Exploration of a Chemotherapy Regime and Its Side Effect - Essay Example

?Exploration of a Chemotherapy Regime Used For Head and Neck Cancers and Its Side Effect- Mucositis Table of Contents Introduction 3 Chemotherapy Regimen in relation to Cisplatin and 4 day 5-Fluorouracil 4 Critical Discussion of the Principles of the Chemotherapy Regime and Its Mode of Action 5 Identification of the Short and Long Term Side Effects of This Chemotherapy 7 Exploration of Mucositis 7 Critical Exploration of the Impact of Mucositis on the Patient 9 Conclusion 10 References 12 Bibliography 14 Introduction Cancer is a disease, which is caused due to the growth of out-of-control cell. It severely affects human body due to uncontrollable division of damaged cells forming tissues that are recognised as tumours. Cancer patients are provided with different types of treatments such as radiation, hormone therapy, surgery, chemotherapy, gene therapy and immunotherapy (MNT, 2013). In this regard, chemotherapy is regarded as one of the effective treatments, which is readily accessible for combatting against cancer. It is often viewed to be an anti-cancer drug, which is used to damage cancer cells. This treatment is offered with the objective of minimising the growth as well as the development of cancer cells. Chemotherapy drugs are injected in the veins of a human body that circulates in the blood throughout the body, so that they are able to reach the cancer cells effectively. In relation to the case of head along with neck cancers, chemotherapy treatment would be applicable with the assistance of radiotherapy in a combined manner. The aforementioned combined treatment for cancer is recognised as chemo radiation. Chemotherapy treatment is offered to shrink tumours before surgery. The most common chemotherapy drugs that are offered for combatting against neck and head cancers are Cisplatin and 4 day 5-fluorouracil. It can be viewed that there are various side effects associated with chemotherapy treatment and related drugs like bleeding, anaemia, numbness and hair loss among others (Macmillan Cancer Support, 2013). With this concern, the essay emphasises exploring of a chemotherapy regime i.e. Cisplatin and 4 day 5-fluorouracil that are mainly used for the treatment of head along with neck cancers and mitigating one of the side effects i.e. mucositis. Chemotherapy Regimen in relation to Cisplatin and 4 day 5-Fluorouracil Chemotherapy treatment in relation to Cisplatin and 4 day 5-Fluorouracil (5FU) is offered to patients with head and neck cancer after conducting a blood test. On ascertaining that the result of blood test is normal, the chemotherapy drugs are prepared. The nurses insert catheter or ‘peripherally inserted central catheters’ (PICC) line in a vein nearby the collarbone or in the arms of human body. The patients suffering with head or neck cancer are offered with anti-sickness drugs through the line before the infusion of Cisplatin and 5FU (Macmillan Cancer Support, 2012). The chemotherapy treatments are offered for mitigating cancer in different ways. There are certain procedures or plans on the basis of which treatments are offered to cancer patients in an effective manner so that damaged cells are restricted to grow uncontrollably. Additionally, following a particular regimen will eventually facilitate in combatting against the significant concern of cancer. In this regard, one of the most appropriate chemotherapy regimens for the treatment of head and neck cancers is to the follow a mentioned schedule. In this context, in the first day of the chemotherapy treatment, a patient having neck and head cancer is provided with Cisplatin infusion combined with pre and post hydration. After the infusion of Cisplatin, the patient is then infused with 5FU. The 5FU infusion has an effect for four days. The patients having central or PICC line are allowed to leave for home with a portable pump after the infusion of Cisplatin and 5FU. Contextually, the patients with the attached portable pump should return to the medical centre and with the assistance of a nurse, are required to get the pump detached from their body. In relation to the case of the patients having no catheter or PICC line, they are required to be in the medical centre till the process of infusion is completed. Subsequently, after the infusion of Cisplatin and 5FU, the patients are provided with a rest period of 17 days without any chemotherapy. In this regard, the procedure on the basis of which chemotherapy treatment offered is often recognised as a chemotherapy treatment cycle. On the completion of the rest period in the