Tumor Board

Ipilimumab blocks cytotoxic T-lymphocyte antigen 4 (CTLA-4) and theoretically enables cytotoxic T cells to more effectively attack melanoma cells.

Advances in the multidisciplinary management of metastatic colorectal cancer have improved survival considerably, and nurses are key to optimal patient care.

Bellury LM, Ellington L, Beck SL, et al: Elderly cancer survivorship: An integrative review and conceptual framework. Eur J Oncol Nurs 15(3):233–242, 2011.Derby S: Assessment and management of delirium in the older adult with cancer. Clin J Oncol Nurs 15(3):247–250, 2011.Holtslander LF, Bally JM, Steeves ML: Walking a fine line: An exploration of the experience of finding balance for older persons bereaved after caregiving for a spouse with advanced cancer. Eur J Oncol Nurs 15(3):254–259, 2011. Kahana B, Kahana E, Deimling G, et al: Determinants of altered life perspectives among older-adult long term cancer survivors. Cancer Nurs 34(3):209–218, 2011. Pieters HC, Heilemann MV, Grant M, et al: Older women's reflections on accessing care across their breast cancer trajectory: Navigating beyond the triple barriers. Oncol Nurs Forum 38(2):175–184, 2011. Swinney JE, Dobal MT: Older African American women's beliefs, attitudes, and behaviors about breast cancer. Res Gerontol Nurs 4(1): 9–18, 2011. Van Cleave JH, Egleston BL, McCorkle R: Factors affecting recovery of functional status in older adults after cancer surgery. J Am Geriatr Soc 59(1):34–43, 2011.

Oncology nurses are on the frontline of telephone triage. Optimizing telephone interactions with patients is key to improving ambulatory nursing practice, as it allows nurses to efficiently provide symptom management; patient education; emotional support; and high-quality, complete documentation for comprehensive and consistent patient care.

More cancer patients are able to receive chemotherapy, including both oral and intravenous agents, in the home setting. Clearly, the option to self-administer therapy in the absence of an oncology nurse or other healthcare provider poses a potential safety risk.

Melanie Bone, MD, was not yet 40 years old and had four young children when she was diagnosed with stage III breast cancer. “Even though I am a doctor and surgeon, I learned firsthand about the side effects of cancer treatment,” said Dr. Bone, a nutritional gynecologist. “I was too sick to work, so I spent time thinking about how to make the cancer experience easier for future cancer patients.”

A pilot mentor-to-mentor oncology nurse–led training program was developed in which volunteer former patients who have undergone brachytherapy for early stage breast cancer at UCSD were taught by the oncology nurse how to provide information and support to new patients about to undergo the procedure.

Cancer patients undergoing chemotherapy can be very anxious at the initiation of treatment. Cancer center–specific patient education materials that detail what patients can anticipate at each step of the chemotherapy process may alleviate patients’ anxiety and improve their overall experience with chemotherapy.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with approximately 20 million people currently infected and an additional 6.2 million infected each year, despite increased media attention to HPV as a cause of cervical cancer and the availability of a vaccination to reduce HPV-associated cervical cancer.

More cancer patients are able to receive chemotherapy, including both oral and intravenous agents, in the home setting. Clearly, the option to self-administer therapy in the absence of an oncology nurse or other healthcare provider poses a potential safety risk.

Following a retrospective analysis which may be the largest of its kind to date, a multicenter team of investigators says treatment-related hypertension may be a useful biomarker of superior clinical outcome with sunitinib (Sutent) in patients with metastatic renal cell carcinoma (RCC).

An analysis of data from 3,400 men in the large nationwide Prostate Cancer Prevention Trial indicates that, contrary to what might be expected, men with the highest blood percentages of DHA (docosahexaenoic acid), an omega-3 fatty acid commonly found in fatty fish, had 2.5 times the risk of developing aggressive, high-grade prostate cancer, compared with men who had the lowest levels.

A team of researchers has used mass spectrometry to identify a novel six-biomarker serum test that effectively identified lung cancer in never smokers, and which may have other important diagnostic applications in lung cancer.

The US Food and Drug Administration (FDA) has approved a portable noninvasive device, worn on the head, to treat adults whose glioblastoma multiforme (GBM) recurs or progresses following chemotherapy and radiation therapy.

Denosumab is an IgG2 monoclonal antibody that inhibits osteoclastic bone resorption (breakdown) via inhibition of RANKL (receptor activator of nuclear factor-kB ligand).

