Toremifene

INTRODUCTION

Indications

Management of metastatic breast cancer in post-menopausal women with estrogen receptor–positive or unknown tumors.

Action

Exerts antiestrogenic effects by competing for estrogen-binding sites found in breast cancers. Therapeutic Effects: Regression of breast cancer.

Adverse Reactions/Side Effects

CNS: depression, dizziness, headache, lethargy. EENT: blurred vision, cataracts, corneal keratopathy, dry eyes, glaucoma. CV: CHF, MI, PULMONARY EMBOLISM, angina, arrhythmias, edema, thrombophlebitis. GI: nausea, elevated liver enzymes, vomiting. GU: vaginal discharge, vaginal bleeding. Derm: sweating. F and E: hypercalcemia. Hemat: anemia. Misc: hot flashes, tumor flare.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of myocardial infarction (MI), including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.

• Monitor signs of pulmonary embolism (PE) such as 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.

• Assess signs of congestive heart failure (CHF), including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician or nursing staff.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• 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.

• Monitor signs of thrombophlebitis, including localized pain, redness, warmth, and swelling in the affected area. Report these signs to the physician or nursing staff.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, bruising, and pale skin. Notify physician or nursing staff if these signs occur.

• Assess any muscle, bone, or nerve pain at or near the tumor site. Increased pain at the onset of drug treatment may indicate tumor enlargement (tumor flare), and should be reported to the physician.

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

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

• 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.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity ...