Chemotherapy

More than 90 drugs available

• M: mitosis - cell divison • daughter cells • G0: resting, no proliferation • G1: cellular contents other than chromosomes duplicated • S: chromosomes duplicated • G2: duplicated chromosomes are double-checked for errors • M: mitosis - cell divison -> daughter cells

• acts on cell cycle within which cell repro occurs • drugs divided into: • cell-cycle phase specific (CCPS) • cell-cycle phase non-specific (CCPNS) • ​combining CCPS + CCPNS drugs -> help achieve max cell kill • cytotoxic drugs interfere with synthesis of DNA, RNA + proteins • CCPNS are effective in all phases, direct effect on DNA + more toxic • cells in rest phase are unaffected

• Constant proportion of cells killed rather than absolute number • eg. if drug kills 90% of tumour cells containing 100,000 cells then 10,000 left, next dose 1000 left, next 100, next 10, next 1 = 5 doses • treatment given in cycles

• Chemo can be used alone • in combo with other therapies too • as neo-adjuvant or adjuvant treatment (eg before or after surgery) • combos of chemo may be synergistic, reduce toxicities + allow normal cell recovery • not all cancers are chemosensitive

• intravenous (bolus or infusion) • oral • sub-cutaneous • intramuscular • intrathecal • intracavitary

Extravasation is the leakage of intravenously (IV) infused potentially damaging medications into the extravascular tissue around the site of infusion Vesicant drugs can cause tissue death + necrosis ADRs may occur, safe handling principles for staff.

• haematological - myelosuppression • GI - nausea, mucositis, diarrhoea/constipation • hair loss • fatigue • organ toxicity (cardio, lung fibrosis, liver, kidney, neuro) • gonadal toxicities - infertility + sexual dysfunction • secondary malignancies

• medical team (medical + clinical oncologists, pathologists, radiologist) • clinical nurse specialist (usually key worker) • chemotherapy-trained nurses • pharmacist • dietician • counsellor • physio, OT • complementary therapy team