From the current literature

The recent Centers for Disease Control and Prevention (CDC) report carrying good news about cancer sur­vivorship is an urgent “heads up” for all of us in cancer care. The report states that between the years 1971 and 2001, the number of cancer survivors increased by more than three-fold (from 3 million to nearly 10 million).

Multiple myeloma (myeloma) is a highly treatable disease, but it remains incurable in the majority of cases. It is a heterogeneous disease with variability in its clinical presentation, treatment options, and prognosis.

Ginseng is an herb from the genus Panax of the Araliaceae family that is an important part of traditional Chinese medicine (TCM). It is termed an “adaptogen,” as it is believed to have properties that help to restore balance to the body and protect the body from physiologic stress.

Cognition is a highly sophisticated, multifactorial, interrelated set of neurologic functions responsible for attention, perception, memory, learning, language, and thinking.

Hypersensitivity/infusion reactions can be caused by monoclonal antibodies and chemotherapeutic agents. Immediate interventions are often required.

The study represents one of the largest cancer genomics investigations reported, with more than 10 trillion chemical bases of DNA sequenced. While its results underscore the complexity of breast cancer biology, the mutations uncovered may provide further clues to inform personalized therapy of this common breast cancer subtype.

In July1999, I learned I was pregnant with my son. My sister was pregnant, too, and due to deliver in the fall. I was excited to share my happy news. But my father, then 65, had news of his own: he had been diagnosed with stage III colorectal cancer.

Today, March 8, is the 100th anniversary of International Women’s Day, Here is a small sampling of initiatives by health organizations and healthcare leaders dedicated to treating, preventing, and increasing awareness of women’s cancers, and improving women’s health.

Esophageal cancer generally has a poor prognosis; while preoperative chemotherapy is recommended, tumors often do not respond to treatment.

In a population-based screening study of nearly 20,000 men in Rotterdam, men with baseline prostate-specific antigen (PSA) levels < 3 ng/mL were at very low risk of developing prostate cancer.

Colorectal cancer is one of the most commonly diagnosed cancers in the US, and it is the second leading cause of cancer-related deaths. The risk of developing colorectal cancer increases with age.

An estimated 250 million people globally, and 25 million in the US, suffer from rare diseases. Clearly, because of their low incidence, rare cancers are difficult to study and pose challenges for detection, diagnosis, prognosis, and treatment.

In a study reported in Nature online on February 2, researchers describe a four-gene signature that was more accurate than the standard Gleason score test in predicting which patients would die from metastatic spread of their prostate cancer.

After IV administration, the human plasma protein binding of eribulin at concentrations of 100 ng/mL to 1,000 ng/mL ranges from 49% to 65%, and drug is eliminated (mean elimination half-life) in 40 hours.

ONCOLOGY Nurse Edition Continuing Medical Education February 2011

Falls and the risk of falls are critical health concerns that can impact cancer treatment and recovery. In 2007, the Centers for Disease Control (CDC) reported that more than 18,000 older adults in the United States died from injuries sustained from falls (CDC, 2010).[1] Older people diagnosed with a malignancy and who are undergoing cancer treatment using chemotherapy have an increased risk of falls.[2]

It is my pleasure to start 2011 by adding a new professional responsibility to my résumé, that of Editor-in-Chief of ONCOLOGY Nurse Edition. Although ONCOLOGY Nurse Edition is a relatively new publication, now entering its fifth year, the journal boasts a readership of 15,000 oncology nurses nationwide.

Patient falls are a common cause of morbidity and are the leading cause of injury deaths in adults age 65 years and older. Injuries sustained as result of falls in a cancer hospital are often severe, regardless of patient age, due to the nature of the underlying cancer.

While 90% of cancers occur as a result of factors related to lifestyle, the environment, or aging, 5% to 10% of cancers are passed down from generation to generation. Breast cancer is the most common cancer diagnosis in American women.

One area in which to start is to ensure that colleagues are aware of the 2007 Oncology Nursing Society (ONS) Position Paper on cancer in the elderly.[8] This position paper lays out the landscape of caring for older adults with cancer both in terms of problems to date and future initiatives to address.

Yoga, an ancient tradition that originated approximately 5,000 years ago in Central Asia, is a complete system of mental and physical practices for health and well-being. Predominantly practiced within the philosophical context of Ayurvedic medicine in India, yoga as a mind-body therapy is now also increasingly popular in the West, practiced by approximately 15 million individuals.

