Chemotherapy regimens should always be administred in keeping with international standards like NCCN guidelies.

Patients and their relatives should be thoroughly counselled on all aspects of this therapy. They should also be provided with complete infomration on what chemotherapy is being administered, how long will the treatment take and what their side effects will be.

They should also be provided a chart which will summarize their treatment plan. This will help the patients and their relatives to follow through with their chemotherapy effectively.

Types of Chemotherapy

Chemotherapy is a powerful treatment that uses drugs to target and kill rapidly dividing cancer cells. There are various types of chemotherapy, classified based on their action mechanism and chemical structure:

1. Alkylating Agents: These drugs damage the DNA of cancer cells, preventing them from dividing.

Examples: Cyclophosphamide, Cisplatin, Carboplatin.

Uses: Common in treating breast cancer, ovarian cancer, and lymphoma.

2. Antimetabolites: These drugs mimic normal cell components, interfering with DNA and RNA synthesis.

Examples: Methotrexate, 5-Fluorouracil (5-FU), Gemcitabine.

Uses: Effective in treating leukemia, breast cancer, and gastrointestinal cancers.

3. Anti-tumor Antibiotics: Interfere with DNA replication, slowing or stopping cancer cell growth.

Examples: Doxorubicin, Bleomycin, Mitomycin.

Uses: Widely used for lung, breast, and bladder cancers.

4. Plant Alkaloids (Mitotic Inhibitors): These drugs inhibit mitosis (cell division).

Examples: Paclitaxel, Vincristine, Vinblastine.

Uses: Used in breast cancer, ovarian cancer, and lymphomas.

5. Topoisomerase Inhibitors: Block the enzyme topoisomerase, preventing DNA replication.

Examples: Irinotecan, Etoposide.

Uses: Commonly used for colorectal and lung cancers.

6. Targeted Therapy: Target specific molecules involved in cancer growth (e.g., HER2 inhibitors, EGFR inhibitors).

Examples: Trastuzumab, Imatinib.

Uses: Breast cancer (HER2-positive), chronic myeloid leukemia.

7. Hormonal Therapy: Blocks hormones that fuel certain cancers, like breast and prostate cancer.

Examples: Tamoxifen, Letrozole, Leuprolide.

Uses: Hormone-sensitive cancers such as breast and prostate cancer.

Methods of Chemotherapy Administration

1. Intravenous (IV) Chemotherapy: Administered through a vein, often using a peripheral IV line, central line, port, or PICC line.

Considerations: Monitor for vein irritation, infection at the insertion site, and potential extravasation (leakage of the drug into surrounding tissues).

2. Oral Chemotherapy: Taken as a pill, capsule, or liquid.

Considerations: Adherence is crucial; the patient must follow dosing instructions carefully. Some drugs may require fasting before administration.

3. Intramuscular or Subcutaneous Injections: Delivered directly into the muscle or under the skin.

Considerations: Less invasive than IV, but may cause localized pain and tissue irritation.

4. Intrathecal Chemotherapy: Delivered directly into the cerebrospinal fluid (spinal canal).

Considerations: Used for cancers affecting the central nervous system (CNS), requires a lumbar puncture or Ommaya reservoir.

5. Intra-arterial Chemotherapy: Delivered directly into the artery feeding the tumor.

Considerations: Allows for high drug concentration at the tumor site, but is technically challenging.

6. Topical Chemotherapy: Applied directly to the skin as a cream or lotion.

Considerations: Used for certain skin cancers like superficial basal cell carcinoma.

7. Intraperitoneal Chemotherapy: Administered into the abdominal cavity, often combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

Considerations: Effective for peritoneal carcinomatosis but can cause significant abdominal discomfort.

Key Considerations Before, During, and After Chemotherapy

Before Chemotherapy

• Patient Assessment: Detailed history, physical examination, and assessment of organ function (liver, kidney, heart).
• Baseline Blood Tests: Complete Blood Count (CBC), liver and renal function tests.
• Informed Consent: Discuss potential benefits, risks, and side effects with the patient.
• Pre-medication: Anti-nausea drugs (antiemetics), steroids, and antihistamines may be given to reduce side effects.
• Hydration: Ensure adequate hydration to prevent kidney damage, especially with nephrotoxic drugs like Cisplatin.

During Chemotherapy

• Monitoring Vital Signs: Regular checks for blood pressure, pulse, temperature, and respiratory rate.
• Side Effect Management: Address nausea, vomiting, allergic reactions, and extravasation immediately.
• Strict Adherence to Protocols: Follow NCCN (National Comprehensive Cancer Network) guidelines to standardize care, ensure safety, and optimize treatment outcomes.
• Patient Education: Educate the patient about signs of complications and the importance of reporting symptoms early.

After Chemotherapy

• Post-treatment Monitoring: Assess for immediate side effects (allergic reactions, nausea, infusion site reactions).
• Blood Tests: Regular CBC to monitor for bone marrow suppression (neutropenia, thrombocytopenia, anemia).
• Supportive Care: Provide medications for nausea, pain, and other side effects.
• Follow-up Visits: Regular visits to monitor response to treatment, manage delayed side effects, and adjust doses as needed.

Importance of Following Protocols (NCCN Guidelines)

• Standardized Care: Following protocols like NCCN guidelines ensures evidence-based, standardized care, reducing variability in treatment.
• Optimized Treatment: Protocols are regularly updated with the latest research, ensuring that patients receive the most effective and safest treatments.
• Patient Safety: Adherence to guidelines minimizes the risk of dosing errors, severe side effects, and complications.
• Decision-Making: Guidelines help in choosing the right chemotherapy regimen, adjusting doses, and knowing when to discontinue treatment.

When to Reduce Dosage or Stop Treatment

1. Severe Side Effects

• Myelosuppression: Significant drop in white blood cells (neutropenia), platelets (thrombocytopenia), or red blood cells (anemia).
• Organ Toxicity: Liver damage (elevated liver enzymes), kidney damage (elevated creatinine), or cardiac toxicity (reduced ejection fraction).
• Neuropathy: Severe peripheral neuropathy affecting daily activities.

2. Patient’s Functional Status

• Poor Performance Status: If the patient is unable to tolerate treatment due to weakness or poor functional status (low ECOG score).
• Weight Loss or Malnutrition: Severe weight loss or inability to maintain adequate nutrition.

3. Disease Progression

• Lack of Response: If the cancer continues to progress despite treatment, consider changing the regimen or stopping chemotherapy.

4. Patient’s Choice

• Quality of Life Consideration: Some patients may choose to stop treatment if the side effects outweigh the potential benefits.

Things to Watch Out For

• Fever and Infection: Any fever in a chemotherapy patient could indicate neutropenia and requires immediate evaluation.
• Severe Nausea and Vomiting: Can lead to dehydration and electrolyte imbalances.
• Allergic Reactions: Symptoms like rash, difficulty breathing, or swelling may indicate a hypersensitivity reaction.
• Bleeding or Bruising: May indicate thrombocytopenia; avoid invasive procedures.
• Fatigue and Weakness: Monitor for anemia or general decline in functional status.

Chemotherapy requires a well-coordinated, multidisciplinary approach, following standardized guidelines like the NCCN for best practices. Proper patient assessment, vigilant monitoring, and timely dose adjustments are critical to maximize benefits and minimize risks.