This document discusses cancer treatment interventions including surgery, chemotherapy, radiation therapy, and biologic and targeted therapies. It outlines nursing management of patients receiving these treatments with a focus on managing common side effects like fatigue, nausea, vomiting and preventing infection. The goal of cancer treatment is cure, control of the cancer or palliation to improve quality of life. Nursing plays a key role in symptom management and ensuring patient safety during complex cancer treatment regimens.

1. Ch. 16 Cancer August 25, 2010

2. Objectives Explain the use of OR, chemo, radiation, and biologic & targeted therapy in the treating cancer Discuss the appropriate nsg mgmt of patients receiving the above interventions

3. Terminology Review Benign VS Malignant Carcinogens Carcinomas VS Sarcomas Protooncogenes VS Oncogenes Hyperplasia VS Hypertrophy

4. Classification of Cancer Tumors can be classified by Anatomic site Histology Grading severity Extent of disease Staging

5. Grades of Abnormal Cells Grade 1 slightly different but well differentiated Grade 2 Grade 3 Grade 4 Cells immature, primitive and undifferentiated Cell of origin is difficult to determine

6. Clinical Staging 0: Cancer in situ 1: Tumor limited to tissue of origin; localized tumor growth 2: Limited local spread 3: Extensive local and regional spread 4: Metastasis

7. Interpreting TNM Breast cancer T2 N2 M0 Prostate cancer T3 N2 M0

8. Detection Prevention C- change in bowel or bladder habit (colon cancer) A- a sore that doesn't heal on skin or on mouth U- unusual bleeding or discharge from rectum, bladder, or vagina T- thickening or lump in the breast tissue I- indigestion or difficulty swallowing O- obvious changes in a wart or mole (skin cancer) N- nagging cough or hoarseness (lung or throat cancer) Lifestyle habits to reduce risks Avoid or reduce exposure to known or suspected carcinogens Cigarette smoke, excessive sun exposure Eat a balanced diet Exercise regularly Obtain adequate rest Regular health examination Change perceptions of stressors Learn to cope with stress Enjoy consistent periods of relaxation and leisure

9. Surgery Chemotherapy Radiation Biologic & Targeted Therapy Medical Interventions

10. Goals Cure Control Palliation Collaborative Care of Cancer

11. Surgical therapy is used Prophylaxis – removal of at risk tissue Dx – Biopsy Cure – attempts to remover all CA tissue Control – debulks the tumor, does not cure Determine efficacy of Tx – “second look” Palliation – does not extend life, ↑ quality of life Reconstruction - ↑ function/appearance Surgery

12. Purpose: To destroy CA cells with minimal exposure of the normal cells to the damaging actions of radiation Radiation

13. Mechanism of Action Delivery methods Teletherapy (Externally) Brachytherapy (Internally) Brachytherapy safety principles: ALARA, time, distance, and shielding Radiation Tx for CA - cont

14. Vary acc. to the side Local skin ∆ ∆ taste sensations Fatigue r/t ↑ energy demands Inflammatory response r/t radiation S/E of Radiation Therapy

15. Teach accurate objective facts to help the clt to cope Do not remove markings Administer skin care Do not use lotions or ointments Avoid direct sun exposure Care for xerostomia R/O bone fracture Nsg Care/Mgmt: Radiation Tx

16. Chemotherapy Used to cure and/or add survival time Some selectivity for killing cancer cells over normal cells

17. S/E of Chemo Skin Δ Hair Intestinal tissues Spermatocytes Hematopoietic Sx Δ Anxiety & sleep disturbances

18. Chemotherapy Administration Given by Oncology nurse Checked by 2 nurses Cancer cycle: course of tx subj.to Nadir Nadir: the time when bone marrow activity + WBC are @ their lowest

19. Nsg Care/Mgmt: Chemotherapy Major role of the oncology - Chemo Drug therapy Protection from infection CAM

20. Tx issues with Chemo Drug dosage Drug schedule Drug administration: Oral IV: Central line Spine Interthecal Extravasation Vesicants

21. Biologic & Targeted Therapy Biological response modifier: modify the clt biologic responses to tumor cells – 3 ways Targeted therapy: targeting specific cellular pathways that are important in tumor growth

22. Stem Cell Transplantation Source Hematopoietic SCT: BMT, PSCT, umbilical cord blood Types of HSCT: allogeneic (HLA), syngeneic, autologous Allows very high dose of chemo & radiation Goal: eradicate tumor cell and/or clear the marrow for engraftment of SCT BMT VS PSCT

23. Main Oncology Nursing Outcome Management of fatigue, nausea and vomiting, prevention of infection, and return to usual function

24. Oncology Nursing Approach/Intervention/Measure symptom experience (dyspnea, fatigue, mucositis, nausea and vomiting, pain, peripheral neuropathy, and sleep-wake disturbances), functional status (nutritional status and return to usual functioning), safety prevention of adverse events (prevention of infection), and psychological distress (depression)

25. Oncology Emergencies IV access issues Adverse response to chemo drugs Sepsis DIC

26. Collaborative Tx in Oncology Emergencies Prevention Intravenous IV abx tx Anticoagulants Cyroprecipitated clotting factors

27. Questions & Answers

28. Resources Article: Put Evidence in Practice Nursing-Sensitive Patient Outcomes: The Development of the Putting Evidence Into Practice Resources for Nursing Practice PodCast on Blackboard/Media Library Managing stress Advocating cancer clients and caregivers