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Cancer Pain Management in the 21st CenturyCancer causes pain as it invades bone, compresses nerves, produces obstructive symptoms in the pulmonary, gastrointestinal, and genitourinary systems, and distends involved visceral organs. This manuscript reviews progress in cancer pain management during the past 2 decades. Since the 1980s, we have seen (1) genuine advances in research on the biology of pain, (2) new approaches to the treatment of cancer pain, and (3) important changes in the health-care system to ensure that pain is appropriately assessed and managed. Currently, clinicians have the appropriate diagnostic and therapeutic tools to ensure that the vast majority of patients with cancer pain can be comfortable during their illness. Nevertheless, too many patients with terminal malignancies continue to die in pain in nations around the globe. An effective strategy to make alleviating pain a major health-care priority remains the primary challenge to effectively palliating patients with cancer pain.
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Study Finds ESR1 Mutations Drive Metastasis in ER-Positive Breast CancerThis video looks at a new study that found that in addition to conferring resistance to hormone therapies, estrogen receptor mutations can cause breast cancer cells to metastasize.
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Intraoperative Radiotherapy for Breast Cancer: Deceptively Simple?Due to the fact that we do not have mature long-term data regarding efficacy, we are still several years away from declaring IORT to be a viable alternative to the current standard of care in patients with early-stage breast cancer.
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Accelerated Partial Breast Irradiation for Breast Cancer: Not Ready for Routine UseWe know that breast cancer represents a spectrum of diseases, with variation in prognosis, and that RT can range from highly complex treatments to the breast and regional lymph nodes, to complete avoidance of radiation.
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he Oncology Nurse's Role in the Informed Consent ProcessCancer 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.
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Multidisciplinary Management of Pediatric Soft-Tissue SarcomaThe management of pediatric soft-tissue sarcomas has improved drastically through the use of multimodal therapy. These tumors include rhabdomyosarcomas and nonrhabdomyosarcomas. Both are staged using
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Genetics and Genomics: A New Frontier in OncologyLea and Calzone have provided an outstanding overview of genetics and genomic research applicable to the subspecialty of oncology nursing.
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Mathematical Modeling for Breast Cancer Risk AssessmentWomen at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]
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The Timing of Breast Cancer Surgery During the Menstrual CycleA number of recent studies have suggested that survival among premenopausal women after primary treatment of breast cancer may be affected by the estimated hormonal milieu at the time of surgery, especially in those with
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ONS: Genetics and Genomics MattersThis interview covers standards for healthcare provider competency in offering comprehensive genetic services, and highlights genetics/genomics resources for nurses.
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Prostate Cancer Risk Assessment ProgramProstate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and
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Stress and Burnout in OncologyThis article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingIntensive outpatient care is rapidly becoming the primary mode of care for selected patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation. Although the traditional inpatient model of care may still be necessary for high-risk patients, published data suggest that outpatient care is safe and feasible during or after administration of high-dose chemotherapy and autologous PBSC transplant. Blood and marrow transplant (BMT) centers have developed programs to provide more outpatient care under three basic models: an early discharge model, a delayed admission model, and a comprehensive, or total, outpatient model. This review will describe these models of care and address the elements necessary for the development of an outpatient BMT program, including patient selection, staff development, and patient and caregiver education. Available supportive care strategies to facilitate outpatient care will also be highlighted.
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Irinotecan/Gemcitabine Followed by Twice-Weekly Gemcitabine/Radiation in Locally Advanced Pancreatic CancerEarly clinical studies combining irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) have yielded encouraging results. Gemcitabine administered via a twice-weekly schedule results in an enhanced radiation-sensitizing effect.
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Treatment of Immunoglobulin Light Chain (Primary or AL) AmyloidosisThis review of the various available options for the treatment of systemic amyloidosis is designed to help the clinician determine which patients are candidates for stem cell transplantation and which should be treated with conventional chemotherapy.
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Romiplostim for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn August 22, 2008, the US Food and Drug Administration (FDA) granted marketing approval (licensure) to romiplostim (Nplate, Amgen Inc) for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
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The ‘Watch-and-Wait’ Approach for Rectal Cancer: Are Outcomes Improved With More Limited T Stage and Routine Use of MRI for Staging?We also propose that limiting the watch-and-wait strategy to patients with T1/T2N0 rectal cancer and using adequate T staging with MRI will result in improvements in local control and patient outcomes.
