2. “It is the use of antineoplastics agents to
attempt to kill tumor cell by interfering with
cellular functions and reproduction”
3. 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.
4. 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
6. Chemotherapeutic drugs
act through variety of mechanism…..
Limiting DNAsynthesis and expression
Cross linking polymer DNA
DNAdouble stand breaks
Preventing formation of mitotic apparatus
7.
8. 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
9. Classification……………
According to chemical groups
Alkylating agents
Antimetabolites
Anti tumor antibiotics
Nitrosureas
Plant alkaloids
Hormonal
agents
Miscellaneous agents
12. Concepts in
chemotherap
y
Combination chemotherapy
(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 )
Adjuvant chemotherapy
(along with surgery and radiation)
13. 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
15. 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
16. 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
17. 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
18. 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…………
19. 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…………
20. 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
Safe preparation, handling and
disposal…………
23. Safe preparation, handling and
disposal…………
•
Exposure can be occur through
–
Inhalation of aerosols
–
Absorption through the skin
–
Ingestion of contaminated material
24. Safe handling of chemotherapy
drugs
Protect patient Protect
environment
Protect your
self
•
Care should be taken to
protect skin
•
All connection b/w drug
and patient should occur
away from patient skin
•
Use Leur lock connection
•
use air inlet device for
preparation of drugs
•
discard gloves after each
use and wash hand
Minimize exposure
•
by inhalation
•
by skin contact
•
by ingestion
26. 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
27. 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
29. Stop drug
administration
Maintain iv access
with 0.9% NS
Notify physician
Maintain airway
( supine position
with feet elevated)
Administer Epinephrin,
Aminophylline, Diphenhydramine
30. Side effects of
chemotherapy….
•
Myelosuppression
•
Fatigue
•
Nausea and vomiting
•
Stomatitis and
mucositis
•
Pulmonary toxicity
•
Renal toxicity
•
Neurotoxicity
•
Gonadal suppression
•
Cardiotoxicity
•
Alopecia
•
Taste changes
•
Skin changes :
Hyper Pigmentation,
Nail Discoloration,
Dermatitis
Fingertip Ulceration
and Photosensitivity
31. 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
32. 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.
33. 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
34. 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
