PBL 2 Flashcards
what are some of the impacts of cancer on patients?
fear of recurrence grief - loss of old life, sex drive, fertility, independance depression body image difficulties spirituality survivor guilt relationship changes stress travel time in hospital can be lonely/boring/scary fear/anxiety of treatment/prognosis
why are MDTs important in cancer care?
it encourages trust in the team
better communication
more holistic and patient-centred practice
events unecessary errors
avoidance of harm from errors
gives patients access to an entire team of experts
what are some examples of who’s in an MDT for a cancer patient?
surgeon physician oncologist specialist nurse dietician cancer information staff clinical psychologists councillors occupational therapist radiographer pharmacist
what are some treatments for cancer?
chemotherapy radiotherapy hormone therapy immunotherapy stem cell transplant surgery targeted therapy
what is hormone therapy used to treat?
breast and prostate cancers
what is immunotherapy used to treat?
bladder, breast, cervical, colorectal. oesophageal, head and neck and leukaemia
what are some examples of immunotherapy?
monoclonal antibodies, oncolytic virus therapy, T cell therapy, cancer vaccines
how is chemotherapy given?
orally or intravenously in cycles
what is external beam radiation?
uses beams of radiation from a machine that focuses directly on the site of your tumor.
what is internal beam radiation?
brachytherapy uses radiation (either liquid or solid) that’s placed inside your body near where the tumor is.
what is systemic radiation?
This method involves radiation in pill or liquid form that’s either taken by mouth or injected into a vein.
what is concurrent therapy?
when chemo and radiation are given at the same time
when is concurrent therapy recommended?
if the cancer cannot be removed with surgery / Is likely to spread to other areas of your body / isn’t responding to one particular type of treatment
what is targeted therapy?
The protein or receptor is precisely targeted by the drug, so normal cells are not affected by the drugs.
what’s the impact of chemotherapy on the patient?
body image issues e.g. hair loss, skin and nail changes, scarring. loss/gain of weight, loss of body part
functional iddues e.g. infertility, earlymenopause, reduced sex drive, satigue, change in bowel/bladder works
emotional issues e.g. shock, denial, fear, sadness, avoidance, blame, guilt, anger
practical issues e.g. work travel, time in hopsital, seeing family
what are the main side effects of chemotherapy?
fatigue diarrhoea nausea/vomiting constipation hair loss anaemia increased risk of infection bruising and bleeding loss of appetite mucositosis skin and nail changes memory and concentration issues insomnia loss of libido fertility issues
how can you attempt to avoid hair loss during chemo?
wearing a scalp cooking cap during the infusions to slow the blood flow to the scalp and therefore limit the amount of chemotherapy reaching the hair follicles
what are some classes of chemotherapy drugs?
alkylating agents nitrosoureas antimetabolites anti-tumour antibiotics anti-microtubule agents topoisomerase inhibitors mitotic inhibitors
how do alkylating agents work
they bind covalently to DNA via their alkyl group whichprevents its replication.
workds in all phases of the cell cycle
what are some examples of alkylating agents?
carboplatin
cisplatin
trabectadin
what are nitrosoureas?
alkylating agents that can cross the blood-brain barrier so can treat brain tumours
what are some examples of nitrosureas?
carmustine, lomustine
how do antimetabolites work?
they act as substitites for normal building blocks for RNA/DNA which intereferes with replication
this is cell cycle dependant and only works in the S phase
what are antimetabolites commonly used to treat?
leukaemias
breast cancers
ovary cancers
intestinal tract cancers
what are some examples of anti-metabolites?
azacitidine
hydroxyurea
pentostatin
how do anti-tumour antibiotics work?
by changing thr DNA within cancer cells to keep them from growing and multiplying e,g, anthracyclines
what’s a major concern of anthracyclines?
they generate lots of free radicals which can permenantly damage the heart if given in high doses
this is why doctors set cumulative doses which are life time dose limits
how do topoisomerase inhibitors work?
◦ plant alkaloids that interfere with topoisomerases which are enzymes that help separate the strands of DNA so they can be copied.
what’s the function of topoisomerase?
enzymes that participate in the overwinding or underwinding of DNA.
what’s the difference between topoisomerase 1 and 2?
Topoisomerase I cuts one strand in the double-stranded DNA and no ATP is required for its function. On the other hand Topoisomerase, II cuts both strands in DNA and needs ATP for its activity.
what are topoisomerase inhibitors used to treat?
leukaemia lung cancer ovarian cancer GI cancer colorectal cancer pancreatic cancer
what are camptothecins?
topoisomerase 1 inhibitors
what are epipodophyllotoxins?
topoisomerase 2 inhibitors
how do mitotic inhibitors work?
plant alkaloids which stop cells from dividing but can damage cells in all phases by keeping enzymes from making proteins needed for cell production.
what are some commonly used mitotic inhibitors?
paclitaxel, docetaxel, vinblastine, vincristine, and vinorelbine
what’s the usually chemotherapy drugs given for leukaemia?
ibrutinib or rituximab
what are the 2 main functions of palliative care?
to relieve symptoms and offer respite
what are the 3 stages of chemotherapy?
induction - to shrink cancer
consolidation - given once cancer remission is achieved
maintenance - given in lower doses to prolong remission for up to 2 years
