes or WBCs
 Occurs as WBCs and cancer cells are destroyed by chemo drugs Signs and Symptoms
 Susceptibility to Infections
 Neutropenia Nursing Interventions
 Watch for the nadir, the point of lowest blood cell count
 Be prepared to administer colony-stimulating factors
 Institute neutropenic precautions
NURSING INTERVENTION
Teach the patient and caregiver about:
 Good hygiene practices
 Signs and symptoms of infection
 The importance of checking the patient’s temperature regularly
 How to prepare low-microbe diet
 How to care for vascular access devices
 Instruct the patient to avoid
 Crowds
 People with colds or respiratory infections
 Fresh fruit ,Fresh flowers and plants
7. NAUSEA and VOMITING
Can appear in 3 different patterns  Anticipatory  Acute  Delayed
ANTICIPATORY NAUSEA and VOMITING
Signs and Symptoms
 Nausea and vomiting that’s a learned response from prior nausea and vomiting after a dose
of chemotherapy
 High anxiety levels (acts as a trigger)

Nursing Interventions
 Posttreatment control of nausea and vomiting may prevent future anticipatory episodes
Prevention measures
 Pre treat the patient with lorazepam (Ativan) at least 1 hr before arriving for treatment
 Patients with overwhelming anxiety may need IV lorazepam before chemo is administered
 MANAGING COMPLICATIONS OF CHEMOTHERAPY

ACUTE NAUSEA and VOMITING

Signs and symptoms
 Nausea and vomiting occurring within the first 24 hours of treatment

Nursing Interventions
 Treat the patient with acute nausea and vomiting with antiemetic drugs
 Dexamethasone
 Granisetron
 Lorazepam
 Metoclopramide
 Ondansetron
DELAYED NAUSEA and VOMITING
Signs and Symtoms
 Nausea or vomiting starting or continuing beyond 24 hours after chemo has begun

Nursing Interventions
 The administration of serotonin antagoninsts, corticosteroids, various antihistamines,
benzodiapines, and and metoclopramide is usually effective in treating patients Prevention
Measures
 Administer antiemetic before chemo begins
 Some patients with delayed nause and vomiting are treated with an antiemetic for 3 days or
longer
8. STOMATITIS
 Inflammation of the lining of the oral mucosa
 Can spread into the esophagus and pharynx Signs and Symptoms
 Painful mouth ulcers that range from mild to severe appearing 3 to 7 days after certain
chemotherapeutic drugs are given
Nursing Intervention
 Instruct the patient to perform meticulous oral hygiene
 Administer topical anesthetic mixtures as appropriate
 If pain is severe, opioid analgesics may be prescribed until the ulcers heal Prevention
Measures
 Instruct the patient to suck on ice chips while receiving certain drugs that cause stomatitis;
this decreases the blood supply to the mouth, thus decreasing ulcer formation
9. THROMBOCYTOPENIA
 Reduced blood platelet count Signs and Symptoms
 Bleeding gums
 coffee-ground emesis
 Hematuria
 Hypermenorrhea
 Increased bruising
 Petechiae
 Tarry stools
Nursing interventions
 Monitor patient’s platelet count
 Avoid unnecessary IM injections or venipuncture
 If an IM injection or venipuncture is necessary, apply pressure for at least 5 minutes; apply a
pressure to the site.
 Instruct the patient to Avoid cuts and bruises, Shave with an electric razor, Avoid blowing his
nose, Stay away from irritants that would trigger sneezing, Avoid using rectal thermometers
 Instruct the patient to report sudden headaches (which could indicate potentially fatal
intracranial bleeding)
10. VEIN FLARE
 Occurs during infusion of an irritant into the vein Signs and Symptoms
 Bright redness possibly appearing in the vein along with blotches or hives on the affected
arms
 Burning pain or aching along the vein as well as up through the arm

Nursing Interventions
 If the reaction is severe, injection of an IV steroid may be required
 If the patient complains of pain or burning during the infusion:

› Increase the dilution of the infused medication

› Decrease the infusion rate
› Restart the IV in a different vein
 BIBLIOGRAPHY

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Oncologist, 8, 187-98.
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