Chemotherapeutic agents are powerful drugs used to fight cancer. They work by targeting rapidly dividing cells, but this also means they can affect healthy cells in the body. Understanding how these drugs work and how to handle them safely is crucial for nurses.

Safe handling and proper administration of chemotherapy are essential skills for oncology nurses. From using personal protective equipment to knowing the various routes of administration, nurses play a key role in ensuring patient safety and maximizing treatment effectiveness.

Safe Handling and Administration of Chemotherapeutic Agents

Safe handling of chemotherapeutic agents

• Use personal protective equipment (PPE) such as gowns, gloves, masks, and eye protection to minimize exposure to chemotherapeutic agents
  • Double glove when handling chemotherapeutic agents to provide an extra layer of protection
• Prepare medications in a designated area with proper ventilation, such as a biological safety cabinet or isolator, to contain any potential spills or aerosols
• Dispose of contaminated materials properly by placing them in leak-proof containers labeled as hazardous waste and following facility protocols for disposal
• Clean up spills immediately using a spill kit containing absorbent materials and PPE, notifying appropriate personnel and following facility protocols
• Educate patients and caregivers on safe handling at home, including wearing gloves when handling bodily fluids or contaminated items, washing hands thoroughly after contact, and disposing of contaminated materials as directed by healthcare provider

Methods and routes of chemotherapy administration

• Conventional chemotherapy administered at maximum tolerated dose to achieve the greatest cancer cell kill
• Dose-dense chemotherapy given at shorter intervals between treatments to minimize cancer cell regrowth
• Metronomic chemotherapy involves low-dose, frequent administration to maintain a constant level of drug exposure
• Induction phase involves initial high-dose treatment to achieve remission by rapidly killing cancer cells
• Consolidation phase provides additional treatment to eliminate remaining cancer cells and prevent relapse
• Maintenance phase involves long-term, low-dose treatment to prevent relapse by suppressing cancer cell growth
• Intravenous (IV) route administers chemotherapy directly into the bloodstream for systemic distribution
• Oral route involves taking chemotherapy by mouth in pill or liquid form for systemic absorption
• Intramuscular (IM) route injects chemotherapy into muscle tissue for gradual absorption into the bloodstream
• Subcutaneous (SC) route injects chemotherapy into the fatty tissue beneath the skin for gradual absorption
• Intrathecal route administers chemotherapy directly into the cerebrospinal fluid to treat central nervous system cancers
• Topical route applies chemotherapy to the skin as a cream or ointment for localized treatment (skin cancers)

Chemotherapeutic Agents and Nursing Considerations

Side effects of chemotherapeutic drugs

• Myelosuppression decreases production of blood cells, leading to anemia, neutropenia, and thrombocytopenia
• Gastrointestinal effects include nausea, vomiting, diarrhea, and mucositis due to damage to rapidly dividing cells
• Hair loss (alopecia) occurs due to damage to hair follicles, which are rapidly dividing cells
• Fatigue results from the body's response to chemotherapy and the increased energy demands of fighting cancer
• Skin changes such as dryness, rash, and hyperpigmentation can occur due to chemotherapy's effects on skin cells
• Peripheral neuropathy causes numbness, tingling, and pain in the hands and feet due to nerve damage
• Cognitive changes ("chemo brain") involve difficulties with memory, concentration, and multitasking
• Fertility issues may arise due to damage to reproductive cells, potentially leading to temporary or permanent infertility
• Secondary malignancies can develop years after chemotherapy treatment due to DNA damage and mutations

Classes of chemotherapeutic agents

• Alkylating agents (cyclophosphamide, ifosfamide) damage DNA by adding alkyl groups, preventing cell division
• Antimetabolites (5-fluorouracil, methotrexate) interfere with DNA and RNA synthesis by mimicking normal metabolites
• Plant alkaloids (vincristine, paclitaxel) disrupt microtubule function, inhibiting cell division and leading to apoptosis
• Antitumor antibiotics (doxorubicin, bleomycin) interfere with DNA replication and transcription by various mechanisms
• Topoisomerase inhibitors (etoposide, irinotecan) prevent DNA unwinding and replication by inhibiting topoisomerase enzymes
• Targeted therapies (imatinib, trastuzumab) block specific molecules involved in cancer cell growth and survival pathways

Nursing considerations for chemotherapy

• Assess patient's understanding of treatment and potential side effects to ensure informed consent and compliance
• Verify correct drug, dose, route, and patient identity to prevent medication errors and ensure patient safety
• Monitor for infusion reactions and adverse effects to promptly identify and manage complications
• Manage side effects by administering antiemetics for nausea and vomiting, providing oral care for mucositis, and encouraging rest and nutrition to combat fatigue
• Educate patients on self-care measures and when to seek medical attention to promote self-management and early intervention
• Maintain strict infection control practices to protect immunocompromised patients from opportunistic infections
• Document administration and patient response to ensure accurate records and facilitate continuity of care

Patient education for chemotherapy

• Explain the purpose, schedule, and potential side effects of treatment to help patients understand and prepare for their chemotherapy regimen
• Teach patients how to manage common side effects through dietary modifications for gastrointestinal issues, proper oral hygiene to prevent mucositis, and strategies for coping with fatigue and cognitive changes
• Emphasize the importance of infection prevention by encouraging frequent hand hygiene, avoiding crowds, and staying up-to-date on vaccinations
• Discuss fertility preservation options, if applicable, to help patients make informed decisions about their reproductive health
• Provide resources for emotional support and coping to address the psychological impact of cancer and its treatment
• Encourage open communication with the healthcare team to foster a supportive and collaborative relationship
• Schedule regular follow-up appointments for monitoring and support to ensure ongoing assessment and management of the patient's condition

Mechanisms of chemotherapeutic agents

• Indications for chemotherapeutic agents are specific to each drug and cancer type, considering factors such as stage, grade, and patient characteristics
• Mechanisms of action vary by class and target specific cellular processes to inhibit cancer cell growth and survival
  1. Alkylating agents directly damage DNA
  2. Antimetabolites interfere with DNA and RNA synthesis
  3. Plant alkaloids disrupt mitotic spindle formation
  4. Antitumor antibiotics intercalate with DNA and generate free radicals
  5. Topoisomerase inhibitors prevent DNA replication and transcription
  6. Targeted therapies block specific signaling pathways
• Potential drug interactions can occur with cytochrome P450 inhibitors or inducers altering drug metabolism, increased risk of toxicity when combined with other myelosuppressive agents, and enhanced or reduced efficacy when combined with certain targeted therapies
• Consult drug references and pharmacists for specific interaction information to ensure safe and effective use of chemotherapeutic agents

Chemotherapy and the Cell Cycle

• Cell cycle: The process by which cells divide and replicate, consisting of various phases targeted by different chemotherapeutic agents
• Cytotoxicity: The ability of chemotherapeutic drugs to kill cancer cells, often by disrupting the cell cycle or inducing apoptosis
• Drug resistance: The ability of cancer cells to develop mechanisms to survive chemotherapy, often through genetic mutations or altered cellular pathways
• Pharmacokinetics: The study of how the body processes chemotherapeutic drugs, including absorption, distribution, metabolism, and excretion
• Tumor markers: Substances produced by cancer cells or the body in response to cancer, used to monitor treatment response and disease progression
• Adjuvant therapy: Chemotherapy given after primary treatment (such as surgery) to reduce the risk of cancer recurrence
• Neoadjuvant therapy: Chemotherapy administered before primary treatment to shrink tumors and improve surgical outcomes