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Chemotherapy Training Level 1. Essex Cancer Network October 2012. INTRODUCTION. Why?. Level One training is required for all staff who may come across chemotherapy in their normal job, such as dispensary technicians, assistants and aseptics staff.

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chemotherapy training level 1

Chemotherapy TrainingLevel 1

Essex Cancer Network

October 2012

slide3
Why?

Level Onetraining is required for all staff who may come across chemotherapy in their normal job, such as dispensary technicians, assistants and asepticsstaff.

Level Two training is for all staff involved in prescription verification of SACT prescriptions.

Level Three training is for specialist oncology staff, who work within the area of cancer for more than 50% of their time, or are designated as a cancer specialist at their trust.

principles for level one training
Principles for Level One Training

Knowledge

  • Basic background knowledge of cancer

Training

  • One hour lunchtime session held each year.

Key elements of syllabus

  • Health and safely/ safe handling
  • Relevant protocols/SOPs to trust
  • Labelling
  • Counselling
  • Where to go for further advice
  • Background and principles of chemotherapy

Revalidation

  • To be revalidated the individual must attend a yearly update in oncology training session.
b ackground knowledge of cancer
Background knowledge of cancer
  • Cancer
    • Abnormal growth of cells which tend to proliferate in an uncontrolled way and may spread
    • Derived from Greek word karkinos meaning crab
  • Tumour
    • Latin word meaning “abnormal swelling”
  • Neoplasm
    • “new growth” (benign or malignant)
  • Benign
    • Not cancer
    • Does not invade surrounding tissue or spread to other parts of the body.
background knowledge of cancer
Background knowledge of cancer
  • Malignant
    • Tending to be severe and become progressively worse
    • Can invade and destroy nearby tissue and that may spread to other parts of the body.
    • Latin combination of "mal" meaning "bad" and "nascor" meaning "to be born“ – literally means "born to be bad"
  • Oncology
    • Branch of medicine that deals with cancer, including study of their development, diagnosis, treatment, and prevention
  • Haematology
    • Branch of medicine that specialises in study & treatment of blood
cancer treatment choices
Cancer Treatment Choices
  • Can be used alone or in combination – to enhance local control & attack potential sites of metastases
  • Systemic therapy
    • Chemotherapy
    • Hormone therapy
    • Biological therapy
    • Experimental chemotherapy
principles of chemotherapy
Principles of chemotherapy

“Normal cells obey strict rules.

Divide only when told.

Die rather than misbehave.”

  • Normal cells have several systems for interrupting the cell cycle if there is a problem
  • These control systems are called “checkpoints”
  • Checkpoints are biological traffic lights telling the cell when it can safely carry on to replicate or when to stop and fix a problem
principles of chemotherapy1
Principles of chemotherapy
  • In cancer cells, some or all of the usual checkpoints fail leading to an over proliferation of abnormal cells
  • The faulty checkpoints make the cell unable to check if the DNA replication was complete, if any mutations needed to be repaired, if the DNA was properly separated between the daughter cells, or many other problems
  • These cells are likely to become cancerous with their multiple genomic problems

Whereas normal cells have functioning checkpoints, abnormal cells checkpoints have been lost or disabled

aim of systemic chemotherapy
Cure

Cancer / Tumour disappears and does not return

Control

If cure is not possible, the goal is to control the disease (stop growth & spreading)

Palliation

For advanced cancer, where control is unlikely. Drugs used to relieve symptoms  Improve QoL

Aim of Systemic Chemotherapy
why in regimens
Why in ‘regimens’
  • Combination chemotherapy is used to try and improve rate and duration of response by combining drugs with different mechanisms of action:
    • helps to prevent resistance
    • known to be effective as single agents
    • different toxicity (toxicities don’t overlap)
    • try to use drugs with synergistic killing effect
    • no clinically important drug interactions between the agents
why in courses
Why in courses?
  • Use pulsed intermittent therapy to allow normal cells to recover
  • Normal (bone marrow cells) cells recover quicker from chemotherapy then cancer cells
  • Normal tissues are inevitably damaged by chemotherapy – bone marrow & epithelial lining cells usually recover within 2-3 weeks
  • On this basis, most chemotherapy given at 3 – 4 weekly intervals
slide15

Pulsed therapy

Bone Marrow Cells

Tumour Cells

Course of treatment

Fraction Cell Survived

Limit of detection

Relapse

0

3

6

Time (Weeks)

common side effects
Common Side Effects

Alopecia

Pulmonary fibrosis

Cardiotoxicity

Local reaction

Renal failure

Myelosuppression

Mucositis

Nausea/vomiting

Diarrhea

Cystitis

Sterility

Neuropathy

npsa rrr risks of incorrect dosing of oral anti cancer medicines 22 january 2008
NPSA RRRRisks of incorrect dosing of oral anti-cancer medicines – 22 January 2008
  • Doctors, nurses, pharmacists and their staff must be made aware that the
    • Prescribing
    • Dispensing, and
    • Administration

of oral anti-cancer medicines should be carried out and monitored to the same standard as injected therapy.

principles for safe dispensing
Principles for Safe Dispensing
  • Prescriptions must be screened by an authorised pharmacist
  • All pharmacy staff involved with dispensing oral anticancer agents must have access to full copies of all relevant protocols (trial and non-trial)
  • Dispensary staff must have ready access to specialist oncology pharmacy advice
  • Dispensary staff should work to detailed operational procedures
  • Label directions must be clear and unambiguous – where relevant include treatment period, start and stop dates and an indication of the need for safe handling
principles for safe dispensing1
Principles for Safe Dispensing
  • Patient information leaflets may be supplemented with additional local information
  • For patients with swallowing difficulties, there is a need to seek specialist advice (medicines information or oncology pharmacist)
  • General risk management issues such as handling of wastage from patients, inappropriate storage and risk to others, especially young children should be given
health and safely
Health and safely

Chemotherapy is:

  • Mutagenic
    • induces mutations
  • Teratogenic
    • disturbs the growth of embryo/foetus
  • Carcinogenic
    • causes cancer, changes normal cells into cancerous cells
routes of absorption
Routes of Absorption
  • Inhalation

aerosols or evaporation

  • Absorption

skin or mucous membranes

  • Ingestion

hand to mouth contact

methods of exposure
Methods of Exposure
  • Direct contact with cytotoxics

Spillage

Splash

Needle-stick

Aerosol

Picking them up

Therefore made up in aseptics in ‘isolators’

oral chemotherapy1
Oral Chemotherapy
  • Should not be touched by hand
  • Use cytotoxic triangle to count - Do not use medicines counter
  • The tablet/capsule should be placed into a medicine cup or spoon and taken by the patient directly from the container without handling
  • For patients with swallowing difficulties, there is a need to seek specialist advice on crushing tablets or opening capsules (medicines information or oncology pharmacist)
relevant protocols sops to trust
Relevant protocols/SOPs to trust
  • Please list for your trust
labelling
Labelling
  • Label directions must be clear and unambiguous – where relevant include treatment period, start and stop dates and an indication of the need for safe handling
  • All labels for chemotherapy agents (not TKIs/MABs) must have stated
    • ‘Cytotoxic – handle with care’
counselling
Counselling
  • Unless you have had specific training on chemotherapy agents to level 2 or 3, you should not counsel patients about taking their chemotherapy agents.
  • If you need further advise please contact your specialist cancer pharmacist