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Untitled Document
ONS Profile

Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, Second Edition

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Contents

Preface.................................................................................................................. ix
   
Abbreviations Used in This Manual......................................................................... xi
   
Generic Medications and Brand-Name Equivalents................................................ xii
   
I. Introduction....................................................................................................... 1
A. Definition of cancer............................................................................................. 1
B. Treatment modalities.......................................................................................... 2
C. The drug development process.......................................................................... 3
D. Ethical issues related to cancer therapy............................................................. 8
E. Legal issues related to cancer therapy............................................................... 9
   
II. Cancer Therapy Goals and Response........................................................... 13
A. Goals of cancer therapy..................................................................................... 13
B. Factors affecting response to treatment............................................................. 13
C. Measuring response........................................................................................... 14
   
III. Principles of Chemotherapy.......................................................................... 18
A. Life cycle of cells................................................................................................. 18
B. Chemotherapeutic agents................................................................................... 18
   
IV. Principles of Biotherapy................................................................................ 36
A. Theory of immune surveillance........................................................................... 36
B. Methods of biotherapeutic action........................................................................ 36
C. Categories of biotherapy.................................................................................... 36
D. Therapeutic uses for biotherapeutic agents....................................................... 36
E. Supportive uses for biotherapeutic agents......................................................... 36
F. Uses for biotherapeutic agents in research........................................................ 36
G. Biotherapeutic strategies.................................................................................... 44
H. Actions of the immune system............................................................................. 44
I. Types of immune response.................................................................................. 44
J. Cells of the immune system................................................................................. 46
K. Tumor escape mechanisms................................................................................ 48
L. Angiogenesis and antiangiogenic agents............................................................ 49
M. Principles of radioimmunotherapy (RIT)............................................................. 49
N. Toxin-conjugated molecules............................................................................... 49
   
V. Fundamentals of Administration.................................................................... 53
A. Safe handling...................................................................................................... 53
B. Treatment schedule............................................................................................ 63
C. Pretreatment....................................................................................................... 68
D. Treatment........................................................................................................... 70
   
VI. Immediate Complications of Cytotoxic Therapy.......................................... 78
A. Extravasation ..................................................................................................... 78
B. Flare reaction..................................................................................................... 83
C. Hypersensitivity and anaphylaxis........................................................................ 83
D. Patient and family education............................................................................... 86
   
VII. Care of the Patient Receiving Cancer Therapy.................................................................................................................. 89
A. Patient education................................................................................................ 89
B. Toxicity management.......................................................................................... 89
   
VIII. Side Effects of Cancer Therapy.................................................................. 93
A. Myelosuppression............................................................................................... 93
B. Gastrointestinal and mucosal side effects........................................................... 109
C. Alopecia.............................................................................................................. 139
D. Fatigue............................................................................................................... 140
E. Cardiac toxicity.................................................................................................... 144
F. Pulmonary toxicity............................................................................................... 167
G. Hemorrhagic cystitis........................................................................................... 180
H. Hepatotoxicity...................................................................................................... 182
I. Nephrotoxicity....................................................................................................... 186
J. Neurotoxicity........................................................................................................ 192
K. Pancreatitis......................................................................................................... 197
L. Alterations in sexuality and reproductive function............................................... 198
M. Cutaneous toxicity.............................................................................................. 206
N. Ocular toxicity..................................................................................................... 206
O. Secondary malignancies.................................................................................... 213
   
IX. Post-Treatment Care...................................................................................... 219
A. General principles............................................................................................... 219
B. Classification of effects....................................................................................... 219
C. Nursing assessment........................................................................................... 219
D. Collaborative management................................................................................. 225
   
X. The Clinical Practicum..................................................................................... 226
A. Course description.............................................................................................. 226
B. Course objectives............................................................................................... 226
C. Clinical activities................................................................................................. 226
D. Evaluation........................................................................................................... 226
   
Appendices........................................................................................................... 227
Appendix 1. Nursing Flow Sheet.............................................................................. 227
Appendix 2. Chemotherapy Flow Sheet.................................................................. 231
Appendix 3. Safe Management of Chemotherapy in the Home............................... 233
Appendix 4. Progression of Intravenous Extravasation........................................... 235
Appendix 5. Clinical Practicum Evaluation: Part I..................................................... 236
Appendix 6. Clinical Practicum Evaluation: Part II.................................................... 237
   
Index...................................................................................................................... 239