Chemotherapeutic Drugs Biologic and Immune Modifiers Flashcards by Kelsey Klipfel

Block hormone receptors on hormone-sensitive tumors to stop or slow cancer growth rate - specific cancers r/t some type of hormone
Used in treatment of breast cancer, prostate cancer, etc.
Cancers hormonal related

Cancer treatments: hormonal manipulation

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Competes with estrogen binding sites in target tissue; antiestrogen - help growth cancer because r/t estrogen activty

MoA: - Hormone Modulators: Prototype: Tamoxifen

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breast cancer; prophylactic breast cancer - certain breast cancers r/t hormonal activity: block hormones thus reduce cancer growth; specific cancer

Indications: - Hormone Modulators: Prototype: Tamoxifen

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oral (may take for sev years) - may go through antineoplastic and may be on this drug for long-period time for number yrs after

Route: - Hormone Modulators: Prototype: Tamoxifen

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r/t antiestrogen effects [blocking receptor sites] (menopausal like symps: needs much edu and if not gone through it: hot flashes, menstrual irregularities); Masculinizing effects in women; risk DVT

AE: - Hormone Modulators: Prototype: Tamoxifen

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pregnancy; breastfeeding, anticoagulants; hx blood clots

Contraindications: - Hormone Modulators: Prototype: Tamoxifen

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comfort measures to help client cope with menopausal signs and symptoms such as hygiene measures, temperature control, and stress reduction

Nursing: - Hormone Modulators: Prototype: Tamoxifen

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Aka chemotherapy drugs
General
Goals of treatment
Caution
Routes

Antineoplastic agents

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Harmful to all rapidly growing cells
Narrow therapeutic index/window:
Fine line between toxic & therapeutic levels - little margin of room; monitored closely; frequent lab monitoring

General

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Limit cancer cells to degree that immune system can then eliminate without causing too much toxicity to the host - kill cells; prob not specifically rapidly growing cancer cells; affect all rapidly growing cells of body - numerous AE to numerous sys in body; kill enough cells that immune sys can finish up killing up rest

Goals of treatment

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Pregnancy / lactation - killing rapidly growing cells: fetus rapidly trying to grow: complicates treatment if pregnant
Bone marrow suppression: antineoplastic sig suppression and decrease cell count; giving if already suppression problematic
Hepatic or renal impairment - toxic to all sys
CNS disorders

Caution

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Variety routes: Oral, SQ, IM, IV, Topically, Intracavity, Intrathecal
Frequent and prolonged admin: Central vascular access devices are common: PICC line/port placed: easy access and last longer period of time; often caustic to veins to central access imp
Nurse require certification to administer chemotherapy - lot for safety

Routes

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Monitor and intervene AE, hydration/nutritional/labs
Complicates growth and development if frequently hospitalized - high risk for infection: tricky to interact with kids appropriately: figure out good ways to assist fam so learn and play and explore appropriately for age and development
Needs support, comfort, to explore and learn like other children
Body image, lack of energy, parental need to protect child-isolate
Risk for infection diff; body image diff if lose hair; challenge for variety reasons

Children - Antineoplastics across the lifespan

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Monitor and intervene AE, hydration/nutritional/labs/status
Body image (hair loss - some shave head); fear of diagnosis, treatment, job (not able work because too ill can be financial strain - very expensive so depending on insurance is financial strain; trying deal with diagnosis and other social things), financial strains, social issues
Need networking support systems, teaching, reassurance, and comfort

Adults - Antineoplastics across the lifespan

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Monitor and intervene AE, hydration/nutrition/labs
More susceptible to the CNS, GI, renal, liver effects – may need reduced dose - toxicities of drugs - might need lower dose

Older adults - Antineoplastics across the lifespan

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Diff classifications because affecting cancer in diff ways; target cell in diff ways

EX of antineoplastic drugs: classifications/prototypes

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kills cancer cells

MoA: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)

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antineoplastic; treats cancer

Indication: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)

