J Nurs Res. A specific list of drugs and foods to be avoided must be provided to patients. The National Cancer Institute's Common Toxicity Criteria provide an excellent tool for this purpose, enabling patient assessment by telephone.[16]. Would you like email updates of new search results? Compared to the control group, the patients in the observation group provided have statistically significant mprovement on anxiety control, sleep quality, and hepatic indexes changes (P<0.05). The observation group also showed remarkably better life quality scores (GQLI-64) than the control group (P<0.01). In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. Sorafenib is stopped while the skin heals and symptoms abate. In addition to initiating treatments, nurses should assess the impact of CINV on patients and their families, provide instruction and information about potential management options, and help patients maintain treatment adherence. 2019 Apr 25;44(4):293-6. doi: 10.13702/j.1000-0607.170614. Making the current National Cancer Institute's Common Toxicity Criteria for Adverse Events available to all staff will encourage more consistent assessment of patients' toxicities. [17-19], The most common adverse events associated with sorafenib are similar in scope and incidence to the other tyrosine kinase inhibitors. The advent of new targeted drugs for the treatment of cancer is an exciting development. These treatment modalities are premised on the concepts of precision medicine, genomic profiling, and using one's immune system to attack cancer. 2017 Sep 12;37(9):947-50. doi: 10.13703/j.0255-2930.2017.09.009. Patients with persistent diarrhea who do not respond to other therapies usually receive antibiotics. Hypertension has been associated with bevacizumab, sorafenib, and especially with ZD6474. Patients are treated on an outpatient basis and may make fewer visits to the physician than patients on more standard anticancer therapies. Less toxic drugs reduce the debilitation associated with cytotoxic agents and can result in improved quality of life. This can progress to erythema and cracking or peeling of the skin that may interfere with normal activities. Because these patients may not visit the clinician's office as frequently, routine telephone assessment becomes increasingly important. However, the occurrence of severe infusion reactions even with cetuximab are uncommon, occurring about 3% of the time. TARGETED NUTRITIONAL INTERVENTION – A BEGINNER’S GUIDE. Diphenhydramine may be repeated and the use of steroids considered for delayed reaction. CHEMO-SUPPORT is a nursing intervention aimed at reducing symptom burden of chemotherapy using coaching, brochures, and access to online or on-call nursing services. It has been described as loose, watery stools without the presence of mucus or blood. Jeanne Riddle has participated in nurse advisory boards for AstraZeneca and has been a speaker for the Inside Cancer series sponsored by a grant from AstraZeneca. Therefore, other therapeutic interventions can be implanted to help ease a patient’s pain. The clinical interpretation and management of these signs and symptoms are often the nurse's responsibility. As with all patients being treated for cancer, those receiving EGFR inhibitors or other targeted therapies require thorough education specific to these agents to maximize therapy. Obtain a drug history to determine possible drug interactions and allergies. 20. Fatal infusion reactions have not been reported with panitumumab.[7]. Because cetuximab is a chimeric MoAb (mouse/human), reactions may occur more frequently than with humanized MoAbs like bevacizumab or trastuzumab or with fully human MoAbs such as panitumumab. If OTC medications are not effective to control the diarrhea, prescription medications such as Lomotil or Sandostatin may be started. Nursing Intervention. The following unclassified interventions (n = 10) were included: humour therapy (n = 2); Reference Cai, Yu, Rong and Zhong 111, Reference Gelkopf, Gonen, Kurs, Melamed and Bleich 112 specialised early intervention for FEP (SEI: n = 2); Reference Thorup, Petersen, Jeppesen, Ohlenschlaeger, Christensen and Krarup 113, Reference Garety, Craig, Dunn, Fornells-Ambrojo, … Rash and Diarrhea Associated With EGFR Inhibitors, Skin rash and diarrhea are the most common side effects of all EGFR inhibitors. Dose reductions are not available for gefitinib, but each of these drugs can be interrupted for up to 14 days. Follow-up is necessary to evaluate efficacy and plan further therapy. Patient education concerning standard measures for diarrhea, including increased fluid intake, dietary modifications, and special care for excoriated perianal tissues should be initiated. [Clinical study of the combination of acupoint catgut-embedding therapy and auricular point pressure in the treatment of insomnia of spleen and stomach disharmony pattern]. As treatment progresses, nurses should ask specific questions to ascertain changes in frequency or character of stools. [1] Sorafenib has been approved for treatment of advanced renal cancer[2] and lapatinib is expected to receive approval for treatment of advanced breast cancer. Genentech, South San Franscisco, and OSI Pharmaceuticals, Melville, New York, 2005. One strategy to assist patients in managing toxicities is to prepare a treatment-specific template of questions for medical staff to ask the patient during clinic visits or phone calls. 