252
Unit 3
Applying concepts from the nursing process
Many of these agents are specific to certain phases of the
cell cycle. Most affect cells in the S phase by interfering with
DNA and RNA synthesis. Others, such as the vinca or plant
alkaloids, are specific to the M phase, where they halt mitotic
spindle formation.
Chemotherapeutic agents that act independently of the
cell cycle phases are termed cell-cycle non-specific agents.
These agents usually have a prolonged effect on cells, leading
to cellular damage or death. Many treatment plans combine
cell-cycle specific and cell-cycle non-specific agents to increase
the number of vulnerable tumour cells killed during a treat-
ment period (Polovich, White & Kelleher, 2005).
Chemotherapeutic agents are also classified according to
various chemical groups, each with a different mechanism of
action. These include the alkylating agents, nitrosureas, anti-
metabolites, antitumour antibiotics, plant alkaloids, hormonal
agents and miscellaneous agents. The classification, mech-
anism of action, common drugs, cell cycle specificity and
common side effects of antineoplastic agents are listed in
Table 11-7.
Chemotherapeutic agents from each category may be used
to enhance the tumour cell kill during therapy by creating
multiple cellular lesions. Combined medication therapy relies
on medications of differing toxicities and with synergis-
tic actions. Using combination drug therapy also prevents
development of drug-resistant mechanisms.
New combinations of chemotherapy are being studied for
effectiveness in resistant tumour lines. For more information
about investigative drugs, see Chart 11-5.
Administration of chemotherapeutic agents
Chemotherapeutic agents may be administered in the
hospital, clinic or home setting by topical, oral, intravenous,
intramuscular, subcutaneous, arterial, intracavitary and intra-
thecal routes. The administration route usually depends on
the type of agent, the required dose and the type, location
and extent of tumour being treated. A position statement
on the minimum education and safety requirements for
nurses involved in the administration of chemotherapy has
been developed by the Cancer Nurse Society of Australia
(CNSA). Patient education is essential to maximise safety
if chemotherapy is administered in the patient’s home
(Chart 11-6).
The G
0
phase, the resting or dormant phase of cells, can
occur after mitosis and during the G
1
phase. In the G
0
phase
are those dangerous cells that are not actively dividing but
have the potential for replicating. The administration of
certain chemotherapeutic agents (as well as administration of
some other forms of therapy) is coordinated with the cell cycle.
Classification of chemotherapeutic agents
Certain chemotherapeutic agents (cell-cycle specific drugs)
destroy cells actively reproducing by means of the cell cycle.
Nursing interventions
a. Bed rest with padded side rails.
b. Avoidance of strenuous activity.
c. Platelet transfusions as
prescribed; administer prescribed
hydrocortisone sodium succinate
(Solu-Cortef) to prevent reaction to
platelet transfusion.
d. Supervise activity when out of bed.
e. Caution against forceful nose
blowing.
Rationale
a. Reduces risk of injury.
b. Increases intracranial pressure and
risk of cerebral haemorrhage.
c. Allergic reactions to blood products
are associated with antigen–
antibody reaction that causes
platelet destruction.
d. Reduces risks of falls.
e. Prevents trauma to nasal mucosa
and increased intracranial pressure.
Expected outcomes
Plan of Nurs ing Care
Care of patient with cancer
(
continued
)
CHART
11-4
2
–
5
h
o
u
r
s
6
–
8
h
o
u
r
s
8
o
r
m
o
r
e
h
o
u
r
s
P
M
A
M
I
T
O
S
I
S
I
n
d
e
f
i
n
i
t
e
T
i
m
e
T
G
1
G
0
G
2
S
Figure 11-1
Phases of the cell cycle extend over the interval
between the midpoint of mitosis to the subsequent end point
in mitosis in a daughter cell. G
1
is the postmitotic phase during
which ribonucleic acid (RNA) and protein synthesis are increased
and cell growth occurs. G
0
is the resting, or dormant, phase of
the cell cycle. In the S phase, nucleic acids are synthesised and
chromosomes replicated in preparation for cell mitosis. During G
2
,
RNA and protein synthesis occurs as in G
1
.
((P
5
prophase, M
5
metaphase, A
5
anaphase, T
5
telophase.) From
Porth, C. M. & Matfin, G. (2009). Pathophysiology: Concepts of altered
health states (8th ed). Philadelphia: Lippincott Williams & Wilkins.)