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toxic increase in uric acid level, CNS toxicity, hemorrhagic cystitis - bleeding in the urine - imp encourage adequate hydration to prevent it

AE: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)

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Encourage hydration to prevent cystitis; see general

Nursing: - Alkylating Agents: Prototype: Cyclophosphamide (Cytoxan)

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kills cancer cells; some autoimmune disease

MoA: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)

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antineoplastic; treats cancer

Indication: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)

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Gastrointestinal ulceration, bone marrow suppression

AE: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)

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See general

Nursing: - Antimetabolites: Prototype: Methotrexate (Rheumatrex)

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kills cancer cells

MoA: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)

antineoplastic; treats cancer

Indication: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)

injection site extravasation (vasocostic: monitor IV site closely - cause localized tissue necrosis if not careful); cardiotoxic (montior cardiac func closely)

AE: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)

see general

Nursing: - Antitumor Antibiotics: Prototype: Doxorubicin (Adriamycin)

Affecting all rapidly growing cells Alopecia – hair loss CNS/PNS: neuropathy/cognitive dysfunction, headache, dizziness CV/Pulmonary – risk toxicity Myelosuppression – leukopenia, anemia, thrombocytopenia GI: N/V, anorexia, diarrhea/constipation; mucous membrane deterioration (stomatitis) Liver/renal – risk toxicity Skin reactions: rashes; blisters; photosensitivity GU/reproductive risks – cystitis; dysfunction

Gen antineoplastic AE

Assessment Nursing Diagnosis Outcomes: what achieve: The client will receive:

Nursing: antineoplastic assessment/diagnosis/outcome

H&P, Contraindications (pregnancy/ lactation, etc.), monitor labs: CBC (imp - weekly), renal/liver functions regular basis - see if decline - see if getting toxic; respiratory or cardiac disease (status of these) Head to toe - note any AE happening for pat

Assessment - Nursing: antineoplastic assessment/diagnosis/outcome

Fatigue R/T drug effects (anemia) disease effects Disturbed body image related to alopecia, skin effects … Risk for injury Risk for infection - HUGE; neutropenic

Nursing Diagnosis - Nursing: antineoplastic assessment/diagnosis/outcome

Best therapeutic effect - killing the cancer; cancer cells die and tumor shrink; hope to remission; take antineoplastic drugs, surgery, and radiation Limited adverse effects - hard goal; most become pretty ill at some point because nature drugs; try intervene to lessen severity AE Understanding or drug therapy, AE, comfort measures

Outcomes: what achieve: The client will receive: - Nursing: antineoplastic assessment/diagnosis/outcome

Do for all pats receiving antineoplastic drugs Schedule blood tests to monitor bone marrow function, liver, renal Monitor AE, pt. response Adm. meds (anti-nausea, antidiarrheal, etc.)- intervene as appropriate to AE and meds to treat AE Ensure hydration to decrease risk of renal toxicity - sometimes hydration can be hard Provide small freq. meals instead larger (harder digest and provoke nausea), good mouth care imperative to prevent effects, dietary consult to maintain nutrition - visit with dietician on good path to maintain nutrition Arrange for proper head covering for alopecia-temp. control; esp if really cold; hair does a lot insulation Avoid exposure to infection - measures take to avoid infection; imp to avoid Observe for signs of bleeding - suffer from thrombocytopenia; report so intervene Energy conservation - suffer from fatigue from antineoplastics and/or cancer and/or anemia; discuss this Barrier contraception - utilized for pats getting antineoplastic drugs and having sex protect partner from from agents, excreted in bodily fluids up to 48 hours; neeed best protect partner from agents; child-bearing age: cogniscent to prevent pregancy because hinders growth of fetus

Nursing: antineoplastic: gen implementation

Alopecia Skin probs/effects

Nursing management: alopecia/skin

Begins 2 to 3 weeks after start of tx with antineoplastic drugs Obtain wig/scarves/caps/hats Avoid vigorous brushing hair Shave head once hair loss begins and get covering Re-growth begins 2 to 3 month after treatment ends; May be different thickness and texture than old hair

