Nursing considerations in caring for the child with vincristine-induced neurotoxicities

Vincristine is a highly effective cell-cycle specific chemotherapeutic agent used in the treatment of most pediatric malignancies. The major dose-limiting side effect of this drug is neurotoxicity, which can present in the form of peripheral, autonomic, or cranial nerve deficits. Conditions such as liver dysfunction can increase the risk for vincristine neurotoxicity. The only treatment for severe toxicity is to decrease the drug dose or to discontinue the drug. Many of the symptoms of neurotoxicity are subjective and therefore adequate assessment is often difficult. Baseline data is obtained before starting vincristine and with each subsequent clinic visit so that the appropriate drug dose can be determined to maximize tumor response with the fewest side effects. Nursing interventions are directed at symptom management. Patient-family education centers on relating informing of the potential and symptoms of neurotoxicity, with an emphasis on safety precautions.