Oncology nurses must play an integral role in improving the treatment of breakthrough pain-one patient, one in-service for colleagues, and one clinical research study at a time.

Franklin, Delengowski, and Yeo have made a strong case for the importance of cancer rehabilitation.

The assessment and management of breakthrough pain in patients with cancer is pivotal to comprehensive pain and symptom management, and good cancer care.

The 5-year survival rate of cancer patients in the United States is about 66%, and today there are approximately 12 million cancer survivors in the US.

Mindfulness meditation and other mindfulness-based practices are gaining popularity due to a burgeoning evidence base supporting its benefits for a broad range of conditions and populations, including cancer patients[1] and healthcare professionals.

Current advances in the field of medicine have aided in the early detection and treatment of cancer, leading to an increased rate of survivorship among cancer patients after an initial diagnosis.

Cabazitaxel is a microtubule inhibitor in the taxane class. It is made from a yew needle precursor using a semisynthetic process. It binds to free tubulin, which is used during mitosis to form two daughter cells.

The increasing national and international attention to October as Breast Cancer Awareness Month brings to mind the tremendous progress made by the women’s rights movement over the last few decades.

Mrs. S. is a 37-year-old Caucasian female who sought care at her home institution overseas during a period of several months for complaints of esophageal reflux, constipation, early satiety, increasing abdominal girth, and fatigue.

Through evidence-based clinical practice, research, and patient teaching, nurses play an important role in addressing infection risk, and in managing infections, in patients with cancer.

Energy therapies consist of interventions that are designed to interact with the biofield of a person. The concept of the biofield is based on the assumption that all living things have a natural flow of energy that is integral to their basic composition.

Drug is indicated for the treatment of patients with cutaneous T-cell lymphoma (CTCL) who have received at least one prior systemic therapy.

Early and appropriate management of infection in the patient with cancer is critical to optimizing patient outcomes.

Early detection of cancer and novel chemotherapy agents have resulted in longer survival following a colorectal cancer diagnosis.

Two very different articles in this issue of ONCOLOGY Nurse Edition drive home the lesson that evidence-based practice improves cancer care.

You are a Registered Nurse working in a busy oncology unit. While assessing one of your patients, you notice that the bag of morphine used in his patient-controlled analgesia (PCA) system is running low.

On February 16, 2010, a Risk Evaluation and Mitigation Strategies (REMS) program to ensure safe use of erythropoiesis-stimulating agents (ESAs) was approved by the US Food and Drug Administration (FDA).

The May 2010 theme of Oncology Nursing Month is “Oncology Nurses: There When You Need Us.”

When she learned that she had breast cancer, Patricia Garrett did what many people with cancer do: she continued working.

More than 2.5 million breast cancer survivors live in the US today.[1] This number will continue to grow thanks to early detection and advances in treatment that are making early stage breast cancer an increasingly curable disease.

Approved Drugs: Pazopanib (Votrient) Indications

With about 12 million cancer survivors living in the US,[1] cancer affects millions of working Americans. Improvements in early detection and treatment have resulted in a significant number of newly diagnosed and long-term survivors of working age.

Curcumin is yellow curry powder, also called turmeric, Indian saffron, “Haldi,” or “curry powder.” It is a yellow pigment present in turmeric and constitutes 2%–5% of turmeric.

The patient, “TB,” is a 44-year-old Caucasian, married woman with three daughters, 21, 18, and 10 years of age.

An estimated 219,440 new cases of lung cancer were expected in 2009, accounting for about 15% of cancer diagnoses.

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most challenging and complex complications of cancer chemotherapy.

None; investigational agents olaparib (AZD2281) and BSI-201 are in phase I and II clinical trials; other PARP inhibitors under investigation include AGO 14699 (Pfizer), ABT-888 (Enzo), and MK4827 (Merck).

Lea and Calzone have provided an outstanding overview of genetics and genomic research applicable to the subspecialty of oncology nursing.

Owing to the success of today’s cancer treatments, many cancer survivors are now living through and beyond the cancer experience.

As a new decade unfolds, we are very fortunate to have an increasing number of new interventions available because of the recent tremendous advances in genetics and genomics.

At least half of all Americans are at risk for consequences resulting from low health literacy

Ginger, the rhizome of Zingiber officinale Roscoe, is best known for its role as a flavoring agent for food in Asian and Indian recipes.