Alopecia - Nursing management: alopecia/skin

Diff types of rashes/blisters Protective clothing sun-burn easily - protection from sun; reduce impact to skin as best can

Skin probs/effects - Nursing management: alopecia/skin

Sig role in preventing nausea Goal: prevent with very first treatment; then have anticipatory and feel it coming and more likely experience it again - want to stay ahead of it Chemotherapy pattern of nausea Prevention

Nursing management GI effects: treatment induced nausea

Early: first 12 hours Delayed: 2 to 5 days Anticipatory (goal: no nausea from first dose)

Chemotherapy pattern of nausea - Nursing management GI effects: treatment induced nausea

Bland diet before and after chemo (not spicy, heartburn, upset stomach, easily digestable); adequately hydrate before chemo - less likely experience dehydration after if vomit after Pre-medication 30 min prior to chemo: ondansetron Around the clock dosing of antiemetics for 48 hours after admin of antineoplastic

Prevention - Nursing management GI effects: treatment induced nausea

Causes (varies): N/V/D/constipation/fatigue/pain Individualize plan to address all contributing factors - figure out exact cause - if cannot use gen measures to ensure getting nutrition needed

Nursing management GI effects: anorexia

Control N&V Good oral care Pain meds prior to eating Conserve energy so not too tired to eat Small, freq. meals high in calories and protein - real dense Avoid noxious stimuli (odors/visual/conversations) Nutritional Supplements-Ensure; high protein/calorie milkshakes Treat constipation/diarrhea Appetite stimulants - stimulate wanting to eat; more severe cases anorexia Last resort- PEG tube/NG tube enteral feedings/TPN (ABSOLUTE LAST RESORT: not great source nutrition) - diff kinds feeding

Individualize plan to address all contributing factors - figure out exact cause - if cannot use gen measures to ensure getting nutrition needed

Stomatitis Mucositis Ulcers diff - painful; hard eat and drink; maintaining hydration imp; imp assess and find ulcers early on Teach pt. to report early signs of dryness of mouth, tenderness of mouth/with eating, lesions Pain medication needed! Good oral hygiene - good thing do to prevent them Maintain hydration Mouth rinses – Magic mouthwash - not want alcohol mouthwashes; lidocaine in there, provider tells what to be included No smoking/alcohol/spicy or acidic foods - avoid irritation: burn and pain Liquid supplements for nutrition - best intake to deal with mouth sores so can heal

Nursing management: GI effects: stomatitis/mucositis

Ulceration of oral mucous membranes

Stomatitis - Nursing management: GI effects: stomatitis/mucositis

Ulceration of any part of GI system from mouth to anus - GI tract

Mucositis - Nursing management: GI effects: stomatitis/mucositis

Typ have with antineoplastic Damage to mucosal lining Low fiber diets, limit fried foods, spicy/gas food - damage to lining avoid as much lining eat low fiber not have process all fiber; limit spicy food and GI distress Treat rectal irritation with lot diarrhea: keep rectal area clean and dry/ointments used PRN Hydration (3 L day) - losing excess fluids; push excess fluids; not have electrolyte imbalances Antidiarrheal meds (Imodium/codeine - cancer pat meds)

Diarrhea - Nursing management GI effects: diarrhea/constipation

Nerves affected/damaged in GI tract - not have same peristalsis and slows down movement through GI tract Hydration - not having to strain/drier stools Exercise - movement up sev times a day to help peristalsis as much as can talk Enemas – last resort; more invasive; at risk for infection and bleeding Laxatives

Constipation - Nursing management GI effects: diarrhea/constipation

Neutropenia Nadir: Teach precautions risk/signs of infection/prevention Weekly CBC Hand hygiene/good personal hygiene/mouth care Avoid crowd/ill people/wear mask Avoid constipation/shaving with blade/No invasive procedures No fresh flowers or plants/No gardening/No fresh fruits or veggies - pesticides and pathogens Who to notify of inf. & when (report temp > 100.5 degree F - concerned with low temp) Minor infection can be fatal - immunosuppressed; not norm WBC count

