The use of medicines is an integral part of an adequate modern treatment for cancer patients. More than half a century of clinical chemotherapy along with data on the effectiveness of antitumor agents and their combinations has been enriched by the extensive experience in identifying complications of drug treatment. However, several side effects significantly impair the quality of life of patients and have a dose-limiting nature, which sets tough conditions for the decision to modify doses of cytostatics, the mode of their administration, and even the possibility of continuing antitumor therapy. This project aims at developing a new neurological assessment tool for patients receiving high doses of Ara-C (cytarabine).
Unlike most other complications of chemotherapy, the clinical manifestation of neurotoxicity is usually subjective and relates to neurosensory symptoms. According to Szoch and Kaiser (2015), “patients receiving high-dose cytarabine have a 7-28 percent incidence of neurotoxicity” (p. 270).
The evaluation of the severity of neurological disorders remains rather conditional and largely depends on the experience of a doctor and a nurse. In this connection, the focus should shift to determining the severity of functional disorders and their effects on the daily activities of patients. The National Cancer Institute-Common Toxicity Criteria (NCI-CTC) present the most frequently used criteria for neurotoxicity detection in clinical practice.
The early prevention as well as timely recognition and correction of chemotherapy complications are the indispensable conditions for the competent and safe treatment of cancer patients. In this regard, the need for the improved neurological assessment instrument becomes evident. It is expected that such a tool would allow enhancing the quality of nursing care by providing the appropriate and timely evaluation of neurotoxicity risks. The early identification of signs and symptoms of neurotoxicity will significantly decrease the occurrence of serious neurological damage to patients. More to the point, the need for the mentioned intervention is caused by the need for providing patients with the best care possible, thus facilitating their quality of life.
The prospective study will be conducted at Baptist Health of South Florida, namely at the oncology unit. The goal of the project aligns well with the core mission of the organization: “to maintain the highest standards of clinical and service excellence” (“Baptist Health of South Florida”, 2016, para. 1). The oncology unit strives to provide development and introduction of multidisciplinary approaches into clinical practice and improvement of quality of medical care for cancer patients. The unit conducts the promotion of scientific research in oncology, contributing to the effectiveness of drug therapy and multidisciplinary approaches.
The reason for selecting this particular project concerns the necessity to pay more attention to the elimination and, most importantly, prevention of the side symptoms, occurring as a result of high doses of cytarabine.
In particular, these effects may be expressed in thrombocytopenia, anemia, and leucopenia from the hemopoietic system; nausea, vomiting, stomatitis, anorexia, and esophagitis on the part of the digestive system; pulmonary edema or diffuse interstitial pneumonitis from the respiratory system; and paresthesia, unusual fatigue, confusion, memory loss, convulsions, and dysarthria from the central and peripheral nervous system (Bradstock et al., 2016; Tran & Kong, 2017). The mentioned list presents the most common effects, yet it is not limited to them.
The application of SMART goals into the elaboration and implementation of this project is likely to contribute to the effectiveness of student learning outcomes, as noted by Lawlor (2012). In this project, the core goal is to improve the organization’s performance to contribute to safety and quality of health care delivery. The expected time of completion is one month that seems to be sufficient to implement all the prospects of this project.
In particular, it is essential to change the current nursing practice and implement a new tool to assess the onset neurological changes in patients. In the course of the new strategy introduction, the particular attention is to be paid to the level of staff performance. The promotion of attentiveness and accuracy as well as personnel engagement into the evaluation are the key aspects needed for the successful implementation of the project.
At the same time, the coordinated care seems to be another key factor that would determine the outcome of the project. The development of the tool is to be implemented in collaboration with all department nurses, so that each of them would be aware of his or her role and also the general purpose of the intervention. Both qualitative and quantitative methods will be used to implement the tool and evaluate its effectiveness. Such an approach will ensure rigor of the study by providing credibility, validity, and reliability (Keister & Grames, 2012).
In the course of the project introduction, it is expected to establish proper contacts with both staff and patients in order to design the open dialogue and promote trustful relationships. To sum it up, one may note that the proposed project will contribute to practice of oncology nursing by serving as guidance for the early detection and effective assessment of cytarabine-related neurotoxicity symptoms.
References
Baptist Health of South Florida. (2016). Web.
Bradstock, K. F., Morley, A., Byth, K., Szer, J., Prosser, I., Cannell, P.,… Seymour, J. F. (2016). Effects of intensive induction and consolidation chemotherapy with idarubicin and high dose cytarabine on minimal residual disease levels in newly diagnosed adult precursor-B acute lymphoblastic leukemia. Contemporary Clinical Trials Communications, 4(1), 9-13.
Keister, D., & Grames, H. (2012). Multi-method needs assessment optimises learning. Clinical Teacher, 9(5), 295-298.
Lawlor, K. B. (2012). Smart goals: How the application of smart goals can contribute to achievement of student learning outcomes. Development of Business Simulation and Experiential Learning, 39(1), 254-267.
Szoch, S., & Kaiser, K. S. (2015). Implementation and evaluation of a high-dose cytarabine neurologic assessment tool. Clinical Journal of Oncology Nursing, 19(3), 270-272.
Tran, P. N., & Kong, X. T. (2017). Cytarabine induced acute cerebellar syndrome during hyper-CVAD treatment for B-cell acute lymphoblastic leukemia. Case Reports in Neurology, 9(1), 114-120.