Cognitive impairment, including memory loss, inability to concentrate, and difficulty multitasking, has become a widely recognized possible late effect of chemotherapy and cancer treatment.

Genetic and genomic research is creating new and more individualized approaches to better manage a person's disease or predisposition to disease, including cancer.

There has been a growing recognition in recent years that young adults with cancer are a distinct demographic group with unique needs, issues, and challenges related to their age and developmental stage of life.

Ms. Hydzik's article on intraperitoneal chemotherapy (IPC) for the treatment of ovarian cancer provides the rationale for IPC, presents the supporting evidence, and describes nursing management of these patients through the Memorial Sloan-Kettering Cancer Center experience.

In July 2009, the US Food and Drug Administration (FDA) granted approval for use of the vascular endothelial growth factor (VEGF) inhibitor bevacizumab (Avastin) in combination with interferon alfa for treatment of patients with metastatic renal cell carcinoma (RCC).

Ovarian cancer is the most deadly gynecologic malignancy. In the US alone, an estimated 21,500 new cases will be diagnosed in 2009, and an estimated 14,600 women will die from this disease.

For young adult survivors, coming to terms with a life-threatening illness is a unique dilemma.

The US Food and Drug Administration's Office of Oncology Drug Products has announced class labeling changes to product labels for the anti-EGFR

As oncology nurses, we increasingly encounter issues related to integrative medicine in our community practices, clinics, and hospitals.

Vitamin D-the so-called “sunshine vitamin”-is a fat-soluble substance and is classified more as a pro-hormone or steroid by some

Hypothyroidism is a common and potentially serious endocrine disorder in the general population.

October marks National Breast Cancer Awareness month, now in its 25th year, a time to contemplate important advances and milestones as well as future research needs.

In the US, breast cancer is the most common invasive cancer in women, with more than 200,000 diagnosed with the disease each year.

Melanoma continues to be a poorly understood and frequently under-recognized cancer threat to society. The authors have provided a comprehensive overview of this malignancy from diagnosis to advanced-stage therapy.

Melanoma affects persons of all ages, causing more years of lost life than any other cancer except leukemia.[1] The American Cancer Society estimates that about 68,720 new melanomas will be diagnosed in the US in 2009, with more than 8,650 deaths, and an estimated lifetime risk of 1 in 50 for whites, 1 in 200 for Hispanics, and 1 in 1,000 for blacks.[2]

While many oncology nurses have heard of survivor care plans, their details remain obscure. Ms. Houlihan has presented an excellent composite overview of what survivor care plans entail and the barriers limiting their use.

Once-daily oral inhibitor of mTOR (mammalian target of rapamycin) for the treatment of patients with advanced renal cell carcinoma (RCC) after failure of treatment with sunitinib (Sutent) or sorafenib (Nexavar).

Recognition of the growing number of cancer survivors in the United States, combined with a greater awareness of the ongoing physical and psychosocial needs after cancer treatment, has created a groundswell of interest in designing quality care initiatives for cancer survivors.

Formal recommendations for the support and management of cancer patients who are transitioning from active treatment to long-term follow-up are fairly recent, documented notably in the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition.

Living life to the fullest is an essential goal for everyone, and cancer survivors deserve no less. Almost 12 million cancer survivors in the US today are living longer and experiencing the long-term consequences of their disease and its treatments. Nurses will be providing much of the care that these survivors will require. The quotation cited in the article by Dr. Haylock articulates the problems of survivors living with advanced cancer. The words “I can’t die yet, I still have frequent flier miles”

Oral mucositis (OM), also referred to as stomatitis, can negatively impact radiation and chemotherapy treatment schedules and add to oncology patients’ emotional and physical distress. About 35% to 40% of patients treated with cytotoxic chemotherapy will develop OM, with higher rates occurring in bone marrow transplant patients.

Cancer-related fatigue is a common side effect during cancer treatment, and research demonstrates that it is a troubling, lingering side effect for many long-term survivors. Long-term cancer survivor fatigue is under-reported, underdiagnosed, and undertreated.[1] Studies suggest that the prevalence of fatigue in breast cancer survivors may be as high as 30%,[2] and that fatigue levels are higher in cancer survivors than in healthy controls,[3] even as long as 5 years after treatment.[1]

Robyn was 63 years old when she was diagnosed with Stage III ovarian cancer. After recovering from a total abdominal hysterectomy and oopherectomy, she traveled to a comprehensive cancer center to consult with a physician specializing in ovarian cancer. She took her entire collection of pathology slides and reports, laboratory and imaging study reports, and the summary of her surgical procedure.

