Cancer Treatment Modalities

1. Cancer Treatment Modalities

2. Objectives The learner will be able to: • Discuss the various treatment modalities available for cancer. 2. State the principles of cancer treatment.

3. Cancer Treatment Goals • Cure • Control • Palliation • Adjuvant • Neoadjuvant

4. Cancer Treatment Goals Adjuvant Therapy Neoadjuvant Therapy Chemotherapy/biotherapy is given prior to surgery to shrink tumor bulk and load. Can limit the surgical procedure that follows therapy • Surgery is primary treatment. • Chemotherapy/biotherapy is given after surgery – as an adjunct (adjuvant).

5. Measuring Tumor Response Complete Response (complete disappearance for at least one month) Partial Response (reduction in measurable tumor mass >50% for one month without new tumor growth) Stable Disease (unchanged without tumor growth or reduction) Progressive Disease (advancing disease in presence of therapy)

6. Treatment Modality Types • Surgery • Radiation therapy • Chemotherapy • Biotherapy • Hormonal therapy • Bone marrow/stem cell transplantation • Multimodal therapy

7. Surgery Surgery for cancer can be used for the following purposes/goals: • Curative • Prophylactic • Diagnostic • Staging • Palliative • Adjuvant or supportive • Reconstructive/rehabilitative

8. Radiation Therapy Local treatment that can be used for the following purposes/goals: • Curative • Palliative • Treat cancer with minimal harm to normal cells.

9. Radiation Therapy Principles of radiation therapy: • Highest energy rays are given. • Divided into doses or fractions • “Radiation absorbed dose” = RAD • Amount of radiation delivered to and absorbed by tissue

10. Radiation Therapy Types: • External beam (EBRT) • Brachytherapy (internal) • 3D conformal • Intensity modulated (IMRT) • Gamma • Stereotactic radiotherapy

11. Chemotherapy • Systemic therapy with the following goals: • Cure • Control • Palliation • Reduce the number of cells to a small number. • Cytotoxic drugs used to destroy cancer cells or prevent cellular replication by interfering with DNA and RNA and vital cellular proteins • Classified according to the pharmacologic action of effect on cellular reproduction

12. Chemotherapy Routes of Administration Intrathecal/intraventricular (central nervous system) Intraperitoneal (abdominal) Intrapleural (lung) Intravesicular (bladder) • Intravenous (peripheral or central line) • Oral • Subcutaneous • Intramuscular • Intra-arterial (arterial)

13. Biotherapy Systemic therapy with the following goals: • Cure • Control Mechanisms of action vary by agent: • May alter the body’s biologic response or immune system • May use the body’s own immune system to treat cancer • May produce antitumor activities • May prevent vascular development of tumor cells • May include radionuclide tags

14. Biotherapy • Also includes supportive care agents to address side effects. • Classified according to the pharmacologic action of effect. • Many times combined with chemotherapy and/or radiation therapy to maximize effects.

15. Hormonal Therapy • Systemic therapy with the following goals: • Cure • Control • Used against hormonally sensitive tumors like breast and prostate cancers. • Must have a positive hormone receptor status to administer these agents. • Creates unfavorable growth environment. • Side effects include hot flashes, blood clots, and fluid retention.

16. Bone Marrow/Stem Cell Transplantation • Goal is to empty bone marrow and replace with new marrow. • Used to treat leukemia, lymphoma, multiple myeloma, aplastic anemia, and some solid tumors. • High doses of chemotherapy and radiation can be given concurrently.

17. Bone Marrow/Stem Cell Transplantation Process/steps: • Mobilization - Blood cell stimulants are administered • Harvest - Marrow is harvested • Conditioning - Cytotoxic treatment is given • Engraftment - Marrow is reinfused

18. Bone Marrow/Stem Cell Transplantation Allogeneic • Usually a sibling or parent; can be related or matched unrelated Syngeneic • Identical twin Autologous • Most common type • Donor is recipient. • Marrow is harvested during disease remission to be reinfused later.

19. Multimodal Therapy Combining one or more treatment modalities is common and can be beneficial. • Therapies can and should have: • Synergistic effects • Different mechanisms of action • Possible delayed drug resistance • Minimal or no overlapping toxicities.

20. Factors Affecting Treatment Response • Tumor burden • Rate of tumor growth • Hormone receptor status • Dose category • Drug resistance (intrinsic or acquired) • Cell sanctuaries and cellular residual • Age, immune status, or poor performance status

21. References Ignatavicius, D., & Workman, M.L. (2010). Medical-surgical nursing: Patient centered collaborative care (6th ed.). St. Louis, MO: Elsevier. Polovich, M., Whitford, J.M., & Olsen, M. (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed). Pittsburgh, PA: Oncology Nursing Society. Yarbo, C.H., Wujcik, D., & Gobel, B.H. (2011). Cancer nursing: Principles and practice (7th ed.). Sudbury, MA: Jones and Bartlett.