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Cyclophosphamide is a medication primarily used in the management and treatment of neoplasms, including multiple myeloma, sarcoma, and breast cancer. Cyclophosphamide is a nitrogen mustard that exerts its anti-neoplastic effects through alkylation. This activity reviews the indications, contraindications, mechanism of action, and other key factors of cyclophosphamide as a valuable agent in the treatment and management of neoplastic diseases by an interprofessional team. There is also a discussion of cyclophosphamide use in the management of severe multiple sclerosis. Objectives: Identify the mechanism of action and administration of cyclophosphamide. Describe the adverse effects and contraindications of cyclophosphamide. Review the appropriate monitoring and toxicity of cyclophosphamide. Summarize interprofessional team strategies for improving care coordination and communication to advance cyclophosphamide and improve outcomes. Access free multiple choice questions on this topic.

Clinicians need to consider possible side effects, interactions, and associated toxicities should before administering cyclophosphamide. As an immunosuppressive agent, cyclophosphamide toxicity correlates with the development of leukopenia, thrombocytopenia, and anemia. These conditions may lead to the occurrence of recurrent infections and may interfere with wound healing. Other symptoms of cyclophosphamide toxicity include GI disturbances, alopecia, hemorrhagic cystitis, renal tubular necrosis, infertility, pulmonary fibrosis, and cardiotoxicity. The manifestation of cyclophosphamide toxicity becomes aggravated by concurrent use of phenobarbital, other myelosuppressives, radiation, and succinylcholine.[19][20] To minimize the negative effects of cyclophosphamide toxicity, recommendations include monitoring the patient’s hematologic profile and modification of treatment as needed. Patients should maintain adequate hydration, and mesna can be prescribed as prophylaxis against the development of hemorrhagic cystitis. If overdose is suspected, the patient or caregiver must seek emergency medical attention immediately.[20]

In the development of professional health care delivery, the ability of interprofessional health care providers to work as a cohesive unit has been proven to increase the quality of patient care and increase positive prognostic outcomes. This paradigm is achieved through integrated patient-centered care, sharing of values, communication, and a clear definition of interprofessional responsibilities.[21][22] In the modern health care environment, patients rely on effective teamwork within a team of health professionals. This methodology should include primary care providers, oncologists, specialty care nurses, and oncologic pharmacists. Effective communication minimizes errors and potential adverse events. Various studies on effective leadership and team development have supported Tuckman’s stages of group development. In this model, a team undergoes four stages: forming, storming, norming, and performing. Passing through all of these stages is both necessary and inevitable for an effective team to form. Following this process, the members of the team are better able to assess their roles and the roles of others on the team. Each member possesses specialized skills and knowledge complementary to the others, allowing for heightened patient care.[23] This coordination is key in the appropriate use of cyclophosphamide. Adhering to the Team-Based Competencies set forth by the Interprofessional Education Collaborative, including honesty, discipline, and mutual goals, the healthcare team, is better able to assess the appropriate management of cyclophosphamide use. On an organizational level, enhanced teamwork can lead to reduced time and costs associated with hospitalizations, reduced unexpected admissions, and increased ease of access to services. From a patient’s perspective, effective teamwork means increased satisfaction with care, improved prognosis, and a reduction in medical error.[22] [Level 1]

This coordination is key in the appropriate use of cyclophosphamide. Adhering to the Team-Based Competencies set forth by the Interprofessional Education Collaborative, including honesty, discipline, and mutual goals, the healthcare team, is better able to assess the appropriate management of cyclophosphamide use. On an organizational level, enhanced teamwork can lead to reduced time and costs associated with hospitalizations, reduced unexpected admissions, and increased ease of access to services. From a patient’s perspective, effective teamwork means increased satisfaction with care, improved prognosis, and a reduction in medical error.[22] [Level 1] Interprofessional team dynamics in using cyclophosphamide include the prescriber deciding it is the appropriate agent for the patient, but that is only the beginning. A board-certified oncology pharmacist should be consulted regarding potential drug interactions, appropriate dosing, and have involvement in the ongoing monitoring of the patient. Once on the drug, oncology specialty nurses should have involvement in monitoring the patient for treatment progress as well as adverse drug reactions and can reach out to the oncology pharmacist and/or the oncologist as appropriate. These interprofessional examples will result in better outcomes with cyclophosphamide. [Level 5]