ONS Connect - December 2008 - (Page 18) fivEMiNuTEiNSERviCE As seen in the CliniCal Journal of onCology nursing Manage Cardiac Side Effects of Cancer Treatment [By elisa Becze, BA, ONS Staff Writer] C ardiotoxicity is a known side effect of certain chemotherapy drugs and targeted agents. When cardiotoxicity is combined with cardiovascular disease, a common comorbidity in older adults who are often the recipients of those drugs, oncology nurses are increasingly caring for patients with cardio conditions and need to be aware of the symptoms of and risk factors for heart failure. In their recent article in the Clinical Journal of Oncology Nursing, Viale and Yamamoto (2008) described cardiotoxicity as it occurs with cancer therapy, discussed the drugs most likely to increase cardiotoxicity in patients with cancer, and addressed the nurse’s role in management of the disease. Chemotherapy and Targeted Agents That May increase Risk Anthracyclines: Cardiotoxicity can develop either immediately after anthracyclines are administered, chronically during treatment, or years to decades after treatment ends. Chronic cardiotoxicity usually occurs as congestive heart failure with the following dosedependent incidence rates. • In 3% of patients receiving cumulative doses of 400 mg/m 2 of doxorubicin • In 7% of patients receiving 550 mg/m2 • In 18% of patients receiving 700 mg/m2 Because cumulative dose is the concern, oncology nurses should carefully monitor patients’ total dosages. Anthracycline cardiotoxicity may be reduced through the use of continuous administration instead of bolus dosing. Using pegylated liposomal versions of the drugs also may have an effect on toxicity. 5-fluorouracil (5-FU) and capecitabine: The incidence of cardiotoxicity with 5-FU ranges from 1.2%–7.6%, leading some researchers to list the agent as the second-most common cause of cardiotoxicity. Patients with preexisting heart disease have increased risk for developing cardiotoxicity from 5-FU, and the mean onset of toxicity is 72 hours after administration. Because capecitabine is an oral prodrug of 5-FU, its risk of cardiotoxicity is similar. Cyclophosphamide and ifosphamide: Smaller doses of cyclophosphamide can cause acute cardiotoxicity, specifically myocarditis and pericarditis, resulting in key Definitions Chemotherapy-related cardiac dysfunction, type I: a type of clinical heart failure that is dose dependent and results in myocardial damage Chemotherapy-related cardiac dysfunction, type II: more of a myocardial dysfunction than actual damage; it is not dose related and it is often reversible. Congestive heart failure: a life-threatening condition where the heart cannot pump enough blood to the other organs in the body Five-Minute In-Service is a monthly feature that offers readers a concise recap of a full-length article published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Cardiovascular Toxicity Associated With Cancer Treatment” by Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP®, and Deanna Sanchez Yamamoto, RN, MS, CS, ANP, AOCNP®, which was featured in the August 2008 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted. 18 ONS CONNECT December 2008
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