first cycle, the next treatment cycle commences. The second treatment starts after three week time period from the date of commencement of the chemotherapy treatment. The chemotherapy treatment is offered to head along with neck cancer patients for two to six cycles (Macmillan Cancer Support, 2012). Thus, this can be regarded as the most appropriate regimen on the basis of which chemotherapy treatment should be offered for better as well as effective treatment of cancer. Critical Discussion of the Principles of the Chemotherapy Regime and Its Mode of Action The chemotherapy regimen should be offered in accordance with certain principles that will eventually assist in selecting appropriate drugs, ensuring that these drugs are effective in eliminating the uncountable damaged cells. The combination of drugs will facilitate in destroying maximum number of damaged uncontrollable cells. Additionally, it will certainly facilitate in having a better coverage near the tumour area in to the form of resisting cell lines. It also ensures that drug-resistant cell lines are prevented from developing the tumour affected areas. In this regard, there are certain principles of chemotherapy regime that require to be followed in order to ensure that the chemotherapy treatment is effective. These principles include: Drugs that are recognised to be active single agents should be combined with other drugs. In this respect, the drugs that assist in providing effective treatment for head as well as neck cancers are required to be combined Drugs having different action mechanisms are to be combined with the intention of ensuring that the chemotherapy drugs offered impose considerable impact upon mitigating damaged cells Drugs having better toxicity level should be combined with the aim of ascertaining that these drugs are effective in offering effective therapeutic doses The chemotherapy drugs should be offered in ideal doses and also in appropriate schedules The chemotherapy drugs are to be offered in a consistent manner and in proper intervals The combination of different drugs will also facilitate in reducing cross-resistance effect of damaged cells (Page & Tikimoto, 2003). The chemotherapy regimen in relation of Cisplatin and 5FU has been identified to follow a certain mechanism of action. The chemotherapy agent Cisplatin is often recognised to be a platinum agent. It is a complex heavy inorganic metal, which performs typical activity in the chemotherapy cycle acting as an alkylating agent. Cisplatin is viewed to form Deoxyribonucleic acid (DNA) cross-links on the basis of intrastand as well as interstand that further develops DNA adducts. In this regard, Cisplatin facilitates in synthesising DNA, proteins and Ribonucleic acid (RNA) along with affecting their replication process. In a similar manner, 5FU follows a different mechanism of action on the basis of which an effective chemotherapy treatment is offered to the patients suffering from head and neck cancers. In this context, 5FU is identified to be interfering in DNA synthesising process. Additionally, this chemotherapy agent is combined with RNA for the purpose of developing toxic effects. Thus, Cisplatin and 5FU are used for the treatment of head and neck cancers as the combination of these two chemotherapy agents assist in minimising uncontrolled growth of damaged cells and in curing tumours (Merck Sharp & Dohme Corp., 2013). Identification of the Short and Long Term Side Effects of This Chemotherapy Short Term Side Effect Long Term Side Effect Bruising and Bleeding Changes in hearing Anaemia Fatigue Nausea and Vomiting Hair loss Sore throat Numbness or tingling in hands or feet Sources: (Macmillan Cancer Support, 2013). Exploration of Mucositis It is worth mentioning that the cancer patients with the chemotherapy treatment may experience various sorts of side effects. It can be apparently observed in this similar concern that during the treatment of head along with neck cancers, there is a rapid breakdown of the epithelial cells in the gastro-intestinal tract lining. In this context, the mucosal tissue is determined to remain open, leading towards ulceration as well as infection, which is often recognised as mucositis. Mucosal tissue, mucous membrane or mucosa is identified to line up with the passages through which air circulates in human body through respiratory along with alimentary tracts. Mucosal tissue has cells along with glands that produce and discharge mucus. In this context, the part of the lining, which is associated with the mouth, is known as oral mucosa. Oral mucosa is the most sensitive part of human body, which is