Vinorelbine

INTRODUCTION

Indications

Inoperable non–small-cell cancer of the lung in ambulatory patients (alone or with cisplatin).

Action

Binds to a protein (tubulin) of cellular microtubules, where it interferes with microtubule assembly. Cell replication is stopped as a result (cell-cycle–specific for M phase). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue. Resp: shortness of breath. CV: chest pain. GI: constipation, nausea, abdominal pain, anorexia, diarrhea, transient increase in liver enzymes, vomiting. Derm: alopecia, rashes. F and E: hyponatremia. Hemat: anemia, neutropenia, thrombocytopenia. Local: irritation at IV site, skin reactions, phlebitis. MS: arthralgia, back pain, jaw pain, myalgia. Neuro: neurotoxicity. Misc: pain in tumor-containing tissue.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor cardiopulmonary symptoms such as chest pain or shortness of breath. Report severe or unexpected cardiac and respiratory problems to the physician.

• Watch for signs of neutropenia (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.

• Assess any joint pain, muscle pain, or pain in the jaw or back 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 neurotoxicity and peripheral neuropathy, including numbness, tingling, and 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 signs of low sodium levels (hyponatremia), including headache, confusion, lethargy, irritability, decreased consciousness, and neuromuscular abnormalities (muscle weakness and cramps). Report severe or prolonged signs to the physician.

• Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report 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 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 and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, ...