Despite it is rare to have allergic reaction toward chemotherapeutic drugs, there are several anti-allergic drugs must be given to patients before chemotherapy as serious reaction can be fatal. (Springhouse, 2004) They mainly work as an agonist for cell receptor. And there are some specific side-effects of chemotherapeutic drugs due to their characteristics that require nursing intervention. Before infusion, patient’s kidney and liver function must be checked to match the needs of the metabolism and excretion of different drug. During infusion, Gemcitabine can cause pulmonary toxic and Paclitaxel can cause abnormal cardiac conduction. So the pulmonary and cardiac function must be monitored. (BC Cancer Agency Cancer Drug Manual, 2011), (Skidmore-Roth, 2011) After the infusion of Carboplatin, mineral supplements are given if mineral deficiency is occurred. It and Paclitaxel can also contribute permanent hearing loss, so patients have to report if they have tinnitus. (Skidmore-Roth, 2011) The cells of hematopoietic and epithelial system are greatly inhibited because they are fast dividing in body. Patients are easy to get anemia, leukopenia, thrombocytopenia, G.I. illness and skin rash. Because of it, the nurses have to take care of patients’ immune, G.I. and skin function and tell the patients do not taking anticoagulants and vaccination. As the drugs are all cytotoxic and being harmful to infant, no pregnancy and breast feeding are suggested. (Springhouse, 2004)
Respond to Questions
Why the greatest dosage of drug should be determined?
The greater amount of antineoplastic drug is used, the lower opportunity of developing drug resistance tumor. (Springhouse, 2004) The reason is twofold. In genetic level, unlike normal cell, every cancer cell responds to the drugs in a different way due to the genetic make-ups of them are different. Their genetic make-up are various by tissue of origin, oncogenes, suppressor-genes and random mutation of mutagens. Some cancer cells can develop some genes that contain drug resistance ability by the above genetic variations. For example, they develop efflux pump to excrete out the antineoplastics. (Gottesman, 2002)
Let’s back to the process of chemotherapy. It is impossible to kill all cancer cells at once. The cells with drug resistance will leave behind. These cells can overcome certain dosage of drug as their efflux pump is enough to excrete out antineoplastics before it reach to fatal level. After they are recovered, they gain the nutrients that were used to support other cancer cell and clonally derive to give a drug resistance tumor. (Gottesman, 2002)
The idea of that should using greatest dosage is to out weight the ability of efflux pump and kill cancer cell as more as possible. Therefore, cells with drug resistance cannot survival and no drug resistance tumor developed.
Critiques and Argument
In our case, A.L. also discovered her tumor in stage III. In her experience, she has no idea to check for cancer regularly. And the outcome is that the government has to pay for the treatment of this citizen. Ovarian cancer is a cancer that two-third cases are discovered in Stage III and only 30% of that patient can survive over 5 years. (Welch, 2012) There are 136 people die of this cancer in 2006 in Hong Kong. (Cancer Fund, 2009) Early diagnosis not just can obviously boost the survival period of patients but also help the government to save a lot of money from the advanced stage treatment. It is suggested that the government should put the resources to give the high risk people a regular cancer check.
In Hong Kong, the first-line treatment of epithelial ovarian cancer is used to be debulking and chemotherapy, the combination of Paclitaxel and Carboplatin. (Cancer Fund, 2009) There will be, however, more effective to combine them with others such as anti-angiogenesis target therapy. (HKSCO, 2012) As angiogenesis is the key factor for the growth of ovarian tumor, antiangiogenic therapy can slow it down and reduce the formation of ascites. (Dean, El-Helw, & Hasan, 2010) It not only inhibits the growth of new blood vessel but also induces epithelial cell apoptosis, blocking the incorporation of haematopoietic and endothelial progenitor cells into new blood vessels, and normalize the vasculature. (Schumacher et al., 2007) The above events are carried by the interference of therapy between the VEGF and VEGFR. (Spannuth, 2008), (Rosa et al., 2007) One of the antiangiogenic therapies is the combination of Bevacizumab, Paclitaxel and Carboplatin. Bevacizumab can direct against the VEGF. The RECIST scale show this treatment have 80% (CRR). (Dean, El-Helw, & Hasan, 2010) Although the cost of anti-angiogenesis target therapies is high, it can relief the sign, ascites, of the patient and give a more effective treatment than the original one.
Few hospitals will provide adjuvant therapies such as acupuncture, massage, hypnosis and yoga courses. They can decrease the drug dependence of pain killer and the most important thing that to reduce the pressure and anxiety of patients. It also increases the tolerance of patients to chemotherapy.(Cancer Fund, 2009) It is suggested that to promote the above adjuvant therapies to all hospital. It is because health service providers not just to cure the disease of your body but also take care the feeling of the patients.
Reference
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Video:
HKSCO (Director). (2012). Cancer Public Awareness Campaign 2012: Ovarian cancer
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