Chemotherapy-induced nausea and vomiting (CINV) remains an important and common toxicity of cancer treatment. Recent guideline revisions have classified chemotherapeutic agents into four categories of emesis risk without the use of preventive agents: high (> 90%), moderate (30%-90%), low (10%-30%), and minimal (< 10%). Currently available antiemetic agents, including corticosteroids, 5-hydroxytryptamine (HT)3 receptor antagonists, and neurokinin (NK)-1 antagonists are used alone or in combination depending on the level of emetogenic potential as prophylaxis against the development of CINV during the acute period (up to 24 hours after chemotherapy) and the delayed period (up to 5 days after treatment). Newer agents, including the second-generation 5-HT3 receptor antagonist palonosetron (Aloxi) and the NK-1 antagonist aprepitant (Emend), offer additional clinical benefit in highly and moderately emetogenic therapy. However, delayed nausea and vomiting continue to occur frequently in many patients and have an impact on quality of life. Other classes of agents including the benzodiazepines and cannabinoids offer the potential for additional protective benefit. Continued research with new drugs and combinations is necessary to meet this significant unmet need of cancer patients.
Diabetes mellitus is a frequent comorbidity of cancer patients. The growing epidemic of diabetes is anticipated to have tremendous impact on health care. Diabetes may negatively impact both cancer risk and outcomes of treatment. Oncology nurses are ideally positioned to identify patients at risk for complications that arise from cancer treatment in the setting of pre-existing diabetes. Additionally, oncology nurses may be the first to identify underlying hyperglycemia/hidden diabetes in a patient undergoing cancer treatment. Strategies for assessment and treatment will be discussed, along with specific strategies for managing hyperglycemia, potential renal toxicity, and peripheral neuropathy. Guidelines for aggressive treatment of hyperglycemia to minimize risks of complications will be reviewed. The role of interdisciplinary care, utilizing current evidence, is crucial to supporting patients and their families as they manage the challenges of facing two life-limiting diseases. Whole-person assessment and individualized treatment plans are key to maximizing quality of life for patients with cancer and diabetes.
Gina, age 9, and Rosemary, age 66. They had different cancers, but developed similar skin ulcers over their entire bodies. Gina's wounds were open to air for 4 weeks. Her pain was severe. Two weeks after starting wound care, Gina allowed us to take pictures of her wounds. We promised to teach doctors and nurses how to care for her wounds. Unfortunately, Gina died. The pictures were lost. A year later, Rosemary was admitted with a similar skin condition and allowed us to photograph the progression of her wound care. Our promise to Gina is now kept. Here we describe the wound care plan necessary to relieve the pain and discomfort of partial-thickness wounds from dermatological conditions in oncology patients.
In a recent letter to Steve Phurrough, MD, of the Centers for Medicare & Medicaid Services (CMS), Joseph S. Bailes, MD, chair of ASCO's Government Relations Council, asked that CMS withdraw its proposed decision memorandum regarding coverage of erythropoiesis-stimulating agents (ESAs) in nonrenal disease indications
Merck & Co., Inc. announced that it has received an approvable letter from the US Food and Drug Administration (FDA) for the company's New Drug Application (NDA) for Emend (fosaprepitant dimeglumine) for Injection, also known as MK-0517, an investigational intravenous therapy for chemotherapy-induced nausea and vomiting.
US Food and Drug Administration (FDA) has approved a new indication for dalteparin sodium injection (Fragmin), for the extended treatment of symptomatic venous thromboembolism (VTE) [proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE)] to reduce the recurrence of VTE in patients with cancer.
The Food and Drug Administration (FDA) should require additional restrictions in product labeling and/or additional clinical trials before approving new erythropoiesis-stimulating agents (ESAs) or new indications for ESAs already on the market, the Oncologic Drugs Advisory Committee (ODAC) told the agency.
Aranesp (darbepoetin alfa, Amgen) significantly reduced red blood cell (RBC) transfusions and did not affect overall or progression-free survival, compared with placebo, in a randomized, double-blind, phase III trial in 600 patients with previously untreated extensive-stage small-cell lung cancer receiving platinum-based chemotherapy.
A phase III study evaluating the benefit of darbepoetin alfa (Aranesp) in preventing transfusions in cancer patients not undergoing chemotherapy failed to reach its primary endpoint and demonstrated worse survival in the treatment arm
FDA has approved a new indication for Pfizer and Eisai's Fragmin (dalteparin sodium injection), for the extended treatment of symptomatic venous thromboembolism (VTE)proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE)to reduce the recurrence of VTE in patients with cancer.
Progenics Pharmaceuticals, Inc., in collabortion with Wyeth Pharmaceuticals, has submitted a new drug application (NDA) to the FDA for the subcutaneous formulation of methylnaltrexone for the treatment of opioid-induced constipation (OIC) in patients receiving palliative care.
Palliative care differs from other oncology care settings because it involves end-of-life discussions. This article is intended to help oncology nurses who deliver news that involves palliative care by describing components of breaking bad news, providing an example for how to break bad news, and suggesting methods for evaluating a nurse-patient interaction. One possible scenario for achieving a positive outcome after delivering unwelcome information will also be described. Applying the methods described in this article can help to promote a positive outcome when a nurse delivers bad news to a patient.