Understanding chemotherapy, a common way to fight many types of cancer, can be hard. You need to learn a lot about how cancer changes the body’s normal ways of working. Cancer doesn’t just affect one part of the body. It upsets the whole system by making cells grow abnormally. These cells can harm and destroy normal body tissues. When you understand this, you see why chemotherapy is important.

Chemotherapy itself is complicated. There are many types of drugs and treatments. Some stop cancer cells from multiplying, some kill them outright, and others help the body’s own defenses fight the cancer. The goal is always to kill cancer cells, slow them down, or stop them from spreading.

Nurses are important in chemotherapy. They don’t just give the treatment. They also keep an eye on the patient’s health, manage side effects, give emotional support, and explain the process to the patients and their families.

Pathophysiology of Most Cancers

In simple terms, cancer starts when the body’s cells begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas. Here are the general steps:

1. Cell mutation: Normally, our body maintains a control system that dictates when cells need to grow, reproduce and die. Sometimes, changes (or mutations) occur in the DNA within cells, which can lead to errors in these instructions. When this happens, cells may start to grow and divide when they shouldn’t, or they might not die when they should.

2. Growth of cancer cells: Unlike normal cells, cancer cells don’t listen to signals from the body to stop growing and dividing. As a result, they build up, forming a mass of tissue. This mass of tissue, called a tumor, can continue to grow and interfere with the body’s normal functions.

3. Invasion and spread: Some cancer cells can break off from the original tumor and travel to other parts of the body through the blood or lymph system. This process is called metastasis. When these cancer cells reach a new part of the body, they may form a new tumor.

4. Effect on the body: As a tumor grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure can cause pain and affect the function of the body parts. Some cancers also cause the immune system to react in ways that produce symptoms such as fatigue, weight loss, and changes in the skin.

Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.

There are several factors that can contribute to the development of cancer, including:

1. Genetic factors: Some cancers run in families. These are caused by specific genetic changes that are passed from parents to children. Other cancers are caused by genetic changes that occur throughout a person’s lifetime.

2. Environmental factors: These include lifestyle factors like diet, tobacco use, certain infections, and exposure to environmental chemicals and radiation. For example, exposure to tobacco smoke is a risk factor for lung cancer, and prolonged exposure to the sun’s ultraviolet rays can lead to skin cancer.

3. Age: Most cancers occur in older people. This is probably because it takes time for the mutations that lead to cancer to accumulate.

4. Certain health conditions: Certain chronic health conditions, such as ulcerative colitis, can significantly increase the risk of developing certain cancers.

5. Immune system dysfunction: People with weakened immune systems (such as those with HIV/AIDS) have a higher risk of many types of cancer.

Chemotherapy Drugs

Chemotherapy is a common treatment for cancer, involving the use of antineoplastic agents to destroy tumor cells by interfering with their cellular functions, including replication. The goal of chemotherapy is to eradicate enough of the tumor so that the remaining cells can be destroyed by the body’s immune system. Chemotherapeutic agents can be classified into different categories, each with its unique mechanism of action:

1. Alkylating agents: Alter DNA structure by misreading DNA code, initiating breaks in the DNA molecule, and cross-linking DNA strands.
2. Nitrosoureas: Similar to alkylating agents, but they can cross the blood-brain barrier.
3. Topoisomerase I inhibitors: Induce breaks in the DNA strand by binding to enzyme topoisomerase I, preventing cells from dividing.
4. Antimetabolites: Interfere with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis.
5. Antitumor antibiotics: Interfere with DNA synthesis by binding DNA and preventing RNA synthesis.
6. Mitotic spindle poisons: Arrest metaphase by inhibiting mitotic tubular formation and inhibiting DNA and protein synthesis.
7. Hormonal agents: Bind to hormone receptor sites that alter cellular growth; blocks binding of estrogens to receptor sites; inhibit RNA synthesis; suppress aromatase of P450 system, which decreases levels​​.

The side effects of chemotherapy can be severe, and vary depending on the specific drugs used. Some common side effects include fatigue, nausea, vomiting, hair loss, anemia, neutropenia, thrombocytopenia, mucositis, and neuropathy.

Nursing Care During Chemotherapy

Nurses play an essential role in assessing and managing many of the problems experienced by patients undergoing chemotherapy. Here are some key nursing interventions:

Preparation before chemotherapy:

• Assess the patient’s overall health, including medical history, current medications, and any existing conditions that may affect chemotherapy administration.
• Educate the patient about the purpose, procedure, and potential side effects of chemotherapy.
• Collaborate with the oncology team to establish an individualized chemotherapy plan for the patient.
• Verify the patient’s understanding and consent for chemotherapy treatment.
• Assess the patient’s emotional well-being and provide support as needed.

During chemotherapy administration:

• Ensure the patient’s safety and comfort during the procedure.
• Monitor vital signs, including temperature, heart rate, blood pressure, and oxygen saturation.
• Maintain strict adherence to chemotherapy protocols and safety guidelines.
• Monitor the intravenous site for signs of infiltration or infection.
• Administer prescribed medications to manage chemotherapy side effects, such as antiemetics for nausea and vomiting.
• Provide emotional support and reassurance to alleviate anxiety or distress.
• Offer distractions or relaxation techniques to help the patient cope with treatment-related discomfort.

Managing chemotherapy side effects:

• Monitor and manage common side effects like nausea, vomiting, fatigue, and hair loss.
• Administer medications as prescribed to relieve symptoms and enhance comfort.
• Encourage the patient to maintain good oral hygiene to prevent oral mucositis.
• Promote adequate hydration and balanced nutrition to support the patient’s overall well-being.
• Educate the patient and family on managing side effects at home, such as providing dietary guidelines and explaining when to seek medical attention.
• Address psychosocial concerns and provide resources for counseling or support groups.

Preventing and managing complications:

• Monitor for signs of infection, such as fever, chills, or increased white blood cell count, and promptly report any abnormalities.
• Educate the patient about the importance of hand hygiene and avoiding individuals with infectious illnesses.
• Collaborate with the healthcare team to assess and manage potential chemotherapy-related complications, such as neutropenia or thrombocytopenia.
• Administer blood transfusions or growth factors as prescribed to support the patient’s blood cell counts.
• Educate the patient on recognizing signs of bleeding or infection and the need for urgent medical attention.

Psychosocial support and education:

• Provide emotional support and encouragement to the patient and their family throughout the chemotherapy journey.
• Offer information about available resources, such as support groups, counseling services, or financial assistance programs.
• Encourage open communication and active participation in decision-making regarding treatment and care.
• Educate the patient and family about the long-term effects of chemotherapy, including potential late effects and the importance of survivorship care.

Monitoring and follow-up:

• Schedule regular follow-up appointments to assess the patient’s response to chemotherapy and manage any ongoing side effects or complications.
• Monitor the patient’s laboratory values, including blood counts and organ function tests.
• Collaborate with the oncology team to evaluate the effectiveness of chemotherapy and make necessary adjustments to the treatment plan.
• Provide ongoing education and support to the patient and family during the entire chemotherapy course.

Chemotherapy is a complex treatment modality requiring in-depth knowledge and meticulous nursing care. Understanding the pathophysiology of cancer, the mechanism of chemotherapy medications, and the potential side effects are key to providing effective nursing care. However, with the correct information, nurses can play a critical role in improving the quality of life and outcomes for patients undergoing chemotherapy.

Keep learning, keep growing, and keep providing the best possible care to your patients.