Cancer Treatment Modalities and Side Effects Original

8/13/2019 Cancer Treatment Modalities and Side Effects Original

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The Good....

The Bad...

And The Ugly


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OVERVIEW

CANCER,

TREATMENTMODALITIES,

ANDSIDE EFFECTS


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O JE TIVES

Upon completion of this session, the learner will be able to:

1. List cancer statistics related to incidence, cases, and deaths.

2. Define cancer.

3. Explain theories of causation, grading, and staging of cancer.

4. Discuss various treatment modalities available for cancer.

5. State principles of cancer treatment.

6. Examine common side effects, complications, and nursing

management related to treatment modalities.

7. Review basic solid tumors and hematological malignancies.


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Glossary of Terminology

Neoplasm new plasmaabnormal tissue growth with rapid

growth

Benign no metastasis

Malignant

local invasion and destructive growthwickedMetastasis

spread form primary via lymphatic and/or

circulatory system


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STATISTICSCancer is the second leading cause of death in

the United States

Cancer affects one in three families
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STATISTICSIncidence:

#1 Skin

Male Female

Prostate Breast

Lung Lung

Colon/Rectum Colon/Rectum

Death:

Male: Female:

Lung Lung

Prostate Breast

Colon/Rectum Colon/Rectum


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CANCER


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THEORIES OF CAUSATION

Environmental(tobacco, occupational, pesticides,asbestos)

Radiation(UV, radon)

Genetics(BRCA)

Hormonal Imbalances

Viral(HIV, H Pylori, HPV)

Stress


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DEFINITIONS

1. Cancer is a disease of the cell

2. Large group of diseases characterized by:

a. Abnormal cell structure(no differentiation)

b. Uncontrolled growth (proliferation)

c. Ability to spread (metastasis)

d. Ability to invade normal tissue (lack contactinhibition


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Differen tiat ion =Maturat ion

&

Pro l i ferat ion = Div is ion


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Cancer cells follow no rulesand have the ability to

stimulate the growth of a newblood supply


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Grading and Differentiation

(need tissue diagnosis):Grade 1 = Well-Differentiated

Grade 2 = Moderately differentiated

Grade 3 = Poorly-differentiated

Grade 4 = Undifferentiated


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TNM STAGINGT= Tumor T0-T4

N = Node No-N3

M = Metastasis


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TREATMENT MODALITIES

(THE GOO )


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SURGERYCurative

Prophylactic

Diagnostic

Staging

Palliative

Adjuvant or Supportive

Reconstructive/Rehabilitative


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RADIATION

Highest energy rays

that can kill any cell or

tissue

May be external source

(brachytherapy)

Curative

Palliative

60% will receive XRT Divided into doses or

fractions

(Preserve normal

cellular growth)


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CHEMOTHERAPY

CHEMOTHERAPY


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Chemotherapy

Cytotoxic drugs that destroy cancer cells or prevent

cellular replication by interfering with DNA and

RNA and vital cellular proteins

Goal is to reduce the number of cells to a small

number that can be (theoretically) handled by the

immune system


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BIOTHERAPY Treatment that alters the bodys biological response

Uses bodys own immune system to treat cancer

Alters the immune system with either stimulatory or

suppressive effect

Produce anti-tumor activities


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HORMONAL THERAPY

used against hormonally sensitive tumors like

breast and prostate

creates unfavorable growth environment


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PRINCIPLES OFCANCER TREATMENT


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GOALS

CURE

CONTROL

PALLIATION


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MEASURE TUMOR RESPONSE

Complete Response

Partial Response

Stable Disease


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SIDE EFFECTS

AND

MANAGEMENTTHE BAD)


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MYELOSUPPRESSIONNEUTROPENIA

THROMBOCYTOPENIA

ANEMIA


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NEUTROPENIA


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Pathophysiology Damage to stem cells in bone marrow with

decreased ability to make these important cells

Hematologic malignancies cause the malignant

cells to crowd the bone marrow and therefore

difficult to make normal amount of normal cells

Solid tumors metastasize to bone marrow with a

decreased normal cell production Radiation damages bone marrows ability to make

cells


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Neutropenia/Leukopenia

Assess risk factors

(Age, renal and liver function, nutrition, bone marrow, other

medications, prior chemotherapy and/or radiation)

Manifestations include fever >38 C or 100.4F (no classic signs)

cough, SOB

skin redness or tenderness, (mouth, perianal, rectal)

urinary symptoms (dysuria frequency, hematuria, hesitancy)

indwelling devices (VADs, pain, edema, swelling,

induration at site)

sepsis (hypotension, agitation, decreased urine)


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Prevention:

No fresh fruits or vegetables, no pepper, live

plants or potting soil

No exposure to live vaccines or pet excreta

Avoid others with colds

Strict hand washing and personal hygiene

Mouth care at least 4 times daily

No trauma or invasive procedures

Prevent constipation and pressure sores


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Management: BC lines and peripheral, urine, sputum

CXR and good physical assessment

Antibiotics immediately (broad spectrum coverage) Administer neupogen or leukine

Patient education (temperature at least 2 times daily)

Vital signs at least every 4 hours or more

Assess for chills, SOB, cough, pain

***This is life-threatening for patients and

requires immediate attention


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BLEEDING&

NO CLOTTING=

THROMBOCYTOPENIA

(NO PLATELETS)


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ThrombocytopeniaManagement

Institute bleeding precautions


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ANEMIA

DECREASED RED BLOOD CELLS


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Anemia Assess for

chemotherapy

kidney damage

tumor infiltration of bone marrow, XRT

bleeding, hemorrhage

age


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Anemia

Management:

