Chemotherapy: toxins and barriers
Abstract
There are many instances in which the cancer patient and its nursing staff may be exposed to toxins and/or require barriers.
Although the beneficial effects of chemotherapy against the cancer generally outweigh the potential side effects in skilled hands, almost all anticancer drugs have side effects. Toxicity is the most significant treatment-limiting factor in cytotoxic drug use.
In addition, multiple studies have shown multiple potential dangers to staff handling cytotoxic drugs, including increased chromosomal alterations, hepatotoxicity and abnormal reproductive outcomes to be associated with exposure to various chemotherapeutic drugs. For these reasons, it is important that written safety protocols be established and followed in the any veterinary clinic administering chemotherapy. There must also be written instructions to pet owners for at-home administration, handling of drugs and for dealing with drug-contaminated excreta. Veterinary nurses have a vital role to play in the care of chemotherapy patients, and in maintaining the health and safety of both patient and staff. Careful administration of cytotoxics and subsequent patient monitoring should avoid many potential complications of using these drugs. If guidelines are followed, the safe use of cyto-toxic drugs should be possible for the majority of veterinary practices, with minimal risk to all staff involved. Practices and personnel should not become complacent with cytotoxic drug use and regular risk assessment, and updates to Control of Substances Hazardous to Health (COSHH) local rules.
Cancer is a major cause of death in older dogs and cats (Withrow, 2007). Despite this, there are a number of treatments available, including chemotherapy, to offer pets a good quality of life. Advances in veterinary oncology have increased owner awareness and the readiness of many veterinary practitioners to treat cancer patients, meaning that greater numbers of pets with cancer are being managed long term.
While the use of chemotherapy is a mainstay of treatment of patients with cancer, due to their cytotoxic nature, they pose a risk for patients, staff members and to pet owners, therefore care is required when handling and administering them, and in the day-to-day care of patients that have received these drugs (Withrow, 2007).
Chemotherapy, being a systemic treatment, is most commonly used to treat diffuse cancers, such as lymphoma, leukaemia (Chun et al, 2007). It may be used in a variety of ways, e.g. as an adjunct to surgery and/or radiotherapy and/or other modalities, in the treatment of solid tumours, e.g. sarcomas, carcinomas, to control microscopic/metastatic disease, with curative or palliative intent — the goal of therapy being maintenance of optimum quality of life (Chun et al, 2007). In human cancer therapy, chemotherapy is often aggressive, with severe debilitating side effects, including immune suppression, vomiting and diarrhoea, weight loss and total hair loss. Therefore, in the author's experience, many owners' first reaction to chemotherapy is, ‘I don't want to put my pet through that’. In veterinary oncology, quality of life is paramount and chemotherapy protocols are used that are less aggressive than those used for humans —in general the doses used are one third of those used in human medicine, with lesser intensity (i.e. weekly treatments, rather than daily) (Chun et al, 2007). The caveat for this emphasis on quality of life is often limited longevity. Given all of this, adequate time should be spent with owners to counsel them on what to expect during their pet's chemotherapy, the anticipated chances and duration of remission, potential side effects and estimated cost of treatment, so that an informed decision can be made.
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