2018 Feb;26(1):10-17. doi: 10.1097/JNR.0000000000000209. For this reason, other medications that affect the QTc interval are not coadministered with ZD6474, nor is it prescribed for patients with baseline QTc prolongation, and EKGs are closely monitored for changes from baseline. These reactions can be as mild as chills and fever. © 2021 MJH Life Sciences and Cancer Network. Zhen Ci Yan Jiu. Hypertension can be aggressively treated by a traditional medical approach, with dose reductions necessary only if these approaches fail or the patient experiences sustained symptoms.[2,9,20]. Oncologist 11:753-764, 2006. 10. Nursing management of patients with advanced malignancies presents a formidable challenge. Further development of these agents hold the promise of truly "individualized" cancer treatment. 158 cases of hepatitis B patients were randomly divided into one control group (78 cases), and one observation group (80 cases). Antibodies are glycoproteins produced in response to a specific antigen found in the body. Drug-drug and drug-food interactions are also possible with erlotinib, gefitinib, sorafenib, ZD6474, and lapatinib. Saltz LB: Understanding chemotherapy-induced diarrhea. Eight targeted areas for nursing assessment and intervention are described: preterm labor, side effects of tocolytic therapy, maternal/fetal infection, fetal compromise, side effects of extended bed rest, maternal stress, educational needs, and routine prenatal care. A sudden exacerbation of pulmonary symptoms or onset of new symptoms such as dyspnea, worsening cough, or hemoptysis requires prompt action. Older adults are at risk for loneliness, and interventions to promote social connectedness are needed to directly address this problem. Standard operating procedures and institutional guidelines should be in place for immediate treatment of severe or life-threatening emergencies. [8] Bevacizumab is currently approved for use in metastatic colorectal cancers, and has recently received approval for use as first-line therapy for nonsquamous non-small-cell lung cancer. ).Other commonly experienced toxicities include dry skin and eyes, itching, paronychial inflammation and fissuring, occasional nausea and vomiting, and asthenia or malaise. Patients should be given adequate information about when to be concerned and when and how to contact the appropriate medical professional. Also called as physician-initiated interventions, these are activities that require doctor’s orders or directions from other health care professionals. 3. The MoAbs cetuximab, trastuzumab, bevacizumab, and panitumumab, administered intravenously, interrupt the pathways on the cell surface. Less common but potentially very dangerous are infusion reactions associated with monoclonal antibodies (less than 3%) and interstitial lung disease (less than 1%). We sometimes even provide a written "contract" for patients to sign that provides complete instructions for drug usage and a synopsis of the patient's responsibilities surrounding medication compliance. Unable to load your collection due to an error, Unable to load your delegates due to an error. • Adequate dosing of targeted therapies is just as important as with cytotoxic therapy in controlling the cancer. AstraZeneca Pharmaceuticals, Wilmington, Delaware, 2005. If no further symptoms develop, the infusion may continue. Nexavar (sorafenib) prescribing information. The CYP3A4 enzyme is known to metabolize the drugs through the liver, and potent inducers or inhibitors of the pathway should be avoided for concomitant use. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. Pediatric Locally Advanced Synovial Sarcoma: What Would Be the Best Treatment Option? http://www.acaai.org/Member/SAFE_Diagnosis_Criteria.htm. A multidisciplinary team approach may improve patient quality of life and survival. The drug can then be restarted at a lower dose; ie, 400 mg once daily with a further reduction to 400 mg every other day. Interstitial lung disease is an uncommon but potentially life-threatening toxicity associated with the use of EGFR inhibitors (cetuximab < 0.5%, erlotinib 0.6%, and gefitinib 1%). Chen P, Zhu JW, Chen T, Wang DF, Yang LP, Ruan B, Yu CB, Li LJ. The interruption of this pathway, which is aberrantly activated or overexpressed in malignant cells, is thought to interfere with the cellular functions of growth, proliferation, invasion or metastasis, angiogenesis, and survival or apoptosis and thus leads to control or death of the cancer cells. Nursing intervention remains a vital component in the successful use of these novel agents. National Library of Medicine Therapy is available in schools, hospitals, and even churches. The following are key elements of nursing management for toxicities associated with targeted agents: • Basic understanding of the mechanism of action on cells, • Knowledge of dosing and administration