Main benefit of neoadjuvant chemotherapy (breast cancer patient) - ANSWER
Neoadjuvant therapy does not increase survival when compared to adjuvant therapy. It only
changes the timing of treatment and can change surgical options if the tumor is shrunk
enough. If this occurs, the patient may only require a lumpectomy plus radiation therapy
instead of needing a mastectomy
Due to Mrs. Turner's age and comorbidities, her oncologist performs a comprehensive
geriatric assessment. You know that this assessment covers all but which of the following: -
ANSWER A comprehensive geriatric assessment (CGA) is a multidisciplinary evaluation to
assess life expectancy and risk of morbidity and mortality in the older patient. This
assessment tool would evaluate and include the following areas: functional status,
socioeconomic issues, psychosocial distress, comorbidities, cognitive function, nutritional
status, polypharmacy, and a medication review (NCCN Older Adult Oncology Guidelines,
version 1.2015).
The NCCN Older Adult Oncology Guidelines (version 1.2015) provides information on what is
included in a comprehensive geriatric assessment. Currently, more than 60% of cancers in
the United States occur in people age ______and older and as the oncology world ages,
nearly half (46%) of cancer survivors are 70 years of age or older - ANSWER 65
What is your best explanation for why Mrs. Turner was given a port to receive her
chemotherapy? - ANSWER Two of the agents (docetaxel and carboplatin) that Mrs.
Turner will receive are categorized as irritants. Docetaxel can cause a significant reaction if it
extravasates. It can lead to edema, erythema, occasional pain and blister formation (ONS
Chemo/Bio guidelines, 2014). That is the most likely reason that Mrs. Turner was given a
port for her treatments. Some patients will receive their treatments through a peripheral IV
without incident. Just because they are intravenous agents does not mean that a port is
required and needing a port has nothing to do with her being older in age. Since none of
these agents are vesicants, they likely could have been given safely via peripheral route but
having a port placed is OK as well.
1
,_____________can cause inflammation, pain, and burning but rarely cause tissue necrosis
comparable to a vesicant (unless a large amount or a very high concentration of the irritant
is extravasated). - ANSWER Irrirtants
_____________can cause blistering and significant pain and tissue damage and destruction,
leading to tissue death. - ANSWER Vesicants
A further classification of an antineoplastic agent's potential to cause damage is whether its
mechanism of action includes DNA binding. - ANSWER Non-DNA-binding solutions
remain in the local area of the extravasation, which improves the possibility of drug
deactivation.
DNA-binding agents attach to DNA nucleic acids, causing the antagonist to be ingested
cellularly, leading to progressive tissue destruction
DNA Binding Irritants - ANSWER Bendamustinea
Dactinomycin
Daunorubicin
Doxorubicin
Epirubicin
Idarubicin
Mechlorethamine
Mitomycin
DNA Nonbinding vessicants - ANSWER Amsacrine
Paclitaxel
Vinblastine
Vincristine
Vindesine
Vinorelbine
2
, Extravasciation Alkylating / Mechlorethamine tx - ANSWER Sodium thiosulfate
Inject 2 ml of sodium thiosulfate for each milligram of
mechlorethamine extravasated.
Inject subcutaneously into extravasation site using a 25
gauge or smaller needle (change needle with each injection).
Monitor extravasation site according to the institution's
policies and procedures.
Extravasciation Alkylating: Oxaliplatin - ANSWER Apply warm compresses.
Dexamethasone
8 mg twice daily
for 14 days
Extravasation Tx: Anthracyclines --- Daunorubicin,
doxorubicin, epirubicin,
idarubicin - ANSWER Totect
Apply ice pack (remove 15
minutes prior to Totect
treatment).
Infusion should be initiated within six hours of extravasation.
Infused over 1-2 hours for three days in an area other
than the extravasation site
The dose recommended is based on the patients' body
surface area.
3
Neoadjuvant therapy does not increase survival when compared to adjuvant therapy. It only
changes the timing of treatment and can change surgical options if the tumor is shrunk
enough. If this occurs, the patient may only require a lumpectomy plus radiation therapy
instead of needing a mastectomy
Due to Mrs. Turner's age and comorbidities, her oncologist performs a comprehensive
geriatric assessment. You know that this assessment covers all but which of the following: -
ANSWER A comprehensive geriatric assessment (CGA) is a multidisciplinary evaluation to
assess life expectancy and risk of morbidity and mortality in the older patient. This
assessment tool would evaluate and include the following areas: functional status,
socioeconomic issues, psychosocial distress, comorbidities, cognitive function, nutritional
status, polypharmacy, and a medication review (NCCN Older Adult Oncology Guidelines,
version 1.2015).
The NCCN Older Adult Oncology Guidelines (version 1.2015) provides information on what is
included in a comprehensive geriatric assessment. Currently, more than 60% of cancers in
the United States occur in people age ______and older and as the oncology world ages,
nearly half (46%) of cancer survivors are 70 years of age or older - ANSWER 65
What is your best explanation for why Mrs. Turner was given a port to receive her
chemotherapy? - ANSWER Two of the agents (docetaxel and carboplatin) that Mrs.
Turner will receive are categorized as irritants. Docetaxel can cause a significant reaction if it
extravasates. It can lead to edema, erythema, occasional pain and blister formation (ONS
Chemo/Bio guidelines, 2014). That is the most likely reason that Mrs. Turner was given a
port for her treatments. Some patients will receive their treatments through a peripheral IV
without incident. Just because they are intravenous agents does not mean that a port is
required and needing a port has nothing to do with her being older in age. Since none of
these agents are vesicants, they likely could have been given safely via peripheral route but
having a port placed is OK as well.
1
,_____________can cause inflammation, pain, and burning but rarely cause tissue necrosis
comparable to a vesicant (unless a large amount or a very high concentration of the irritant
is extravasated). - ANSWER Irrirtants
_____________can cause blistering and significant pain and tissue damage and destruction,
leading to tissue death. - ANSWER Vesicants
A further classification of an antineoplastic agent's potential to cause damage is whether its
mechanism of action includes DNA binding. - ANSWER Non-DNA-binding solutions
remain in the local area of the extravasation, which improves the possibility of drug
deactivation.
DNA-binding agents attach to DNA nucleic acids, causing the antagonist to be ingested
cellularly, leading to progressive tissue destruction
DNA Binding Irritants - ANSWER Bendamustinea
Dactinomycin
Daunorubicin
Doxorubicin
Epirubicin
Idarubicin
Mechlorethamine
Mitomycin
DNA Nonbinding vessicants - ANSWER Amsacrine
Paclitaxel
Vinblastine
Vincristine
Vindesine
Vinorelbine
2
, Extravasciation Alkylating / Mechlorethamine tx - ANSWER Sodium thiosulfate
Inject 2 ml of sodium thiosulfate for each milligram of
mechlorethamine extravasated.
Inject subcutaneously into extravasation site using a 25
gauge or smaller needle (change needle with each injection).
Monitor extravasation site according to the institution's
policies and procedures.
Extravasciation Alkylating: Oxaliplatin - ANSWER Apply warm compresses.
Dexamethasone
8 mg twice daily
for 14 days
Extravasation Tx: Anthracyclines --- Daunorubicin,
doxorubicin, epirubicin,
idarubicin - ANSWER Totect
Apply ice pack (remove 15
minutes prior to Totect
treatment).
Infusion should be initiated within six hours of extravasation.
Infused over 1-2 hours for three days in an area other
than the extravasation site
The dose recommended is based on the patients' body
surface area.
3
