The Patients’ Journey with Targeted Therapies

  • Christine RemacleEmail author
Part of the Principles of Specialty Nursing book series (PSN)


Oral targeted therapies have become central in the management of advanced cancer since they delay the progression of the disease and extend overall survival of the patients. Targeted therapies, despite inducing some dramatic response, rarely eradicate cancer but rather switch it to a chronic state. This implies that the treatments are taken chronically over several months or years with consequences on compliance. This is of particular importance since these drugs have also specific side effects that can greatly affect patients’ quality of life. In the present chapter, the main side effects of targeted therapies, their management from the angle of specialised nursing care, and several prophylactic measures have been reviewed. The nurse indeed plays a critical role in guiding and supporting patients receiving oral treatments. A multidisciplinary and multi-professional approach involving physicians, pharmacists, and paramedical staff guarantees a better efficiency. In addition, properly educated patients will improve their adherence to treatment.


Targeted cancer therapy Treatment adherence Therapeutic education Side effects Guidelines Quality of life 


  1. 1.
    Adherence to long-term therapies: evidence for action. Available from
  2. 2.
    Mikael D. Chimiothérapie orales: Mythes et réalités, centre Henri Bequerel, Rouen. 2010.
  3. 3.
    Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, et al. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract. 2011;7(1):7–12.CrossRefGoogle Scholar
  4. 4.
    National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Available from Accessed 16 Mar 2009.
  5. 5.
    Targeted Therapy, American Society of Cancer. Available from
  6. 6.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 388. Scholar
  7. 7.
    Autier J, Escudier B, Wechsler J, Spatz A, Robert C. Prospective study of the cutaneous adverse effects of sorafenib, a novel multikinase inhibitor. Arch Dermatol. 2008a;144(7):886–92.CrossRefGoogle Scholar
  8. 8.
    Lacouture ME, Tsao AS, Oishi K. Strategies for rash management: an expert-guided discussion for nurses. ONS Connect. 2010;25:47–8.Google Scholar
  9. 9.
    Autier J, Mateus C, Wechsker J, Spatz A, Robert C. Cutaneous side effects of Sorafenib and sunitinib. Ann Dermatol Venereol. 2008b;135(2):148–53;quiz 147, 154.CrossRefGoogle Scholar
  10. 10.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 385–6. Scholar
  11. 11.
    Ocvirk J, Heeger S, McCloud P, Hofheinz RD. A review of the treatment options for skin rash induced by EGFR-targeted therapies: evidence from randomized clinical trials and a meta-analysis. Radiol Oncol. 2013;47:166–75.CrossRefGoogle Scholar
  12. 12.
    Robert C, Soria J-C, Spatz A, Le Cesne A, Malka D, Pautier P, et al. Cutaneous side effects of kinase inhibitors and blocking antibodies. Lancet Oncol. 2005;6(7):491–500.CrossRefGoogle Scholar
  13. 13.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 397–8. Scholar
  14. 14.
    Mario E, Lacouture ME. The growing importance of skin toxicity in EGFR inhibitor therapy. Oncology (Williston Park). 2009;23(2):194–6.Google Scholar
  15. 15.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 399–400. Scholar
  16. 16.
    Braiteh F, Kurzrock R, Johnson FM. Trichomegaly of the eyelashes after lung cancer treatment with the epidermal growth factor receptor inhibitor erlotinib. J Clin Oncol. 2008;26:3460–2.CrossRefGoogle Scholar
  17. 17.
    Scheinfeld N. Imatinib mesylate and dermatology part 2: a review of the cutaneous side effects of imatinib mesylate. J Drugs Dermatol. 2006;5(3):228–31.PubMedGoogle Scholar
  18. 18.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 483. Scholar
  19. 19.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 485. Scholar
  20. 20.
    Ederhy S, Cohen A, Dufaitre G, Izzedine H, Massard C, Meuleman C, et al. QT interval prolongation among patients treated with angiogenesis inhibitors. Target Oncol. 2009;4(2):89–97.CrossRefGoogle Scholar
  21. 21.
    Maitland ML, Kasza KE, Karrison T, Moshier K, Sit L, Black HR, et al. Ambulatory monitoring detects sorafenib-induced blood pressure elevations on the first day of treatment. Clin Cancer Res. 2009;15(19):6250–7.CrossRefGoogle Scholar
  22. 22.
    Van der Veldt AAM, de Boer MP, Boven E, Eringa EC, van den Eertwegh AJM, van Hinsbergh VW, et al. Reduction in skin microvascular density and changes in vessel morphology in patients treated with sunitinib. Anti-Cancer Drugs. 2010;21(4):439–46.CrossRefGoogle Scholar
  23. 23.
    Dicato MA, editor. Side effects of medical cancer Therapy. p. 515–6. Scholar
  24. 24.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 277. Scholar
  25. 25.
    Bjordal JM, Bensadoun RJ, Tuner J, Frigo L, Gjerde K, Lopes-Martins RA. A systematic review with meta-analysis of the effects of low-level laser therapy (LLLT) in cancer therapy-induced oral mucositis. Support Care Cancer. 2011;19(8):1069–77.CrossRefGoogle Scholar
  26. 26.
    Hapani S, Chu D, Wu S. Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis. Lancet Oncol. 2009;10(6):559–68.CrossRefGoogle Scholar
  27. 27.
    BCCA guidelines for management of chemotherapy-induced diarrhea. Available from
  28. 28.
    Benson AB, Ajani JA, Catalano RB, Engelking C, Kornblau SM, Matrenson JA Jr, et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol. 2004;22(14):2918–26.CrossRefGoogle Scholar
  29. 29.
    Lim SL, Ang E. Validity and reliability of nutrition screening administered by nurses. Sage Journals. First published October 9, 2013.Google Scholar
  30. 30.
    Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116–22.CrossRefGoogle Scholar
  31. 31.
    Nitenberg G, Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol. 2000 Jun;34(3):137–68.CrossRefGoogle Scholar
  32. 32.
    Joly F. Renal carcinoma and fatigue: which challenge in the era of antiangiogenic drugs. Bull Cancer. 2011;98(9):1071–81. Scholar
  33. 33.
    Dicato MA, editor. Side effects of medical cancer therapy. p. 278–9. Scholar
  34. 34.
    Horne R. Compliance, adherence and concordance. In: Taylor KMG, Harding G, editors. Pharmacy practice. London: Taylor & Francis; 2001.Google Scholar
  35. 35.
    NICE Medicines Adherence guidelines. 2009. Available from
  36. 36.
    Claxton AJ, Cramer J, Pierre C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296–310.CrossRefGoogle Scholar
  37. 37.
    McCue DA, Lohr LK, Pick AM. Improving adherence to oral cancer therapy in clinical practice. Pharmacotherapy. 2014;34(5):481–94.CrossRefGoogle Scholar
  38. 38.
    MASCC Oral Agent Teaching Tool (MOATT). Available from
  39. 39.
    NCCN Distress thermometer and problem list for patients. Available from

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.King Albert II Institute for Cancerology and HaematologyCliniques Universitaires Saint-LucBrusselsBelgium

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