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Chemotherapy

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Debbie Coats, RN, ONC.

Publications Cancer Information Nurse Specialist, CancerBACUP, London

Chemotherapy drugs, or cytotoxic agents, may be used to treat cancers, leukaemias and lymphomas. There are over 50 such drugs, which can be used as single agents, or in combination.

Chemotherapy drugs, or cytotoxic agents, may be used to treat cancers, leukaemias and lymphomas. There are over 50 such drugs, which can be used as single agents, or in combination.

 


 

They act by preventing the growth and division of cancer cells, but they also affect healthy cells in the body, such as those in bone marrow, the gastrointestinal lining, and the hair follicles.

 


 

There are five main classes of chemotherapy drug:

 


 

- Alkylating agents

 


 

- Cytotoxic antibiotics

 


 

- Antimetabolites

 


 

- Vinca alkaloids and etoposide

 


 

- Other antineoplastic drugs.

 


 

Cytotoxic drugs may be given with the aim of curing a malignant disease, or prolonging life and palliating symptoms in advanced cancers. Chemotherapy may be used alongside treatments such as surgery, radiotherapy, immunotherapy or monoclonal antibody therapy.

 


 

Routes of administration
- Intravenous injection or infusion - (most common)

 


 

- Orally, as tablets or capsules

 


 

- Intramuscular injection (rare)

 


 

- Subcutaneous injection.

 


 

Drugs given by the above routes are absorbed into the blood and carried around the body, enabling them to reach the cancer cells. They cause systemic side-effects.

 


 

The following routes are used more rarely to administer the drugs:

 


 

- Intrathecal injection - for central nervous system tumours

 


 

- Intracavity injection - into body cavities such as the bladder

 


 

- Creams - for skin cancer.

 


 

Drugs given by these routes remain in the area of administration and cause local side-effects.

 


 

Intravenous chemotherapy regimens commonly involve drugs being given every three to four weeks, and repeated four to eight times. Treatment takes four to six months.

 


 

Possible side-effects
All cytotoxic agents cause side-effects and a balance has to be struck between the benefits and possible toxicity.

 


 

Bone marrow suppression
This is caused by most cytotoxic drugs. It commonly occurs 7-10 days after drug administration. Blood counts must be checked before each treatment: if the bone marrow has not recovered, the dose may need to be reduced or the next treatment delayed. Side-effects include (Box 1):

 


 

- Neutropenia

 


 

- Anaemia

 


 

- Thrombocytopenia.

 


 

Other possible side-effects
Other side-effects of chemotherapy include (Box 1):

 


 

- Fatigue

 


 

- Nausea and vomiting

 


 

- Alopecia

 


 

- Changes in taste

 


 

- Sore mouth

 


 

- Loss of appetite

 


 

- Diarrhoea or constipation

 


 

- Peripheral neuropathy

 


 

- Neurological changes

 


 

- Effects on fertility

 


 

- Anaphylactic shock

 


 

- Tinnitus.

 


 

Women’s periods often stop during treatment. With most cytotoxics there is a 30% chance of an early menopause (Perry, 2001). Hormone replacement therapy can be used, but there is ongoing research into its safety for women with breast or gynaecological cancers.

 


 

There is no evidence of an increased risk of miscarriage or fetal abnormalities following chemotherapy.

 


 

Any new side-effect should be reported to the patient’s oncology specialist or chemotherapy nurse.

 


 

Extravasation of IV drugs can cause tissue necrosis.

 


 

Many cancer support organisations offer advice on managing side-effects. The British National Formulary, Martindale and product literature from manufacturers contain information on the effects of specific drugs.

 

 

 

Perry, M. (2001)The Chemotherapy Source Book. Philadelphia, Pa: Lippincott.

 

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