Managing the side effects of chemotherapy.

More chemotherapy is being administered today than ever before. Megadoses of these drugs are becoming commonplace. Better methods of drug delivery, patient monitoring, and sophisticated support services such as infectious disease specialists, transfusion therapy, intensive care facilities, oncology clinical nurse specialists, and others, enable the physician to treat the patient in a variety of settings, including ambulatory care centers and the home. Just as the nurse needs advanced skills and the knowledge to know the subtle differences between an expected side effect and a toxic reaction, the patient needs to learn preventive health care and which symptoms to report at a time when management strategies can be most effective. Research by Dodd indicates that patients who received information on side-effect management techniques performed more self-care behaviors, and many acted promptly before side effects became persistent or severe. In addition, Stromberg advocates teaching self care to encourage persons with cancer to increase their sense of self-control and lessen feelings of helplessness that often accompany cancer and its treatment. The nurse is further challenged to teach patients to actively participate in their care rather than remaining dependent on the health-care professional. Using skill as a patient educator, the nurse enlists the patient and family members in a partnership to promote self-care. This requires the nurse to use great creativity and flexibility to individualize the approach to patient management problems.