Pharmacologic: microtubule inhibitors
Metastatic breast cancer that has progressed despite at least two previous regimens which included an anthracycline and a taxane in either regimen.
Inhibits intracellular microtubule growth phase, causing G2/M cell-cycle block resulting in apoptotic cell death. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones, ↓ spread of breast cancer.
Adverse Reactions/Side Effects
CNS: fatigue, weakness, depression, dizziness, headache, insomnia. EENT: ↑ lacrimation. CV: QTC PROLONGATION, peripheral edema. Resp: cough, dyspnea, upper respiratory tract infection. GI: anorexia, constipation, nausea, abdominal pain, abnormal taste, dry mouth, dyspepsia, mucositis, diarrhea, vomiting. Derm: alopecia, rash. F and E: hypokalemia. Hemat: ANEMIA, NEUTROPENIA. MS: arthralgia, myalgia. Neuro: peripheral neuropathy. Misc: fever, urinary tract infection.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances such as QTc prolongation or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
Monitor signs of neutropenia (fever, sore throat, mucosal lesions, other signs of infection) and unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff immediately.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Assess any breathing problems, and watch for signs of upper respiratory tract infection such as cough, sneezing, dyspnea, shortness of breath, mucous production, fatigue, and a low-grade fever. Notify physician or nursing staff if these signs occur.
Assess any joint or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.
Monitor and report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).
Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.