Hypertension (HTN) is prevalent in the general population, particularly in individuals over the age of 60 years. More than 50% of individuals aged 60 to 69 years and more than 75% of individuals age 70 or older are affected.[1]

Bendamustine HCl for injection is FDA approved for treatment of patients with chronic lymphocytic leukemia (CLL) or indolent B-cell non-Hodgkin’s lymphoma (NHL) that has progressed during or within 6 months of treatment with rituximab (Rituxan) or a rituximab-containing regimen.

The patient, “JB,” is a 68-year-old woman who underwent a right lumpectomy and axillary node dissection for stage II breast cancer. Her oncologist suggested adjuvant chemotherapy (four cycles of cyclophosphamide [Cytoxan] at 600 mg/m2 plus doxorubicin [Adriamycin] at 60 mg/m2) followed by local radiation therapy.

When caring for patients with a new cancer diagnosis, oncology nurses generally have clear and distinct plans to assist each patient through the phases of diagnosis and treatment. Nurses provide guidance, support, and well-defined patient education regarding the planned treatment, as well as anticipatory guidance regarding management of side effects and emotional responses to diagnosis and treatment.

One of the potential side effects of chemotherapy is cardiac toxicity. The resulting damage to the heart can range from non–life-threatening events to devastating heart failure. The spectrum of these events can occur almost immediately, during a drug infusion, or as a delayed complication later in the patient’s life. Oncology nurses not only need to be familiar with identifying and intervening in acute cardiac events, but also in some instances will need to monitor for delayed cardiac toxicities during the continuum of the patient’s life.

Hospice care continues to be underutilized. Indeed, owing to untimely referrals, many patients who begin hospice care unfortunately die shortly thereafter, having never received the full benefits provided by hospice. In her excellent article, Dr. Prince-Paul provides a case example that demonstrates the familiar multifaceted issues faced by cancer patients nearing end of life and discusses how hospice care could be of tremendous benefit to the patient, family, and professional.

Ms. D is a 45-year-old woman with ovarian cancer and hepatic metastatic disease. She has received multimodal treatment over the past 5 years. Ms. D lives in her own home, is divorced, and is a single parent of two adolescent children. Her mother is her primary caregiver and also has a deteriorating health condition.

Change is in the air-and I don’t just mean the arrival of spring. The current national focus on health care is clearly evident from many quarters, including policy makers, health care institutions, and clinical staff. In addition to the discussion on health care coverage, there is an increasing emphasis on patient-centered care. As a result, we have before us a unique opportunity to assure the inclusion of survivorship and end-of-life care as formal parts of the health care continuum.

The patient, "JD," is a 62-year-old Caucasian female who had stage IV non–small cell lung cancer (NSCLC) diagnosed 3 months ago. Her medical history is significant for chronic obstructive pulmonary disease (COPD). She quit smoking cigarettes more than 6 months ago after having smoked a pack per day for 40 years.

The cytochrome P450 microenzyme system has been an important protective system for living things for at least 3 billion years. It is a group or superfamily of isoenzymes that live in the endoplasmic reticulum and mitochondrial membrane of cells, and initially were responsible for detoxifying any poisons that were inhaled or ingested. As a result, these enzymes are found in the nose, saliva, kidneys, and lungs, and in greater numbers in the small intestines and liver. Cytochrome P450s account for about 75% of total metabolism and are important in oxidative metabolism-chemical modification/degradation of drugs.

In their informative article, Richard O’Hara and Diane Blum touch on several key challenges of cancer survivorship. Looking at cancer through the lens of social concerns and developmental issues, they have brought important psychosocial aspects of survivorship to the forefront of our attention, with a particular focus on the domain of social well-being within the parameters of interpersonal relationships, and financial, employment, insurance, and legal issues.

When my doctor told me that I would have to put my life on hold at age 25 because tests confirmed that I had Hodgkin’s disease-cancer!-my life changed totally. I had to quit my job, move back in with my parents, and wonder about the quantity and quality of the rest of my life.

It is estimated that more than 62,000 men and women will be diagnosed with melanoma in 2008, with more than 8,400 deaths, and an estimated lifetime risk predicted to be 1 in 55.[1] Although deadly in its later stages, melanoma carries an excellent prognosis if it is diagnosed early. Fortunately, most melanoma cases (80%) are diagnosed at a localized stage; the 5-year survival rate for this group is 98.5%.