Nursing management myelosuppression: neutropenic precautions

low level of type WBC; why monitor CBC weekly - high risk for infection

Neutropenia -

Predictable point in time that WBC lowest point after treatment Treat with granulocyte colony stimulating factor: Filgrastim (Neupogen) - raise WBC and stimulate production

Nadir:

Stimulates production, maturation, and activation of neutrophils to reduce incidence of infection; stimulates bone marrow to produce more neutrophils since killing more

MoA: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)

myelosuppression conditions (Antineoplastic drugs, bone marrow transplant, HIV)

Indications: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)

SQ - taught - sent home

Route: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)

fatigue, bone pain - driving bone marrow work overtime to produce more and bone marrow in bone so get pain, fever, N/V, peripheral edema, GI

AE: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)

Frequent LAB MONITORING (CBC before treatment & twice weekly if diagnosed with neutropenia because want it to rise; monitor it if when get to acceptable place for next round of treatment because is chance too low for next round treatment delayed); teach self-administration

Nursing: - Immunostimulants: Colony Stimulating Factors: Prototype: Filgrastim (Neupogen)

Platelet count less than 50,000/mm3: Danger/concerned about/of minor or major bleed Platelet transfusion if < 10,000mm3 Weekly CBC Low platelet count: risk for bleeding Thrombocytopenic Precautions - specific bleeding precautions; protect from unecessary bleeding

Nursing management myelosuppression

Avoid IM/SQ/IV or invasive procedures No aspirin/NSAID - drugs participate more bleeding Soft toothbrush/no flossing/dental procedures No razor blades (use electric) Avoid hard stools (stool softeners/laxatives) Teach signs of bleeding: bruises/nose/gums/urine/stool/severe HA Avoid falls/trauma

Thrombocytopenic Precautions - specific bleeding precautions; protect from unecessary bleeding - Nursing management myelosuppression

Can affect development of RBCs Drop in RBC due to destruction by tx.-poor tissue perfusion Signs and symptoms Anemia management

Nursing management myelosuppression: anemia

Fatigue, decreased endurance, headache, tachycardia, angina, dizziness, dyspnea at rest, pallor, feel colder than usual

Signs and symptoms - Nursing management myelosuppression: anemia

Injection with epoetin-alfa SQ weekly Weekly CBC - track RBC; monitor Hgb and Hct Energy conservation techniques RBC transfusion (hemoglobin < 7.5)

Anemia management - Nursing management myelosuppression: anemia

Erythropoietin factor controlling rate of RBC production

MoA: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)

Treat disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments

Indications: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)

Angina, anticoagulant therapy, caution in CHF/Renal

Contraindications: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)

Fatigue, bone pain, edema, hypertension (HTN), headache, fever, (DVTs CVAs and MI’s have occurred with tx)

AE: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)

Monitor CBC weekly (dose depends on Hgb & indication), check VS (risk for HTN); analgesia for bone pain; goal above 10; hold or dose reduction if hold if Hgb >12; SQ - taught to admin at home while getting antineoplastic drugs

Nursing: - Immunostimulants: Colony Stimulating Factors: Epoetin-Alfa (Epogen)

Convo between pt with cancer and if childbearing age Females Males

Reproductive effects: risk for infertility

Age important predictor of future fertility Women < 30 more likely to regain ovarian function after cancer treatment than > 30; more fertility when younger Premenopausal will stop periods No periods with treatment in chemo and is norm Advise no pregnancy first year post tx - allow regain ovarian func and body rest; consider chances of relapse

Females - Reproductive effects: risk for infertility

Testes more sensitive (constant mitosis) Sperm banking advised if wants try to have baby after cancer treatment

Males - Reproductive effects: risk for infertility

Will prepare/hang drugs

Oncology nurse - Safety for med-surg nurse

Monitor client during and after infusion Intervene as appropriate to manage adverse effects Wear PPE when handling (gown and gloves at min, splash: mask and face shield) to prevent accidental exposure to hazardous drugs Call the oncology nurse if questions arise during monitoring or before taking down the IV bag and tubing and if something happens

