Tamoxifen

INTRODUCTION

Indications

Adjuvant therapy of breast cancer after surgery and radiation (delays recurrence). Palliative or adjunctive treatment of advanced breast cancer. Prevention of breast cancer in high-risk patients. Treatment of ductal carcinoma in situ following breast surgery and radiation. McCune-Albright syndrome with precocious puberty in girls 2–10 yr.

Action

Competes with estrogen for binding sites in breast and other tissues. Reduces DNA synthesis and estrogen response. Therapeutic Effects: Suppression of tumor growth. Reduced incidence of breast cancer in high-risk patients. Delayed puberty in McCune-Albright syndrome.

Adverse Reactions/Side Effects

CNS: confusion, depression, headache, weakness. EENT: blurred vision. CV: PULMONARY EMBOLISM, STROKE, edema. GI: nausea, vomiting. GU: UTERINE MALIGNANCIES, vaginal bleeding. F and E: hypercalcemia. Hemat: leukopenia, thrombocytopenia. Metab: hot flashes. MS: bone pain. Misc: tumor flare.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of stroke (sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances), especially during exercise. Seek immediate medical assistance if these signs occur.

• Monitor signs of pulmonary embolism, including shortness of breath, chest pain, cough, and bloody sputum. Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

• Be alert for signs of uterine malignancy, including abnormal uterine bleeding, vaginal discharge, abdominal pain, bloating, unexplained weight loss, or a change in bowel or bladder habits. Report these signs to the physician immediately.

• Report signs of leukopenia (fever, sore throat, signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums).

• 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 bone pain or other musculoskeletal pain. Suggest additional tests (radiography, MRI) as needed to rule out fracture.

• Monitor and report depression, confusion, or other changes in mood and behavior.

• Report signs of high calcium levels (hypercalcemia), including muscle pain, weakness, joint pain, confusion, and lethargy.

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 stroke and pulmonary embolism, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Advise patient and family or caregiver about the signs of stroke and pulmonary ...