Posted on 26th Sep 2024 11:03:42 PM Medicine
1. Introduction
Cancer is a troubling, deadly disease that has been affecting people for centuries. Cancer involves the uncontrollable growth of cells in the body, forming tumors (Cancer. U.S. National Library of Medicine; 2010). In2008, cancer was a leading cause of death (13% of deaths) in the world (Cancer. Media Center. WHO, 2012). There are over 200 types of cancer and many facts are still unknown about the disease. Treatment options and effectiveness has significantly grown and improved over the years, especially recently; however, one common theme among cancer treatments is the incidence of adverse effects. Even though tumors may be eliminated after surgery or shrunk immediately after chemotherapy, the health and well-being of patients are affected by conditions such as nausea, hair loss, infection, anemia, nerve problems, urinary problems, and many others (Chemotherapy Side Effects Fact Sheets. National Cancer Institute, 2012). Furthermore, many potential cancer treatments that can have curative implications do not even receive FDA (Food and Drug Administration) approval because of the severity of their side effects compared to their effect on the tumor (Arrowsmith J Trial watch: Phase III and submission failures: 2007–2010).
The incidence of side effects can be explained by the current, common approach of treating cancer. Proliferating cells are targeted by small molecules, antibodies, radiation, or other compounds, usually causing apoptosis, or cell death. However, tumor cells are not the only proliferating cells in the body of a cancer patient. Normal, noncancerous proliferating cells, such as blood cells, hair cells, and cells that line the digestive system, are also unintentionally targeted by cancer treatments, leading to the adverse effects previously mentioned. This realization highlights the importance of improving treatment delivery so that only cancerous cells are targeted, sparing normal cells and diminishing adverse effects. One area of research that has gained much attention bridges biology and engineering to generate medical devices which can be used to direct cancer treatments, such as chemotherapy and radiation, to desired locations within patients. With modern technology, medical devices are involved in almost every aspect the medical field and are responsible for saving countless lives. Medical devices have been used for many years, including the scalpels used for the first surgeries and syringes that delivered the first vaccines. However, medical devices only started being regulated, similar to drugs, in the 1970s as they became more advanced and medically influential (Flannery, 2012). According to the FDCA (Federal Food, Drug, and Cosmetic Act), medical devices:
“An instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including any component, part, or accessory, which is
1. Recognized in the official National Formulary or the United States Pharmacopeia, or any supplement to them,
2. Intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or
3. Intended to affect the structure or any function of the body of man or other animals, and which does not achieve its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of its primary intended purposes?” (Flannery, 2012).
Therefore, medical devices include a wide variety of instruments with varying applications that can range from operating room monitors to contact lenses to sunscreen. The vast potential of medical devices illustrates the importance it can have in treatment delivery. For example, rather than administer a drug or radiation alone, a medical device, that can be injected or implanted, can be designed to deliver the treatment at particular times and/or locations. Since the medical device is expected to provide precise delivery, normal cells can be avoided, diminishing side effects. Medical devices that exhibit these properties are either practiced in the medical field or being developed and tested today (SIR-Spheres®- P990065. Medical Devices. FDA, 2012).
Balloon catheters also deliver localized radiation to tumors, but can be used in hard-to-treat regions such as the brain (Gliasite Radiation Therapy. Med Central Health System,2012). Nanoparticles and carbon nanotubes that encase or carry a desired therapeutic compound have been constructed in a manner that only or mainly cancerous cells receive treatment (Mathur et al.,2010). Implantable microelectromechanical systems (MEMS) are currently being designed that can locally deliver anticancer agents to tumors at a controllable time, rate, and dosage (Rao et al.,2005)
The promising capabilities of these examples suggest that medical devices may be the key to improving treatment delivery in cancer patients so that normal cells are unharmed and adverse effects are either eliminated or reduced.
1.1 Cancer
Cancer is not a single disease. It is a group of more than 200 different diseases. Cancer can be generally described as an uncontrolled growth and spread of abnormal cells in the body. Cells are basic units of life.
1.2 Chemotherapy
The word chemotherapy means the use of any drug (such as aspirin or penicillin) to treat any disease, but to most people chemotherapy refers to drugs used for cancer treatment. It’s often shortened to “chemo.” Two other medical terms used to describe cancer chemotherapy are antineoplastic (meaning anti-cancer) therapy and cytotoxic (cell killing) therapy.
1.3 Chemo that’s given with other treatments
Sometimes, chemotherapy is the only treatment used. In other cases,chemotherapy maybe given along with other treatments. It may be used as adjuvant therapy or neoadjuvant therapy.
1.3.1 Adjuvant chemotherapy
After surgery to remove the cancer, there may still be some cancer cells left behind that cannot be seen. When drugs are used to kill those unseen cancer cells, it’s called adjuvant chemotherapy.
1.3.2 Neoadjuvant chemotherapy
Chemotherapy can be given before the main cancer treatment(such as surgery or radiation). Giving chemotherapy first can shrink a large cancerous tumor, making it easier to remove with surgery. Shrinking the tumor may also allow it to be treated more easily with radiation.
1.4 Different types of chemotherapy drugs
· Alkylating agents
· Antimetabolites
· Anti-tumor antibiotics
· Topoisomerase inhibitors
· Mitotic inhibitors
· Corticosteroids
· Miscellaneous chemotherapy drugs
· Targeted therapies
· Hormone therapy
· Immunotherapy
1.5 Deciding which chemotherapy drugs to use
In some cases, the best choice of doses and schedules for giving each drug are clear, and most oncologists would recommend the same treatment. In other cases, less may be known about the single best way to treat people with certain types and stages of cancer. In these situations different cancer doctors might choose different drug combinations with different schedules.
Factors to consider in choosing which drugs to use for a chemotherapy regimen include:
· The type of cancer
· The stage of the cancer (how far it has spread)
· The patient’s age
· The patient’s general state of health
· Other serious health problems (such as heart, liver, or kidney diseases)
· Types of cancer treatments given in the past.
1.6 Chemotherapy given
Chemotherapy treatments can be given in the following locations:
· Hospital
· Doctor’s office
· Outpatient clinic
· Home
· Workplace
1.7 Chemo side effects
1.7.1 Causes side effects
Cancer cells tend to grow fast, and chemo drugs kill fast-growing cells. But because these drugs travel throughout the body, they can affect normal, healthy cells that are fast-growing, too. Damage to healthy cells causes side effects. Side effects are not always as bad as might expect, but many people worry about this part of cancer treatment.
The normal cells most likely to be damaged by chemo are blood-forming cells in the bone marrow; hair follicles; and cells in the mouth, digestive tract, and reproductive system. Some chemo drugs can damage cells in the heart, kidneys, bladder, lungs, and nervous system. In some cases, medicines can be given with the chemo to help protect the body’s normal cells.
1.7.2 About side effect
· Every person doesn’t get every side effect, and some people get few, if any.
· The severity of side effects (how “bad” they are) varies greatly from person to person. Be sure to talk to doctor and nurse about whom side effects are most common with chemo, how long they might last, how bad they might be, and when should call the doctor’s office about them. For more information, see the section called.
· Your doctor may give medicines to help prevent some side effects before they happen.
· Many people have no long-term problems from chemo. And while side effects can be unpleasant, they must be measured against the need to kill the cancer cells.
1.8 Side effect
1.8.1 The less common side effect of chemotherapy
a. Allergic reaction
b. Bladder symptoms
c. Eye symptom
d. Fluid retention
e. Flu like symptoms
f. Hearing symptoms
g. Blood clots
h. Memory and concentration
i. Tissue damage
1.8.2 The common side effect of chemotherapy
· Diarrhoea or constipation
· Hair loss (alopecia)
· Appetite change
· Nausea and vomiting
· Infection
· Anaemia
· Brusing and bleeding
· Sore mouth
· Depression
· Test change
1.8.3 The long term risk of patient
· Developing a second cancer
· Damage the heart muscle
· Kidney, lung and liver damage.
1.8.4 Effect on life style of patient
· Alcohol consumption
· Loss of money
· Fatigue
· Travels and holidays.
1.9 Management and treatment
1.9.1 Nausea and Vomiting
Generally, if there’s more than a 10 percent risk of causing nausea or vomiting with chemotherapy, patients are given anti-nausea medicines — also known as anti-emetics — to prevent the symptoms. When it comes to nausea and vomiting, we know that younger people are more at risk than older people, and that women are at a slightly greater risk than men.
Certain drugs commonly cause nausea and vomiting, including:
· Cisplatin (Platinol and others)
· Dexamethason (steroid)
· Dolasetron (serotinin)
· Granisetron (kytril)
· Ondansetron (zofran)
· Palonosetron (Aloxi)
· Doxorubicin
· Cyclophosphamide (Cytoxan)
Doctors have used these standard chemotherapies for many years.
Coping with Nausea and Vomiting
In addition to medical treatments for nausea and vomiting, there are things you can do to ease symptoms. For example:
· Eat and drink slowly. Try having small meals throughout the day instead of your usual breakfast, lunch, and dinner.
· Avoid sweet, fried, or fatty foods, as well as foods with strong odors. Eating foods cold or at room temperature can help you avoid strong smells.
· Be sure that you fully understand your doctor’s and nurse’s instructions for taking anti-nausea medicines.
· See that you have a good supply of the correct drugs.
· Be sure that you are drinking enough fluids. Ask your nurse or doctor about proper nutrition, which is especially important during this time.
· Find out from your doctor if any other medicines you may be taking require special precautions.
1.9.2 Hair Loss
Not all anti-cancer medicines cause hair loss; your doctor or nurse can tell whether might be affected. Hair loss is often one of the more frustrating aspects of cancer treatment. When hair falls out, it can affect self-image and quality of life. But there are ways to cope with this side effect.
Everyone’s experience is different, so it’s important to talk with doctor or nurse about how particular treatment affects hair loss. Depending on the treatment, hair loss may start anywhere from seven to 21 days after the first chemotherapy session. Hair starts to grow back when are finished with treatment. It may have a different texture or color, but these changes are usually not permanent.
Coping with Hair Loss
Generally, when they lose their hair, most people want to wear some kind of head covering, whether it’s a scarf, turban, hat, or wig. Some insurance plans cover part of the cost of head coverings. Organizations such as Cancer Care can also suggest places where you can find wigs.
If you choose to wear a wig, consider buying one before all of hair falls out. This way, will have a good match to own hair color. Having a wig ahead of time will also help feel more prepared. Wig professionally fitted and styled by a full-service wig salon. Some of these salons even specialize in hair loss from chemotherapy.
1.9. 3 Diarrhea
Defined as two or more loose stools per day, diarrhea may be caused by some types of chemotherapy, including:
· Irinotecan (Camptosar and others)
· 5-fluorouracil (5-FU)
· Erlotinib (Tarceva)
· Gefitinib (Iressa)
There are many things can do to help control diarrhea. If diarrhea persists, especially large and frequent stools, should report it to doctor or nurse.
Replacing Lost Fluids and Salts
If experiencing diarrhea, it is very important to drink plenty of fluids such as water an can also increase your intake of drinks such as Gatorade or Pedialyte, an over-the-counter solution made for infants that can be used by adults as well. These drinks provide electrolytes — the body’s salts that must stay in balance in order for cells to work properly. Occasionally, intravenous fluids are needed if the diarrhea is especially severe.
