C H A P T E R 1 4
Antineoplastic agents
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CRITICAL THINKING SCENARIO
Antineoplastic therapy and breast cancer
THE SITUATION
B.P., a 34-year-old woman, is a schoolteacher with two
young daughters. She noticed a slightly painful lump under
her arm when showering. About 2 weeks later, she found
a mass in her right breast. Initial assessment found that
she had no other underlying medical problems, had no
allergies and took no medications. Her family history was
most indicative: many of the women in her
family—her
mother, two grandmothers, three aunts, two older sisters
and one younger sister—died of breast cancer when they
were in their early 30s. All data from the initial examination,
including an evaluation of the lump in the upper outer
quadrant of her breast and the presence of a fixed
axillary node, were recorded as baseline data for further
drug therapy and treatment. B.P. underwent a radical
mastectomy with biopsy report for grade IV infiltrating
ductal carcinoma (28 of 35 lymph nodes were positive
for tumour) and then radiation therapy. Then she began
a 1-year course of doxorubicin, cyclophosphamide and
paclitaxel (AC/paclitaxel/sequential).
CRITICAL THINKING
What are the important implications for B.P.?
Think about the
outlook for B.P., based on her biopsy results and her family
history.
What are the effects of high levels of stress on the immune
system and the body’s ability to fight cancer?
What impact will this disease have on B.P.’s job and her
family?
Think about the adverse drug effects that can be
anticipated.
How can good teaching help B.P. to anticipate and cope
with these many changes and unpleasant effects?
What future concerns should be addressed or at least
approached at this point in the treatment of B.P.’s
disease? What are the implications for her two
daughters? How may a coordinated health team work to
help the daughters cope with their mother’s disease, as
well as the prospects for their future?
DISCUSSION
The extent of B.P.’s disease, as evidenced by the biopsy
results, does not signify a very hopeful prognosis. In this
case, the overall care plan should take into account not
only the acute needs related to surgery and drug therapy,
but also future needs related to potential debilitation and
even the prospect of death. Immediate needs include
comfort and teaching measures to help B.P. deal with the
mastectomy and recovery from the surgery. She should be
given an opportunity to vent her feelings and thoughts in a
protected environment. Effort should be made to help her
to organise her life and plans around her radiation therapy
and chemotherapy.
The adverse effects associated with the antineoplastic
agents she will be given should be explained and possible
ways to cope should be discussed. These effects include
the following:
Alopecia
. B.P. should be reassured that her hair will grow
back, but she will need to cover her head in extremes
of temperature. Purchasing a wig before the hair loss
begins may be a good alternative to trying to remember
later what her hair was like.
Nausea and vomiting
. These effects will most often occur
immediately after the drugs are given. Antiemetics may
be ordered, but they are frequently not very effective.
Bone marrow suppression
. This will make B.P. more
susceptible to disease, which could be a problem for
a teacher and a mother with young children. Ways to
avoid contact and infection, as well as warning signs to
report immediately, should be discussed.
Mouth sores
. Stomatitis and mucositis are common problems.
Frequent mouth care is important. The person should be
encouraged to maintain fluid intake and nutrition.
Because the antineoplastic therapy will be a long-term
regimen, it might help to prepare a calendar of drug dates
for use in planning other activities and events. All of B.P.’s
treatment should be incorporated into a team approach
that helps B.P. and her family deal with the impact of this
disease and its therapy, as well as with the potential risk to
her daughters. B.P.’s daughters are in a very high risk group
for this disease, so the importance of frequent examinations
as they grow up needs to be stressed. In some areas of the
country, healthcare providers are encouraging prophylactic
mastectomies for women in this very high risk group.
CARE GUIDE FOR B.P.: ANTINEOPLASTIC AGENTS
Assessment: History and examination
Allergies to any of these drugs, renal or hepatic dysfunction,
pregnancy or breastfeeding, bone marrow suppression,
or GI ulceration
Concurrent use of ketoconazole, diazepam, verapamil,
quinidine, dexamethasone, cisplatin, cyclosporine,
teniposide, etoposide, vincristine, testosterone or
digoxin, which could interact with these drugs
Local
: evaluation of injection site
CNS
: orientation, affect, reflexes
Skin
: colour, lesions, texture
GI
: abdominal, liver evaluation
Laboratory tests
: FBC with differential; renal and hepatic
function tests