seemed to be vulnerable towards cancer treatments that include chemotherapy along with radiation. Oral cavity is ascertained as the most common place for the development of mucositis. Oral mucositis is recognised to be the leading factor for causing various problems arising from chemotherapy as well as radiation treatment of cancer. The various problems that are associated with oral mucositis include pain and decreased nutritional level among others. Additionally, there pertains an increased chance of infection due to the factor of open sores present in oral mucosa. In this respect, mucositis adversely affects the life quality of cancer patients by a significant extent and subsequently, hampers the process of chemotherapy treatment (OCF Inc., 2013; Taylor & et. al., 2010; Kostler & et. al., 2001). Oral mucositis is also identified as stomatitis and it occurs in around 40 per cent of the patients undergoing cancer treatment. Mucositis severely affects the immunity system of the human body resulting to pain, inflation as well as infection. In this regard, mucositis is recognised to be a significant problem amid cancer patients provided with high dose of radiation and chemotherapy drugs for the treatment of head and neck cancer. Cancer patients with chemotherapy and radiation therapy treatment for head and neck cancer are identified to have the side effect of mucositis at an estimation of 85% to 100% (Petersen, 2005; OCF Inc., 1998). Thus, it can be comprehended that there exist an increased chance of having mucositis in cancer patients who are offered with chemotherapy and radiation treatment. In this regard, management of oral mucositis has developed along with implemented various procedures on the basis of which cancer treatments such as chemotherapy and radiation should be offered in an appropriate manner. Additionally, oral mucositis management provides treatment as along with prevention guidelines with regard to mucositis. Subsequently, cancer patients before having chemotherapy treatment should be provided with adequate education along with measures that are essential in preventing mucositis. Patients are required to remain much aware about different essentials or significant aspects such as non-medicated saline rinses, hydration, aware of systematic pain control procedure, infection surveillance process and nutritional support for preventing mucositis. It is often viewed that clinical strategies are formulated and executed with the intention of preventing mucositis. In this regard, cancer patients provided with 5FU should be offered with standard doses of drugs. Moreover, the doses should be provided with the use of cryotherapy for the prevention of mucositis. Specially mentioning, acyclovir should not be used in the prevention procedure of mucositis, which mainly occurs due to chemotherapy treatment using Cisplatin and 5FU (Petersen, 2005; Rubenstein & et. al., 2004). In this regard, it can be comprehended that cancer patients receiving chemotherapy treatment are exposed to the risks of having mucositis extensively. Critical Exploration of the Impact of Mucositis on the Patient Mucositis is regarded as one of the critical side effects of cancer treatments that include chemotherapy and radiation. There are various signs along with symptoms on the basis of which mucositis can be identified. The signs and symptoms of mucositis have been provided hereunder. Redness in the mouth Swollen mouth Blood in the mouth Pain and sores in the mouth Difficulty in swallowing as well as talking Intolerance towards chemotherapy or radiotherapy treatment Source: (OCF Inc., 2013) The toxicity level of mucositis is determined by a grading procedure which represents: Source: (BC Cancer Agency, 2005) Therefore, it can be comprehended that based on the identification of different signs as well as symptoms, the patients having mucositis are required to be graded on the basis of their toxicity. In this respect, in accordance with the grading, the patients possessing mucositis are determined whether the toxicity level is none, mild, moderate, severe or life threatening. Conclusion From the above discussion, it can be comprehended that chemotherapy treatment is used as one of the most effective procedures for cancer treatment. Patients having head and neck cancer are provided with chemotherapy treatment such as Cisplatin and 5FU, proving much effective in destroying damaged cells that grow in an uncontrollable manner. Additionally, this chemotherapy treatment should be offered following an appropriate regimen in order to ensure that the chemotherapy drugs are offered with proper doses and