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Caring for the Life You SavedWe may find that in the case of recurrence surveillance, doing less than we now do is better. Conversely, for persistent symptoms, adoption of lifestyle behaviors by survivors, and the meeting of family needs, doing more than we do now is better.
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Integrating Genetics and Genomics Into Oncology NursingGenetic and genomic research is creating new and more individualized approaches to better manage a person's disease or predisposition to disease, including cancer.
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Including Oncology Outcomes of Care in the Computer-Based Patient RecordChanges in the health care system have caused a shift in research to outcomes of care, effectiveness, efficiencies, clinical practice guidelines, and costs. The greater use of computer systems, including decision support systems, quality assurance systems, effectiveness systems, cost containment systems, and networks, will be required to integrate administrative and patient care data for use in determining outcomes and resource management. This article describes developments to look forward to in the decade ahead, including the integration of outcomes data and clinical practice guidelines as content into computer-based patient records; the development of review criteria from clinical practice guidelines to be used in translating guidelines into critical paths; and feedback systems to monitor performance measures and benchmarks of care, and ultimately cost out cancer care. [ONCOLOGY 9(Suppl):161-167, 1995]
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Rationale and Dose-Finding Studies of the Combination of Irinotecan and a Taxane on a Weekly ScheduleCisplatin (Platinol)-based chemotherapy has been the standard systemic therapy for both non-small-cell and small-cell lung cancer for the past 2 decades, though the efficacy and benefit remain modest. Recently, several novel
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Pain Management in Cancer Patients at Risk of Opioid AbuseIn this interview we discuss pain management for cancer patients who are at high risk of opioid abuse.
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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
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Tailoring Treatment for Multiple Myeloma Patients With Relapsed and Refractory DiseaseResponses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months. Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high β2-microglobulin, and low serum albumin.
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Subacute Headache in a Patient With Metastatic Gastric CancerA 59-year-old man with metastatic gastric cancer presented to the oncology clinic with a 1-week history of positional headache, nausea, and vomiting. He stated that the headache was located in the frontal region, was 8 on a scale of 10 in intensity.
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Specialty Nutrition: New Approaches and Novel IngredientsSpecialty nutrition for patients with cancer is anexciting area in research. It is well known thatpatients with cancer experience many nutritionalproblems during the course of their disease-in particularanorexia and weight loss.[1,2] Specialty nutritioncan impact nutritional status directly by improvingweight and lean body mass, or indirectly by improvingcommon symptoms often associated with cancerand cancer therapies.
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Recognizing and Managing Side Effects Associated With Novel Targeted Therapies:Nursing management of patients with advanced malignancies presents a formidable challenge. In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. Nursing intervention remains a vital component in the successful use of these novel agents.
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Quality of Life in Myelodysplastic SyndromesWhat is the impact of being diagnosed with myelodysplastic syndromes (MDS)? What are the physical/psychosocial ramifi cations of RBC transfusions to manage the extreme fatigue and weakness that accompany refractory anemia; of parenteral or oral iron chelation therapy for
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Adjuvant Endocrine Therapy for Breast Cancer: Longer Therapy and the Need for Personalized Treatment-Should We Treat Beyond the Data?In the future, we also need to improve our ability to personalize the duration of endocrine therapy, with a goal of optimizing patient selection for extended therapy. Hopefully, clinical-pathologic indices and predictive biomarkers similar to the Oncotype DX 12-gene recurrence score or the PAM50 risk of recurrence score for adjuvant chemotherapy will soon emerge to guide adjuvant endocrine therapy.
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Bone-Targeted Therapy in Early Breast CancerIn this article, we describe the role of bone-targeted therapies, specifically for managing early breast cancer, by reviewing their bone-specific and cancer-specific benefits.
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Commentary (Moryl/Foley)-Opioid Rotation in Cancer Patients: Pros and ConsThe use of sequential therapeutictrials to determine the optimaldrug for a given patienthas become a standard strategy in painmanagement. We appreciate Estfanand colleagues’ thoughtful and practicalreview of the advantages and disadvantagesof opioid rotation in cancerpain management.[1] Their commentson the need for individualization ofopioid dose and ongoing monitoring,opioid choice in renal and liver insufficiency,compliance, and cost reductionare particularly important.
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Prognostic and Predictive Markers for the New ImmunotherapiesCharacterizing tumors by PD-L1 expression, immune infiltration, chemokine signature, and tumor mutational frequency may be a means of creating an integrated model for determining which patients may benefit from which immune-checkpoint inhibitors, either alone or in combination.
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The Neutropenic Diet....Still Ageless?As practicing doctors and a practicing nutritionist in a large pediatric oncology program, we applaud Nicole Fox and Alison Freifeld for questioning the utility of the neutropenic diet.