Unit nurse - Safety for med-surg nurse

Wear correct PPE designated for chemotherapy Prevention of Contamination by body fluid for long period time; Safe disposal

Safe handling of chemotherapeutic drugs/waste

Ingestion Inhalation of aerosols Absorption through skin Antineoplastic agents

Prevention of - Safe handling of chemotherapeutic drugs/waste

Discard in cytotoxic waste in leak proof, puncture proof sealable containers marked cytotoxic waste

Safe disposal - Safe handling of chemotherapeutic drugs/waste

Take antiemetics - prescribed and know when take them; diet/fluids; when to call; next CBC Manage n/v/d Know when call: presence infectionl fever >100.5 When lab schedule and how often come in after with current condition rn Check with provider on need for growth factors Prevent contamination by body fluids at home - person living with needs be protected as well; educate them on this

Discharge instructions: client and fam edu

Wear gloves when handling body fluids-wash hands Avoid splashing when use toilet, close lid, flush 2-3 times to ensure body fluids down and not exposing others Place soiled linen in separate, washable pillowcase and wash twice, separate from other laundry Drug waste; placed in sealed receptacle and transported in a non-passenger area to home agency for disposable

Prevent contamination by body fluids at home - person living with needs be protected as well; educate them on this - Discharge instructions: client and fam edu

Assists immune system to fight cancer Types of immunotherapy:

Emerging cancer treatment: immunotherapy

Immune checkpoint inhibitors T-cell transfer therapy Monoclonal antibodies Treatment vaccines Immune system modulators

Types of immunotherapy: - Emerging cancer treatment: immunotherapy

Modify the actions of immune system Umbrella term; affecting immune sys in one-way or another

Immune modulators - Immune modifying drugs

Energize immune system when it needs help fighting a specific pathogen Filgrastim - stimulating bone marrow to build up WBCs

Immune stimulants - Immune modifying drugs

Block normal effects of the immune system in organ transplantation and autoimmune disorders Some implications

Immune suppressants - Immune modifying drugs

Inhibits action of helper T-cell; block antibody production of B cells - all Ig; suppressing immune sys so not try attack new organ and reject it since seen as foreign; farther out transplant lower dose need organ been in body longer less likely be rejected

MoA: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine

anti-rejection organ transplant; psoriasis, rheumatoid arthritis

Indications: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine

Hypersensitivity, pregnancy or lactation, renal/liver dysfunction, infection, malignancies

Contraindications: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine

grapefruit juice -increase levels by 50-200% - sig; big piece of edu

Drug/Food: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine

infection risk (suppressing immune sys - big piece edu; immunosuppressant drug forever), kidney/liver damage

AE: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine

monitor lab: CBC, renal/liver function (highly nephrotoxic), drug level; Teach – avoid infection, no grapefruit juice, s/s kidney/liver toxicity

Nursing: - Immunosuppressant: T and B cell suppressors: Prototype: Cyclosporine

Body recognizes a foreign protein and begins producing antibodies to react with it

Active - Types of Immunity - Review immunity and immunization

Occurs when preformed antibodies are injected and react with a specific antigen

Passive - Types of Immunity - Review immunity and immunization

Process of artificially stimulating active immunity by exposing body to weakened disease causing organisms - introduce disease in some fashion to body in some amount and enough for immune sys to see and recongize it so next time exposed amount more quicker and stronger response

Immunization (Vaccines) - Review immunity and immunization

Routine immunization for children is standard of care; routine prac Provide parents written records of immunizations (assure continuity of care); how adequately keep track is hard Educate parents to report common adverse reactions to any immunization Warm soaks for injection site, acetaminophen to reduce fever or aches

Children - Vaccines across the lifespan

Immunize if traveling to areas with high risk for specific disease See list for recommendations