Rest, slow position changes

Oxygen

Iron

Transfusion

Epogen (Hct


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Leukine

they are glycosylated proteins that function to regulate cell

reproduction, cell maturation, and cell function of blood cells

Hematopoietic

Growth Factors

Neupogen

NeumegaProcrit

Aranesp Neulasta
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I SymptomManagement


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Symptom Management


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Nausea/Vomiting

* * * As many as 60% patients exper iencenausea and vomiting

Patterns

Anticipatory (starts and may last several hours to days)

Acute (0-24 hours)

Delayed (1-4 days)

medications, ICP, SIADH, stress

Assess for weight loss, albumin, hydration

y p g

NAUSEA AND VOMI TING


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Nausea/Vomiting

SeratoninInhibitors/Antagonists

receptors on vagus nerve

and in the CTZ

effectiveness may be

enhanced by concurrent

administration of decadron

act by blocking seratonin

from binding to receptors in

GI tract (not indicated for

anticipatory or delayed

N&V)

Ondansetron (Zofran)

Dolestron (anzemet)

Ganisetron (Kytril)


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Nausea/VomitingPhenothiazines

only mildly useful as single

agents better in combination with

other antimetics

block dopamine receptors in

CTZ works well for XRT, and

morphine associated nausea

Prochlorperazine

(compazine) Chlorpromazine

(Thorazine)

Promethazine (Phenergan) Thiethylperazine (torecan)


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Nausea/Vomiting

Glucocorticosteroids

effective with mild emeticdrugs

may block prostaglandin

release from hypothalmus

Dexamethasone

(decadron) Methylprednisone

(solumedrol)

prednisone


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Nausea/Vomiting

Metoclopramide (reglan)

Most effective agent

against Cisplatin Do not use with GI

obstruction

Blocks CTZ and promotesgastric emptying


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Nausea/VomitingCannabinoids

effective with some

refractory cases Dronabinol (marinol)

Butyrophonones

Inapsine (droperidol)

Haldol


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Nausea/VomitingAntihistamines

good with motion sickness

blocks extrapyrammidaleffects of other antimetics

not effective as single

agents

Hydroxyzine (vistaril,atarax)

Diphenhydramine

(benadryl)


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Nausea/Vomiting

Benzodiazepines

amnesiac effect in drugcombinations

blocks short term memory

Diazepam (valium)

Lorazepam (ativan)


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Nausea/VomitingAnticipatory N & V

need to mediate the

response of the centers inthe cerebral cortex which

result in anticipatory

nausea and vomiting

ativan

valium

dronabinol


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Nausea/VomitingACUTE N&V:

mild potential drugs

suggested to usephenothiazide =/- steroidor low dose reglan =/-steroids

moderate potential benefitfrom po/IV 5-HT3antagonist =/- steroid orreglan =/- steroid

high potential benefit from

po/IV 5-HT3 antagonist

PLUS a steroid =/- a

benzodiazepine


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Nausea/VomitingDelayed N&V corticosteroids

commonly used in

combination with 5-

HT3 antagonist or

reglan

result of unknown

mechanism


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Other Notable Side Effects

HOWDO WE

TREAT???


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Up to 80% develop mouth

sores

Assess and prevent

NSS mouth rinses


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Damage is to shaft (thinning

and breakage)

Damage to roots (completealopecia)

Loss begins about 2 weeks

after treatment

Regrowth may take up to 3-5

months after treatment


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50-100%patients


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SKIN REACTIONS Hypersensitivity

Hyper pigmentation

Photo sensitivity

Radiation recall

Radiation enhancement

Ulceration Palmar-Planter

Erythrodysestheses (PPE)
http://www.naturalawakenings.com/images/dep-skin.gif


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THE UGLY
http://www.scribblecartoon.com/archive/cartoons/ugly.gif


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Cardiac Toxicity


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Pulmonary


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Urologic


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Renal/Nephrotoxicity


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Hepatotoxicity


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Neurotoxicity


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Ocular Toxicities


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???WHICH TREATMENT DO I CHOOSE??


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SOLID TUMORS

Neurological:

Brain

Spinal Cord


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SOLID TUMORS

Head and Neck

Bone and Soft Tissues


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SOLID TUMORS

LUNG


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SOLID TUMORS

Esophageal

Gastric Colorectal

Pancreatic

Hepatocellular


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SOLID TUMORSGU

CANCERS

Kidney

BladderProstate


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SOLID TUMORS

GENITALCANCER

Cervical

Endometrial

Ovarian

Testicular

Breast


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SKIN CANCER


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LEUKEMIASACUTE:

AML

ALL

CHRONIC:

CML

CLL


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LYMPHOMAS

Non-Hodgkins

&

Hodgkins


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MULTIPLEMYELOMA


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HEMTOLOGICAL MALIGNANCIES

IDIOPATHIC

THROMBOCYTOPENIC

PURPURA (ITP)
http://noblood.getsmart2.com/platelets_1.jpg


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THROMBOTIC THROMBOCYTOPENIAPURPURA TTP)


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PL STICNEMI
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REFERENCES

Fishman, M., & Orlowski, M.M. (Eds.). (1999). Cancer

chemotherapyguidelines and recommendations for practice: ONS (2nded.).

OncologyNursing Press Inc.

Groenwald, S.L., Froygl, M.H., Goodman, M., & Yarbo, C.H. (Eds.).

(2002). Cancer nursing: Principles and practice (5thed.). Boston: Jones and Bartlett

Publishing

Itano, J.K. & Taoka, K.N. (1998). Core curriculum for oncology nursing(3rded.).

Philadelphia: W.B. Saunders.

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