systematically. There are certain principles on the basis of which chemotherapy drugs ought to be provided for better chemotherapy treatment. The chemotherapy drugs should be combined suitably in accordance with the mechanism of actions, ensuring that head along with neck cancers are treated effectively. There are various side effects that are associated with chemotherapy treatment and the most common one is mucositis. In this regard, proper assessments and measures should be undertaken with the objective of preventing mucositis, as it might act as a hindrance in the chemotherapy treatment. References BC Cancer Agency, 2005. Nutritional Guidelines for Symptom Management. Mucositis. [Online] Available at: http://www.bccancer.bc.ca/NR/rdonlyres/5C9BA6AE-C7EC-40FA-AAEF-2B81AA26BEE5/56311/Mucositis.pdf [Accessed December 19, 2013]. Kostler, W. J. & et. al., 2001. Chemotherapy and/or Radiotherapy: Options for Prevention and Treatment. A Cancer Journal for Clinicians, Vol. 51, pp. 290-315. Macmillan Cancer Support, 2012. Cisplatin and Fluorouracil (5FU) Chemotherapy. National. [Online] Available at: http://www.nhs.uk/ipgmedia/national/macmillan%20cancer%20support/assets/cisplatinandfluorouracil5fumcs6pages.pdf [Accessed December 19, 2013]. Macmillan Cancer Support, 2013. Chemotherapy for Head and Neck Cancer. Cancer Information. [Online] Available at: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Headneck/Treatingheadneckcancers/Chemotherapy.aspx [Accessed December 19, 2013]. Merck Sharp & Dohme Corp., 2013. Overview of Antineoplastic Agents. Pharmacology. [Online] Available at: http://www.merckmanuals.com/vet/pharmacology/antineoplastic_agents/overview_of_antineoplastic_agents.html [Accessed December 19, 2013]. MNT, 2013. What Is Cancer? What Causes Cancer? All About Cancer. [Online] Available at: http://www.medicalnewstoday.com/info/cancer-oncology/ [Accessed December 19, 2013]. OCF Inc., 2013. Mucositis. Treatment. [Online] Available at: http://www.oralcancerfoundation.org/treatment/mucositis.html [Accessed December 19, 2013]. OCF Inc., 1998. Prevention and Treatment of Oral Mucositis in Cancer Patients. Evidence Based Practice Information Sheets for Health Professionals, Vol. 2, Iss. 3, pp. 1329-1874. Page, R. & Tikimoto, C., 2003. Principles of Chemotherapy. Chapter 3. [Online] Available at: http://www.thymic.org/uploads/reference_sub/03chemoprinc.pdf [Accessed December 19, 2013]. Petersen, D. E., 2005. New Strategies for Management of Oral Mucositis in Cancer Patients. Review, Vol. 4, No. 2, pp. 9-14. Rubenstein, E. B. & et. al., 2004. Clinical Practice Guidelines for the Prevention and Treatment of Cancer Therapy–Induced Oral and Gastrointestinal Mucositis. Mucositis: Perspectives and Clinical Practice Guidelines, Vol. 100, No. 9, pp. 2026-2046. Taylor, G. W. & et. al., 2010. Oral and General Health - Exploring the Connection. Research Review. [Online] Available at: http://www.deltadentalnj.com/dentists/downloads/OralHealthofNonHeadNeckCancerPatients.pdf [Accessed December 19, 2013]. Bibliography Kau, V. F. & et. al., 2013. Carboplatin/5-fluorouracil as an Alternative to Cisplatin/5-Fluorouracil for Metastatic and Recurrent Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma. Asian Pacific Journal of Cancer Prevention, Vol. 14, pp. 1121-1126. Licitra, L. & et. al., 2004. Cisplatin and Fluorouracil Concurrent to Radiotherapy in Nasopharyngeal Cancer: Is the Schedule Compatible? Journal of Clinical Oncology, Vol. 22, No. 2, pp. 377-385. Nishiyama, M. & et. al., 1999. Low-Dose Cisplatin and 5-Fluorouracil in Combination Can Repress Increased Gene Expression of Cellular Resistance Determinants to Themselves. Clinical Cancer Research, Vol. 5, pp. 2620-2628. Peterson, D. E. & et. al., 2011. Management of Oral and Gastrointestinal Mucositis: ESMO Clinical Practice Guidelines. Clinical Practice Guidelines, Vol. 22, No. 6, pp. 78-84. Rodriguez, S. & et. al., 2003. Chemotherapy for Head and Neck Cancer. Grand Rounds Presentation. [Online] Available at: http://www.utmb.edu/otoref/grnds/Chemo-030416/Chemo-030416.htm [Accessed December 19, 2013]. Schrijvers, D. & et. al., 2004. Docetaxel, cisplatin and 5-fluorouracil in Patients with Locally Advanced Unresectable Head and Neck Cancer: A Phase I–II Feasibility Study. Oxford Journal, Vol. 15, Iss. 4, pp. 638-645. Silverman, S., 2006. Diagnosis and Management of Oral Mucositis. Review, Vol. 5, No. 2, pp. 13-21. Stanford Medicine, 2013. Chemotherapy Drugs and Side Effects. Information. [Online] Available at: http://cancer.stanford.edu/information/cancerTreatment/methods/chemotherapy.html [Accessed December 19, 2013]. Read More