ONCOLOGY Vol 21 No 4 | Oncology

Accelerated Partial-Breast Irradiation: A Promising Technique Under Investigation

April 01, 2007

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Communicating With Oncology Patients About Palliative Care

April 02, 2007

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.

Programs Work Toward Transitioning Survivors to Primary Care

April 02, 2007

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.

When to Consider Adjuvant/Neoadjuvant Therapy for Adult Soft-Tissue Sarcoma

April 01, 2007

In patients with adult soft-tissue sarcoma (ASTS), the use and timing of adjuvant chemotherapy or chemoradiotherapy remains controversial. The appropriate target population is generally accepted as International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) stage III extremity or trunk sarcomas (ie, > 5 cm, grade 3/4, located deep to the superficial fascia, with no evidence of metastases). After definitive local treatment, the 5-year disease-free and overall survival rates in this population are approximately 52% and 56%.

Accelerated Partial-Breast Therapy: An Evolving Technique in the Treatment of Breast Cancer Patients

April 01, 2007

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Health-Care Disparities, Civil Rights, and Human Rights

April 01, 2007

With regard to cancer management, minority populations do not fare as well as the majority in the US health-care system. There is clear evidence of an increased incidence of cancer in minority populations, in many cases accompanied by reduced survival. Several factors appear to contribute to these differences, and the biomedical community has begun to focus on definining the scope of the problem and possible solutions. 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.

Understanding Racial Disparities in Cancer Care

April 01, 2007

With regard to cancer management, minority populations do not fare as well as the majority in the US health-care system. There is clear evidence of an increased incidence of cancer in minority populations, in many cases accompanied by reduced survival. Several factors appear to contribute to these differences, and the biomedical community has begun to focus on definining the scope of the problem and possible solutions. 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.

Management of Delirium

April 02, 2007

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.

Broadening Our Perspective on Breast Cancer

April 01, 2007

Several issues raised in the article by Cianfrocca and Wolff and the accompanying reviews in the January issue of ONCOLOGY (21:63-80, 2007) deserve further comment. First, all authors address American resource-rich patient populations only. According to data from Parkin et al, nearly two-thirds of all new cases of breast cancer globally (a total of 1 million cases) occur among poor women. Half of these (500,000 cases) are in premenopausal women with hormone-receptor-positive tumors.[1] We need to broaden our horizons to consider these much larger populations whenever we discuss breast cancer therapies.

Current Controversies in the Management of Hodgkin's Lymphoma

April 01, 2007

Despite significant improvements in the treatment of Hodgkin's lymphoma over the past 2 decades, physicians continue to face dilemmas in therapy for the disease, and many cured patients live with complications of treatment. Newer therapeutic options are still needed for the disease, to minimize complications and to improve the treatment of patients in relapse. This review considers the treatment of Hodgkin's lymphoma in younger patients, addressing such issues as which patients with early-stage disease may require radiotherapy, what prognostic factors provide information that can affect treatment choices in patients with advanced disease, and what we have learned about treatment complications in this setting.

Hurricane-Hit Practice Offers Lessons in Disaster Planning

April 02, 2007

In a recent conversation with the ONCOLOGY Nurse Edition, Ms. Donohue discussed the short- and long-term effects of these disasters on patient care, and offered recommendations for emergency preparation in any setting.

Debate, Discuss, Decide

April 02, 2007

n this issue of ONCOLOGY Nurse Edition you'll find a carefully referenced review of cancer pain management using complementary medicine approaches. This is a perfect topic for discussion and debate. We all have our own attitudes toward complementary medicine, but how much of what we think, either for or against, is based on published research evidence and further informed by rigorous discussion? Debunking myths and offering our patients information about and access to evidenced-based therapies, no matter what their origins, is what we all want.

Cancer Pain Management

April 01, 2007

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.

Brain Metastases and the Need for a Multispecialist Approach

April 01, 2007

Metastatic lesions to the brain occur commonly in oncology patients and portend a very poor outcome, as they often occur in the setting of progressive systemic metastatic disease and can result in neurologic deterioration that may preclude therapy. Therapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis (eg, with surgical resection or radiosurgery) and to reduce the subsequent risk of recurrences elsewhere in the brain (eg, with whole-brain radiation). Successful therapy of extracranial systemic metastases is required for optimal outcomes. Clinical trials are currently underway to define the optimal role of whole-brain radiation and radiosurgery in different subsets of patients. Novel therapies to enhance radiation responsiveness are also under investigation. In the current review, we discuss recent developments in the management of patients with brain metastases.