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Commentary (Ghosh et al): Advising Women at High Risk of Breast CancerDr. Wood has provided an excellentreview of the issuesfacing women at high risk fordeveloping breast cancer. In additionto emphasizing the significance of accuraterisk assessment, he describessurveillance techniques that enableearly detection of the disease and hasprovided a comprehensive review ofrisk-reduction options for women athigh risk.
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The Application of Breast MRI in Staging and Screening for Breast CancerContrast-enhanced breast magnetic resonance imaging (MRI) is arelatively new but increasingly used modality for the detection of breastcancer. MRI has demonstrated utility in identifying additional tumorfoci and extent of disease in patients with known breast cancer. This isespecially useful with invasive lobular carcinoma, which is difficult toevaluate on mammography. MRI has been found to identify the primarytumor in 70% to 86% of cases of occult breast cancer. Contrastenhancedbreast MRI has shown some usefulness in the detection ofresidual cancer following surgery but is limited by postoperative changes.In patients who have undergone neoadjuvant chemotherapy, breast MRIis most accurate in those patients in whom there is little or no responseto chemotherapy. The use of contrast-enhanced breast MRI for breastcancer screening is controversial. It has only been used in a few smallstudies of high-risk patients. The limitations of breast MRI includeuptake in benign lesions and normal tissue, sensitivity for ductal carcinomain situ, cost, and availability. This paper will discuss the uses,benefits, and limitations of contrast-enhanced breast MRI in the stagingand screening of breast cancer.
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Meta-analysis: Methods, Strengths, and WeaknessesThe growing quantity of clinical research data has created a need to find ways to effectively provide an overview of information that addresses specific medical questions. Meta-analysis is being used ever more frequently for this purpose. Therefore, it is important to recognize both the strengths and weaknesses of this analytical methodology.
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Roles of Advanced Practice Nurses in OncologyThere is no doubt that managed care is changing health care and the practice environment of all health-care providers. As Baird states, “The economics of health care will probably exert a greater influence on the future practice of nursing than any other single factor.”[1]
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Radiation Dermatitis42-year-old Caucasian female who was in her usual state of health when her first mammogram showed suspicious calcifications and a spiculated mass in the upper outer quadrant of the right breast. An ultrasound-guided biopsy showed an invasive ductal carcinoma. She underwent a lumpectomy, with the excised tumor measuring 1.2 cm. The tumor was estrogen and progesterone positive and HER2/neu negative.
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BRAF inhibition may enhance immunotherapy in melanomaA preclinical study provides the rationale for combining BRAF-targeted therapy with immunotherapy agents in patients with BRAF mutations. These mutations activate the MAPK signaling pathway, which leads to increased oncogenic potential. The researchers showed that in BRAF-mutant melanoma cell lines, a selective BRAF inhibitor (PLX4720) blocked the MAPK pathway and increased tumor antigen expression without affecting T-cell function.
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A2ARs Receptor Agonist Combo May be Synergistic in Clear Cell RCCClear cell renal cell carcinoma is driven by a metabolic switch that decreases VHL and increases ATP, according to an expert from Vanderbilt University Medical Center.
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Lymphoepithelioma-Like Carcinoma of the Urinary BladderA 65-year-old woman presented to a local emergency department complaining of right flank pain that had worsened over the past 10 days. A CT scan of the abdomen and pelvis showed intravesical tumors of the urinary bladder.
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Management of a Patient With Stage IIIA (N2) NSCLCThe appropriate treatment of patients with stage IIIA (N2) non–small-cell lung cancer (NSCLC) is unclear. With this case report and review, we address the history, assessment, and management of a 67-year-old patient with this diagnosis, and then discuss the challenges in managing N2 disease, as well as the roles of systemic therapy, surgery, and postoperative radiation therapy.
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Endometrial Carcinoma and Precursors: Diagnosis and TreatmentThis clinically oriented text focuses on the diagnosis and management of endometrial adenocarcinoma and endometrial hyperplasia. Due to its clinical orientation, the book does not include information on the molecular basis of endometrial cancer.
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Targeted Therapy for Mutation-Driven Metastatic Non–Small-Cell Lung Cancer: Considerations for ALK-Rearranged TumorsIn this article, important concepts in the molecular testing of non–small-cell lung cancer are highlighted.
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What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?There is ample evidence suggesting that physical activity and exercise can be therapeutic tools for patients with prostate cancer. Patients diagnosed with localized disease should be advised to stay physically active; furthermore, patients who are undergoing radiation therapy and/or treatment with ADT appear to benefit from regular aerobic and resistance exercise to alleviate side effects.
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Quality of Life in Men With Breast CancerThis video highlights quality-of-life results from a large prospective study of men treated for breast cancer.
