Preface

ix

Abbreviations Used in this Manual

x

Generic Medications and Brand-Name Equivalents

xii

I

INTRODUCTION

1

A

Definition of Cancer

1

B

Treatment Modalities

2

C

The Drug Development Process

4

D

Ethical Issues Related to Cancer Therapy

11

E

Legal Issues Related to Cancer Therapy

12

II

CANCER THERAPY GOALS AND RESPONSE

17

A

Goals of Cancer Therapy

17

B

Factors Affecting Response to Treatment

17

C

Treatment Strategies

18

D

Measuring Response

19

III

PRINCIPLES OF ANTINEOPLASTIC THERAPY

25

A

Life Cycle of Cells

25

B

Chemotherapeutic Agents

26

C

Actions of the Immune System

26

D

Types of Immune Response

26

E

Cells of the Immune System

28

F

Tumor Escape Mechanisms

29

G

Principles of Biotherapy

30

H

Categories of Biotherapy

30

I

Principles of Radioimmunotherapy

32

J

Toxin-Conjugated Molecules

33

K

Therapeutic Uses for Biotherapeutic Agents

33

L

Supportive Uses for Biotherapeutic Agents

33

M

Biotherapeutic Strategies

33

N

Angiogenesis and Antiangiogenic Agents

34

IV

FUNDAMENTALS OF ADMINISTRATION

73

A

Safe Handling

73

B

Verification and Maintenance of Treatment as Planned

84

C

Pretreatment

93

D

Treatment

95

V

IMMEDIATE COMPLICATIONS OF CYTOTOXIC THERAPY

105

A

Extravasation

105

B

Irritation

110

C

Flare Reaction

111

D

Acute Infusion Reactions

111

E

Patient and Family Education

114

VI

CARE OF THE PATIENT RECEIVING CANCER THERAPY

117

A

Patient Education

117

B

Adherence to Therapy

118

C

Toxicity Management

118

VII

SIDE EFFECTS OF CANCER THERAPY

121

A

Myelosuppression

121

B

GI and Mucosal Side Effects

146

C

Cutaneous Toxicity

182

D

Alopecia

197

E

Cardiovascular Toxicity

200

F

Pulmonary Toxicity

231

G

Hemorrhagic Cystitis

255

H

Hepatotoxicity

259

I

Nephrotoxicity

266

J

Neurotoxicity

274

K

Cancer Treatment-Related Cognitive Changes

284

L

Ocular Toxicity

300

M

Pancreatitis

310

N

Fatigue

311

O

Alterations in Sexuality

315

P

Reproductive Alterations

320

VIII

POST-TREATMENT CARE

325

A

General Principles

325

B

Types of Effects

326

C

Secondary Malignancies

326

D

Collaborative Management

339

E

Preventive Screening Recommendations

340

F

Patient and Family Education

340

G

Professional Education

340

H

Nursing Assessment

340

IX

NURSING EDUCATION AND MANAGEMENT

343

A

The Clinical Practicum

343

B

Policy and Procedure

344

C

Issues in Antineoplastic Administration

344

D

Documentation

345

APPENDICES

347

Appendix 1

Nursing Flow Sheet

347

Appendix 2

Chemotherapy Flow Sheet

351

Appendix 3

Safe Management of Chemotherapy in the Home

353

Appendix 4

Progression of Intravenous Extravasation

355

Appendix 5

Clinical Practicum Evaluation: Part I

356

Appendix 6

Clinical Practicum Evaluation: Part II

357

Appendix 7

Oncology Nursing Society Position on the Education of the RN Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy

358

Appendix 8

Consent Document

359

Appendix 9

Extravasation Flow Sheet

360

Index

361