Bill, 53 years old and a 3-year survivor of non-Hodgkin’s lymphoma, reflects on his ongoing journey as a cancer survivor: “I was very sick and treatment was very rough, complete with a severe allergic reaction that was difficult to diagnose for a long time. But I made it through to the other shore…remission. Since then, I’ve been trying to rebuild a new life…Living with an 18-year-old [son], I can see how in some ways I’m in a parallel universe…Both of us are looking out at the world before us, at all the many possible options...trying to figure out what we want tomorrow to look like.

As difficult as treatments are for many cancer patients, another difficult time awaits them at the conclusion of therapy. Until that point, patients have become accustomed to the fleeting comfort of regularly scheduled appointments for diagnostic testing, chemotherapy and/or radiation treatments, and ongoing contact with health care professionals. Conclusion of treatment can seem abrupt and the absence of attention can be unsettling for many. It is at this point that patients often ask, “What can I do now to help myself?”

In 2008, roughly 1.44 million Americans were diagnosed with cancer,[1] and accordingly were labeled as “cancer survivors.” Fortunately, for roughly 65% of those who were newly diagnosed, this label will expand to encompass issues of long-term survivorship and health maintenance.[2] Extended cancer survivorship is a relatively new concept. In the past, most people who were diagnosed with the disease did not survive it. While longer survival times are a measure of success, the dark side of this victory is that a substantial proportion of these survivors will experience recurrence or second cancers. In addition, many more will go on to develop comorbid conditions such as cardiovascular disease (CVD), diabetes, or osteoporosis, which often kill or debilitate survivors at much higher rates than the cancer itself.[3,4]

Osteoporosis, the most common late effect of cancer treatment in the US, occurs with greater frequency among cancer survivors than the general population. Survivors of breast cancer, prostate cancer, and childhood leukemia are at particularly high risk for changes in bone mineral density (BMD) / osteoporosis that can lead to fractures.[1] In breast and prostate cancer patients, bone effects are often the result of endocrine therapy–induced alterations in bone microarchitecture. They also can be caused by other types of cancer therapy, vitamin D deficiency, and other physiological changes that may or may not be related to cancer or its treatment. In childhood leukemia patients, bone effects can be caused by a variety of factors, including corticosteroid therapy, radiation therapy to the brain, and the disease itself.

When you have cancer, you can get diarrhea for a number of reasons. Most often, it is a side effect of treatments, such as chemotherapy or radiation therapy.

Cancer occurs in approximately 1 per 1,000 pregnancies. For the woman and her family, the diagnosis creates an emotional upheaval of hopes and fears and raises the issue of immortality and mortality simultaneously. The treatment proposed to save the mother can appear in direct conflict with the desire to protect the developing fetus.

A diagnosis of cancer and its subsequent treatment can be a very frightening and confusing experience for the pregnant patient, and are challenging for the physician and nurse. As women delay childbirth until later in life, the incidence of pregnancy associated with cancer is expected to increase. Currently, approximately 1 in 1,000 pregnancies is complicated by cancer.[1–5]

When you have cancer, constipation is more likely to occur because of the cancer itself or as a side effect of treatment. If you have constipation, your doctor or nurse can help you to treat it and prevent it in the future.

42-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.

Gina, age 9, and Rosemary, age 66. They had different cancers, but developed similar skin ulcers over their entire bodies. Gina's wounds were open to air for 4 weeks. Her pain was severe. Two weeks after starting wound care, Gina allowed us to take pictures of her wounds. We promised to teach doctors and nurses how to care for her wounds. Unfortunately, Gina died. The pictures were lost. A year later, Rosemary was admitted with a similar skin condition and allowed us to photograph the progression of her wound care. Our promise to Gina is now kept. Here we describe the wound care plan necessary to relieve the pain and discomfort of partial-thickness wounds from dermatological conditions in oncology patients.

With perhaps 100 patients scheduled for chemotherapy each day and about the same number of consultations, the nurses, physicians, and staff in any medium-sized oncology clinic are fully booked. Changing their routines may be the last thing anyone wants to think about.

