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P A R T 2
Chemotherapeutic agents
CANCER CELL–SPECIFIC AGENTS
The goal of much of the current antineoplastic drug
research is directed at finding drugs that are cancer
cell specific. These drugs would not have the devastat
ing effects on healthy cells in the body and would be
more effective against particular cancer cells. Three
groups of drugs are available for cancer cell–specific
actions: protein tyrosine kinase inhibitors, an epidermal
growth factor inhibitor and a proteasome inhibitor (see
Table 14.6).
Implementation
Ensure safe administration of the drug.
Provide comfort and safety measures: mouth and skin care,
rest periods, safety precautions, antiemetics as needed,
maintenance of nutrition and head covering.
Provide support and reassurance to deal with drug effects,
body image changes, discomfort and diagnosis.
Provide teaching regarding drug name, dosage, adverse
effects, precautions to take, signs and symptoms to
report and comfort measures to observe.
Evaluation
Evaluate drug effects: resolution of cancer.
Monitor for adverse effects: GI toxicity, bone marrow
suppression, CNS changes, renal and hepatic damage,
alopecia, extravasation of drug.
Monitor for drug–drug interactions as listed.
Evaluate effectiveness of teaching program.
Evaluate effectiveness of comfort and safety measures.
TEACHING FOR B.P.
Antineoplastic agents work to destroy cells at various
phases of their life cycle. The drugs are given in
combination to affect the cells at these various stages.
These drugs are prescribed to kill cancer cells that are
growing in the body. Because these drugs also affect
normal cells, they sometimes cause many adverse
effects. Your drug combination includes doxorubicin,
cyclophosphamide and paclitaxel.
• These drugs are given in a 21-day cycle, followed by a
rest period. You will need to mark your calendar with
the treatment days and rest days. You will need to have
regular blood tests to follow the effects of these drugs on
your blood cells.
• Common adverse effects of these drugs include the
following:
•
Nausea and vomiting
. Antiemetic drugs and sedatives
may help. Your healthcare provider will be with you to
help if these effects occur.
•
Loss of appetite
. It is very important to keep up your
strength. Tell people if there is something that you
would be interested in eating—anything that appeals to
you. Alert someone if you feel hungry, regardless of the
time of day.
•
Loss of hair
. Your hair will grow back, although its colour
or consistency may be different from what it was
originally. It may help to purchase a wig before you
lose your hair so that you can match appearance if you
would like to. Hats and scarves may also be worn. It is
very important to keep your head covered in extremes
of temperature and to protect yourself from sun, heat
and cold. Because much of the body’s heat can be lost
through the head, not protecting yourself could cause
serious problems.
•
Mouth sores
. Frequent mouth care is very helpful. Try to
avoid very hot or spicy foods.
•
Fatigue, malaise
. Frequent rest periods and careful
planning of your day’s activities can be very helpful.
•
Bleeding
. You may bruise more easily than you normally
do and your gums may bleed while you are brushing
your teeth. Special care should be taken when shaving
or brushing your teeth. Avoid activities that might cause
an injury and avoid medications that contain aspirin.
•
Susceptibility to infection
. Avoid people with infections or
colds, and avoid crowded, public places. In some cases,
the people who are caring for you may wear gowns and
masks to protect you from their germs. Avoid working in
your garden because soil can be full of bacteria.
• Report any of the following to your healthcare provider:
bruising and bleeding, fever, chills, sore throat, difficulty
breathing, flank pain, and swelling in your ankles or
fingers.
• Take the full course of your prescription. It is very
important to take the complete regimen that has been
ordered for you. Cancer cells grow at different rates, and
they go through rest periods during which they are not
susceptible to the drugs. The disease must be attacked
over time to eradicate the problem.
• Tell any doctor, nurse or other healthcare provider that
you are taking this drug.
• Try to maintain a balanced diet while you are taking this
drug. Drink 10 to 12 glasses of water each day during the
drug therapy.
• Use a barrier contraceptive while you are taking this drug.
These drugs can cause serious effects to a developing
fetus, and precautions must be taken to avoid pregnancy.
If you think that you are pregnant, consult your healthcare
provider immediately.
• You need to have periodic blood tests and examinations
while you are taking this drug. These tests help to guard
against serious adverse effects and may be needed to
determine the next dose of your drug.
