Hormones and hormone modulators for cancer: Nursing pharmacology

Hormones and hormone modulators are a group of medications that suppress the function of specific hormones, which slows or stops the growth of hormone-dependent cancers, such as breast, endometrial, and prostate cancers.

They can also be used to ease the symptoms caused by certain types of cancer, such as brain or renal cancers. Now, hormones and hormone modulators can be broadly classified as sex hormones, anti-estrogens, aromatase inhibitors, anti-androgens, and gonadotropin releasing hormone analogs.

Now, some commonly used sex hormones include hydroxyprogesterone, which is administered intramuscularly or subcutaneously for advanced uterine adenocarcinoma, as well as medroxyprogesterone and Magestrel, which are taken orally for endometrial or breast cancer.

Once administered, these medications work by suppressing the pituitary gland from releasing gonadotropins, so follicle stimulating hormone or FSH for short, and luteinizing hormone, or LH.

As a result, gonadotropins aren't available to stimulate sex hormone production by the gonads, which ultimately delays the growth of sex hormone dependent tumors.

There are also anti-estrogens, which include selective estrogen receptor modulators, or SERMs for short, such as tamoxifen, raloxifene, and Fulvestrant.

These medications are administered orally and work by blocking estrogen receptors on cancer cells, which delays the growth of estrogen dependent tumors.

Similarly, there's aromatase inhibitors, which include anastrozole, letrozole, and exemestane. These medications are administered orally and act by blocking the production of estrogen, which ultimately also helps limit the growth of estrogen dependent tumors.

Next, there are anti-androgens, which include flutamide, alutamide, and bialutamide. These medications are also administered orally, and they block androgen receptors on cancer cells, ultimately stopping the growth of androgen dependent tumors like prostate cancer.

Finally, gonadotropin releasing hormone or GNRH analogs include leuprolide and goerrelin. These medications are administered subcutaneously, and leuprolide may also be administered intramuscularly.

Once administered, these medications inhibit the release of gonadotropins from the pituitary gland. This blocks the secretion of sex hormones by the gonads, ultimately stopping the growth of sex hormone dependent tumors, like breast or prostate cancers.

All right, now, common side effects of hormones and hormone modulators can include weight gain, myalgia, arthralgia, and even fractures due to decreased bone mineral density, as well as decreased libido, gynecomastia, hot flashes, and vaginal discharge, dryness or irritation.

Additionally, clients may experience gastrointestinal side effects such as anorexia, nausea, vomiting, or diarrhea. More serious side effects include an increased risk for cardiovascular disease.

Finally, tamoxifen and Raloxifene have boxed warnings for causing thromboembolic events and stroke. And tamoxifen also has a boxed warning for causing uterine cancers.

And flutamide has a boxed warning for severe hepatotoxicity. Now, some hormones and hormone modulators are contraindicated in pregnancy and breastfeeding.

Caution should be taken in clients with hepatic or renal disease. All right.

When caring for a client prescribed tamoxifen for ductal carcinoma in situ, start by assessing their vital signs and reviewing their most recent laboratory test results, including liver and renal function, CBC, calcium, and lipid panel.

Lastly, review diagnostic tests like mammogram, ultrasound, MRI and biopsy results, as well as baseline bone mineral density test.

OK, moving on to client education. Explain to your client that the medication will help delay the growth of their tumor and decrease the risk of developing invasive breast cancer.

Instruct them to take their medication once daily, with or without food, and remind them to avoid grapefruit juice during treatment.

Let your client know that during therapy, they will follow up with their healthcare provider regularly for breast, eye, and bone density exams, as well as for mammograms, gynecological exams to detect the development of endometrial or uterine carcinoma, and laboratory tests to monitor lipids and calcium levels.

Then, let your client know some of the common side effects they may experience during therapy, such as weight gain, hot flashes, and myalgia, as well as vaginal dryness or irritation.

And encourage them to notify their healthcare provider if these side effects become severe or persistent. Also, let your client know that at the start of therapy, they may experience a temporary increase in the size of their tumor.

In addition, emphasize the importance of seeking immediate medical attention if they experience symptoms of clotting, such as weakness on one side of the body, problems speaking or breathing, chest pain, coughing up blood, and pain or swelling in the lower extremities, or if they notice any visual changes, such as decreased visual acuity or changes in color perception.

Lastly, prompt your client to notify their healthcare provider if they notice any symptoms of hypercalcemia, which can manifest as muscle weakness, fatigue, nausea, constipation, or bone pain, as well as indications of new malignancies, such as breast soreness or pain, as well as pelvic pain or pressure, or abnormal vaginal bleeding.

Finally, during treatment with a hormone modulator like tamoxifen, be sure to closely monitor your client for the development of side effects and evaluate for the desired therapeutic effect of a decreased tumor size and slowed cancer progression.

All right, as a quick recap, hormones and hormone modulators are a group of medications that slow or stop the growth of hormone dependent cancers and ease symptoms of brain or renal cancers.

These medications can be classified as sex hormones, anti-estrogens, aromatase inhibitors, anti-androgens, and gonadotropin releasing hormone analogs.

Once administered, these medications work by either suppressing or reducing the release of gonadotropins from the pituitary gland, blocking sex hormone receptors on cancerous cells, or blocking estrogen production.

Side effects can include weight gain, hot flashes, myalgia, arthralgia, and decreased bone mineral density, as well as hepatotoxicity, increased risk of clot formation and thromboembolic events.

Increased risk of uterine cancer and QT prolongation. When caring for a client taking a hormone or hormone modulator, nursing considerations include performing a baseline assessment and monitoring for the development of side effects, as well as for the desired therapeutic effect.

Client teaching is focused on safe self-administration, learning to recognize side effects, and when to contact the healthcare provider.