Making Changes to your Diet
Many foods can nourish you without contributing to diarrhea. Here are some suggestions for making healthy choices:
CHOOSE
High-protein foods such as eggs (well cooked), lean meat, fish, or poultry, smooth peanut butter*, or beans*
Skim or low-fat milk, yogurt, or cottage cheese (use lactose-free dairy products if you are lactose intolerant)
Cooked vegetables* such as carrots, green beans, or mushrooms
Fresh fruits without the skin or canned fruit (except prunes)
Desserts low in fat and lactose, such as sorbets, fruit ices, or graham crackers
INSTEAD OF
Fried or fatty foods (such as sausage, bacon, chicken nuggets, fried seafood, or pizza)
Regular milk or cheese with more than 9 grams of fat per ounce
Raw vegetables, especially those with thick skins, seeds, or stringy fibers
Dried fruits
High-fat ice creams or any candies, gum, or breath mints containing sorbitol, mannitol or xylitol
Taking Medicine for Diarrhea
Over-the-counter medicines and prescription treatments are available for diarrhea.Doctor may need to prescribe something stronger, such as diphenoxylate and atropine (Lomotil and others). Like all drugs, these products can interact with other drugs may be taking, such as opiate pain relievers.
For severe diarrhea that does not respond to these oral medications, doctor may consider giving injectio approved specifically for diarrhea caused by chemotherapy or radiation treatments, doctor may choose to prescribe it “off label.”
1.9.4 Constipation
Defined as fewer than three bowel movements a week (although fewer than four or five may be a reduced number for some people), this symptom can be caused by:
· Certain chemotherapy drugs, including vinorelbine (Navelbine and others), vincristine (Oncovin and others), and temozolomide (Temodar)
· Inactivity
· Low fluid intake
· Low amounts of fiber in the diet
· Anti-nausea medications
· Opiate pain medications.
Avoiding Constipation
Here are some things you can do to help prevent constipation:
· Eat plenty of dietary fiber. Grains, beans, and vegetables such as cauliflower or broccoli are good sources of fiber.
· Drink plenty of fluids.
· Make light exercise a part of your everyday schedule.
Treating Constipation
Stool softeners such as docusate sodium (Colace and others), although helpful, are not enough to manage this side effect. Pharmacies carry a number of different laxatives that are available without a prescription such as senna (Senokot and others), bisacodyl (Correctol, Dulcolax, and others), magnesium hydroxide (milk of magnesia), Metamucil and MiraLAX.
1.9.5 Fatigue
Feeling tired — really tired — can be tied to a number of factors:
· The cancer itself
· Treatment of the disease
· The emotional aspects of coping with cancer and cancer pain
· Anemia (low levels of red blood cells)
Treating Fatigue
To determine whether there is an underlying physical cause, doctor may order a blood test to find out if red blood cell count is abnormally low (anemic). If anemic, there are treatment options available. Be sure to take only treatments prescribed by doctor
Coping with Fatigue
These tips can help reduce fatigue:
· Take several short naps or breaks in a comfortable chair rather than in bed.
· Take short walks or do some light exercise, if possible.
· Try easier or shorter versions of the activities enjoy.
· Ask family or friends to help with tasks find difficult or tiring.
· Save energy for things find most important.
· Talk to an oncology social worker or oncology nurse.
1.9.6 Mouth Sores (Mucositis)
Radiation treatments and some types of chemotherapy can cause sores inside the mouth and on the mucous lining of the throat and digestive tract.
Maintaining Oral Health
One of the key things can to manage mucositis is to take good care of mouth and keep it clean. Here are some tips:
· Visit dentist before treatment. A small problem could turn into a large one if mouth sores develop later on.
· Choose a soft bristle brush for brushing your teeth.
· If toothpaste irritates mouth, use a mixture of ½ teaspoon salt with 4 cups water.
· Gargling may also help. Use a solution made up of 1 quart plain water, ½ teaspoon table salt, and ½ teaspoon baking soda.
· Drink plenty of fluids.
1.9.7 Infections
As we mentioned earlier, chemotherapy can lower the levels of infection- fighting white blood cells, a condition known as neutropenia. Of special concern of people with cancer is their level of neutrophils, the most abundant of the different types of white blood cells. These cells contain tiny packets filled with potent chemicals called enzymes that can destroy bacteria when the chemicals are released.
