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Cancers of the gallbladder and biliary tract are uncommon malignancies in the United States with a combined incidence of less than 8,000 new cases per year, about 5,000 of which are gallbladder cancer and about 2,000 to 3,000 of which are cholangiocarcinomas, including intrahepatic, hilar, and distal bile duct cancers.[1] For gallbladder cancer with mucosa-confined disease, the 5-year survival rate is approximately 32%, and for advanced disease, less than 10% of patients survive longer than 1 year.[2]

As active participants in the care of patients with acquired immunodeficiency syndrome (AIDS), oncologists need to be aware of the many facets of pain management in this population. This two-part article, which began in the

Neoplasms of the biliary tract tree are uncommon and have a poor overall prognosis. Although numerous risk factors have been identified, little is known about the pathogenesis of these tumors, and no effective screening

ORLANDO-When combined with standard antiemetic therapy, the neurokinin-1 (NK1) receptor antagonist aprepitant (MK-869[M]) protects against acute and delayed chemotherapy-induced nausea and vomiting, according to two separate studies (ASCO abstracts 1467 and 1467).

SAN ANTONIO, Texas-An exercise rehabilitation program similar to that used for cardiac patients significantly improved both exercise tolerance and quality of life (QOL) for cancer patients participating in a pilot study. Stacey Young-McCaughan, RN, PhD, and colleagues tested the exercise program in patients at two military medical centers in San Antonio, Texas. Lieutenant Colonel Young-McCaughan is deputy director of the Congressionally Directed Medical Research Programs at the US Army Medical Research and Materiel Command at Fort Detrick, Maryland.

SEATTLE-The proportions of deaths in HIV-infected individuals caused by non-AIDS-related diseases have increased since the advent of highly active antiretroviral therapy (HAART), according to a study presented at the 9th Conference on Retroviruses and Opportunistic Infections (abstract 14). Mitchell I. Wolfe, MD, MPH, medical epidemiologist, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), presented the data.

The world’s first clinically operational molecular imager with lutetium oxyorthosilicate (LSO) technology-the biograph LSO, manufactured by Siemens Medical Solutions-has produced a precisely registered, combined positron-emission tomography (PET)/computed tomography (CT) image in 7 minutes at the Hong Kong Baptist Hospital. The biograph LSO imager uses the high-speed properties of LSO as the PET scintillator to provide shorter scan times and unmatched patient throughput.

SAN FRANCISCO-More than one-third of cancer outpatients report two or more symptoms such as pain, fatigue, nausea, depression, and sleep disturbances. Because severity of individual symptoms and risk of clinical depression both worsen as the number of symptoms increases, these symptom clusters or groupings have important clinical implications, according to Marylin J. Dodd, RN, PhD, professor of nursing at the University of California at San Francisco.

The National Cancer Institute (NCI) announced recently that it is expanding access to its clinical trials to more oncologists around the country. This new policy will allow cancer patients anywhere in the United States to participate more easily in advanced (phase III) treatment trials.

ORLANDO-Allogeneic bone marrow transplant (BMT) significantly reduced relapse rates and increased event-free survival (EFS) rates, but not overall survival, in adults with Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) in first complete remission.

SEATTLE-A new HIV-1 vaccine that uses a replication-defective adenovirus vector has proved to be safe, well tolerated, and immunogenic to date in an ongoing phase I trial, according to research presented at the 9th Conference on Retroviruses and Opportunistic Infections (abstract 12). Emilio Emini, PhD, senior vice president of vaccine research at Merck Research Laboratories, presented the results.

Oncology care will be the focus of one of the new Medicare disease management demonstration programs soon to be initiated. Medicare remains convinced that disease management services can provide substantial savings. There is, however, a problem: Fee-for-service Medicare, which includes most recipients, does not allow for disease management, except in one or two instances, such as diabetes self-education. The Medicare+Choice program-comprised mostly of health maintenance organizations-offers disease management, but seniors have, for the most part, avoided this plan. Therefore, Medicare has selected 15 sites for case management and disease management services, which will be offered to Medicare fee-for-service beneficiaries with complex chronic conditions. Quality Oncology, Inc, of McLean, Va, will implement an urban disease management program targeting beneficiaries in Broward County, Fla.

SAN FRANCISCO-Routine use of aspirin provides a modest reduction in the recurrence of large bowel adenomas, according to the results of a randomized, double-blind, placebo-controlled study presented by the Polyp Prevention Study Group. Paradoxically, the group found that an 80 mg daily dose, the equivalent of one baby aspirin, was much more effective in preventing polyps than was the 325 mg daily dose, the amount contained in a typical adult aspirin.

ORLANDO-Giving rituximab (Rituxan) after high-dose chemotherapy/autologous peripheral blood stem cell transplantation for B-cell non-Hodgkin’s lymphoma (NHL) produced better survival and freedom from progression rates than would be expected with a conventional transplant regimen, according to a phase II study reported at the 43rd Annual Meeting of the American Society of Hematology (abstract 3578).

