You are on page 1of 24

MANAGEMENT OF CANCER PATIENT

Other doctors (consultant)

Cytopathologist
Patient Doctor

Radiologist

Laboratory

diagnosis and treatment patient depend on one clinician only


MANAGEMENT OF CANCER PATIENT

Patient

Medical Team (teamwork)


Standard Facility
Standard Protocol
Medical Record Better Communication
Unity of work rhythm

Minimal mistake
Maximal patient service
Oncology aspect

Patients & family aspect

Outcome & Side Effect Monitoring


Oncology Aspect

Diagnose:- pathology :* morphologic class : adenoCa ?


* histologic grade
* pattern of invasion
- tumor biology ? : Her2Neu, CD20, p53, Bcl2
proliferation indeces

Diagnose: Staging
Medical Status: Risk group
- Anamnesa (co-morbid)
- Physic, Laboratory, ECG
- Performance status (Karnosfky-ECOG)
Patients & family Aspect

Information about :
- indication chemotherapy
- regimen & cycle of Chx
- Side effect of drug
- living with chemotherapy
- informed consent
Outcome & Side Effect Monitoring

Outcome Side Effect

Survival Diagnose
Objective & management
& Subjective Outcome
 Mechanism chemotherapy in cellular level
 Reduction of tumor after Chemotherapy
 Rational , patient financial ?
( influence on the response to chemotherapy )

1.Tumor cell proliferation Doubling Time


Check point controle mechanism

Cell Cycle mechanism Target of Actions of drugs


( Phase specificity ? / Non phase ?)

Mechanisme of Actions

2.Tumor cell Apoptosis Mitochondrial pathway (Bcl2 family,p53)


Death receptor pathway
(Fas-FasL, caspase family of protein)
Vinblastine
Vincristine
5 FU Colchicine
Phleomycin
Griseofulvin
Bleomycin
Cyclophosphamide
0,5-1h
Actinomycin 0.5-1h Differentiation

G2 M Hydrocortisone
2-10h Chalones
Purin antagonis
Hydroxy urea
Actinomycin D
S G1
Cyclophosphamide Mytomycin
6-20h 18-30h
6-Marcaptopurine
Doxorubicin
6-Thioguanine

5 Fudr .5FU, Ara C. 5 Fudr


Mitomycin,Doxorubicin ara C
Thioguanine 6-Hydroxyurea
5 FU
Alkylating agent METHOTREXATE
Antimetabolic
Mitotic inhibitor, Antibiotic
Number of No response Early recurrence Late recurrence
Tumor cell 1012
(1kg)

109 Tumor detectable


(1 g) (clinically)

106 Long-term Remission


(1 mg) Not palpable

Tumor invisible
Immune resistance
(Remission) 103 of host
(1 úg)
(humoral&cellular)

Induction Consolidation Maintenance Cure


Tepat indikasi : kemoterapi tepat dipilih berdasar titik
tangkap kerjanya berdasar patogenesis kanker  sehingga
dapat tercapai tujuan :
1.kuratif
2.mencapai bebas penyakit (DFI) yang lebih lama
3.neoadjuvant (mengecilkan volume tumor preoperasi-
down staging)
4.mempertahankan atau meningkatkan quality of life
(terapi paliatif)
Tepat jenis obat : sebaiknya lebih spesifik, selektif, mem-
punyai Response rate tinggi, established,
dan dapat dijangkau oleh penderita

Tepat dosis obat : sesuai Maximum Tolerated Dose


( Risk group )
Tepat cara pemberian obat : oral, IV, bolus, infusion dsb
yang penting : penderita nyaman , tidak takut dan
dengan kesadaran sendiri ingin melanjutkan kemoterapi

Tepat monitoring efek obat :


- penilaian hasil / respons terapi
- kemampuan hidup (quality of life) dan
- efek samping obat
CANCER OUTCOME of TREATMENT

1.Objective Response Evaluation


2.Subjective Response Evaluation
(3). Survival
OBJECTIVE RESPONSE EVALUATIONS

1. TUMOR SIZE :
- Complete remission (CR)
- Partial remission (PR)
- No Changes (Stable Disease = St D)
- Progressive Disease (PD)
2. Marker Tumour :
- CEA, CA15-3, MCA  Breast Ca
- CEA, CA19-9  Pancreas Ca, Colorectal Ca
- HCG  Chorio Ca
- PSA  Prostat Ca

3. Objective-Qualitative :
- Change of Clinical sign : Brain Ca-neurology sign
SUBJECTIVE RESPONSE EVALUATION

Performance status : Karnofsky / ECOG

Palliative

CURATIVE : caution of safety of side effects


SIDE EFFECT MONITORING

DIAGNOSE of Side Effect

PHARMACOLOGY
When Side effect become: NADIR point (degree of SE)
Onset of SE, Specificity of organ target

MANAGEMENT of Side Effect


Anticipation & Prevention
Dose related side effect monitoring
Early treatment of side effect
PROFILE EPISODE of FEBRIL NEUTROPENI

1 6 11 16 21 26
nadir Chemotherapy day

Chemotherapy day
FEBRILE NEUTROPENIA
CRITERIA :
• NEUTROPENIA :
absolute count of neutrophill in circulating blood < 2000 cells/mm3
• FEVER :
body temperature > 38.50C in 3 x measurement per 24 hours

DEGREE OF NEUTROPENIA

• Mild : 2000 – 1000 cells/mm3


• Moderate : 1000 – 500 cells/mm3
• Severe : < 500 cells/mm3
TREATMENT of FEBRIL NEUTROPENI

Empiric antibacterial

nadir Chemotherapy day

Empiric antibacterial
G-CSF
Sterile room

Chemotherapy day
1. Onset of SE :
- Immediately ( < 1 Hour post Chemotx)  Anaphylaxsis
- early (1- 48 hours )  Nausea-Vomiting profuse
- delayed (2 days -2 months )  leucopenia
- Late (after 2 months )  myopathy, neuropathy

2.Organ Target : CNS, Cardiovascular, Respiratory,


Gastroentestinal System

3.Level/degree of SE (IUCC,WHO, ECOG) :


- grade 0-2 : tolerable ( safety enough )
- grade 3 (severe) : must be alert (Yellow light), need treatment ±
- grade 4 (life threatening) : Hazard, early and adequate treatment
RESUME :

Better Communication
Unity of work rhythm
Minimal mistake
Maximal patient service
RESUME :

Oncology aspect Patients & family aspect

Diagnose:- pathology Information about :


- biology cell type ? - indication chemotherapy
- regimen & cycle of Chx
Diagnose: Staging - Side effect of drug
Medical Status: Risk group - living with chemtherapy
- informed consent

Outcome & Side Effect Monitoring


Survival
Side Effect : Diagnose & management
Objective & Subjective Outcome

You might also like