A Look Through the Prism of Cancer Nursing Today

This issue of ONCOLOGY Nurse Edition represents the full range of the cancer-management spectrum: Anna Schwartz and Laura Zitella, respectively, re-examine standard protocols and prevailing clinical assumptions in their review of evidence-based approaches toward relieving cancer-related fatigue and managing cancer patients' anemia. In contrast, Ellen Giarelli, in her cancer vaccine review, looks over the horizon at novel and promising approaches now under investigation for both treatment and prevention of cancer.

Also in this issue, Sandra Kurtin provides a comprehensive review of diagnosis and management options for patients with myelodysplastic syndromes; Gail Wilkes discusses histone deacetylase inhibitors, a promising class of gene-modulating antitumor agents; Melissa Craft explores in a case report genetic counseling and monitoring guidelines for women at high risk of breast cancer; Belinda Mandrell describes a case study evaluating secondary breast cancer as a late effect of radiation treatment in childhood for Hodgkin lymphoma; and Sharon Van Fleet reports on clues that a patient may benefit from a referral for psychiatric counseling.

This range of discussions embodies the essence of our practice: continuous reassessment of standard protocols, procedures, and treatments, and ongoing education about a variety of new and emerging management approaches.

Cancer-related fatigue presents special clinical challenges, as Dr. Schwartz suggests. As Ann M. Berger notes in an accompanying commentary, translational research eventually may uncover the root causes of fatigue in common types of cancer, enabling development of more effective interventions. In the meantime, as Drs. Schwartz and Berger indicate, exercise programs continue to benefit many cancer patients with fatigue.

With respect to cancer vaccines, given the increasing number of clinical trials in this area, it will be incumbent upon oncology nurses to develop at least a basic understanding of the immunotherapeutic principles underlying some of the more common vaccine types in development, as Dr. Giarelli concludes and as Patricia Buchsel underscores in her commentary on the article.

In a case report about a breast cancer patient with a family history of hereditary breast and ovarian cancer (HBOC), Melissa Craft notes that until very recently, standard recommendations did not exist for monitoring women at high risk for breast cancer. In April 2007, however, Dr. Craft writes, the American Cancer Society, based on studies in high-risk women, published guidelines defining high risk and recommending screening MRI for women with about a 20%–25% or greater lifetime risk of breast cancer, including women who have a strong family history of breast or ovarian cancer and women treated for Hodgkin disease.

As Belinda Mandrell points out in her Late Effects Clinic report, improved treatment regimens are translating into a growing number of survivors of childhood cancer, with monitoring for potential late effects in adulthood becoming critical to ensure long-term survival of these patients. It is important, she emphasizes, for caregivers to be aware not only of past chemotherapy and radiation regimens, but also of genetic factors that may pose additional risk to patients.

In her case study of a patient with early breast cancer whose clinical management also involved a psychiatric consultation for depression, Sharon Van Fleet comments informatively on the importance of careful patient assessment to uncover prior histories of depression or other psychiatric disorders, rather than solely operating under the assumption that exhibited symptoms simply represent an adjustment disorder related to the cancer diagnosis and treatment.

The reports in our October issue are all facets in the same prism of cancer care, and all touch on what we do every day to ensure best practice: reflect on new data, reconsider our treatment approaches based on new information, and always be receptive to further educating ourselves.

--Mary McCabe, RN, MA
Editor-in-Chief