Cancer chemo therapy

“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

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

• Eg : Buzalfan ,Cyclophosphamide, Carboplatin
Alkylating agents
• Eg: Cladribine , Methotrexate Sodium, 5-
flurouracil
Antimetabolites
• Eg: Bleomycin Sulfate, Dactinomycin , Epirubicin
Antitumor antibiotics

• Eg: Carmustine, Lomustine, Semustine
Nitrosureas
• Eg : Docetaxel, Etoposide, Pacltitaxel
Pant alkaloids /natural products
• Eg: Altetramine, Amsrcrine, Asparaginase
Miscellaneous agents

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)

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

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

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

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

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”

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

• Exposure can be occur through
– Inhalation of aerosols
– Absorption through the skin
– Ingestion of contaminated material

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

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
administration
Maintain iv access
with 0.9% NS
Notify physician
Maintain airway
( supine position
with feet elevated)
Administer Epinephrin,
Aminophylline, Diphenhydramine

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

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

• 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.

• 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

• 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

Cancer chemo therapy

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