Adults - Vaccines across the lifespan

Greater risk for severe illness prevent disease, no age limit to any vaccination

Older adult - Vaccines across the lifespan

Lab test -evaluates level of antibodies from prior vaccine or infection; antibodies are present at high enough level to provide protection Still immune to certain disease + want: proves immunity -: not have immunity and need booster

Titers: - Childhood vaccinations (Birth-18)

repeat injections of vaccine after time has passed to strengthen immune response and maintain protection Regain immunity

Boosters: - Childhood vaccinations (Birth-18)

Influenza (yearly) Tetanus: Tdap or TD (every 10 years; exposure; pregnancy) Varicella Zoster Pneumococcal

Adult vaccinations (19+)

Alive but weakened – could produce disease if immune compromised Example: MMR, varicella Imp for pat’s status to receive vaccines

Attenuated (LIVE) - Types of vaccines

Introduces inactive cells; Initiates B cell response (antibodies) and destruction of pathogen if exposed

MoA: - Biological Agents: Vaccines

disease preventionIndications: immunosuppressant drugs - not give any vaccines on if on these drugs not get good response so vaccine not helpful - esp if live vaccines: risk for developing disease, including corticosteroids

Drug/Drug(person): - Biological Agents: Vaccines

Common: redness and discomfort at injection site, fever, minor aches/muscle pain (acetaminophen and muscle soaks), arthralgia Rare: anaphylactic reaction

AE: - Biological Agents: Vaccines

Moderate to severe acute illness with or without fever: already sick immune sys working not want hinder more; wait till feeling better Severe allergic reaction to vaccine or component Immunosuppression History of Gillain-Barre syndrome following vaccination - rare Pregnancy

Vaccine contraindications

Influenza injectable: eggs used in development of vaccine

Severe allergic reaction to vaccine or component - Vaccine contraindications

MMR and varicella (live, attenuated) - susceptible to getting diseases

Immunosuppression - Vaccine contraindications

Influenza, Tdap, TD

History of Gillain-Barre syndrome following vaccination - rare - Vaccine contraindications

Influenza (nasal), MMR, varicella, Meningococcal B

Pregnancy - Vaccine contraindications

Actual disease and vaccination history - immunosuppressed; more vaccinations needed Previous allergic responses, allergies to components (eggs) Contraindications Physical assessment with VS to determine baseline status (free of infection) - well enough get vaccine Evaluate ROM of the extremity to be used for vaccine administration Route: Intramuscular (deltoid) Medication contraindication: immunosuppressants

Gen nursing: vaccines: History / Examination

Do not admin if s/s of illness Arrange for proper preparation and administration-varies on vaccinations Emergency equipment standby - in case have allergic rxn so appropriately respond Written record of immunization Evaluation Teach:

Nursing: gen vaccines: interventions/eval

Consider immune status for some vaccines

Do not admin if s/s of illness

Correct Timing of boosters

Written record of immunization

Serum titers reflecting immunization (if appropriate)

Evaluation

Importance of compliance with schedule Common AE and symptomatic care (No aspirin) Warning signs of problems (anaphylaxis): tachycardia, muscle weakness, rashes, dyspnea, LOC

Teach:

Vaccination would be contraindicated in which client? A.A client receiving an immunostimulant B.A client who is 90 years old C.A client prescribed high dose prednisone D.A client with allergic rhinitis

Answer: C Rationale: The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could cause disease and the body would not be able to respond as anticipated if in an immunodeficient state; or in clients who are receiving immune globulin or who have received blood or blood products within the last 3 months because a serious immune reaction could occur. Prednisone compromise immune systems action; no age limit on vaccinations; allergic rhinitis is okay; immunostimulant enhances rxn of immune sys

The nurse is caring for a client receiving an immunosuppressant. The nurse should monitor the client for which adverse effects? Select all that apply. A.Cancer B.Infection C.Cardiac standstill D.Increased bleeding E.Hepatomegaly

Answer: A, B Rationale: Immunosuppressants decrease the immune system’s function putting clients at risk for certain cancers and infections. Immunocompromised: more at risk for cancer; immunosuppressants one long term helps body from developing cancers