Chemotherapy and Biotherapy Guidelines and Recommendations for Practice

Order your copy of the third edition of the best-selling resource used by more than 72,000 healthcare professionals. Edited by Martha Polovich, Julie M. Whitford, and MiKaela Olsen, this new edition has been revised and updated to reflect the current procedures and practices in your specialty.

Featured are sections detailing principles of antineoplastic therapy, cancer therapy goals and response, fundamentals of administration, pretreatment, treatment and post-treatment care, side effects of cancer therapy, immediate complications of cytotoxic therapy, and more.

Also included are treatment schedules, including dose category and determination, as well as nursing and chemotherapy flow charts, information on safe management of chemotherapy in the home, clinical practicum and evaluations, and much, much more. 

Preface

The Oncology Nursing Society (ONS) Chemotherapy and Biotherapy Guidelines and Recommendations for Practice is now in its third edition. Since its first chemotherapy-related publication in 1984, ONS has provided leadership in this important area of oncology nursing practice. The goal of the publication has always been competent oncology nursing practice, which promotes patient safety. After 25 years, these guidelines have formed the foundation for the delivery of quality cancer care. While ONS is not a regulatory agency and, therefore, does not decide what treatments may be considered “standard of care,” ONS provides the information contained in these guidelines based on evidence and research. Each institution or practice needs to make its own decision on whether to add a medication to its formulary based on the information that is available.

Because cancer treatment has changed since publication of the 2005 edition, the authors and editors have provided new and updated information to reflect those advances. The content related to targeted therapies and oral therapies has been expanded. Information on the management of skin, pulmonary, and cardiac toxicity has been updated accordingly. A chapter on treatment-related cognitive changes has been added. New tables and figures are included, and previous tables have been updated to provide information on newly approved drugs and care of the patients who receive them.

ONS gratefully acknowledges the authors and editors who have contributed to previous editions of this manual as well as the editors and authors of the material presented in this edition. The content has undergone an extensive peer review by both external reviewers and trainers for the ONS Chemotherapy and Biotherapy Course. Thanks to all who have participated in the preparation of this publication.

Contents

Preface ............................................................................................................	ix
Abbreviations Used in This Manual ......................................................................	x
Generic Medications and Brand-Name Equivalents ................................................	xii
I. Introduction ..................................................................................................	1
A. Definition of cancer ........................................................................................	1
B. Treatment modalities ......................................................................................	2
C. The drug development process ........................................................................	4
D. Ethical issues related to cancer therapy ..........................................................	11
E. Legal issues related to cancer therapy .............................................................	12
II. Cancer Therapy Goals and Response ..........................................................	17
A. Goals of cancer therapy .................................................................................	17
B. Factors affecting response to treatment ...........................................................	17
C. Treatment strategies ......................................................................................	18
D. Measuring response .......................................................................................	19
III. Principles of Antineoplastic Therapy ..........................................................	25
A. Life cycle of cells ...........................................................................................	25
B. Chemotherapeutic agents ...............................................................................	26
C. Actions of the immune system .......................................................................	26
D. Types of immune response .............................................................................	26
E. Cells of the immune system ...........................................................................	28
F. Tumor escape mechanisms ............................................................................	29
G. Principles of biotherapy ..................................................................................	30
H. Categories of biotherapy .................................................................................	30
I. Principles of radioimmunotherapy .....................................................................	32
J. Toxin-conjugated molecules ............................................................................	33
K. Therapeutic uses for biotherapeutic agents .......................................................	33
L. Supportive uses for biotherapeutic agents .........................................................	33
M. Biotherapeutic strategies ...............................................................................	33
N. Angiogenesis and antiangiogenic agents .........................................................	34
IV. Fundamentals of Administration ................................................................	73
A. Safe handling ................................................................................................	73
B. Verification and maintenance of treatment as planned .......................................	84
C. Pretreatment .................................................................................................	93
D. Treatment .....................................................................................................	95
V. Immediate Complications of Cytotoxic Therapy .........................................	105
A. Extravasation ................................................................................................	105
B. Irritation ........................................................................................................	110
C. Flare reaction ................................................................................................	111
D. Acute infusion reactions .................................................................................	111
E. Patient and family education ...........................................................................	114
VI. Care of the Patient Receiving Cancer Therapy ..........................................	117
A. Patient education ..........................................................................................	117
B. Adherence to therapy ....................................................................................	118
C. Toxicity management .....................................................................................	118
VII. Side Effects of Cancer Therapy .................................................................	121
A. Myelosuppression .........................................................................................	121
B. GI and mucosal side effects ............................................................................	146
C. Cutaneous toxicity .........................................................................................	182
D. Alopecia .......................................................................................................	197
E. Cardiovascular toxicity ....................................................................................	200
F. Pulmonary toxicity .........................................................................................	231
G. Hemorrhagic cystitis ......................................................................................	255
H. Hepatotoxicity ...............................................................................................	259
I. Nephrotoxicity ................................................................................................	266
J. Neurotoxicity ..................................................................................................	274
K. Cancer treatment–related cognitive changes ....................................................	284
L. Ocular toxicity ...............................................................................................	300
M. Pancreatitis ..................................................................................................	310
N. Fatigue .........................................................................................................	311
O. Alterations in sexuality ...................................................................................	315
P. Reproductive alterations .................................................................................	320
VIII. Post-Treatment Care ................................................................................	325
A. General principles ..........................................................................................	325
B. Types of effects .............................................................................................	326
C. Secondary malignancies ................................................................................	326
D. Collaborative management ..............................................................................	339
E. Preventive screening recommendations ...........................................................	340
F. Patient and family education ...........................................................................	340
G. Professional education ...................................................................................	340
H. Nursing assessment ......................................................................................	340
IX. Nursing Education and Management ..........................................................	343
A. The clinical practicum ....................................................................................	343
B. Policy and procedure .....................................................................................	344
C. Issues in antineoplastic administration .............................................................	344
D. Documentation ..............................................................................................	345
Appendices ......................................................................................................	347
Appendix 1. Nursing Flow Sheet ..........................................................................	347
Appendix 2. Chemotherapy Flow Sheet ................................................................	351
Appendix 3. Safe Management of Chemotherapy in the Home ...............................	353
Appendix 4. Progression of Intravenous Extravasation ...........................................	355
Appendix 5. Clinical Practicum Evaluation: Part I ..................................................	356
Appendix 6. Clinical Practicum Evaluation: Part II .................................................	357
Appendix 7. Oncology Nursing Society Position on the Education of the RN Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy	358
Appendix 8. Consent Document ..........................................................................	359
Appendix 9. Extravasation Flow Sheet .................................................................	360
Index ................................................................................................................	361