Chemotherapy for gliomas

Abstract

Standard treatment approaches for adult gliomas consist of surgery, radiotherapy and chemotherapy, based on the histological diagnosis and molecular profile of the specific glioma. Patient performance status and other prognostic factors are also taken into consideration when deciding upon treatment options. Temozolomide (TMZ), procarbazine, vincristine and lomustine (PCV) are all types of alkylating (e.g. damaging the DNA, affecting the ability of cancer cells to multiply) chemotherapy agents frequently used in the treatment of gliomas. They can be given as initial treatment (either in combination with or adjuvant to radiotherapy) or administered at recurrence. Oncology specialist nurses work closely together with patients receiving chemotherapy, as well as their caregivers. Effective education by the oncology nurse of the patient and his/her caregiver(s) promotes patient safety and well-being, helps maintain optimal dosing and ensures accurate assessment and evaluation of side effects and toxicities. Specialist nurses evaluate the process and initiate supportive therapies as required, such as fatigue management, nutritional advice, psychosocial support and physiotherapy. Temozolomide, lomustine and procarbazine can cause myelosuppression (also known as bone marrow suppression) and require careful monitoring of full blood counts to prevent complications associated with neutropenia, thrombocytopenia and lymphopenia. Other side effects such as nausea and fatigue are manageable, neuropathy is a specific side effect of vincristine, but all can have significant impacts on quality of life. These side effects and their nursing implications and considerations will be explored in more detail in this chapter. Interventions such as treatment delay may lead to recovery of the bone marrow function and blood counts. Dose adjustments-if deemed necessary-may allow the patient to continue chemotherapy treatment as long as there is no evidence of tumour progression during treatment. Should a patient's tumour progress whilst on active chemotherapy treatment, the treating physicians and specialist nurse will need to help manage the patient's expectations and adjust their goal settings.