Chemotherapy

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This extensive drug table describes the drug and food interactions associated with many oral therapies for cancer.
View this 16-minute presentation to learn how chemotherapy doses are calculated.
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A.B. is a 61‐year‐old woman with metastatic HER2‐positive breast cancer. She is a self-employed consultant and travels extensively in the United States and internationally to work with her diverse clients. She is divorced and has three adult married children. She is active, in good health, and has no comorbid conditions. A.B. was treated with adriamycin plus cyclophosphamide (AC) followed by paclitaxel plus trastuzumab in the adjuvant setting. Two years later, she recurred with symptomatic disease (pain) in the liver.
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Unlike radiation exposure, exposure to hazardous drugs cannot be measured with a badge or device. Instead, healthcare workers must strive to minimize exposure to these drugs. In addition to engineering controls, safer work practices, and the use of personal protective equipment (PPE), healthcare workers should be routinely monitored in a medical surveillance program. ONS, the Occupational Safety and Health Administration (OSHA), and the American Society of Health-System Pharmacists (ASHP) all have recommendations related to employee medical surveillance.
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In "Neutropenia: State of the Knowledge," a two-part ONS white paper, the authors identify what currently is known and, importantly, not known about the most common dose-limiting toxicity of cancer chemotherapy: chemotherapy-induced neutropenia (CIN).
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Patients can have multiple risk factors for developing neutropenia, including type of chemotherapy or radiation, doses, and administration schedule of the treatment regimen. Additionally, high dose density (administration of chemotherapy with less time between treatments), dose intensity (giving the maximum tolerable dose at each administration), and relative dose intensity (a percentage of the dose intensity that is given as a portion of the dose that is planned) also increase the potential for developing neutropenia. Other risk factors include the following.
Following is "Practice Safe Nursing With Oral Hazardous Drugs," an article featured in the January 2010 issue of ONS Connect.  The num­ber of cur­rently avail­able haz­ardous oral drugs is increas­ing and now includes small mol­e­cules and hor­mones in addi­tion to tra­di­tional agents such as cyclophos­phamide. Nurses are pre­sented with unique safety chal­lenges in han­dling these medications.

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