Neoadjuvant therapy does not increase survival when compared to adjuvant therapy. It only changes the timing of treatment and can change surgical options i... [Show More] f the tumor is shrunk enough. If this occurs, the patient may only require a lumpectomy plus radiation therapy instead of needing a mastectomy
Main benefit of neoadjuvant chemotherapy (breast cancer patient)
A comprehensive geriatric assessment (CGA) is a multidisciplinary evaluation to assess life expectancy and risk of morbidity and mortality in the older patient. This assessment tool would evaluate and include the following areas: functional status, socioeconomic issues, psychosocial distress, comorbidities, cognitive function, nutritional status, polypharmacy, and a medication review (NCCN Older Adult Oncology Guidelines, version 1.2015).
Due to Mrs. Turner's age and comorbidities, her oncologist performs a comprehensive geriatric assessment. You know that this assessment covers all but which of the following:
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The NCCN Older Adult Oncology Guidelines (version 1.2015) provides information on what is included in a comprehensive geriatric assessment. Currently, more than 60% of cancers in the United States occur in people age ______and older and as the oncology world ages, nearly half (46%) of cancer survivors are 70 years of age or older
Two of the agents (docetaxel and carboplatin) that Mrs. Turner will receive are categorized as irritants. Docetaxel can cause a significant reaction if it extravasates. It can lead to edema, erythema, occasional pain and blister formation (ONS Chemo/Bio guidelines, 2014). That is the most likely reason that Mrs. Turner was given a port for her treatments. Some patients will receive their treatments through a peripheral IV without incident. Just because they are intravenous agents does not mean that a port is required and needing a port has nothing to do with her being older in age. Since none of these agents are vesicants, they likely could have been given safely via peripheral route but having a port placed is OK as well.
What is your best explanation for why Mrs. Turner was given a port to receive her chemotherapy?
Irrirtants
_____________can cause inflammation, pain, and burning but rarely cause tissue necrosis comparable to a vesicant (unless a large amount or a very high concentration of the irritant is extravasated).
Vesicants
_____________can cause blistering and significant pain and tissue damage and destruction, leading to tissue death.
Non-DNA-binding solutions remain in the local area of the extravasation, which improves the possibility of drug deactivation.
DNA-binding agents attach to DNA nucleic acids, causing the antagonist to be ingested cellularly, leading to progressive tissue destruction
A further classification of an antineoplastic agent's potential to cause damage is whether its mechanism of action includes DNA binding.
Bendamustinea
Dactinomycin
Daunorubicin
Doxorubicin
Epirubicin
Idarubicin
Mechlorethamine
Mitomycin
DNA Binding Irritants
Amsacrine
Paclitaxel
Vinblastine
Vincristine
Vindesine
Vinorelbine
DNA Nonbinding vessicants
Sodium thiosulfate
Inject 2 ml of sodium thiosulfate for each milligram of
mechlorethamine extravasated.
Inject subcutaneously into extravasation site using a 25
gauge or smaller needle (change needle with each injection).
Monitor extravasation site according to the institution's
policies and procedures.
Extravasciation Alkylating / Mechlorethamine tx
Apply warm compresses.
Dexamethasone
8 mg twice daily
for 14 days
Extravasciation Alkylating: Oxaliplatin
Totect
Apply ice pack (remove 15
minutes prior to Totect
treatment).
Infusion should be initiated within six hours of extravasation.
Infused over 1-2 hours for three days in an area other
than the extravasation site
The dose recommended is based on the patients' body
surface area.
• Day 1: 1,000 mg/m2
• Day 2: 1,000 mg/m2
• Day 3: 500 mg/m
Extravasation Tx: Anthracyclines --- Daunorubicin,
doxorubicin, epirubicin,
idarubicin
Hyaluronidase
Apply warm pack for
15-20 minutes four times
daily the next 24-48
hours and keep extremity
elevated.
Administer 1 ml of hyaluronidase subcutaneously in five
separate injections, each containing 0.2 ml of the solution
using a 25 gauge or smaller needle.
Extravasation Tx: Plant alkaloid Vinblastine, vincristine,
vindesine,
vinorelbine
Apply ice pack for 15-20
minutes four times daily
the first 24 hours.
No known antidote
Extravascation Tx: Taxanes Docetaxel, paclitaxe
include aching and tightness along a peripheral vein above the administration site that occurs as the drug infuses, as well as potential redness or darkening of the vein without swelling and ulceration. Blood return is typically present; if not, an infiltration may have occurred
Signs of symptoms of venous irritation:
warm compress
Most sources recommend the application of heat using _______________ to help reduce local discomfort and the restart of the peripheral IV in a larger vein (Polovich et al., 2014).
irinotecan
The manufacturer of ______________ recommends topical flushing of the skin with sterile water and application of ice in the event of extravasation of the drug (Pfizer Inc., 2012).
Burning, stinging pain around the administration site, although it is important to note that some patients do not experience any pain with vesicant extravasation and may in fact experience a feeling of coolness at the site (Polovich et al., 2014).
Extravasation signs and symptoms can include
Constipation is not a likely side effect with the agents that Mrs. Turner is to receive. Actually diarrhea is more likely when receiving both of the targeted therapies in this regimen.
Knowing the most common side effects of these agents (docetaxel, carboplatin, trastuzumab and pertuzumab), which of the following side effects will you not be covering in your patient teaching today since it is not usually seen with the chemotherapy agents Mrs. Turner is going to receive?
ANC = (Neutrophils + Bands) x WBC / 100
To calculate the ANC:
Find the WBC, the polys/neutrophils and bands on your CBC (neutrophils can be called many things in a differential including: polymorphonuclear cells or polys, PMNs, granulocytes, segmented neutrophils, or segs). WBC = 2.1
Add the polys and bands (polys = 22%, bands = 4%). 22 + 4 = 26
Multiply the sum of the polys and bands by the WBC. 26 X 2.1 = 54.6
Multiply the product by 10. 54.6 X 10 = 546
Mrs. Turner's ANC is 546
ANC Calculation
Restriction of fresh fruits and vegetables is no longer necessary based on the evidence (ONS PEP resource Prevention of Infection https://www.ons.org/practice-resources/pep/prevention-infection/prevention-infection-general)
You meet with Mrs. Turner to discuss neutropenia and her increased risk of infections and to reinforce with her some ways that she can prevent infections. You are familiar with the ONS PEP resources including the resource Prevention of Infection.
You review with Mrs. Turner what the evidence recommends to prevent infections. Which of the following is unlikely to be effective for infection prevention?
Recommended for Practice:
Adherence to General Infection Control Recommendations
Antibiotic Prophylaxis in At-Risk Patients
Antifungal Prophylaxis in At-Risk Patients
Antiviral Prophylaxis for Select At-Risk Patients
Catheter Care Bundle for Prevention of Central Line Associated Infection (CLABSI)
Chlorhexidine Skin Prep
Colony-Stimulating Factors Including Biosimilars for At-Risk Patients
Contact Precautions for Resistant Organisms
Environmental Interventions
Hand Hygiene With Alcohol Sanitizer
Influenza Vaccination
Pneumococcal and Meningococcal Vaccination
Likely to Be Effective:
Antibiotic Abdominal Lavage in Colorectal Surgery
Antimicrobial Coated CVC Catheters in Adults
Chlorhexidine Impregnated Washcloths—Chlorhexidine Bath
Institutional Initiatives
Positive Expiratory Pressure and Self-Monitoring
Pre-construction Planning
Preoperative Antibiotics
Prevention of Infections: Practice Recommended [Show Less]
