Chemotherapy administration

To translate this approach into clinical scenarios, the risk-benefit assessment of chemotherapy administration in already immunocompromised patients would favor situations in which cytotoxic drugs are indicated anyhow, such as in AIDS-related lymphomas, where alkylating agents are part of the standard regimens. 

Knowing how to prevent and treat adverse events from chemotherapy is an important aspect of patient care. Unmanaged events may result in excess morbidity and cause delays in chemotherapy administration and reduced chemotherapy doses and contribute to treatment failure. 

What symptoms or signs should you watch for during chemotherapy administration ... 

Always test the line with intravenous fluids before chemotherapy administration, and observe the site for swelling. 

Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis and with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration. 

Nausea and vomiting that occur within 24 hours of chemotherapy administration is defined as acute, whereas when it starts more than 24 hours after chemotherapy administration, it is defined as delayed. The emetogenic potential of the chemotherapeutic agent or regimen (see Table 27-2) is the primary factor to consider when selecting an antiemetic for prophylaxis of CINV. 

Patients receiving chemotherapy that is classified as being of high emetic risk should receive a combination antiemetic regimen containing three drugs on the day of chemotherapy administration (day 1)—an SSRI plus dexamethasone plus aprepitant. 

To optimize chemotherapy administration, the clinician must identify, monitor, treat, and prevent or minimize treatment-related toxicity. Pertinent laboratory data and other procedures should be reviewed to establish a baseline for monitoring purposes. Major organ and system toxicities to be monitored include hematologic, neurologic, skin, pulmonary, GI, renal, and cardiac. 

Pennock GD, Dalton WS, Roeske WR, et al. Systemic toxic effects associated with high-dose verapamil infusion and chemotherapy administration. J Natl Cancer Inst 1991 83(2) 105-110. 

Haematological parameters. Full blood count must be analysed prior to administration of FOLFOX chemotherapy to check for persistent bone marrow suppression as previously described. Fow neutrophil or platelet counts (typically neutrophils <1.5 x 109/F or platelets <80 x 109/L) will necessitate a delay in chemotherapy administration, usually by one week. 

Continued treatment with bisphosphonate may also be appropriate to not only reduce the likelihood of recurrent hypercalcaemia but also to manage Mrs CR s bone metastases. Many guidelines (including the NICE Improving outcomes guidance for breast cancer, 2002a) recommend the use of bisphos-phonates to reduce the onset of skeletal complications such as skeletal fractures. An appropriate suggestion would be to continue one of the bisphosphonates previously outlined at three-weekly intervals (to coincide with chemotherapy administration). 

It is worth mentioning that temozolomide accumulates significantly in the brain after oral administration. It is well tolerated and therefore is considered a potential candidate for combination chemotherapy. Administration of 200mg/m2 of temozolomide for 5 days and liposomal doxorubicin 35 mg/m2 on day 1 was performed on 19 patients. The overall response rate was 36.8% and the median overall survival was 10.0 months. 

The emetogenic potential of individual chemotherapeutic agents is an important factor in the onset and severity of emesis. Acute nausea and vomiting occurs within 24 hours of chemotherapy administration. Delayed nausea and vomiting occurs greater than 24 hours after chemotherapy... 

E Lorazepam is most effective for anticipatory nausea and vomiting, or emesis that oaurs prior to chemotherapy administration. The antiemetic effects may be related to the sedative and anxiolytic properties of lorazepam. 5-HT3 antagonists and dopamine antagonists are poor choices because efficacy has not been shown in anticipatory nausea and vomiting. 

High risk. Medications, procedures, processes, and disease states for which there is a greater chance for adverse outcomes (e.g., chemotherapy administration, intravenous potassium use, intrathecal injections, anticoagulation, medications with a narrow therapeutic index, and care of immunocompromised patients). 

Pfeiffer documented the impact of an oncology pharmacist s review of chemotherapy administrations. The pharmacist reviewed chemotherapy admissions on a monthly basis for 20 months. Pertinent patient demographic data, chemotherapy administrations information, and admissions stay data were collected and were compared to an ideal that was predetermined based on the institution s admissions standards and chemotherapy care maps. The pharmacist identified opportunities for education for cases where length of stay exceeded the institution s standards or where problems were identified... 

Pfeiffer, C.M. In Impact of a Clinical Pharmacist s Review of the Chemotherapy Administration Process, ASHP Midyear Clinical Meeting, Las Vegas, NV, Dec. 3-7, 2000 American Society of Hospital Pharmacists Beth-esda, Maryland, 2000 94H. 

This is good information to teach, but it is not based on the laboratory values. The client may develop mouth ulcers as a result of chemotherapy administration, and the nurse should discuss methods of maintaining nutrition for this reason but not because of the laboratory values. 

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