Hormonal Therapy

Introduction

Hormonal Therapy: Hormones are chemicals secreted from the organs of the body’s endocrine system (the pancreas, and the pituitary, thyroid, and adrenal glands). These chemicals move through the body in the bloodstream. Some examples of hormones are estrogen, testosterone, insulin, thyroid hormone, cortisol, and epinephrine. Hormone therapy is most often used to treat breast and prostate cancers.

Definition

Hormone therapy is a type of cancer treatment that removes, blocks, or adds specific hormones to the body. It is also called hormonal therapy or endocrine therapy.

Purposes

• Treat a certain kind of cancer by stopping or slowing its growth.
• Lessen symptoms related to a certain type of cancer.

Indications

• Breast cancer.
• Estrogen and progesterone receptor testing for breast cancer.
• Prostate cancer.
• Thyroid cancer.
• Adrenal cancer.
• Neuroendocrine tumors.
• Pituitary gland tumor.
• Uterine cancer.

Contraindications

• Current, past, or suspected breast cancer.
• Known or suspected estrogen-sensitive cancer.
• Undiagnosed vaginal bleeding.
• Untreated endometrial hyperplasia.
• Previous idiopathic or current venous thromboembolism (deep vein thrombosis or pulmonary embolism), unless the woman is already on anticoagulant treatment.
• Active or recent arterial thromboembolic disease (e.g., angina or myocardial infarction).
• Untreated hypertension.
• Active liver disease with abnormal liver function tests.
• Pregnancy.

Types

Routes of Administration

Hormone therapy can be given in different ways. They include the following:

• Oral hormone therapy.
• Injected hormone therapy.
• Surgical ablation.

Advantages

• Reduction of vasomotor symptoms.
• Improvement of urogenital symptoms.
• Reduction of the risk of developing osteoporosis.
• Cardiovascular protection.

Complications

• Breast cancer.
• Stroke.
• Venous thromboembolism.

General Guidelines on Hormonal Therapy

• Ensure proper hand washing before performing the procedure.
• Use personnel protective equipment (gown, mask, caps, chemotherapy gloves/double gloves, goggles) and biological safety cabinet (laminar hood).
• The examinations required to be conducted prior to hormonal replacement are history taking, physical examination, and blood investigations such as liver function, kidney function, anemia, fasting blood sugar, and blood tests of serum lipid profile followed by confirmatory diagnosis.
• Hormone therapy during menopausal transition should primarily be conducted based on the frequency and severity of symptoms, and lifestyle adjustments and use of adjuvant therapy could be partially effective.
• Monitor for adverse reactions such as hot flashes, night sweats, weight gain, vaginal dryness, headache, nausea, hair loss, thinning, muscle aches and joint pain, blood clots and increased risk of uterine/endometrial cancer, breast tenderness or enlargement, loss of sex drive, and impotence. Immediately report to the physician for withholding the therapy.
• Monitor the IV site for any signs of infection.
• Teach the patient about the complications of therapy.

Documentation

• Document the date, time, number of cycles, duration of therapy, and condition of the patient before and after the procedure.
• Document if any side effects were experienced.

Special Considerations

• Assess for cardiovascular disease, osteoporosis, and cancer risk before initiating therapy.
• Some patients may require genetic screening to determine suitability for hormone therapy.
• Patients should undergo routine screenings for breast cancer, blood pressure, and bone density.
• Monitor for hot flashes, mood changes, and thrombotic risks associated with hormone therapy.
• Hormone therapy should be customized based on patient needs and response.
• Therapy should be initiated within 10 years of menopause for optimal benefits.
• Hormonal therapy may be contraindicated for those with hormone-sensitive cancers.
• Older adults may require adjusted doses due to metabolic changes.
• Encourage healthy nutrition and physical activity to support hormonal balance.
• Some patients may benefit from non-hormonal treatments for symptom relief.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
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4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
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