WASHINGTON, DC-Recombinant human erythropoietin is accepted treatment for chemotherapy-related anemia, but a panel of four oncology nurses convened to review an evidence-based clinical practice guideline for anemia concluded that guidelines are not being consistently followed. The panel’s findings were presented by Denise Oseguera, RN, of University of California, Los Angeles, and Susan Ross, MD, of MetaWorks Inc., Medford, Massachusetts.

HOUSTON-Patient satisfaction with patient-controlled analgesia (PCA) rose from 75% to 90% with an education program implemented by Elizabeth Fogarty, RN, and colleagues from the gastrointestinal surgery unit at The University of Texas M. D. Anderson Cancer Center. The patient and staff education program is now being used in nursing practice throughout the entire institution.

BOSTON-Fatigue is a worse problem than pain for most cancer patients but oncologists rarely know this because discussions with patients about symptom distress are typically "don’t ask, don’t tell." Physicians don’t ask, and patients don’t tell, according to Marybeth Singer, MS, RN.

WASHINGTON-InTouch magazine, published by PRR for cancer patients and their family members, has been selected by the US National Library of Medicine (NLM) to be indexed and included in Index Medicus and MEDLINE.

SEATTLE-A new CD-Rom provides a wide range of flexible, thorough and authoritative materials on end-of-life care. Nursing educators can adapt these materials to the needs of their programs and students and fill a serious gap in the curricula of many nursing schools, reported Diana J. Wilkie, PhD, RN, professor and pain management specialist at the University of Washington School of Nursing in Seattle.

BOSTON-Up to 70% of patients undergoing bone marrow transplantation suffer oral mucositis painful enough to require treatment with intravenous opioids. Nurses in the bone marrow transplant unit at Dana-Farber Cancer Institute in Boston became concerned that the lack of practice standards for managing this type of pain was resulting in suboptimal treatment and increasing the risk of adverse events. Barbara Fine, RN, BSN, and Maureen Lynch, MS, RN, developed an evidence-based practice algorithm and an approach to implementing it that was successful in changing established practice, improving outcomes, and increasing staff and patient satisfaction with pain control.

WASHINGTON, DC-A nurse-directed intervention to help chemotherapy patients manage pain and fatigue not only relieved those symptoms but also reduced the number of other symptoms patients suffered, according to Barbara Given, PhD, RN, professor of nursing at Michigan State University in East Lansing. She reported results on behalf of researchers at that institution, as well as at the University of Michigan in Ann Arbor and Yale University in New Haven, Connecticut.

DUARTE, California-Nurses play a crucial role in the quality of patients’ experience at the end of life, but nursing schools have not traditionally provided high-quality training in caring for the dying, according to Rose Virani, RNC, MHA. Now a program funded by the Robert Wood Johnson Foundation aims to upgrade the offerings of the nation’s nursing schools through specialized end-of-life courses for nursing educators.

WASHINGTON, DC-Oncology Nursing Society (ONS) President Paula T. Rieger, RN, MSN, has made "more seats at the table" her model for internal ONS matters, for improving oncology practice, and for giving nurses and patients more voice in health policy. An advanced practice nurse, Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center in Houston, Ms. Rieger discussed these issues in her presidential address to the 27th Annual Congress of the Oncology Nursing Society. With 30,000-members, ONS is the world’s largest professional oncology association.

Wireless tablet-sized computers and user-friendly software may soon be helping investigators collect clinical trials toxicity data. A new handheld prototype with all the capabilities of a standard laptop computer was demonstrated at the LENT IV workshop.

ALEXANDRIA, Virginia-More than 20 national advocacy groups, professional medical societies, and scientific organizations have joined to form the Alliance for Childhood Cancer to support quality cancer care for children and adolescents.

ROCKVILLE, Maryland-The Food and Drug Administration has warned three Internet pharmacies selling nicotine-laced lollipops and lip balms as smoking cessation aids that the products appear to be illegal and ordered them pulled from the marketplace.

ST. PETERSBURG, Florida-As cancer survival increases, outcomes research must focus on both quality of life and length of survival, and must define and quantify late effects of cancer treatment, Noreen Aziz, MD, PhD, MPH, said at the Late Effects of Normal Tissues (LENT) IV workshop on late effects criteria and applications.

SAN FRANCISCO-When combined with TRAIL (TNF-related apoptosis-inducing ligand), resveratrol-an antioxidant and anti-inflammatory flavinoid found in red wine-promotes apoptosis in a variety of cancers, including difficult-to-treat brain cancers, according to a study presented at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 4238).

SAN FRANCISCO-Complete axillary lymph node dissection followed by chemotherapy is standard treatment for larger breast tumors, but it is less frequently performed when the tumor is smaller than 1 cm. Still, approximately 5% to 8% of these small breast tumors are very aggressive. Currently, there is no way to identify which of these small tumors are more likely to metastasize and thus should receive more appropriate treatment.

SAN FRANCISCO-Although tamoxifen (Nolvadex) kills glioma cells in culture, it has not been effective in prolonging survival in patients with recurrent glioma. A study presented at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 2442), however, found that pretreating with propylthiouracil and Lugol’s solution (a solution of potassium iodide and iodine) to induce chemical hypothyroidism prior to high-dose tamoxifen therapy resulted in dramatic increases in survival time in these patients.