Biotherapy (immunotherapy)

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Biotherapy (immunotherapy)

• uses the bodys defenses against tumor cells
• Biologic response modifiers (BRM)-produced by
  normal cells to repair, stimulate, or enhance
  substances in the immune system to hopefully kill
  cancer cells

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Biotherapy

• CSF-part of hematopoietic growth factors that
  encourage growth and maturation of blood cell
  components
• If successful, myelosuppression is reduced and
  the client can receive higher doses of
  chemotherapy agents

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Biotherapy

• BRMs produced in a lab include Monoclonal
  antibodies, Interferons, Colony-stimulating
  factors, Interleukins, Retinoids
• MOAB-produced by fusing cancer cells and normal
  cells
• Specific antibodies to seek out and bind to
  specific targets on cancer cells
• Able to improve immune response to cancer and
  interfere with normal cells
• Currently used for renal transplant rejections
• Nursing Interventions monitor for
  anaphylactic reactions (MOABs), flushing,
  pallor, resp. distress,chills, fever,
  diaphoresis, urticaria, n/v, hypotension

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Biotherapy

• Interferons-made by lymphocytes to enhance immune
  system
• 3 types alpha, beta and gamma
• protect normal cells from parasitic invasion or
  viruses
• appear to induce antitumor activity
• Nursing interventions teach side effects of
  flu-like such as fever, fatigue, chills, h/a,
  myalgia

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hematopoietic growth factors

• Consist of substances that have the ability to
  support tissues that are involved in the
  production of blood, bone marrow and lymph nodes
• 3 main groups
• CSF
• Interleukin 3
• erythropoietin

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interleukins

• Promote immune response of the T lymphocytes to
  stimulate the immune system to destroy neoplasms

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Biotherapy

• Retinoids-derived from retinol or vitamin A
• Effect of retinoids -antibody and immune
  responses to suppress proliferation
• Retinoic acid syndrome-side effect s/s
  respiratory distress, pleural effusions, weight
  gain

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Nursing Considerations for Clients with Cancer

• Diagnostic procedures and treatments can be
  uncomfortable to intolerable
• Will need support after treatment d/t side
  effects, especially depression
• Preop and postop teaching
• Allow clients to participate in their treatment

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Chemotherapy

• Nurses need special training to administer and
  monitor for side effects
• Safe handling procedures, drugs extremely toxic
• Some can be administered orally
• Parenteral chemo must take special
  precautions-see book!!
• Chemo induces vomiting by stimulating
  neuroreceptors in the medulla
• Anticipatory n/v may occur before chemo

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Chemotherapy Administration

• Oral, IM, intracavitary, IV, intraperitoneal,
  intra-arterial, intrapleural, topical
• Intra-arterially access usually requires vascular
  access devices such as PIC, PICC, central venous
  access device, external catheters, infusion pump
• Maybe infused intermittently to enhance the
  kill rate of cancer cells
• Chemo does not differentiate between normal and
  abnormal cells

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Radiation therapy

• May be used as primary therapy, combined with
  chemo, or palliative tx
• Reduces tumor size
• Directs ionizing radiation to target tissues for
  damage or destruction of the cells
• Kills cells by preventing their ability to
  reproduce
• Radiation does damage normal and abnormal cells
• 3 types of rays involved
• alpha and beta penetrate the upper layer of the
  skin
• gamma penetrate deeply into body tissues

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Radiation therapy

• Safety when dealing with radiation TIME,
  DISTANCE, AND SHIELDING
• Employees in radiation dept. must wear special
  badges that monitor radiation exposure

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Radiation therapy

• 2 main types of radiation using an internal or
  external radiation beam
• External-given by machines called linear
  accelerators-radiation aimed at cancer but most
  pass through normal cells
• monitor side effects-decreased appetite, abd.
  Cramping, diarrhea and cutaneous irritation ,
  nausea, dysphagia, bone marrow suppression
• Nursing Care-aimed at ensuring client and staff
  safety, keeping healthy cells from hazards
• Do Not wipe off ink marks!!
• Avoid using creams and powders on irradiated skin
  (increases irritation) use only tepid water
• if skin is red and warm 2 weeks after tx-notify
  MD!!

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Radiation therapy

• Internal Radiation
• placing radioactive substances directly into a
  tumor
• delivers large amounts of radiation to destroy
  cancer cells within
• radioactive sources are encapsulated so as not to
  contaminate body fluids
• treat areas such as brain, tongue, breast,
  vagina, rectum, prostate, etc.

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Radiation Therapy

• Explain procedure
• Area treated will not feel hot, notify MD if you
  observe this
• Radioactive iodine may be given for thyroid
  cancer-body fluids will be radioactive for a
  short time
• Teach side effects
• Teach care of skin Box 83-1 in book pg. 1385

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Management of Side Effects

• N/V
• Some clients will postpone or forego treatments
• Antiemetics
• Guided imagery
• distraction
• Massage

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Manage Side Effects

• Stomatitis or mucositis common
• Avoid ETOH or foods that cause irritation
• Avoid flossing or using ETOH containing products
• Rinse mouth after eating and at bedtime
• use soft brush when cleaning the teeth and rinse
  the mouth thoroughly after meals and at bedtime
• MD may order a swish and swallow preparation-do
  so in small amounts, the mixture will anesthetize
  the throat and may cause difficulty in
  swallowing, talking or even breathing

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Manage Side Effects

• Fatigue
• After pain, the second most distressing symptom
  reported
• due to chemo decreasing RBCs
• assess nutrition, rest, work, psychological
  distress, you should increase fluids and seek
  medical management

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Manage Side Effects

• Alopecia
• can occur in eyelashes, eyebrows, pubic and body
  hair
• Affects all frequently dividing cells (including
  cells of the hair follicles in addition to
  cancerous cells)
• encourage wigs, purchase prior to losing hair
  (can obtain similar color to hair and style)
• avoid harsh chemicals
• use mild shampoos
• monitor for emotional side effects

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Manage Side Effects

• Secondary Infections
• WBC count is depressed (neutropenic isolation)
• Teach to avoid activities that could injure
• Dont take rectal temps, allow use of razor
  blades, etc.
• Avoid persons and places with increased risk for
  infection!
• WASH HANDS-STAFF AND VISITORS!!