Diabetes mellitus is a frequent comorbidity of cancer patients. The growing epidemic of diabetes is anticipated to have tremendous impact on health care. Diabetes may negatively impact both cancer risk and outcomes of treatment. Oncology nurses are ideally positioned to identify patients at risk for complications that arise from cancer treatment in the setting of pre-existing diabetes. Additionally, oncology nurses may be the first to identify underlying hyperglycemia/hidden diabetes in a patient undergoing cancer treatment. Strategies for assessment and treatment will be discussed, along with specific strategies for managing hyperglycemia, potential renal toxicity, and peripheral neuropathy. Guidelines for aggressive treatment of hyperglycemia to minimize risks of complications will be reviewed. The role of interdisciplinary care, utilizing current evidence, is crucial to supporting patients and their families as they manage the challenges of facing two life-limiting diseases. Whole-person assessment and individualized treatment plans are key to maximizing quality of life for patients with cancer and diabetes.

FDA-Approved Drugs: 5-HT3 receptor antagonists Zofran (ondansetron), Kytril (granisetron), Anzamet (dolasetron), Aloxi (palonosetron); NK-1 receptor antagonist: Aprepitant (Emend)

Cancer clinical trials are a necessary component of the effort to improve cancer prevention, diagnosis, and treatment. Essential to this process is the informed consent of the individuals who participate in these research studies. The purpose of this article is to describe patient, provider, and informed consent process issues with presentations of data reported in the current literature. The role of nursing in the facilitation of informed consent is discussed.

Bisphosphonates are an important part of managing bony metastasis of prostate, breast, lung, and other cancers but can cause osteonecrosis of the jaw (ONJ) in some patients.

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.

The high prevalence of pain in the cancer population underscores why pain management is integral to comprehensive cancer care. How well pain is controlled can have a profound effect on the cancer experience for both patient and family. The goals of pain assessment are to prevent pain if possible, and to identify pain immediately should it occur. This can be facilitated by standardized screening of all cancer patients for pain, on a routine basis, across care settings. A comprehensive assessment of pain follows if a patient reports pain that is not being adequately managed. Oncology nurses play a huge role in pain assessment and management throughout the course of a patient's disease. A basic understanding of the types of pain seen in the cancer population as well as inferred neurophysiologic pain mechanisms and temporal patterns of pain can help focus the pain assessment. This in turn will lead to targeted pain management strategies

Chemotherapy-induced febrile neutropenia (FN) predisposes patients to life-threatening infections and typically requires hospitalization. The goal was to investigate whether a risk assessment tool aligned with national guidelines could help identify patients at risk of FN and reduce FN-related hospitalizations. Beginning in October 2004, oncology nurses applied the new risk assessment tool to all patients initiating chemotherapy or a new regimen. Patients at risk for FN received prophylactic colony-stimulating factor. Charts for 189 patients receiving chemotherapy in fiscal year 2005 (FY05) were compared with charts of 155 patients receiving chemotherapy in FY04, before the tool was implemented. The incidence of FN-related hospitalization declined by 78%, from 9.7% in FY04 to 2.1% in FY05 (P = .003). Total hospital days decreased from 117 to 24. Routine systematic evaluation by oncology nurses improves recognition of patients at risk of FN and substantially reduces FN-related hospitalization.

Major deficiencies in the management of cancer-related pain are well documented and impact all dimensions of the patient's life, including physical, psychological, social, and spiritual well-being.

With the trend toward the use of oral rather than intravenous therapies for cancer, nonadherence to treatment has become an increasing concern. Advanced practice nurses are in a good position to assess and monitor adherence to oral endocrine therapies. Research on adherence has been limited; to date there are no specific published guidelines for ensuring adherence to endocrine regimens. However, studies have identified many factors that may lead to nonadherence, including demographic, social, and psychological characteristics of the patient; characteristics of the disease and the treatment regimen; and the nature and quality of the patient/clinician relationship. These factors provide a framework that advanced practice nurses can use to identify potential problems and to work collaboratively with patients.

Dr. Ann Berger does an excellent job of writing to the chronic pain sufferer in her book Healing Pain. Health-care providers and family caregivers will also find it an excellent resource and can benefit greatly from reading this work. Throughout the book the author maintains a true sense of hope for the individual experiencing significant pain. Her ability to communicate this sense of hope will be rather contagious for the health-care provider who may have become less than enamored with our ability to accomplish pain management in individuals with complex pain syndromes.

Oncology nurses play a pivotal role in educating the cancer patient who is about to commence oral chemotherapy. Increasing numbers of patients are receiving oral chemotherapy at home, and with this move to oral self-