Mitomycin

INTRODUCTION

Indications

Used with other agents in the management of disseminated adenocarcinoma of the stomach or pancreas.

Unlabeled Use: Palliative treatment of Carcinoma of the colon or breast, Head and neck tumors, Advanced biliary, lung, and cervical squamous cell carcinomas.

Action

Primarily inhibits DNA synthesis by causing cross-linking; also inhibits RNA and protein synthesis (cell-cycle phase–nonspecific but is most active in S and G phases). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

Resp: PULMONARY TOXICITY. CV: edema. GI: nausea, vomiting, anorexia, stomatitis. GU: infertility, renal failure. Derm: alopecia, desquamation. Hemat: leukopenia, thrombocytopenia, anemia. Local: phlebitis at IV site. Misc: HEMOLYTIC UREMIC SYNDROME, fever, prolonged malaise.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See appendixes I, J, K). Report immediately any signs of pulmonary toxicity, including rales/crackles, dyspnea, shortness of breath, decreased breath sounds, pleuritic friction rub, tachypnea, cough, wheezing, pleuritic pain, fever, fatigue, hemoptysis, and hypoxia.

• Monitor signs of renal failure and hemolytic uremic syndrome, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, pale or yellowish brown skin, small bruises (petechiae), and confusion that progresses to seizures and coma. Report these signs to the physician or nursing staff immediately.

• 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 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 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.

• Because of the risk of pulmonary toxicity, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (respiratory symptoms, blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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 ...