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The 3 events that led to the development of cancer treatment began with 3 events in the last century: the discovery of X-rays by Wilhelm Konrad Roentgen, the use of transplantable animal-tumor models in cancer research, and the first surgical procedure developed by Halsted (radical mastectomy).[1] The term “chemotherapy” was coined by German chemist Paul Ehrlich, who investigated the use of drugs to treat infectious diseases. He was also the first scientist to study animal models to screen a series of chemicals regarding their potential activity against diseases. Historical documents suggest the use of arsenicals started in the 1900s. Radiotherapy and surgery were the mainstays of cancer management in the 1960s. As micrometastases and the recurrence of cancer after surgery and radiation therapy became evident, combination chemotherapy started gaining significance.[2] Publication of the Lindskog article suggesting nitrogen mustard's success in treating lymphoma had a considerable initial effect on the development of cancer chemotherapy, including oral derivatives like chlorambucil and, ultimately, cyclophosphamide.[2] The discovery of actinomycin D pioneered the search for more antitumor antibiotics, including anthracyclines, mitomycin, and bleomycin.[3] Farber et al, in 1947, showed success in treating childhood leukemia by using antimetabolites with antifolate activity, called aminopterin, later known as methotrexate.[4] The successful management of choriocarcinoma and leukemias with methotrexate led to further investigations in cancer chemotherapy. And drugs like thiopurines (eg, 6-mercaptopurine), 5-fluorouracil came into the forefront of cancer treatment.[5] Nowell et al studied the association of translocation of chromosomes 9 and 22 to several leukemias, which later led to the development of the first molecular targeted treatments years later (imatinib).[6] Charles Huggins won a Nobel Prize in 1966 for investigations on hormone therapy in prostate cancer.[7] This work was a stepping stone to a new era of hormone therapy, with the introduction of drugs like tamoxifen and anastrozole, etc.[8][9]

Publication of the Lindskog article suggesting nitrogen mustard's success in treating lymphoma had a considerable initial effect on the development of cancer chemotherapy, including oral derivatives like chlorambucil and, ultimately, cyclophosphamide.[2] The discovery of actinomycin D pioneered the search for more antitumor antibiotics, including anthracyclines, mitomycin, and bleomycin.[3] Farber et al, in 1947, showed success in treating childhood leukemia by using antimetabolites with antifolate activity, called aminopterin, later known as methotrexate.[4] The successful management of choriocarcinoma and leukemias with methotrexate led to further investigations in cancer chemotherapy. And drugs like thiopurines (eg, 6-mercaptopurine), 5-fluorouracil came into the forefront of cancer treatment.[5] Nowell et al studied the association of translocation of chromosomes 9 and 22 to several leukemias, which later led to the development of the first molecular targeted treatments years later (imatinib).[6] Charles Huggins won a Nobel Prize in 1966 for investigations on hormone therapy in prostate cancer.[7] This work was a stepping stone to a new era of hormone therapy, with the introduction of drugs like tamoxifen and anastrozole, etc.[8][9] With an increased understanding of the biology of cancer, several therapeutic monoclonal antibodies are now available. Rituximab and trastuzumab were approved during the late 1990s to treat lymphoma and breast cancer, respectively.[10] Molecular targeted therapy is a new approach to cancer treatment. Several agents have received approval from the U.S. Food and Drug Administration in the last decade. Researchers are designing molecular targeted therapy on these pathways, selectively inhibiting growth, eg, targeting cell signaling or angiogenesis, blocking protein degradation, etc. Targeted therapies are discussed as a separate topic[11]. Immune checkpoint inhibitors PD1, PDL1, and CTLA 4, which cause immune activation against cancer cells, are widely used in various cancers. Immunotherapy is discussed in a separate topic.

Since most chemotherapy agents are administered at infusion centers, nursing and allied health professionals are significant in caring for patients on such drugs. They are usually the first point of contact for the patients. All health professionals need to understand the type of drug in use and its associated side effects for the patient. Close monitoring and early recognition of side effects can help prevent significant morbidity and mortality. For example, patients with a history of anemia or thrombocytopenia should avoid the use of NSAIDs. Intramuscular injections and rectal suppositories should be avoided in such patients. Thorough buccal cavity assessments and avoidance of commercial mouthwashes in patients with mucositis can help decrease patient discomfort. Many chemotherapeutic agents have specific known side effects that are minimizable prophylactically. For instance, following folate inhibitors such as methotrexate with folate analogs such as leucovorin helps reduce bone marrow suppression severity.[15] This concept applies to general chemotherapy side effects. For example, oral mucositis is a common chemotherapy side effect, which can be minimized by administering Palifermin, a keratinocyte growth factor that helps reduce mucosal endothelial cell damage.[16]

Thorough buccal cavity assessments and avoidance of commercial mouthwashes in patients with mucositis can help decrease patient discomfort. Many chemotherapeutic agents have specific known side effects that are minimizable prophylactically. For instance, following folate inhibitors such as methotrexate with folate analogs such as leucovorin helps reduce bone marrow suppression severity.[15] This concept applies to general chemotherapy side effects. For example, oral mucositis is a common chemotherapy side effect, which can be minimized by administering Palifermin, a keratinocyte growth factor that helps reduce mucosal endothelial cell damage.[16] Patients undergoing chemotherapy usually need strong emotional support, and they are going through anxiety, depression, and anticipatory grief from the expected side effects of the drugs. Multidisciplinary and interprofessional interventions at various stages of their treatment regimen can promote mental health. Patients undergoing chemotherapy require a team-based approach for monitoring any adverse events. The role of nursing and allied health professionals includes providing supportive care, preventing infections, monitoring for adequate nutrition and hydration, and monitoring patient safety: handwashing and infection precautions like isolation protocols require strict adherence. Since patients require frequent laboratory monitoring, it is essential to understand and equip themselves with the infusion protocol parameters and alert the treating clinicians if they notice abnormal parameters. Early nursing interventions can result in worse outcomes for patients. It is crucial to recognize the common causes and magnitude of the impact of errors involving cancer chemotherapy. Improving communication, standardizing protocols, utilizing read-back and verifying dosages, and working with pharmacists are all interventions that can help reduce medical errors in a multidisciplinary setup.

A nursing team is necessary for chemotherapy infusion and administration/monitoring. As outlined in the 'other issues' section, patients who experience complications from vesicant extravasation require nursing management.