ONS Connect - September 2008 - (Page 19)

and frank anaphylaxis with hypotension and angioedema of the airway). Studies have shown that the overall incidence of cetuximab infusion reactions in the United States is about 3%, but these may, in fact, be hypersensitivity reactions. However, that percentage jumps to 15%–20% for patients who live in the middle-southern states. Although researchers do not know why the phenomenon occurs, residents of those states are more likely to have preexisting cetuximab-specific IgE antibodies, which sensitize the mast cells so that they are at higher risk for a reaction on the initial infusion. In addition, because cetuximab is a monoclonal antibody, patients still may experience infusion reactions (cytokinerelease syndrome). Those symptoms may include • Fever, arthralgias and myalgias, lethargy, headache, or tumor pain • Hyper or hypotension, pruritis, rash, chills, rigors, tachycardia, urticaria, nausea, and vomiting. Nursing assessment and management When faced with a suspected infusion or hypersensitivity reaction with cetuximab, nurses should immediately stop the infusion of the drug and assess patients’ airway patency, breathing, and circulation. If those features are intact, nurses should provide supportive care and comfort. During an infusion reaction, early intervention may prevent serious side effects and death. After stopping the drug immediately when the reaction is first observed, nurses’ next steps are to manage the physiologic effects. Infusion rooms should have evidence-based standing orders for interventions to manage reaction symptoms, such as ad- case Study J.S. is a 54-year-old African American man originally from North Carolina who now lives in Boston, MA. He was diagnosed with stage IV colon cancer two years ago; his past medical history is remarkable only for intermittent asthma related to seasonal allergies. J.S.’s tumor responded to treatment with FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan) and bevacizumab but recently has progressed. A new regimen of irinotecan and cetuximab is planned. J.S. comes into the clinic to begin the new treatment. The nurse’s baseline examination reveals a temperature of 98.2°F, heart rate 76 and regular, blood pressure 110/70 mmHg, respiratory rate 14, and oxygen saturation 98% on room air. His breath sounds are clear. His skin is smooth, unblemished, and without rash. He is premedicated with diphenhydramine and acetaminophen as ordered. The nurse stays with J.S. during initiation of the cetuxmab infusion and monitors him closely. Immediately after beginning the drug, J.S. complains of feeling uneasy; shortly thereafter, he develops wheezing and shortness of breath. What should the nurse’s first action be? What are the next steps the nurse should take? What were J.S.’s risk factors for infusion reaction? Visit http:// chemotherapy.vc.ons.org and click on “Discussion” to talk about the case with other readers. Note. Based on information from Wilkes, 2008. ministering IV normal saline, antihistamines, and steroids. Immediately stopping the drug will turn off the reaction, and administration of diphenhydramine will offset high serum histamine levels and manage urticaria. Nurses should administer acetaminophen for fever and meperidine for rigors as ordered and monitor vital signs, including airway, breathing, circulation, oxygen saturation, respiratory rate, breath sounds, heart rate, and blood pressure. Oxygen and epinephrine should be immediately accessible in case of a more severe reaction that involves bronchospasm or laryngeal edema; those interventions should be used at the first sign of either condition. Even after a reaction is controlled, patients may need to be admitted to the hospital for observation in case the reaction recurs as the rescue agents wear off. Although infusion and hypersensitivity reactions will continue to be a po- tential side effect that oncology nurses need to watch for, quick intervention by nursing staff may save patients’ lives. Nurses should closely monitor patients at highest risk for a reaction (e.g., those receiving drugs associated with high risk, those who have a history of allergic reactions) during infusions. For more details on infusion reactions associated with cetuximab, as well as additional information on management, see the full article by Wilkes (2008). ✱ Wilkes, G. (2008). Managing drug infusion reactions: Focus on cetuximab monoclonal antibody therapy. Clinical Journal of Oncology Nursing, 12(3), 530–532. For more information or to view the full article, visit http://ons.meta press.com and click on the June 2008 issue of the Clinical Journal of Oncology Nursing. September 2008 ONS CONNECT 19 http://chemotherapy.vc.ons.org http://chemotherapy.vc.ons.org http://ons.metapress.com http://ons.metapress.com

Table of Contents Feed for the Digital Edition of ONS Connect - September 2008

ONS Connect - September 2008 Contents Editor's Note Just In Advances in Prostate Cancer Treatment A Year in the Life - Month Nine Web Connect Capitol Connection Manage Infusion Reactions From Cetuximab Notice Nursing Now Caregiver Care Oropharyngeal Cancer in Men Associated with HPV Working for You Calendar of Events Staying on Top

ONS Connect - September 2008

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