Palliative and Supportive Care

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.

Hepatic Arterial Chemoembolization (HACE) May Prolong Survival in Melanoma Patients With Liver Mets

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

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.

Although some see complementary and alternative medicine (CAM) therapies as lying outside the mainstream clinical setting

A structured communication tool helps oncology nurses effectively convey information and concerns to physicians when a patient's condition changes or a patient's care is in transition, which can promote patient safety and quality patient outcomes

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.

In a Quality Indicator (QI) project, oncology nurses at M.D. Anderson Cancer Center showed that changing intravenous (IV) bags of hazardous drugs (such as chemotherapy agents) is an unsafe procedure with nearly universal contamination of the nurses' gloves, gowns, and drapes.

Many cancer patients who have heart attacks often are not treated with lifesaving aspirin given the belief in the medical community that they could experience lethal bleeding.

A recent Prime Therapeutics study found significant patterns of "off-label" prescribing for transmucosal fentanyl lozenges on a stick (Actiq) among patients taking the powerful painkilling "lollipop."

Over the past decade, new cytotoxic and biologic therapies beyond the old standard-of-care, biomodulated fluorouracil (5-FU), have become available for the treatment of metastatic colorectal cancer (mCRC). The introductions of irinotecan (Camptosar), oxaliplatin (Eloxatin), and bevacizumab (Avastin) have prolonged survival, but the optimal use of these new therapies remains to be determined. Issues remain regarding management of toxicities, treatment of elderly patients or those with poor performance status, and the duration of treatment with front-line therapy. This article reviews recent and ongoing studies of newer therapies in an effort to determine the best use of these drugs in the treatment of mCRC. Current data support the front-line use of bevacizumab added to either 5-FU/leucovorin alone or 5-FU/leucovorin in combination with oxaliplatin (FOLFOX/bevacizumab) or irinotecan (FOLFIRI/bevacizumab). If oxaliplatin is used in first-line therapy, oxaliplatin should be discontinued before the development of severe neurotoxicity and be reintroduced or replaced with irinotecan on disease progression. Definitive conclusions on the sequence and duration of front-line therapy and the most effective strategy to ameliorate toxicity await results of ongoing prospective clinical trials.

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.

Oncology is undergoing a sea change. Because of sophisticated cancer screening, combined with increasingly effective treatments, the majority of cancer patients are surviving beyond the period of active treatment. As a consequence, cancer care teams are striving to confront the new—and very welcome—challenge of caring for long-term cancer survivors.

Ms. B is a 44-year-old married African-American female who was diagnosed with locally advanced right breast cancer in 2002. Immunohistochemistry in the original tumor was estrogen- and progesterone-receptor-negative, HER2-positive. Her past medical history is significant for hypertension and miscarriage in 1995.

Ms. C is a 41-year-old Hispanic woman that came to our facility regarding her leukemia. She presented in January 2005 with migratory myalgias, headaches, and gingival bleeding. Complete blood count (CBC) revealed a white blood cell count (WBC) of 18.0/µL with 53% blasts, hemoglobin at 8.1 g/dL, and a platelet count of 12/µL. Bone marrow biopsy confirmed a diagnosis of acute lymphocytic leukemia.

Fatigue is one of the most common, distressing, and frustrating side effects of cancer and its treatment.[1] While red blood cell growth factors (erythropoietin) have greatly reduced the fatigue associated with anemia, patients continue to be confronted with fatigue that interferes with normal physical and emotional function both during and following treatment.

A subcutaneous injection of the investigational agent idraparinux (Sanofi-Aventis) given once a week is just as effective and safe as the standard regimen of heparin plus a vitamin K antagonist in preventing recurrences of deep vein thrombosis (DVT)

The number of mutated genes driving the development of cancer is larger than previously believed, a finding that unveils a new challenge for researchers.

Because so many cancer patients are using dietary supplements, the Integrative Medicine Service of Memorial Sloan-Kettering Cancer Center (MSKCC) created a website (www.mskcc.org/AboutHerbs) that provides scientific information on more than 200 herbs, vitamins, and other dietary supplements commonly used by cancer patients.

Patients receiving radiation therapy (RT) typically have fatigue and other side effects that interfere with their ability to maintain their usual daily activities.

The Life Tapes Project (LTP)—a 2-hour videotaped cancer patient interview aimed at reducing feelings of isolation and existential anxiety—significantly improved patients' FACT-G functional and overall quality of life (QOL) subscale scores only 2 weeks post-taping, with many patients reporting they were better able to enjoy life, sleep well, and accept their illness.

The FDA has approved Alexion Pharmaceuticals' Soliris (eculizumab), the first product for the treatment of paroxysmal nocturnal hemoglobinuria (PNH), a rare, disabling and life-threatening blood disorder defined by chronic red blood cell destruction (hemolysis).

A simple intervention addressing the emotional impact of cancer can help put the "care" back in caregiving

Given the prevalence of pain in people with cancer, Cancer Pain Management is an excellent resource for all oncologists, oncology nurses, and other professionals. The editors are outstanding pain clinicians and investigators who have published and lectured extensively on this topic. By representing different specialties (oncology and anesthesiology), they bring a wealth of experience and diverse approaches that nicely complement one another. The majority of the 54 authors are highly regarded experts in the field; those who are not as easily recognized likely will be in the future. In particular, M.D. Anderson Cancer Center is well represented, with 28 authors coming from that institution.

There is an increased incidence of cancer in minority populations, accompanied by reduced survival. This review will address specific areas of disparity in cancer care, including prevention, diagnosis, treatment, and outcomes, and will consider steps toward resolving these issues.

Three cancer organizations have joined in supporting FDA in an appeal to the District of Columbia Circuit Court of Appeals to overturn a decision that terminally ill patients have a fundamental right of access to experimental drugs.

Two clinical studies with a total of 1,202 patients have found posaconazole (Noxafil) significantly more effective than two other antifungal agents in preventing fatal invasive fungal infections in acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) patients who develop neutropenia as a result of chemotherapy

An observational study published in the January issue of the Journal of Supportive Oncology shows that most discussions between cancer patients and community-based oncologists lack the specificity necessary to create a clear understanding of how anemia and related fatigue affects patients' daily lives. The study found this to be the case even though 52% of office-visit time with oncologists is spent discussing chemotherapy-related symptoms and side effects of treatments.

The book is organized around the questions or concerns that commonly arise among patients and families.

As oncology professionals, we all look forward to seeing our successfully treated patients come in for their follow-up visits. In a busy day filled with making complex medical decisions, delivering bad news, managing symptoms, and dealing with insurance companies, it is a real highlight. These individuals are among the over 10 million cancer survivors in the United States and represent 3.5% of the population. However, along with these optimistic results come new challenges for survivors that require ongoing medical care and psychosocial support. Survivors face lifetime health risks that are dependent on the cancer, treatment exposures, genetic predispositions, comorbid health conditions, and lifestyle behaviors.