guidelines, • Familiarity with the toxicities associated with their use, • Strategies for monitoring patients' progress and assessing and grading toxicities, • Evidence-based guidelines for treatment of toxicities, • Plans and materials for patient education, • Tools to help patients maximize compliance with dosing and to prevent or modulate toxicities. Sorafenib, sunitinib, lapatinib, and ZD6474 have more than one molecular target and are considered multitargeted agents. Waxman ES: Nursing Management: Targeted Therapies, in Current Topics in Lung Cancer, pp 36-48. FOIA National Cancer Institute Fact Sheet: Herceptin (Trastuzumab): Questions and Answers. All rights reserved. The National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network has also published a useful algorithm for the treatment of anaphylaxis, which is available at http://www.acaai.org/Member/SAFE_Diagnosis_Criteria.htm. Less than 1% of patients treated (2/1,467) exhibitied this toxicity. Ann Pharmacother 40:261-269, 2006. [8] Panitumumab (Vectibix) has been associated with infusion reactions in only about 1% of treated patients. The US Food and Drug Administration (FDA) has granted approval to the following agents that target specific areas of two important molecular pathways in solid tumors-the HER family (EGFR/HER1 and HER2) and the VEGF family: erlotinib (Tarceva), gefitinib (Iressa), sorafenib (Nexavar), sunitinib (Sutent), cetuximab (Erbitux), trastuzumab (Herceptin), bevacizumab (Avastin), and panitumumab (Vectibix). Family Nursing Interventions – involve intervention that impacts an entire family, such as a program that offers support for new mothers learning how to breastfeed. ACE inhibitors and beta blockers have been successfully used to control the hypertension associated with these drugs. The treatment team should adopt a uniform plan for managing toxicities to reduce patients' confusion. This plan should be presented to patients and caregivers in writing. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. ImClone Systems and Bristol-Myers Squibb Company. Patients should be instructed how and when to report toxicities and reminded that it is easier to treat problems when they are identified early. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020 Nov 20;11:586355. doi: 10.3389/fpsyt.2020.586355. Unfortunately, there is limited research on perioperative targeted nursing intervention for liver transplant pati- ents, especially on infections after … Erlotinib, gefitinib, cetuximab, trastuzumab, bevacizumab, and panitumumab are all agents with single targets. LAF Level 2 Introducing Targeted Interventions Last updated: May 2008 © State of Victoria (DEECD), 2008 Activities produced/used as part of Scaffolding Numeracy in the Middle Years • Two 6 or 10 sided dice . Infusion reactions are an uncommon but potentially lethal toxicity related to administration of MoAbs, including cetuximab, bevacizumab, panitumumab, and trastuzumab. 21. Sutent (Sunitinib Malate) for Health Care Professionals. [8] Recent information released by the manufacturer indicated that arterial thrombotic events have been associated with bevacizumab. eCollection 2020. To test this hypothesis, we launched the Targeted Adherence Intervention to Reach Glycemic Control With Insulin Therapy for Patients With Diabetes (TARGIT-Diabetes) study, a pragmatic, prospective, intention-to-treat randomized clinical trial. targeted nursing intervention can improve gas-trointestinal functions and prognosis of pati- ents with liver cancer. Vectibix (panitumumab) prescribing information. Biologic therapies include several classes of cancer medications, which are broadly categorized into three main groups: targeted therapy, monoclonal antibody therapy, and immunotherapy. Treatment with acetaminophen, diphenhydramine, and/or meperidine is usually effective. 8. Semin Oncol Nurs 18 (4 suppl 4):11-19, 2002. This site needs JavaScript to work properly. Rarely, IV hydration may be required if the diarrhea is not effectively controlled. Clinical trials continue for ZD6474 (Zactima) in various solid tumors. • Nurses should always utilize the most current dosing and toxicity information available. Nelson MH, Dolder CR: Lapatinib: A novel dual tyrosine kinase inhibitor with activity in solid tumors. Candidates for treatment with trastuzumab should be carefully assessed at baseline for any cardiac dysfunction. Patients are given written instruction for use of OTC loperamide at doses exceeding package instructions and continuing as necessary. However, nursing management remains a vital component in the successful use of these novel agents. Privacy, Help New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Use of alternative therapies should also be closely monitored; some substances, such as St. John's wort, should not be taken. However, the drug is also known to cause hand-foot syndrome in approximately 30% to 35% of treated patients. Loneliness and social isolation are growing public health concerns in our ageing society. A targeted therapy can be used by itself or in combination with other treatments, such as traditional or standard chemotherapy, surgery, or radiation therapy. NURSING CARE OF CLIENTS RECEIVING IMMUNOTHERAPY Immunotherapy can consist of various substances used alone, such as interleukin-2, or combination biotherapy, such as alpha interferon with 5-fluorouracil. These interventions can include ice/heat, music therapy, repositioning, Healing Touch, etc. [2], Diarrhea has been the major dose-limiting toxicity in clinical trials of erlotinib and gefitinib, although it is less commonly seen with cetuximab. Patients undergoing treatment should undergo frequent monitoring for deteriorating cardiac function. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. In most instances, the diarrhea occurs within the first three weeks of treatment. It is critical to understand that children and adults with Down syndrome do not process nutrition the same way that typical people process nutrients. The second case developed symptoms of pulmonary fibrosis, including cough, wheezing, exertional dyspnea, and CT evidence of pulmonary fibrosis while being treated with panitumumab as a single agent. Common Terminology Criteria for Adverse Events (CTCAE). Nursing interventions should include assessing the patient for airway, breathing, circulation, and level of consciousness changes, as well as obvious signs of bleeding, petechiae, purpura, and other signs of thrombotic events. Hypomagnesemia (also associated with cetuximab and panitumumab[6,7]), hypercalcemia, and hypokalemia have recently been reported as well. Medical therapy should be available to manage reactions. Nursing Responsibilities •Moont frio r side effects: Alpha interferon may cause mental Clin Colorectal Cancer 5(suppl 2):S71-S80, 2005. Hypothyroidism has also been observed. EdCaN Cancer Nursing Program (Entry to Specialty) The National Cancer Nursing Education Project 217 Monoclonal antibodies Monoclonal antibody therapy includes some of the first agents that were used in the modern era of targeted therapies. Proper premedication as ordered by the physician should be administered before the infusion begins. Patients must then be referred to a pulmonary specialist to manage the condition. [4,5], Cardiovascular Toxicities Seen With VEGF Inhibitors and Multitargeted Agents, Hypertension has been identified as a common side effect of both single-targeted and multitargeted drugs that inhibit the vascular endothelial growth factor (VEGF) pathways. Evidence-Based and Promising ... intervention for parents wanting intensive training . © 2021 MJH Life Sciences™ and Cancer Network. Clin Cancer Res 11:3369-3376, 2005. Information about the likely incidence and severity of diarrhea should be provided to patients and their families. Instruct patients to report diarrhea with the first loose stool and to begin treatment immediately. 6. Patients should be thoroughly assessed for normal bowel habits before initiation of therapy so that changes can be more easily evaluated. Diarrhea was observed in approximately 50% of patients in early clinical trials (54% with erlotinib and 58% with gefitinib). If an underlying infection such as Clostridium difficile is identified, adequate medical treatment should be initiated. J Clin Oncol 19:3267-3279, 2001. The same mechanism may interfere with the normal functions of epithelial cells and produce the constellation of toxicities associated with the EGFR inhibitors. 16. A patient who has a severe or life-threatening reaction should never be rechallenged with cetuximab.[6]. Washington, DC, US Government Printing Office, 2006. Erlotinib and gefitinib were originally approved for the treatment of advanced non-small-cell lung cancer, but use of gefitinib was subsequently restricted to patients for whom the treatment had previously proved effective. Most reactions (90%) are associated with the first infusion, but they can occur even after multiple infusions. At grade 3, a temporary dose reduction or interruption should be considered. Nurses are in a unique position to support patients suffering from CINV by using evidence-based interventions. 7. 14. [3], Sunitinib has recently been FDA-approved for the treatment of patients with gastrointestinal stromal tumors and advanced kidney cancer-two tumor types that have been very difficult to treat.[4,5]. Whilst these experiences occur across the life span, 50% of individuals aged over 60 are at risk of social isolation and one-third will experience some degree of loneliness later in life. Aminoadamantanes versus other antiviral drugs for chronic hepatitis C. Effect of Psychological-Behavioral Intervention on the Depression and Anxiety of COVID-19 Patients. How to Implement: 1. If all symptoms resolve, the patient may be rechallenged by restarting the infusion at 50% decrease in rate. COVID-19 is an emerging, rapidly evolving situation. Frequent contact with the treatment team allows patients to feel supported and may improve compliance with the treatment regimen. Trastuzumab is a humanized monoclonal antibody but may still cause infusion reactons up to 24 hours after dosing. Serum magnesium and electrolytes are checked regularly, as deficiencies in these levels can contribute to the risk of QTc prolongation. Each of these drugs has a unique