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Supportive Therapies

Supportive Therapies. Cell boosters Cell protectants Blood and blood products CTR Constipation Integumentary support Infection control. Colony Stimulating Factors (CSFs / cell boosters). A substance that stimulates the bone marrow to produce blood cells

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Supportive Therapies

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  1. Supportive Therapies

  2. Cell boosters • Cell protectants • Blood and blood products • CTR Constipation • Integumentary support • Infection control

  3. Colony Stimulating Factors(CSFs / cell boosters) • A substance that stimulates the bone marrow to produce blood cells • granulocyte colony-stimulating factor (G-CSF), • granulocyte-macrophage colony-stimulating factor (GM-CSF), • Promegapoietin - platelets Usually not given for patients with hematopoetic malignancies

  4. http://www.bmtinfonet.org/newsletters/issue14/colony.html

  5. Stimulates bone marrow to produce blood cells Produced by the body Also available as SC injection Given 1-3 days post chemo Refrigerate for storage but give at room temp. Uses: pts with neutropenia at risk for infections Bone marrow transplantation pts CSFs JAMA, 2006

  6. Common Side Effects CSFs RashBone PainMuscle PainWeaknessFeverHeadacheChills redness and swelling at injection site Usually managed with premedication and symtomatically with Tylenol

  7. Adverse Effects • Signs and symptoms of allergic reactions • Swelling • Difficulty of breathing • Chest tightness • Rash Usually managed with Benadryl

  8. Chemoprotectants • increase tumor kill while inflicting minimal injury to normal tissue • reduce the effects of therapy on normal cells while maintaining tumor sensitivity to the therapy • Amifostine (Ethyol)

  9. Amifostine (Ethyol) • Uses: • protect the kidneys against the harmful effects of the cancer-fighting drug cisplatin in patients with ovarian cancer or lung cancer • reduce the severe dry mouth caused by radiation treatment after surgery for head and neck cancer

  10. Administration • Given IV • Have patient lying down, on their back • Have crash cart readily available • Frequently check VS – BP tendency to bottom out administer IV fluids

  11. Side-effects • nausea • vomiting • flushing (feeling of warmth) • chills ( feeling of coldness) • fever • dizziness or lightheadedness • drowsiness • sneezing • hiccups • Allergic reactions

  12. Blood and Blood Products • Whole blood • Anemia • Blood loss • Surgery • Packed Red Blood Cells • Anemia • Fresh Frozen Plasma • Thrombocytopenia • DIC • Platelets • White Blood Cells • Cryoprecipitate – blood clotting factors • Granulocyte/neutrophil

  13. Reasons • Disease-related • Anemia due to chronic bleeding (CRC) • Hematological malignancies • Anemia of chronic disease • Treatment-related • Blood loss from surgery • Bone marrow suppression • Chemotherapy • RT • Bone Marrow Transplantation

  14. Side-Effects • Transfusion reactions • noncardiogenic pulmonary edema • Alloimmunization • Hypervolemia leading to cardiac failure • Infection • CMV • hepatitis • HIV

  15. Infection Control • Infection is the leading cause of morbidity and mortality in cancer patients during the treatment phase. • Risk Factors: • Therapy-related immunosuppression • Decreased nutritional levels

  16. Infection Control • essential component of any health care delivery. • Infection control measures • Simple hand washing • Dressing changes • Good venipuncture procedures • High-level disinfection of surgical instruments • Prophylactic use of antibiotics

  17. Environmental control • Handwashing and hygiene habits • Thoroughly cook foods • No fresh flowers or plants • Protect from insect bites, moldy areas, pets • Clean eating utensils and equipments • Avoiding crowds • Vaccinations ??? • Clean environment • Clothes • Home – check for presence of molds

  18. Patient education • Healthy hygiene habits • Home cooked foods vs. vendor food • How to take temperature • What to do if there is fever • Outside activities • Avoidance of crowds • Use of masks • Gardening

  19. Complementary therapyintegrative medicine; holistic healing • Additional forms of treatment given along with traditional cancer therapies • Recognized and approved by HCP • NOT designed to cure but rather to alleviate the treatment side-effects, pain and anxiety

  20. Alternative Therapies • Includes non-approved, non-tested treatments that can be harmful • “miracle cures”

  21. Sensory • Works with the 5 senses as well as the body’s energy • Aromatherapy • Landscape therapy • Music therapy: listening to or playing • Massage • Therapeutic touch • Reiki • Reflexology • Acupuncture

  22. Massage - Precautions • Signs of infection • Risk of developing blood clots • Skin exposed to radiation • Presence of pancytopenia • Presence of bone metastasis or osteoporosis • Provided by a licensed massage therapist

  23. Cognitive • Promotes mind-body healing through the power of positive thinking • Guided imagery; visualization • Hypnotherapy • Prayer • Meditation • Relaxation/deep breathing • Biofeedback

  24. Expressive • Patients expresses their thoughts • Alleviate anxiety by allowing patients to release fear and frustration in a positive, creative way • Journaling, blogging • Writing poems, composing music • Painting, sculpting

  25. Psychotherapy and Counseling • Support groups • Live meetings with a therapist or leader • Web groups • “sisterhood” or “brotherhood” • Volunteering i.e. Reach to Recovery • Individual counseling

  26. Physical • Physical exercise • walking • Yoga • stretching • Tai Chi • Meditation in motion • Qi Gong • Calming, breathing techniques

  27. Advantages • Weight control • Relaxation, anxiety reduction • Strength development

  28. Medical systems • Other non-traditional medicines • Naturopathy • Western herbalism • Vitamin B12 • Vitamin E • Echinacea • Fish Oil • Flaxseed oil • Saw Palmetto • Chinese herbalism • Department of Health approved alternative complementary therapies

  29. doh

  30. Nurses Role • Investigate appropriateness for the patient • Explain benefits, disadvantages and precautions • DO NOT prescribe and be very careful when suggesting

  31. Patient teaching • Consult physician and nurse before using any complementary therapies • Vigorous exercise • Medications or any concoctions • Tell HCP any complementary tx being used • Do not stop taking prescribed medications without consulting HCP • Inform complementary therapist about the prescribed medications being taken • See physician if symptoms persist or worsen

  32. ~ What is now proved was only once imagined Sian Keogh

  33. Thank you / Salamat po!!!!!

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