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Manage Side Effects

• Pain
• R/T disease, treatment or procedures
• Monitor pain level!!! Give round the clock pain
  meds
• Prevent, rather than tx pain!!

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Manage Side Effects

• Stress
• Use therapeutic visualization or guided imagery
• Provide diversional activities

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Manage Side Effects

• Hormone-Related Effects
• Women who take tamoxifen for breast cancer may
  experience menopause like sxs-amenorrhea, hot
  flashes, insomnia and depression
• Tx herbal products (check with MD first),
  clonidine, or other combo drugs could be useful

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Nutritional Needs

• Cancer can deplete proteins
• cachexia
• Diet needs to be high in protein, CHO and
  vitamins
• Monitor for taste changes, supplements may be
  needed
• Alternate forms of fluids, such as popsicles, or
  foods such as liquid supplements can be helpful
• Recommend drinking fluids after meals
• Assess for cultural dietary practices

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Client and family teaching

• Self-exams
• Sign
• Can be seen by someone else
• Symptom
• Noticed by the client like fatigue, nausea,
  malaise
• If a patient is going to receive Hospice care
• The focus is on controlling the symptoms and
  relieving pain, uses a multidisciplinary
  approach, and bereavement care is provided to the
  family
• should have advance directives in place

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Hodgkins Disease

•       Most common cancer in young adults
•       More common in men
•    First recognized in 1832
•   Etiology viral infections, suppressed immune
  functions

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Hodgkins Disease

•   AP review
• Lymph nodes produce and store lymphocytes (2
  types)
•      B lymphocytes-protect body from invading
  germs by changing into plasma cells, then produce
  antibodies which mark germs for destruction
•   T lymphocytes-destroy infected bacteria or
  assist immune system to perform their job better
•    Lymph nodes are connected by lymph vessels

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Hodgkins Disease

•   Hodgkins disease can start anywhere, but
  usually occurs in the upper chest, neck or axilla
•      S/S-enlarged lymph nodes, low-grade fever,
  fatigue, night sweats, generalized pruritis
•    Dx-biopsy revealing Reed-Sternberg cells
  (abnormal B lymphocyte)

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Both types are malignant because they grow and
compress vital organs

• Treatment
•   Radiation
•   Chemo
•    Combination
•   monoclonal antibodies
• High-dose chemo and stem cell transplant
• (American Cancer Society, 2015)

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Non-Hodgkins Lymphoma (NHL)

•  There are many different types of non-Hodgkin
  lymphoma. These types can be divided into
  aggressive (fast-growing) and indolent
  (slow-growing) types, and they can be formed from
  either B-cells or T-cells.
• B-cell non-Hodgkin lymphomas include Burkitt
  lymphoma, chronic lymphocytic leukemia/small
  lymphocytic lymphoma (CLL/SLL), diffuse large
  B-cell lymphoma, follicular lymphoma,
  immunoblastic large cell lymphoma, precursor
  B-lymphoblastic lymphoma, and mantle cell
  lymphoma.
• (National Cancer Institute)

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Non-Hodgkins Lymphoma (NHL)

• S/S painless, enlarged single lymph node in the
  neck, abdominal discomfort, back pain, GI c/o
  resulting from lymph node involvement

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Tx of non-Hodgkins lymphoma

•    Chemo
• Immunotherapy
• Targeted therapy (newer class of drugs that
  target these cells that cause cancer)
•   Radiation
•  peripheral stem cell transplant may be used

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LEUKEMIA

•     Abundance of abnormal WBCs
•  acute
• Immature cells proliferate and accumulate in a
  persons bone marrow
• Chronic
• Mature cells become diseased
• Depends on which line is affected lymphoid or
  myeloid

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       Acute Lymphocytic Leukemia

•    Acute develops quickly
•    Starts in WBC in bone marrow and moves
  quickly to blood
•    Develops from B or T lymphocytes
•   acute means that the leukemia can progress
  quickly
• If left untreated, may probably be fatal within a
  few months.

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Acute myeloid/Myelogenous leukemia

• AML starts in the bone marrow
• quickly moves into the blood
• can sometimes spread to other parts of the body
  including the lymph nodes, liver, spleen, central
  nervous system (brain and spinal cord), and
  testicles
• s/s-wt. loss, fever, unusual bleeding from a
  minor cut
• Tx-chemo, stem cell transplant, surgery,
  radiation

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Chronic lymphocytic leukemia

• the cells can mature partly but not completely,
  may look fairly normal, but they are not.
• do not fight infection as well as normal white
  blood cells do
• leukemia cells survive longer than normal cells,
  and build up, crowding out normal cells in the
  bone marrow
• Mainly affects older adults

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  Tx

• ALL
•   chemotherapy
• Targeted therapy
• Stem cell transplant
• Steroids (may have increase wt. gain)
• CLL
• chemotherapy
• Targeted therapy
• Monoclonal antibodies
• Stem cell transplant
• (American Cancer Society, 2015)