Chemotherapy, targeted therapy and immune therapy
The area of chemotherapy, targeted therapy and immune therapy is continually evolving with new agents regularly being brought to market. Regimes can be complex and the agents used often have multiple side effects and potential for serious interactions (e.g. dasatinib, ibrutinib and regorafenib are known to increase the risk of bleeding).
Depending on the medication involved treatment may be oral, intravenous, subcutaneous, intramuscular or intrathecal. Chemotherapy is usually given in cycles whereas targeted therapy and immune therapy can involve continuous treatment. Treatment can either have a curative or palliative intent.
The management of cancer patients requiring surgery requires special consideration. Surgery may be related to the cancer diagnosis / treatment (e.g. neo-adjuvant chemotherapy before oesophagectomy or radiologically inserted gastrostomy (RIG) insertion for a patient receiving treatment for head and neck cancer) or it may be unrelated.
The current UKCPA Handbook does not include perioperative recommendations for patients receiving chemotherapy, targeted therapy or immune therapy due to the specialist nature of these agents, however this is something we are looking to include in future updates. The patient’s Oncologist / Haematologist should be involved in the planning for surgery for these patients and advice sought from specialist oncology Pharmacists where appropriate. This multidisciplinary input is required as it may be necessary to schedule surgery around treatment cycles, delay treatment cycles or even omit doses.