Chapter 24

Care of Patients with Cancer

Mrs. M. Kreisel MSN, RNNU130 Adult Health 1Summer 2011

General Disease-Related Consequences of Cancer: Nursing Diagnosis

• Impaired immune and blood-producing function

• Altered GI structure and function

• Motor and sensory deficits• Decreased respiratory function

Surgery as Cancer Treatment

• Oldest form of cancer treatment used for:• Prophylaxis• Diagnosis• Cure• Control• Palliation• Second-look surgery• Reconstruction or rehabilitation

Resection of Pancreatic Tumor

Radiation Therapy for Cancer

• Purpose—to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation

• Teletherapy: radiation source outside the body

• Brachytherapy: (opposite of teletheraphy) the use of implants of radioactive materials such as radium, cesium, iridium or gold at the cancer site

Radiation Therapy

Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Side Effects of Radiation Therapy

• Vary according to the site• Local skin changes and hair loss that will likely be

permanent depending on the total absorbed dose• Altered taste sensations • Fatigue related to increased energy demands• Inflammatory responses that cause tissue fibrosis

and scarring

Nursing Care of Patients Undergoing Radiation Therapy

• Teach accurate objective facts to help patient cope.

• Do not remove markings.• Administer skin care.• Avoid direct exposure of the skin to the

sun. • Care for xerostomia (dry mouth).• Bone exposed to radiation is more

vulnerable to fracture.• Do not use lotions or ointments.

Chemotherapy

• Treating cancer with chemical agents• Major role in cancer therapy• Used to cure and increase survival time• Some selectivity for killing cancer cells

over normal cells• Normal cells most affected—the skin,

hair, intestinal tissues, spermatocytes, and blood-forming cells

Chemotherapy

Chemotherapy Drugs

• Antimetabolites• Antitumor antibodies• Antimitotic agents • Alkylating agents• Topoisomerase inhibitors• Miscellaneous chemotherapeutic agents• Combination chemotherapy

Treatment Issues

• Drug dosage• Drug schedule• Drug administration:

• Extravasation: The escape of fluids into the surrounding tissue

• Vesicants: blistering

Side Effects of Chemotherapy

• Anemia, neutropenia, thrombocytopenia• Alopecia or hair loss• Nausea and vomiting• Mucositis in the entire GI tract• Skin changes• Anxiety, sleep disturbance• Altered bowel elimination• Changes in cognitive function

Chemotherapy Patient-Centered Nursing Care

• Infection risk• Chemotherapy-induced nausea and

vomiting (CIN)• Mucositis• Alopecia• Changes in cognitive function• Peripheral neuropathy

Hormonal Manipulation

• Some hormones make hormone-sensitive tumors grow more rapidly.

• Some tumors actually require specific hormones to divide. Therefore decreasing the amount of these hormones to hormone-sensitive tumors can slow the cancer growth rate.

Side Effects of Hormone Therapy

• Androgens (substances that produce male characteristics) and antiestrogen receptor drugs cause masculinizing effects in women.

• For men and women receiving androgens, acne may develop, hypercalcemia is common, and liver dysfunction may occur with prolonged therapy.

• Feminine manifestations often appear in men who take estrogens, progestins, or antiandrogen receptor drugs.

• Gynecomastia.

Gynecomastia

Photodynamic Therapy

• Selective destruction of cancer cells through a chemical reaction triggered by different types of laser light

• Patient teaching• General sensitivity to light for up to 12

weeks after the photosensitizing drug is injected

Immunotherapy: Biological Response Modifiers (BRMs)

• Drugs that modify the patient’s biological responses to tumor cells

• Cytokines—enhance the immune system they include Interleukins & interferons (they release proteins and other cell responses to try and prevent the unwanted cell from growing)

• Side effects—generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes

Gene Therapy

• Experimental as a cancer treatment• Renders tumor cells more susceptible to

damage or death by other treatments• Injection into tumor cells, enabling the

immune system to better recognize cancer cells as foreign and kill them

• Human leukocyte antigen (HLA)• Cytokines, IL-2

Targeted Therapy

• Combination of gene therapy and immunotherapy

• Side effects:• Allergic reaction• Skin, mucous membranes, GI tract

lining

Oncologic Emergencies

• Sepsis and disseminated intravascular coagulation

• Collaborative management includes:• Prevention (the best measure)• IV antibiotic therapy• Anticoagulants, cryoprecipitated clotting

factors

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Water is reabsorbed to excess by the kidney and put into system circulation.

• SIADH is most commonly found in carcinoma of the lung.

• Collaborative care:• Patient safety• Restore normal fluid balance• Provide supportive care

Spinal Cord Compression

Spinal Cord Compression (Cont’d)

• Collaborative management includes:• Early recognition and treatment• Palliative• High-dose corticosteroids • High-dose radiation• Surgery• External back or neck braces to reduce

pressure in the spinal cord

Hypercalcemia

• Occurs most often in patients with bone metastasis• Fatigue, loss of appetite, nausea and vomiting, constipation,

polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes

• Collaborative management includes:• Oral hydration• Normal saline IV• Drug therapy• Dialysis

Superior Vena Cava Syndrome

• Superior vena cava is compressed or obstructed by tumor growth.

• Condition can lead to a painful, life-threatening emergency.

• Signs include edema of face, Stokes’ sign, edema of arms and hands, dyspnea, erythema, and epistaxis.

Superior Vena Cava Syndrome (Cont’d)

Collaborative Care: SVC Syndrome

• High-dose radiation therapy• Metal stent in the vena cava

Tumor Lysis Syndrome

• Large numbers of tumor cells are destroyed rapidly, resulting in intracellular contents being released into the bloodstream faster than the body can eliminate them.

• Collaborative management includes:• Prevention• Hydration• Drug therapy

Tumor Lysis Syndrome (Cont’d)

NCLEX TIME

Question 1

In affluent countries, what percentage of people diagnosed with cancer each year are cured of their disease?

A. 25%B. 40%C. 50%D. 65%

Question 2

What is the expected outcome related to hair loss for the patient who is undergoing

chemotherapy?

A. Hair loss may be permanent.B. Hair regrowth usually begins about 1

month after completion of chemotherapy.C. New hair growth will likely be identical to

previous hair growth in color and texture. D. Viable treatments exist for the prevention

of alopecia.

Question 3

A patient who is receiving radiation therapy for breast cancer would experience which side effect?

A. Severe fatigueB. MucositisC. Hair lossD. Nausea and vomiting

Question 4

The nurse is assessing for tumor lysis syndrome in a patient who has been receiving chemotherapy. Which

findings are possible for tumor lysis syndrome?

A. HypercalcemiaB. Edema of the face, progressing later to

arms and handsC. Dyspnea and epistaxisD. Hyperkalemia and hyperuricemia

Question 5

True or False: The goal of therapy with erythropoiesis stimulating drugs, such as darbepoetin alfa (Aranesp)

and epoetin alfa (Epogen and Procrit), is to return hemoglobin or hematocrit levels to normal levels after

chemotherapy.

A. TrueB. False