pattern of action and resulting side effects or toxicities. Targeted Therapies Issue Date: 06/13/2006. [14,15], Nursing care of patients experiencing diarrhea associated with EGFR inhibitors focuses on assessment, accurate grading (Table 1), and early intervention. Zhou L, Chu X, Tao S, He T, Duan X, Song Y, Ding J, Bing X. Zhongguo Zhen Jiu. Such activity has been likened to a “lock and key effect.” For a tumor-associ… Any They may "self-regulate" dosing to reduce side effects. Effects of Auricular Acupressure on Sleep Quality, Anxiety, and Depressed Mood in RN-BSN Students With Sleep Disturbance. [A clinical trial of treatment of primary insomnia of patients with. If these measures do not control the diarrhea, and it progresses to grade 3 or 4, more aggressive treatment is required. Eur J Cancer 37 (supp 4):S16-S22, 2001. 2. Erbitux (cetuximab) prescribing information. The monoclonal antibody (MoAb) cetuximab is approved for use in advanced colorectal and head and neck cancers,[6] and panitumumab recently received approval for treatment of advanced colorectal cancers. 4. Patients treated with sunitinib also experienced fatigue, high blood pressure, bleeding, swelling, and taste disturbance. One of these patients had preexisting idiopathic pulmonary fibrosis and was treated in combination with chemotherapy. [2], The dermatologic side effect of hand-foot syndrome associated with sorafenib differs from the dermatologic effects of EGFR inhibitors. Unlike many types of cancer therapies that are given for a prescribed period of time, these novel agents may be continued for an extended period. • Written instructions for patients and care-givers must include phone numbers of clinicians, symptoms to report, specific interventions, and what constitutes an emergency situation. The package insert for cetuximab[6] recommends the following intervention for infusion reactions: "If a grade 1 or 2 hypersensitivity reaction occurs, the first response is to stop the infusion. Anaphylaxis occurs as part of a continuum, and early recognition of symptoms and prompt intervention is imperative to prevent more severe and potentially fatal reactions (Tables 2 and 3).[21]. Lapatinib (Tykerb) is expected to receive approval within the next few months. Snyder LC, Astsaturov I, Weiner LM: Overview of monoclonal antibodies and small molecules targeting the epidermal growth factor receptor pathway in colorectal cancer. [9], Infusion Reactions Associated With Monoclonal Antibodies. 13. 9. Patients being treated with these agents should be instructed in the use of home blood pressure monitors and informed of the criteria for calling the clinician. The following are the most common signs and symptoms of anaphylaxis seen with grade 3 or 4 reactions: • Respiratory changes: Rapid onset of airway obstruction such as dysphonia, stridor, cough, wheezing, or dyspnea, • Altered mental status: Lightheadedness, headache, seizures, loss of consciousness (may be an indicator of hypoxia), • Cardiac changes: Hypotension with or without syncope or cardiac arrhythmias and shock, • Skin changes: Localized or diffuse erythema, urticaria, pruritus, and angioedema, • Gastrointestinal changes: Nausea, vomiting, or diarrhea, All of these symptoms may present in a milder form, as grade 1 or 2. Hand-foot skin reactions usually begin as a mild tingling or pain on the palms or soles of the feet within the first 6 weeks after starting the medication. As with any diarrhea, thorough evaluation is essential to rule out other possible causes. This delay in cardiac repolarization can lead to torsades de pointes, a potentially fatal variation of ventricular tachycardia. Nursing management of patients with advanced malignancies presents a formidable challenge. Utility of the 21-Gene Recurrence Score in Node-Positive Breast Cancer, Guidelines for Palliative Treatment of Spinal Metastases: Choosing Between Stereotactic Body Radiation Therapy and Conventional Fractionation. The threshold is $3,000 for speech-language pathology andphysical therapy services combined from 2018-2028. Panitumumab should be permanently discontinued in patients developing interstitial lung disease, pneumonitis, or lung infiltrates.[7]. Targeted interventions can be further split into selective interventions that focus on populations with a specific risk factor for the disorder (e.g. • Therapy may be administered as part of a clinical trial. Nursing intervention remains a vital component in the successful use of these novel agents. Mood disorders are common problems in patients with chronic hepatitis B virus (HBV) infection, most clinical treatment focus on anti-viral and anti-fibrosis rather than taking care of mood disorders. Kathleen Gillaspy has served on advisory boards and acted as a speaker for Genentech. [8] Infusion reactions are reported in approximately 40% of treated patients. Miller KD, Trigo JM, Wheeler CB, et al: A multicenter phase II trial of ZD6474, a vascular endothelial growth factor receptor-2 and epidermal growth factor receptor tyrosine kinase inhibitor, in patients with previously treated metastatic breast cancer.
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