Treating Infections
Doctors use antibiotics to treat infections. Although most people think of antibiotics as pills, intravenous antibiotics are often recommended for people on chemotherapy. Using intravenous antibiotics knocks out infections until the white blood cell count returns to normal.
Commonly used white blood cell growth factors include filgrastim (Neupogen) and pegfilgrastim (Neulasta). Both of these drugs have to be given by injection. Doctor or nurse can train patient or a caregiver to administer this injection at home if prefer.
Preventing Infections
The risk of infection by taking these simple steps:
· Wash hands often with soap and water, especially after using the toilet and before eating.
· Clean cuts and scrapes right away. Use an antiseptic and keep wounds clean and dry until they heal.
· Carry alcohol-based sanitizers, such as Purell, with in case don’t have access to soap and water.
· Be extra careful not to nick or cut when using a razor, knife, or scissors.
· Wear protective gloves when gardening or cleaning up.
· Avoid contact with cat litter boxes, bird cages, and fish tanks.
1.9.8 Nerve Damage
Some people on chemotherapy experience numbness or tingling in their hands and feet, what doctors call peripheral neuropathy. Symptoms related to neuropathy and other types of nerve damage can include:
· Difficulty picking up objects or buttoning clothing
· Problems with balance
· Difficulty walking
· Jaw pain
· Hearing loss
Managing Nerve Damage
It’s important to tell doctor as soon as possible if experience these types of side effects. He or she may want to adjust some of medicines or chemotherapy and may want to see if there is another reason for the problem that can be treated.
Often, nerve damage is temporary; it will usually get better, but it can take time. In the meantime, take extra caution when handling hot, sharp, or dangerous objects. And use handrails on stairs and in the tub or shower.
1.10 Objectives
1.10.1 General objective
The study will be carried out with a view to assess the level of knowledge regarding on management of side effect of chemotherapy at Rajshahi Medical College Hospital.
1.10.2 Specific objectives
1. To assess the level of nurses knowledge about side effect management of chemotherapy Attending Rajshahi Medical College Hospital.
2. To find out the knowledge about chemotherapy.
3. To assess the knowledge about side effect of chemotherapy.
4. To assess the knowledge about management of side effect of chemotherapy.
5. To find out the socio-demographic characteristics of the respondents.
CONTENTS
Abstract
CHAPTER 1. INTRODUCTION
1.1 Cancer
1.2 Chemotherapy
1.3 Chemo that’s given with other treatments
1.4 Different type of chemotherapy drugs
1.5 Deciding which chemotherapy drugs to use
1.6 Chemotherapy given
1.7 Chemo side effects
1.8 The side effects
1.9 Management and treatment
1.10 Objectives
CHAPTER 2. REVIEW OF LITERATURE
CHAPTER 3. MATERIALS AND METHODS
3.1 Research methodology
3.2 Design of the study
3.3 Setting, Population and Sample of the study
3.4 The inclusion criteria
3.5 Research Instrumentation
3.6 Validity and reliability of the instrument
3.7 Data collection procedure
3.8 Statistical Analysis
CHAPTER 4. RESULTS
CHAPTER 5. DISCUSSION
CHAPTER 6. CONCLUSION
CHAPTER 7. REFERENCES
CHAPTER 8. APPENDICES
LIST OF TABLES
Table 1. Demographic information of the participated nurses in the Rajshahi Medical College Hospital.
Table 2. Information regarding knowledge of the participated nurses about management of side effect of chemotherapy
LIST OF FIGURES
Figure 1. Distribution of the respondent by their age
Figure 2. Distribution of the respondent by their sex
Figure 3. Distribution of the respondent by their religion
Figure 4. Distribution of the respondent by yes/ no question
Figure 5. Distribution of the respondent by regarding their knowledge
Figure 6. Distribution of the respondents regarding their knowledge
Thesis, Nurses, Knowledge, Management, Side, Effect, Chemotherapy, Rajshahi, Nursing, College, Medical, Hospital
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