Chemotherapy

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.
ONS Oral Adherence Toolkit
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"Care of Patients With Neutropenia," available as a journal article and podcast, summarizes caring for patients experiencing chemotherapy-induced neutropenia. Potential risks, management, and preventive measures are discussed to help guide nurses in providing comprehensive care.
"Oncology Nurses' Use of National Comprehensive Cancer Network Clinical Practice Guidelines for Chemotherapy-Induced and Febrile Neutropenia," available as a journal article and podcast, summarizes findings from the first study to assess oncology nurses’ reported use of National Comprehensive Cancer Network clinical practice guidelines for chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN).
This brief slideshow provides an overview of the causes of neutropenia, as related to chemotherapy and other incidences. 
A "Review of Complementary and Alternative Medicine Practices Among Cancer Survivors," available as a journal article and podcast, discusses how nurses can play a critical role in the assessment and education of CAM use within survivor programs.
"Use of Neurokinin-1 Receptor Antagonists in Patients Receiving Moderately or Highly Emetogenic Chemotherapy," available as a journal article and podcast, discusses the use of neurokinin-1 (NK-1) receptor antagonists in managing chemotherapy-induced nausea and vomiting (CINV).
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