CANCER CHEMOTHERAPY Brief History. R.J. is a 57-year-old woman who was diagnosed with metastatic breast cancer 1 year ago, at which time she underwent a modifi ed radical mastectomy followed by treatment with antineoplastic drugs. The cancer, however, had evidently metastasized to other tissues, including bone. She recently developed pain in the lumbosacral region, which was attributed to metastatic skeletal lesions in the lower lumbar vertebrae. She was admitted to the hospital to pursue a course of radiation treatment to control pain and minimize bony destruction at the site of the skeletal lesion. Her current pharmacological regimen consists of an antineoplastic antimetabolite (doxorubicin) and an antiestrogen (tamoxifen). She was also given a combination of opioid and nonopioid analgesics (codeine and aspirin) to help control pain. Physical therapy was initiated to help control pain and maintain function in this patient.
Problem/Influence of Medication. The patient began to experience an increase in GI side effects, including nausea, vomiting, loss of appetite, and epigastric pain. The patient, however, experienced adequate pain relief from the aspirin-codeine combination and was reluctant to consider alternative medications. The persistent nausea and loss of appetite had a general debilitating effect on her, and the physical therapist was having diffi culty engaging her in an active general conditioning program.
1. Why does R.K.’s drug regimen contribute to her GI problems?
2. How might the therapist intervene to help decrease the patient’s pain and reduce the need for analgesic medications?
