Week 2 Flashcards
What is Multidisciplinary Care?
Multidisciplinary (MD) Care is the forefront concept in providing exemplary cancer care.
It is well documented and accepted that multidisciplinary care represents best practice in terms of treatment planning and care for cancer patients.
MD Care encompasses:
- A focus on continuity of care,
- Development of pathways and protocols for treatment and care,
- Development of appropriate referral networks, including appropriate referral pathways to meet psychosocial needs,
- Development of multidisciplinary team meeting audit mechanisms, and
- Consumers/patients who consent to their case being discussed by the multidisciplinary team and who understand the process, know that they will be informed about the treatment and care recommendations and will be involved in decision-making.
An effective multidisciplinary approach can result in:
improved treatment planning, improved team communication, survival benefits, increased clinical trial recruitment, emotional patient detection, reduced psychological morbidity, service duplication reduction, clear responsibility lines, and improved sharing of incidental and informal information.
Cancer Treatments
- Surgery
- Radiation
- Chemotherapy
- Targeted therapy (e.g. herceptin)
- Immunotherapy (e.g.pembrolizumab)
- Hormone therapy
- Transplant
The order of cancer treatment
Neo-adjuvant treatment involves treatments administered before primary cancer treatment, like radiotherapy or chemotherapy, and adjuvant treatment is administered after primary treatment. The goal is to increase treatment effectiveness while minimizing adverse effects. Surgery may be the first treatment choice, and treatment is specific to each individual.
Chemotherapy
- Chemotherapy targets rapidly dividing cells
- It works by interfering with the process of DNA replication or by damaging the DNA so badly that the cell must go through apoptosis.
- Chemotherapy cannot distinguish between normal cells and malignant cells
Cell kill hypothesis
Cell kill hypothesis states that a chemotherapy concentration given for a defined period of time, kills a constant fraction of the cells in the population, independent of the number of cells.
Because only a fraction of the cancer cells are killed with each treatment, repeated doses must be administered to reduce the size of the tumour. The fractional killing of tumours in response to treatment is due to the cell-cycle specificity of the chemotherapy.
Chemotherapies can also be classified according to their cell cycle activity:
Cell cycle specific: Agents act on the cells in a specific phase. They are most effective against cancers that are rapidly growing.
Cell cycle non-specific: Agents act on cells no matter what phase of the cell cycle they are in. Because they also effect cells in the resting (G0) phase, they are effective against slow growing tumours and rapidly dividing tumours.
Chemotherapy Combinations
Chemotherapy is rarely given as a single agent. It is most often given in combination with other chemotherapies. Chemotherapies that act on differing stages of the cell-cycle are often given in combination. This is because cells are in different stages of the cell cycle at different times and combining different chemotherapies ensures a greater chance of damaging the DNA of the cell during stages of cellular division.
Chemotherapy Cycles
Chemotherapy is administered in cycles which is a treatment followed by a period of rest. A cycle can last one or more days, but is usually one, two, three or four weeks long. A course of chemotherapy consists of multiple cycles.
Chemotherapy routes of administration
- Oral – by mouth
- Topical – on the surface of the skin as a cream
- Intravenous – into a vein
- Intramuscularly – into a muscle
- Subcutaneously – under the skin
- Intra-arterial - into an artery
- Intrathecal – into the central nervous system via the cerebrospinal fluid
- Intrapleural – into the chest cavity
- Intraperitoneal – into the abdominal cavity
- Intravesical – into the bladder
- Intralesional – into the tumour
Chemotherapy Side Effects
- We know that chemotherapy works by attacking rapidly dividing cells. It however cannot distinguish between “normal” rapidly dividing cells and malignant cells. The damage that the chemotherapy does to the normal, rapidly dividing cells is referred to as the side-effects or toxicities of treatment. Side effects vary depending on the type of chemotherapy.
- Effective management of side effects is essential not only for patient comfort but to ensure additional toxicities do not develop or patients choose to discontinue further treatment due to the short term effects of treatment. Patient education and early symptoms identification and management are vital to the patient experience.
Side effects to chemotherapy are specific to the individual agents and additionally compounded by combination chemotherapy regimes
Chemotherapy is most effective on rapidly dividing cells therefore there are some common side effects with many agents.
These may include;
* Nausea and Vomiting (70-80% patients)
* Inflammation and damaging to the lining of the GI tract
* Fatigue
* Skin changes
* Bone Marrow Suppression (often most serious complication of chemotherapy)
* Hair thinning or loss
Bone Marrow Suppression
Anaemia - Low red blood cell count. Low red blood cell count = low haemoglobin (hb) count Low hb = less oxygen being carried around the body and the patient can become fatigued, short of breath, tachycardic and anaemic.
Leucopenia - Low white blood cell count. White blood cells fight infection and a reduction in the number of white blood cells in the body means that the patient can become immunocompromised and at greater risk of infection
Thrombocytopenia - Low platelet count. The function of platelets is to maintain haemostasis. Low platelet count means the patient is at greater risk of bruising and bleeding.
Hair loss
- Effects different patients in different ways
- Younger patients tend to experience more stress from hair loss than older patients but this is not always the case
- Female patients, particularly younger female patients can feel a loss of sexual identity with hair loss.
- Hair loss from chemotherapy involves the hair falling out rapidly which can be frightening even though the patient is expecting it to happen
