1. Vega-Stromberg, Teri MSN, RN, AOCN


Changes in chemotherapy protocols have influenced the risk and rate of secondary malignancies in high-risk populations. The alkylating agents, topoisomerase inhibitors, and anthracycline agents pose the highest risk of initiating carcinogenesis. Normal cells that are especially sensitive to chemotherapy and most likely to begin carcinogenesis include those of the bone marrow, hair follicles, and the epithelial cells of the gastrointestinal tract. Thus, the development of secondary hematologic cancers such as leukemia and lymphoma pose the greatest risk to adult and childhood cancer survivors. Lifelong surveillance is recommended.


Nurses are attracted to oncology care for several reasons. Many are drawn and rewarded by meaningful relationships established with patients and families. Cancer nursing gives nurses the opportunity to meet and follow oncology patients for several months to years. The average age of a nurse is 44 years in our acute care setting. Many nurses have remained in our acute cancer care for more than 10 years; some for more than 20 years. The nurse's role in the care of patients receiving chemotherapy is multifaceted. Nurses are actively involved in patient education, drug administration, side-effect management, and in making patients aware of long-term effects. Nurses make a significant contribution to the patient's ability to get through treatment and maintain their quality of life. 1


Sadly, for some patients, cancer returns or a second malignancy develops. Witnessing patients return to clinical settings after a cancer recurrence or secondary malignancy is devastating. How do nurses feel about their role in giving treatment that may have caused a secondary malignancy? Nurses often struggle with the ethical principles of nonmaleficence, to do no harm, and beneficence, to do good. Does the chemotherapy we administer provide more benefits or more risks to patients? How do we prepare and educate potential cancer survivors? What are the chances that a second malignancy will occur? This article will review the process of carcinogenesis, provide an overview of chemotherapy agents that are risk factors for developing a secondary malignancy, and discuss high-risk patient populations.