Docetaxel

INTRODUCTION

Indications

Breast cancer (locally advanced/metastatic breast cancer or with doxorubicin and cyclophosphamide as adjuvant treatment of node-positive disease). Non–small-cell lung cancer (locally advanced/metastatic) after failure on platinum regimen or with platinum as initial therapy). Advanced metastatic hormone-refractory prostate cancer (with prednisone). Squamous cell carcinoma of the head and neck (inoperable, locally advanced) with cisplatin and fluorouracil.

Action

Interferes with normal cellular microtubule function required for interphase and mitosis. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue, weakness. Resp: bronchospasm. CV: ASCITES, CARDIAC TAMPONADE, PERICARDIAL EFFUSION, PULMONARY EDEMA, peripheral edema. GI: diarrhea, nausea, stomatitis, vomiting. Derm: alopecia, rashes, dermatitis, desquamation, edema, erythema, nail disorders. Hemat: anemia, thrombocytopenia, leukopenia. Local: injection-site reactions. MS: myalgia, arthralgia. Neuro: neurosensory deficits, peripheral neuropathy. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of pericardial effusion and cardiac tamponade, including chest pain, dyspnea, shortness of breath when reclining, dry cough, low-grade fever, fainting, dizziness, tachycardia, and a feeling of anxiety. Report these signs to the physician or nursing staff immediately.

• Assess any breathing problems, bronchospasm, or signs of pulmonary edema, including cough, shortness of breath, chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• 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 leukopenia (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 or nursing staff.

• Be alert for signs of peripheral neuropathy (numbness, tingling, 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.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or biomechanical problems.

• Monitor IV injection site for pain, swelling, and inflammation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are ...