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Course: Oncology Nursing

Topic: Targeted Therapies in Cancer Treatment Part 2

The Nurses International Community

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Module Goals

Learners will be able to:

Describe detection of common health alterations experienced by people receiving targeted therapies for cancer.
Describe prevention of common health alterations experienced by people receiving targeted therapies for cancer.
Describe the management of common health alterations experienced by people receiving targeted therapies for cancer.

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Side Effects of Targeted Therapy

American Cancer Society, 2020

The most common side effects of targeted therapy include:

Skin problems:

Rash, dry skin, photosensitivity, itching, red sore cuticles
Hand- foot syndrome
Changes in hair growth,
Changes in and around the eyes
A hole through the wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder (very rare)

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Side Effects of Targeted Therapy

American Cancer Society, 2020

Skin rash:

Most common skin changes in targeted therapy.
Often looks like acne and shows up in the scalp,face, neck, chest and upper back.

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Side Effects of Targeted Therapy

American Cancer Society, 2020

Hand-Foot Syndrome:

Starts in the first two to six weeks of treatment.
Symptoms:
Painful sensitivity
Tingling, or numbness in the hands and feet
Palms of the hands and the soles of the feet become red and swollen.
The redness looks like sunburn and may blister
In severe cases, the blisters may open and become sores

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Side Effects of Targeted Therapy

American Cancer Society, 2020

Red Sore Cuticles:

Swollen, red, and painful sores around the fingernails and toenails.
Often happens to the big toes and thumbs.
Sores may get infected.
Nails may also become brittle and grow more slowly.

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Side Effects of Targeted Therapy

American Cancer Society, 2020

The serious side effects of targeted therapy include:

Diarrhea
Liver problems
Bleeding and blood clotting problem
Poor wound healing,
High blood pressure,
Autoimmune reaction
Swelling

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Side Effects of Targeted Therapy

American Cancer Society, 2020

Blood clotting problems:

Stomach and intestines bleeding may be severe and life threatening.

Signs of bleeding include:

Throw up blood or material that looks like coffee grounds.
Black stools or bright red blood in your stool.
Blood clots can cause heart attack or stroke.

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Side Effects of Targeted Therapy

American Cancer Society, 2020

Other side effects include:

Nausea and vomiting
Constipation
Mouth sores
Shortness of breath
Fatigue
Headache
Hair loss
Allergic reactions
Risks of infections
Second cancer

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Critical Thinking Question

Mr Andrew is receiving targeted therapy for cancer. What could be the sign of serious side effects of this therapy? (Select the correct answer.)

blood clotting problems
skin rash
hand-foot syndrome
change in and around the eyes

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Prevention of Skin Changes

American Cancer Society, 2020

Suggestions to prevent skin changes:

Use very mild soaps, body washes, and shampoos with no alcohol or perfume.
Take oatmeal bath products to soothe the skin.
Bathe with cool or lukewarm (instead of hot) water.
Moisturize skin at least twice a day with a thick emollient cream with no alcohol, perfumes, or dyes.
Wear loose, soft clothing.
Keep nails short.

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Prevention of Skin Changes (continued)

American Cancer Society, 2020

Stay out of the sun as much as possible.
Use a broad-spectrum sunscreen with SPF of at least 30 and zinc oxide or titanium dioxide at least one hour before going out.
Do not use acne medicines even if the rash may look like acne.
Try gel shoe inserts if the soles of feet are tender.

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What would the nurse do?

Miss Rani is receiving targeted therapy to for the treatment of cancer. After a few days of therapy she developed an acne like rash on her face, and back of the neck. What would the nurse suggest to minimize her rash? (Select all that apply)

use mild soap and body wash without alcohol
use acne medicine
avoid sun as much as possible
use sun’s cream screen when exposed to sun

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Management of Common Side Effects of Targeted Therapy

Mild changes: Patients with mild skin changes may not need treatment include:

Rashes that are only in a limited to a certain area, that do not cause distress, and are not infected.
Heavy skin creams or ointments that contain no alcohol, perfume, or dye can sometimes help with dryness.
If eyelids are crusty or swollen, careful cleansing and clean, warm, wet clothes laid over your closed eyes may help.

American Cancer Society, 2020

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Management of Common Side Effects of Targeted Therapy (continued)

Moderate Change: Includes a rash over a larger area of the body or skin changes causing mild distress from itching or soreness, but with no signs of infection.

Prescriptions of cream or gel
An oral antibiotic
Drops or ointments may be prescribed to help with eye problems.
The dose of the targeted therapy drug usually does not need to be changed for moderate skin problems
Close observation if rash becomes better or worse

American Cancer Society, 2020

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Management of Common Side Effects of Targeted Therapy ( continued)

Severe Changes: Severe rashes that cover large areas of skin, cause itching and soreness that affect quality of life (sleep problems or pain), and are likely to get become infected.

Prescriptions of cream or gel
Oral antibiotics
A course of corticosteroid tablets is often prescribed
The dose of the targeted therapy drug is often reduced
If the rash doesn’t improve within 2 weeks, the targeted drug is often stopped until the skin changes improve

American Cancer Society, 2020

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Management Side Effects of Targeted Therapy (continued)

National Cancer Institute, 2020

Constipation

Drink plenty of fluids (water, warm juices, and prune juice)
Be active, take walks regularly
Eat more fiber-containing foods
Drink warm liquid (coffee, tea, and warm milk)
Talk to doctor before taking laxatives, stool softeners, or any medicine to relieve constipation
Limit certain foods if gas develop,(broccoli, cabbage, cauliflower, beans, and cucumbers)

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Management Side Effects of Targeted Therapy (continued)

Diarrhea

Drink plenty of fluids to replace those lost from diarrhea.
Eat foods and liquids that are high in sodium and potassium.

Liquids: bouillon or fat-free broth.
Foods: bananas; canned apricots; and baked, boiled, or mashed potatoes.

Eat low-fiber foods.
Have foods and drinks at room temperature.
Avoid foods such as: High-fiber foods, spicy, Greasy, fatty, and fried foods.

National Cancer Institute, 2020

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Managing Targeted Cancer Therapy Side Effects (continued)

Hillman Cancer Center, 2020

A few ways to help manage side effects and symptoms of targeted cancer therapy include:

Maintaining a healthy diet
Getting enough rest
Reducing alcohol use
Quitting smoking
Getting enough exercise

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What would the nurse do?

A nurse is working in a targeted therapy ward.What are the tips a nurse can suggest to manage side effects and symptoms of targeted cancer therapy patients? (Select all that apply)

Maintain a healthy diet
Rest
Quit smoking
Getting exercise
Reduce alcohol use

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References

American Cancer Society, 2020. Targeted Therapy Side Effects. Retrieved from: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-therapy/side-effects.html

Hillman Cancer Center, 2020. Short and Long term side effects of Targeted Therapy. Retrieved from: https://hillman.upmc.com/cancer-care/medical-oncology/targeted-therapy/side-effect s

NationaL Institute of Cancer(2020).Side effects of cancer Treatment. Retrieved from: https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq#_104

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