Скачать презентацию Treatment Modalities Ayda G Nambayan RN DSN International Скачать презентацию Treatment Modalities Ayda G Nambayan RN DSN International

dd7237ab01e90a3409899c1bac0401ad.ppt

  • Количество слайдов: 36

Treatment Modalities Ayda G. Nambayan, RN, DSN International Outreach Program St. Jude Children’s Research Treatment Modalities Ayda G. Nambayan, RN, DSN International Outreach Program St. Jude Children’s Research Hospital Memphis, TN

Traditional Cancer Therapies Traditional Cancer Therapies

Novel Cancer Therapy Evolves n n n n n Surgery -- less invasive Radiation Novel Cancer Therapy Evolves n n n n n Surgery -- less invasive Radiation – more focused and intense Chemotherapy – still the mainstay Hormone therapy – as adjuvant/maintenance Bone marrow/stem cell transplantation Biologic/Immunologic therapy - promising Molecularly targeted therapy Gene therapy – experimental stage Supportive Therapy Complementary and Alternative Therapies

Chemotherapy Science is Rapidly Unfolding n Chemotherapy still mainstay of treatment n n Metastatic Chemotherapy Science is Rapidly Unfolding n Chemotherapy still mainstay of treatment n n Metastatic Elderly Adjuvant Novel therapies hold promise n n n Novel combinations Different settings Hope for breast, colorectal, pancreatic cancer - EGFR survival outcomes for patients with locally advanced or metastatic pancreatic cancer 1 n Development of chemoprevention strategies Kim ES, Astra-Zeneca

Chemotherapy – What’s new n Combination modality n n Dosing schema n n Agents Chemotherapy – What’s new n Combination modality n n Dosing schema n n Agents that are complementary Inclusion of protective agents Critical timing of administration Dose dense Dose intensification Dose escalation Individualized dosing n n Drug pharmacokinetics Pharmacogenomics

Surgery – What’s New n Cryosurgery – freezing the cells n n Reconstructive Surgery Surgery – What’s New n Cryosurgery – freezing the cells n n Reconstructive Surgery n n n Prostate Breast Head and Neck/ dental Less Invasive/ tissue sparing n n n Percutaneous procedures Stereotactic methods Use of biomedically engineered devices n n Repiphysis for limb sparing Reconstruction/prosthetic surgeries

Tissue Sparing Reconstruction Limb Sparing Cryosurgery Tissue Sparing Reconstruction Limb Sparing Cryosurgery

Radiation Therapy – What’s New n More focused n n Prevention of immediate and Radiation Therapy – What’s New n More focused n n Prevention of immediate and late SE’s n n n Brachytherapy/ implanted Stereotactic Radioimmunotherapy – target RT Protection of RT-sensitive tissues Protective medications Normal tissue sparing n n IMRT Conformal

Radiation Therapy - types n External n n n n Total Body Irradiation Radioimmunotherapy Radiation Therapy - types n External n n n n Total Body Irradiation Radioimmunotherapy n n n Conformal RT Intensity Modulated RT Image Guided RT Stereotactic RT Palliative Zevalin (Ibritumomab tiuxetan; anti-CD 20 + Yttrium-90) Bexxar (Tositumomab Iodine-131; anti-CD 20 + Iodine 131) Internal n n Brachytherapy Implanted Targeted Radioisotope Therapy (RIT)

External Beam RT Mammosite Targeted Implanted RT IGRT External Beam RT Mammosite Targeted Implanted RT IGRT

Biologic/Immunologic therapy Molecularly targeted therapy Biologic/Immunologic therapy Molecularly targeted therapy

Target Therapy n Targeting specific antigens (Biologic/Immunotx) n n Targeting mutation-activated kinases (Molecular) n Target Therapy n Targeting specific antigens (Biologic/Immunotx) n n Targeting mutation-activated kinases (Molecular) n n HER 2, CD 20, CTLA-4 KIT, PDGF-R, BCR-ABL, EGF-R Targeting specific pathways n n Angiogenesis inhibition via VEGF-receptors Cp. G immunosyimulation through TLR-9

