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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.

WASHINGTON-The Bush Administration has abandoned plans to suspend the Food and Drug Administration’s "pediatric rule," which requires pharmaceutical companies to study the use of drugs in pediatric patients when seeking new drug applications.

PORTLAND,Oregon-Aerobic exercise can sharply reduce the bone-wasting effects of chemotherapy, according to Anna L. Schwartz, PhD, associate professor and research scientist at the Oregon Health and Science University School of Nursing in Portland. Osteoporosis is becoming an increasingly common and troublesome side effect of chemotherapy, particularly in breast cancer, she reported. In addition to the treatment regimens, premature menopause and inactivity all contribute to a decline in bone mineral density (BMD). Aerobic exercise can reduce this decline and help prevent treatment-related weight gain while increasing muscle strength.

NEW YORK-A drug that targets a protein important to two cancer cell pathways will be tested in combination with paclitaxel (Taxol) in phase II clinical trials slated to begin soon at Memorial Sloan-Kettering Cancer Center and the Mayo Clinic, Neal Rosen, MD, PhD, said at a "Meet the Experts" media briefing sponsored by the American Society of Clinical Oncology.

BALTIMORE-Between 65% and 85% of advanced cancer patients suffer pain, but between 85% and 95% of those patients, if properly treated, can experience relief. Providing effective pain management is a multidisciplinary effort requiring detailed planning and persistent implementation by a team committed to using a variety of resources and techniques. These concepts and how they are integrated into the Johns Hopkins approach to pain management were described by Suzanne A. Nesbit, PharmD, BCPS, clinical specialist in pain management in the Department of Pharmacy at Johns Hopkins Hospital in Baltimore and Kathy Smolinski, LCSW-C, senior clinical social worker in the Cancer Pain Service of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

BETHESDA, Maryland-The understanding of carcinogenesis that has emerged from molecular and genetic studies has provided a new vision of treatment, commonly called molecular targeting. In it, debilitating cytotoxic drugs will give way to agents that target specific proteins that mark specific cancer cells.

InTouch magazine, a sister publication of ONCOLOGY and Oncology News International, has been selected by the National Library of Medicine to be indexed and included in Index Medicus and Medline. InTouch is published by PRR for cancer patients and their families.

NEW YORK-The next decade will bring advances in pain management as a direct result of research currently making its way from bench to bedside, said pain management expert Russell K. Portenoy, MD.

BALTIMORE-Medical personnel are often "dreadful" at singling out individuals facing mood disturbances, emotional issues, and practical problems that can cause severe distress during cancer treatment, according to Matthew Loscalzo, MSW, director of patient and family services and co-director of oncology pain services at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore. A new screening and assessment tool used at the onset of treatment, however, identifies the issues most important to each individual patient and allows staff to promptly arrange for needed services, he told an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting.

BALTIMORE-Fatigue is a universally recognized complication of cancer, caused by both the disease itself and its treatment, but the role of anemia in causing fatigue has received insufficient attention, according to MiKaela Olsen, RN, MS. This oversight has led to undertreatment of anemia, but proper evaluation and treatment can reduce anemia and the fatigue and other troubling symptoms it causes, she said at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting. Ms. Olsen is an oncology/bone marrow transplant/hematology clinical nurse specialist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore.

NEW YORK-Aromatherapy massage reduces short-term anxiety in cancer patients, improves quality of life (QOL), and is perceived by cancer patients as being beneficial, according to results to date from evaluations conducted by researchers in the United Kingdom.

Payne, Coyne, and Smith present a concise review of the surprisingly meager literature regarding costs of end-of-life cancer care, an issue with substantial ethical and financial implications. They present evidence that improved coordination of care holds the potential to lower costs, or at least to offer better services at the same cost. The authors are to be commended for pursuing more rigorous studies regarding this difficult-to-quantify area of medical and social services. Moreover, they appropriately highlight the difficulties in attempting to capture direct costs of medical care and the far more elusive indirect costs.

The non-Hodgkin’s lymphomas (NHL) are the fifth most common cause of cancer in men and women in the United States, and the fifth and sixth leading causes of cancer deaths, respectively. Approximately 54,000 new cases are projected to be diagnosed in the United States this year,[1] 25% to 30% of which are indolent histologies, with the remainder being aggressive tumors.

A 54-year-old female seeks medical attention with a complaint of worsening exertional dyspnea of 3 to 4 weeks’ duration. She has a history of small-cell lung carcinoma, first diagnosed 3 months previously, and has had an excellent response to treatment, which included both chemotherapy and external-beam radiation. Consistent with her cancer diagnosis, she has a 30 pack-year history of cigarette smoking, and her pulmonary function tests indicate mild airflow obstruction, slight hyperinflation on lung volumes, and a mildly decreased diffusion capacity. In addition to her dyspnea with exertion, the patient describes symptoms of an intermittently productive cough, fatigue, and, recently, a poor appetite.

I read with interest the commentary by Drs. Michael S. Givel and Stanton A. Glantz, regarding state-level disbursement of monies generated by the Master Settlement Agreement with Big Tobacco, which appeared in the February 2002 issue of ONCOLOGY.[1] Unfortunately, the authors omitted the key challenge facing antitobacco activists. Although they accurately depicted underfunding of tobacco control programs (~5% of total annual allocated payments)-far lower than levels recommended by the Centers for Disease Control and Prevention (~25%)[2]-they failed to analyze the deceptive nature of how the remaining funds are being categorized.

Dyspnea is an extremely common symptom among cancer patients.[1] Like pain, it is inherently subjective and is best defined as the perception of difficulty in breathing, or an uncomfortable awareness of breathing. Although it may be associated with one or more physiologic disturbances (such as hypercapnia, hypoxia, obstructive or restrictive patterns on pulmonary function tests, or various abnormalities on chest imaging studies), it is not strongly associated with any specific abnormality and may occur in the absence of any. Patient self-report is the gold standard for assessment and may range from mild breathlessness on exertion to a terrifying sense of suffocation.

Adjuvant chemotherapy is an integral component of the multidisciplinary curative treatment of primary breast cancers. The experience of the last 3 decades indicates that anthracycline-containing regimens provide the most effective cytotoxic treatment for this purpose.

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 will conclude in the July 2002 issue, describes the prevalence and types of pain syndromes encountered in patients with AIDS, and reviews the psychological and functional impact of pain as well as the barriers to adequate pain treatment in this group and others with human immunodeficiency virus (HIV)-related disease.

EVANSTON, Illinois-Although biopsy of sentinel lymph nodes is often considered an almost risk-free procedure in the staging of breast cancer, a retrospective chart review showed a surprising incidence of lymphedema associated with this procedure. Carole H. Martz, RN, MS, and colleagues at Evanston Northwestern Healthcare in Illinois reported a 3% risk of lymphedema after sentinel lymph node biopsy (SNLB, n = 303), compared to a 17% risk after axillary dissection (n = 117).

ST. PETERSBURG, Florida-New cancer regimens are sometimes a double-edged sword, offering better survival but also delayed toxicity affecting quality of life. At the Late Effects of Normal Tissues (LENT) IV workshop, an international, multidisciplinary panel tackled the Herculean task of defining, grading, and reporting chronic toxicity. The workshop included representatives from more than 10 countries, including two European organizations.