Management of Brain Metastases: Neurosurgical Considerations

April 01, 2007

Metastatic lesions to the brain occur commonly in oncology patients and portend a very poor outcome, as they often occur in the setting of progressive systemic metastatic disease and can result in neurologic deterioration that may preclude therapy. Therapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis (eg, with surgical resection or radiosurgery) and to reduce the subsequent risk of recurrences elsewhere in the brain (eg, with whole-brain radiation). Successful therapy of extracranial systemic metastases is required for optimal outcomes. Clinical trials are currently underway to define the optimal role of whole-brain radiation and radiosurgery in different subsets of patients. Novel therapies to enhance radiation responsiveness are also under investigation. In the current review, we discuss recent developments in the management of patients with brain metastases.

Upper Limb Swelling Following Mastectomy: Lymphedema or Not?

April 02, 2007

BH is a 54-year-old white, married female with a health history significant for depression at the time of breast cancer diagnosis. She was scheduled for a routine bilateral mammogram in the summer of 2001. Following an abnormal mammogram of the right breast, BH was referred for an excisional biopsy, which was performed in July 2001.

More Questions About Hodgkin's Lymphoma

April 01, 2007

Despite significant improvements in the treatment of Hodgkin's lymphoma over the past 2 decades, physicians continue to face dilemmas in therapy for the disease, and many cured patients live with complications of treatment. Newer therapeutic options are still needed for the disease, to minimize complications and to improve the treatment of patients in relapse. This review considers the treatment of Hodgkin's lymphoma in younger patients, addressing such issues as which patients with early-stage disease may require radiotherapy, what prognostic factors provide information that can affect treatment choices in patients with advanced disease, and what we have learned about treatment complications in this setting.

Infection in a Leukemia Patient

April 02, 2007

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.

Proteasome Inhibitors

April 02, 2007

bortezomib, Velcade, PR-171, PS-341, NPI-0052, Drug inhibits the action of proteasomes, which normally break down proteins that have been ubiquinated or tagged for destruction, such as p53, the "guardian of the genome," and cell cycle proteins.

Exercise Regimen Reduces Fatigue

April 02, 2007

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.

Management of Cancer Pain With Complementary Therapies

April 02, 2007

Pain is one of the most feared consequences of cancer. Pain is a major symptom in 75% of hospitalized cancer patients. Poorly relieved pain contributes to the suffering of the patient and family, which may motivate them to seek additional complementary and alternative therapies. Evidence-based complementary therapies are being used for symptom control and to improve quality of life. There is recent research on several complementary therapies—acupuncture, mind-body therapies, massage, reflexology, and Reiki—that provides evidence for pain management. These therapies are not well utilized due to a lack of information on benefits, risks, and resources. There is a call for education to alert patients, families, nurses, and physicians to the benefits of evidence-based complementary therapies and to the dangers of "unproven" cancer therapies. Oncology nurses are ideally positioned to assess patients' pain, to educate patients, to determine with the patient and physician the most appropriate and safe complementary therapy for pain, to refer patients to appropriate resources, and in some cases to provide the therapy itself. This article will discuss specific complementary therapies for pain control and will arm nurses with the confidence to intervene with knowledge, referrals, and ideas for hands-on ­implementation.

Innovation in the Management of Brain Metastases

April 01, 2007

Therapy of patients with brain metastases requires a combination of measures to achieve local control at the site of metastasis and to reduce the subsequent risk of recurrences elsewhere in the brain. In the current review, we discuss recent developments in the management of patients with brain metastases.

Current Application and Research Directions for Partial-Breast Irradiation

April 01, 2007

Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.

Hodgkin's Lymphoma in Younger Patients: Lessons Learned on the Road to Success

April 01, 2007

Despite significant improvements in the treatment of Hodgkin's lymphoma over the past 2 decades, physicians continue to face dilemmas in therapy for the disease, and many cured patients live with complications of treatment. Newer therapeutic options are still needed for the disease, to minimize complications and to improve the treatment of patients in relapse. This review considers the treatment of Hodgkin's lymphoma in younger patients, addressing such issues as which patients with early-stage disease may require radiotherapy, what prognostic factors provide information that can affect treatment choices in patients with advanced disease, and what we have learned about treatment complications in this setting.

Disparities in Cancer Care: Challenges and Solutions

April 01, 2007

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.