Small Molecules Small Molecules

TKI – small molecules TKI – small molecules

Molecular - m. TOR Molecular - m. TOR

Transplantation – BMT, SCT Unrelated Transplantation – BMT, SCT Unrelated

Bone Marrow/Stem Cell Transplantation n Conditioning Regimen n n Donor Sources n n n Bone Marrow/Stem Cell Transplantation n Conditioning Regimen n n Donor Sources n n n Cord Blood Mismatch family member (Haploidentical transplantation) Use of specialized machines to decrease side-effects n n Less toxicity Clinimac separator machine Newer drugs to combat Gv. HD

Clini. MACS Selection System Clini. MACS Selection System

Clini. MACS cells plus magnetic microbeads with anti -CD 133 magnet CD 133+ cells Clini. MACS cells plus magnetic microbeads with anti -CD 133 magnet CD 133+ cells (graft) Waste

Integumentary Gv. HD Integumentary Gv. HD

Hormonal Therapies n Steroids – Dexamethasone, Prednisone n Estrogen Receptor blockers – Breast cancers Hormonal Therapies n Steroids – Dexamethasone, Prednisone n Estrogen Receptor blockers – Breast cancers n n n Tamoxifen (Nolvadex) Aromatase Inhibitors (Aromasin, Femara, Arimidex) Anti-androgen drugs - Prostate cancer n n n Flutamide (Eulexin; Flutamin) Bicalutamide (Casodex, Cosudex, Calutide, Kalumid) Nilutamide (Nilandron; Anandron)

Gene Therapies Types n Replacement - healthy variant of an otherwise mutated gene is Gene Therapies Types n Replacement - healthy variant of an otherwise mutated gene is re-introduced into the cell, thereby repairing the function of the mutated gene and reverting the phenotype n Suicide - the delivery of a cytotoxic gene into the cancer cells, which upon activation, results in the production of a toxic component causing cell death

Suicide Gene Therapy Suicide Gene Therapy

Supportive Therapies Important dimension of cancer therapy n Treatment modalities prevents, alleviate disease and Supportive Therapies Important dimension of cancer therapy n Treatment modalities prevents, alleviate disease and treatment – related effects n Proven to an effective ally in decreasing morbidity and mortality from cancer therapies n Improves patient’s quality of life n

Goal Prevent or treat as early as possible the symptoms of the disease, side Goal Prevent or treat as early as possible the symptoms of the disease, side effects caused by treatment of the disease, n Manage psychological, social, and spiritual problems related to the disease or its treatment. n Improve patient’s quality of life n

Types of Supportive Therapies n Management of fever and neutropenia n n n Prevention Types of Supportive Therapies n Management of fever and neutropenia n n n Prevention of Infection n n Blood transfusions for anemia, thrombocytopenia, neutropenia Monitoring and management of drug toxicity n n Prophylactic use of antibiotics Blood component therapy n n Use of growth factors – Neupogen, Procrit, Neumega Proactive use of antibiotic therapy Patient/family Education Nutritional support n Calorie boosters

Other aspect of supportive care Palliative Care given to improve the quality of life Other aspect of supportive care Palliative Care given to improve the quality of life of patients who have a serious or lifethreatening disease. n Aggressive EOL symptom management n

Complementary and Alternative Therapy n group of diverse medical and health care systems, practices, Complementary and Alternative Therapy n group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine n Considered part of supportive care

CAM n Complementary therapy - used together with conventional medicine. n n Massage and CAM n Complementary therapy - used together with conventional medicine. n n Massage and Hydrotherapy Music, relaxation, imagery Vitamins and herbal supplements Alternative medicine is used in place of conventional medicine. n n Arbolaryo, hilot Faith healers

Nursing Requirements n Thorough knowledge of the treatment modalities available n n Competency in Nursing Requirements n Thorough knowledge of the treatment modalities available n n Competency in patient assessments Competency in drug administration n Actions Side-effects and its management Venous access skills Ability to observe and recognize adverse reactions and complications of therapy Competency in patient and family education

n It’s all to do with training. You can do a lot if you n It’s all to do with training. You can do a lot if you are properly trained. Queen Elizabeth

n Questions? ? ? n Questions? ? ?

n Thank you / Salamat po!!!!! n Thank you / Salamat po!!!!!