Page 24 Complete Your CE Test Online - Click Here ● ● Whether there are co-morbidities such as diabetes, renal failure, or heart disease. Most patients get chemo in cycles. A cycle is a period of treatment followed by a break. For instance, chemo may be given every day for one week followed by three weeks with no chemotherapy. This is one- four-week cycle. The break gives the patient a chance to recover before the next cycle. Regimens may be modified based on the patient’s tolerance and side effects. Some side effects like myelosuppression are serious enough to merit a longer break, changing the dose or regimen, or even suspending treatment until the patient recovers enough to resume the same or a modified treatment [152]. It is important when patients return home after treatment, that they and caregivers have a listing of problems for which the doctor must be notified, especially which ones may be emergencies. This partly based on the types of drugs the patient received or will be taking at home, and expected or serious side effects, e.g. [6]: ● ● Bleeding or unexplained bruising. ● ● Blood in the stool or urine. ● ● Fever of 100.5°F or higher. ● ● Shaking chills. ● ● Shortness of breath. ● ● Cough, sore throat, or burning on urination. ● ● Unusual pain, including severe headaches or abdominal pain. ● ● Diarrhea of more than two days’ duration. ● ● Vomiting or the inability to keep down medicines. ● ● Signs of allergic reaction such as swelling of the mouth or throat, trouble breathing or swallowing, dizziness or faintness, severe itching, or hives. Patient safety and safe medication practices for chemotherapy In the process of preparing and administering chemotherapy medications, nurses need to be sure that there are mechanisms, procedures, and qualified staff to independently verify drug names and doses, times and dates each is due, routes of administration, and patient identification. It is important to be sure that drugs are fully labeled as they leave their original containers (including individual syringes, medication containers, or basins), and are transported safely to the bedside. Nurses also must have quick access to extravasation kits in case of vesicant leaks, and procedures to minimize exposures to dangerous drugs in the event of breakage or spills, including safe disposal of cleanup materials. These are just some of the minimum standards covered in the American Society of Clinical Oncology/ Oncology Nursing Society Chemotherapy Administration Safety Standards (see “Nursing Resources” for details) [223]. Targeted therapy Most targeted therapies are either small-molecule drugs or monoclonal antibodies [199]: ● ● Small-molecule drugs are small enough to enter cells easily, so they are used for targets that are intracellular. ● ● Monoclonal antibodies are not able to enter cells easily. Instead, they attach to specific targets on the outer surface of cells. Who receives targeted therapy Targeted therapy can be used for some types of cancer. Many patients with cancer will have a target for a certain drug, so they can be treated with that drug. In order to find out, the tumor will need to be tested to look for targets for which there are drugs. Tumor testing for targets may involve an additional biopsy [199]. How targeted therapy works against cancer Most targeted therapies help treat cancer by interfering with specific proteins that help tumors grow and spread throughout the body. They treat cancer in many different ways. They can [199]: ● ● Help the immune system destroy cancer cells. Certain targeted therapies can mark cancer cells so it is easier for the immune system to find and destroy them. Other targeted therapies help boost the immune system to work better against cancer. ● ● Slow or stop cancer cells from growing. Some targeted therapies interfere with proteins that prompt cells to divide. This helps slow a cancer’s uncontrolled growth. ● ● Stop signals that help form blood vessels. Some targeted therapies are designed to interfere with signals that trigger blood vessels to form and grow. Without a blood supply, tumors stay small. If a tumor already has a blood supply, these treatments can cause blood vessels to die, which can cause the tumor to shrink. ● ● Deliver cell-killing substances to cancer cells. Some monoclonal antibodies are bound with toxins, chemotherapy drugs, and radiation. Once the monoclonal antibodies attach to targets on the surface of cancer cells, the cells take up the cell-killing substances, causing them to die. Cells that do not have the target are typically not harmed. ● ● Cause cancer cell death. Some targeted therapies can cause cancer cells to go through the normal process of cell death. ● ● Starve cancer of the hormones needed to grow. Some breast and prostate cancers require sex hormones to grow. Hormone therapies are a type of targeted therapy that can prevent the body from making specific hormones, while others prevent the hormones from acting on cells, including cancer cells. Genetics, genomics, and treatment with targeted therapy Many targeted therapies depend on testing for tumor genetics before the treatment starts. For example, one well-known test involves looking at estrogen receptors in breast cancer to determine whether anti-estrogen compounds can help with treatment of that particular woman’s cancer. Another example from breast cancer is the over expression of human epidermal growth factor receptors (HER2), indicating that the patient will likely benefit from using trastuzumab. Some call this “tumor profiling” and others call it individualized or personalized therapy. Tumor tissue testing is different from testing germline mutations, which are present in all the body’s cells and can be done with a blood sample. Tumor testing requires a sample of the cancerous tissue and is often done using part of the biopsy sample. This kind of testing can show whether certain targeted drugs can help stop cancer growth. Targeted therapy can cause side effects Side effects of targeted therapy depend on the drug and the patient’s responses. The most common side effects of targeted therapy include diarrhea and elevated liver function tests. Other side effects might include bleeding and delayed wound healing, high blood pressure, fatigue, mucositis, nail changes, loss of hair color, and skin problems, like rash or dry skin. Very rarely, a fistula might form through the wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder. Many of these side effects are treatable, and most of them fade after treatment ends [199]. Fistulas and severe diarrhea, although rare, can be life-threatening. Immunotherapy Cancer is able to grow and evolve in part because cells develop ways to elude the immune system. Immunotherapy is a type of cancer treatment that helps the immune system fight cancer. The immune system consists of lymphocytes made by: the bone marrow; the thymus; lymph nodes; spleen; tonsils; and specialized tissues in the mucous membranes of the nose, bronchi, gut, urinary tract, and other tissues. Immunotherapy is a type of biological therapy, which uses substances made from living organisms to treat cancer [171]. Types of immunotherapy Many different types of immunotherapy are used to treat cancer. They include [15,171]: ● ● Monoclonal antibodies are drugs designed to bind to specific targets in the body. They can cause an immune response that destroys cancer cells (such as pembrolizumab or nivolumab) or helps to stop them from growing (such as trastuzumab). Other types of monoclonal antibodies “mark” cancer cells so the immune system can destroy them, which is called targeted therapy (see “Targeted Therapy”). ● ● Adoptive cell transfer is a treatment that attempts to boost the ability of T cells (T-lymphocytes) to fight cancer. Researchers take T cells from the patient, isolate the T cells that are most active against the cancer or modify the genes in them to make them better able