Caring for the patient undergoing biological therapy

12 Caring for the patient undergoing biological therapy



Chapter aim




• To introduce the principles of biological therapy


• To understand the impact of biological therapy on the individual



Introduction


One of the most exciting and most recent developments in cancer treatments are the biological therapies. These have been developed as a result of the expansion of our knowledge of cancer biology. Many of these treatments are still in the trial phase and are still being investigated to optimise their effectiveness and to identify what side effects they may cause. However NICE has approved many of these treatments for general use. During your cancer/palliative care placement, you may come across patients receiving biological therapies alongside other cancer treatments such as cytotoxic therapy or radiotherapy. If you are allocated to a cancer centre, you may be able to arrange an insight visit with the clinical research team who coordinate and run cancer clinical trials.


Many of the treatments are administered orally and patients who are physically able will self-administer the drugs at home, so you may encounter the treatments while on a community placement or in the outpatient setting. Alternatively, if you have a placement in an inpatient area, try to find out what biological treatments some of your patients are on. Patients often confuse these drugs with cytotoxic therapy, but they act very differently and the side effects of biological therapies are variable in terms of the range of toxicities as well as the severity.


Biological therapies are treatments that use natural substances from the body, or drugs made from these substances. Biological therapies stimulate, direct or boost the body’s own immune cells to:



– attack or control the growth of cancer cells


– restore blood cells following an episode of cytotoxic-related neutropenia


– interfere with the way cells interact and signal to each other.



image Activity


Read Waugh and Grant (2010) (see References) or a similar textbook to refresh your knowledge of the different parts and cells of the immune system. How does the immune system work to get rid of non-self cells?


NMC Domain 3: 3.2


There are numerous types of biological therapies. Table 12.1 identifies some of the main groups and provides examples of drugs/agents. Each group is discussed in turn.


Table 12.1 Types of biological therapies
























Groups of biological therapies Examples of agents
Cytokines Interferon, interleukins, tumour necrosis factor, colony-stimulating factors (G-CSF: pegfilgrastim/filgrastim and epoetin alfa)
Monoclonal antibodies (MoAbs) Trastuzumab (Herceptin), rituximab, bevacizumab, cetuximab
Cancer growth blockers Tyrosine kinase inhibitors: erotinib (Tarceva), imatinib (Glivec), getitinib (Iressa), sunitinib, dasatinib, lapatinib
Proteasome inhibitors: bortezomib (Velcade)
Anti-angiogenic agents Thalidomide
Cancer vaccines Bacillus Calmette–Guérin (BCG)
Gene therapies In development


Cytokines


Cytokines are natural protein messengers secreted from blood cells that coordinate the immune system. They attach to a receptor on the surface of white blood cells and trigger them to multiply, recognise and deal with anything that is foreign to the body, such as a cancer cell, bacteria, etc.


Interferon is a cytokine that is produced when white blood cells come in contact with a virus. It interferes with the ability of the virus to reproduce and stops other cells becoming infected with the virus. Interferon alpha is given subcutaneously. It interferes with or stops the cancer’s growth, makes cancer cells more vulnerable to being killed by white blood cells and reduces the number of blood vessels around the cancer. Interferon alpha is used to treat renal cell cancers, melanoma and chronic myeloid leukaemia. It can also be given topically to treat some types of skin cancer.


Another group of cytokines are the interleukins which are given intravenously (Batchelor 2006).


Yet another group is the haemopoietic growth factors. These stimulate production of white blood cells and help them mature. Rather than being used to eliminate cancer, these factors can be made synthetically, and boost recovery of the immune system when it has been damaged by cytotoxic therapy. Generally, granulocyte colony-stimulating factor (G-CSF) is used subcutaneously to stimulate neutrophil production and maturation, to prevent or minimise the severity and length of neutropenia and to lower the risk of infection when a patient is undergoing cytotoxic therapy and is likely to become immunocompromised. G-CSF is also used in haemopoietic transplant to increase the number of stems cells in the blood, before harvesting (discussed in Ch. 11).

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Related posts:

  1. Introducing the case study
  2. What cancer is
  3. Principles of palliative care nursing
  4. Transferable skills for future placements

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Feb 25, 2017 | Posted by in NURSING | Comments Off on Caring for the patient undergoing biological therapy

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