Dactinomycin

INTRODUCTION

Indications

Alone or with other treatment modalities in the management of: Wilms' tumor, Rhabdomyosarcoma, Ewing's sarcoma, Trophoblastic neoplasms, Testicular carcinoma, Metastatic nonseminomatous testicular cancer, Gestational trophoblastic neoplasia. As a component of regional perfusion for treatment of locally recurrent solid malignancies.

Action

Inhibits RNA synthesis by forming a complex with DNA (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Also has immunosuppressive properties.

Adverse Reactions/Side Effects

CNS: lethargy, malaise. GI: anorexia, nausea, stomatitis, vomiting, abdominal pain, ascites, diarrhea, dysphagia, esophagitis, hepatotoxicity, ulceration. Derm: acne, alopecia, erythema (especially of previously irradiated skin), hyperpigmentation (especially of previously irradiated skin), skin eruptions, photosensitivity, rash. EENT: pharyngitis. Endo: hypocalcemia, gonadal suppression. Hemat: anemia, leukopenia, thrombocytopenia. Local: phlebitis at IV site. MS: myalgia. Resp: pneumonitis. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor respiratory function and report signs of pneumonitis, including dry cough, dyspnea, chest pain, shortness of breath, and fever. Report these signs, especially if patient begins to show acute respiratory distress.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.

• Assess any muscle pain or neuromuscular signs of low calcium levels (hypocalcemia), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs become problematic.

• Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report signs of phlebitis or other prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Use caution during exercise, especially if patient has any respiratory problems (pneumonitis) or severe fatigue due to anemia of other blood dyscrasias. Assess exercise tolerance frequently (blood pressure, heart rate, breathing responses, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

• Advise patient about the likelihood of GI reactions, including nausea, vomiting, diarrhea, difficulty swallowing, heartburn, loss of appetite, and inflammation in or around the mouth. Instruct patient ...