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Contemporary Issues in NSCLCLung cancer remains the number one cancer killer in both men and women, with more deaths attributable to lung cancer than breast, prostate, and colorectal cancers combined.[1]
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Wall Chart Featuring Skin-Related Toxicities of Targeted TherapiesWall Chart Featuring Skin-Related Toxicities of Targeted Therapies
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Ovarian Cancer and Lower Limb LymphedemaC.W., is a 46-year-old white female who presented to her gynecologist complaining of an egg-shaped mass between her right hip bone and umbilicus, and irregular menstrual cycles. Physical examination confirmed a large palpable mass in her lower abdominal area. Past medical history was unremarkable. She was not taking any regular medications. She has been married for 17 years and has worked as a respiratory therapist for 16 years in a large pediatric hospital. She had been actively participating in a program of daily exercise at an area health club that included aerobics and weight training. She is a social drinker and denies any illicit drug use.
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Guiding Post-Treatment Decisions in Rectal Cancer: mrTRG Is a Practical Place to StartThe authors propose that current policies regarding the use of chemoradiotherapy or short-course preoperative radiotherapy have resulted in an approach to rectal cancer management that often represents overtreatment, with significant loss of quality of life for patients.
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In-Transit Melanoma: An Individualized ApproachThe management of in-transit metastases is challenging, since the treatments and extent of disease vary greatly based on the number, depth, location, and distribution of lesions, and on their biological behavior.
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Irinotecan and Gemcitabine in Patients With Solid Tumors: Phase I TrialUsing a day 1 and 8, every-3-week schedule, our purpose was to determine the maximum tolerated dose of irinotecan (CPT-11, Camptosar) that can be administered immediately after gemcitabine (Gemzar) at a dose of 1,000 mg/m² IV. In this phase I trial, the maximum tolerated dose was defined as the dose level immediately below the level in which two of the first three patients in any cohort, or at least two of six patients in any expanded cohort, experienced dose-limiting toxicity. Dose-limiting toxicity pertained only to toxicity during the first cycle of treatment. Escalation of irinotecan was planned in groups of three patients, with three additional patients added at the first indication of dose-limiting toxicity. A total of 19 patients have been enrolled.
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Management of DCIS-A Work in ProgressImproved screening practices have lead to a dramatic increase in the diagnosis of ductal carcinoma in situ (DCIS) over the past 40 years.
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Book Review: Adjuvant Therapy of Cancer--VIIThis is the seventh in a well-known series of conference summaries, organized and edited by Dr. Salmon. A perusal of the contents of these volumes over the past two decades reveals the evolution of concepts related to combined-modality therapy
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Beyond Futility: Good Shared End-of-Life Decision-Making Takes Ongoing Discussions, Realistic GoalsDecision-making at the end of life is difficult, and it should be. Rather than face these time consuming and emotionally demanding discussions, doctors too often look to unsuitable conceptual models.
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The Myelodysplastic Syndromes: Help Is On The Way!Most adult patients with hematopoietic failure due to myelodysplastic syndrome (MDS) are treated with supportive care measures, including hematopoietic growth factors (epoetin alfa, darbepoetin alfa, filgrastim, pegfilgrastim, sargramostim), red blood cell or platelet transfusions, and antimicrobial agents. Allogeneic stem cell transplantation can be curative, but only a small subset of patients are eligible for transplantation, and until recently there were few options other than supportive care for transplant-ineligible patients. Since 2004, the US Food and Drug Administration (FDA) has approved three new therapies specifically for the indication of MDS: two DNA methyltransferase inhibitors (azacitidine and decitabine) and an immunomodulatory agent (lenalidomide). Several other drugs are used by clinicians for treatment of patients with MDS, but are not specifically FDA-approved for this indication. With several therapeutic options available, yet none of them effective in the majority of cases, it can be challenging for clinicians to choose the most appropriate treatment for an individual patient. Here we discuss a risk-based management approach to MDS that incorporates recent data regarding these new therapies. While many questions remain about the optimal use of newer agents, the long-standing perception of MDS as a syndrome where therapeutic nihilism is the only realistic approach is slowly beginning to change.
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Nonepithelial Malignancies of the BreastChugh and Baker have presenteda concise and contemporaryreview of the commonnonepithelial malignancies of thebreast, focusing mainly on the managementof this heterogeneous groupof neoplasms. Needless to say, appropriatemanagement of any neoplasmis entirely dependent on accurate pathologicdiagnosis. Due to the rarity ofthese nonepithelial malignancies of thebreast, they commonly present difficultiesin pathologic diagnosis. Issuesrelating to the diagnosis of these tumorsmay not be obvious to nonpathologists,and deserve comment.
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PARP Inhibition in Prostate Cancer: A Promising ApproachHaving said that, PARP inhibition is one of the most promising approaches for “precision therapy” so far. Within the next few years and with the help of ongoing clinical trials, we should have a better understanding of whether or not the high expectations raised will be translated into clinical reality.
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Salivary Gland Cancers: Biology and Systemic TherapyThis article reviews the pathology and current evidence on systemic therapies for the management of advanced salivary gland cancers that are not amenable to local therapy.
