October 2011: Nurse Perspectives on Developments in Cancer Care

Valproic Acid in Glioblastoma

Colleen M. O'Leary, RN, MSN, AOCNS

Otolaryngology Clinical Nurse Specialist

The James Cancer Hospital

The Ohio State University Medical Center, Columbus

There are already inherent difficulties when treating patients with glioblastoma, including the stress to patients and families that are often dealing with personality changes in the patient. In addition, there are often adherence issues when giving oral therapies to patients. The additional risk of seizure activity in these patients can only add to the already mounting stress for patients and families. Therefore, the addition of an AED is imperative for many patients.

Given the variety of AEDs available, the findings of Weller, et al are encouraging. The fact that we can increase overall survival with valproic acid should be considered significant; however, this survival benefit does not come without its own cautions.

As discussed in the article, patients treated with valproic acid have increased incidence and severity of thrombocytopenia and leukopenia. It would be imperative for nurses to educate the patient and family on precautions to take for thrombocytopenia and leukopenia, and to encourage them to call their healthcare provider with any indication of bleeding or infection. A thorough physical assessment would be warranted in order to uncover subtle changes that may detect thrombocytopenia or leukopenia before they become severe. In addition, a social history including living conditions and activities should be completed to reveal any risks that need to be addressed.

Weller et al are also clear to point out that there are some shortcomings to their study that may warrant additional research, but that these encouraging results may help guide us in the choice of AEDs in patients receiving the current standard treatment. As always, the nurse is in a perfect position to discuss these findings with the physician and advocate for the patient when appropriate.

Find out more >>> Valproic Acid May Prolong Survival in Glioblastoma

Improving HER2 Testing

Marsha Schmit, RN, BSN

Breast Health Navigator

Hurley Medical Center

Flint, Michigan

Trastuzumab (Herceptin) and lapatinib (Tykerb) have proven to be very valuable in treating patients with HER2-positive invasive breast cancer. While efforts to improve HER2 testing continue, the most important aspect is to create a system of uniformity in testing and interpretation.

The goal is to make sure everyone who could benefit from these medications is receiving them. Therefore, it is imperative that quality standards are instituted, as well as followed, in order to prevent false negatives that might prevent a patient from receiving this worthwhile treatment.

Protocols do not appear to be enough to standardize this process. Additional coordination of the tissue is essential. As the number of testing sites increases and these medications are being successfully used in other disease processes, we are now talking about life or death in terms of whether the test is done correctly or not.

There must be standardized proficiency testing for IHC, FISH, ER, and PgR markers. It is not a question as to which one might be best, but rather attending to the details of how the test should be performed and read, which will ultimately improve the performance of these tests. In the end, it is important to have a test that is as reliable as the treatment that is offered.

Find out more >>> Efforts to Improve HER2 Testing Continue ASCO Panelist Sees Progress

HPV Vaccination Gaps

Colleen Masterson, RN, BSN

John Theurer Cancer Center

at Hackensack University Medical Center

Hackensack, New Jersey

Issues with completion rates for vaccination with the human papillomavirus (HPV) infection can be related to scheduling; however, knowledge gaps in parents and teenagers regarding HPV vaccination can also strongly affect the likelihood of complete vaccination.

Parents need to be made aware that efficacy of the vaccine is not accomplished until the vaccine series is completed. With constant controversy over vaccines being considered a health risk, perception is critical. Addressing questions and educating parents and teens on vaccination efficacy needs to be a high priority before starting the process. Healthcare professionals should describe not just what the vaccine is treating, but what follow-up dosing involves, and the time frame for each vaccine. Being forthcoming and having a “treatment plan” prior to patients leaving the office reduces the likelihood that the adolescent or the parent would potentially not remember a scheduled dose.

One distinct advantage of the adolescent generation being more tech savvy is the ability to create a reminder system for the teenager and for the parent through e-mail or cell phone to keep all parties connected. The prior scheduling of the second and third doses is one way to keep on track. Providing a prerecorded message or an e-mail as a reminder at different intervals can help with adherence and reduce the vaccination completion gap.

Find out more >>> HPV Vaccination Completion Rates Increase, but Gaps Remain

Benefits of a Prudent Diet

Laura Metcalfe, MSN, RN, APN, C, AOCNS®

John Theurer Cancer Center, Hackensack, New Jersey

The adoption of a “prudent” diet has been well established as a strategy to reduce one’s risk of colorectal cancers. The American Cancer Society (ACS) recommends 5 or more servings of vegetables and fruits daily, whole grains instead of processed grains and sugars, and limited red meat consumption, especially high-fat and processed meats. Further, the ACS recommends maintaining a healthy weight, limiting alcoholic beverages, no smoking (as well as limited exposure to secondhand smoke), and adopting a physically active lifestyle as further risk-reduction strategies.

This study looked only at black women, and one must always be careful about applying findings across heterogeneous groups; however, I personally believe that adopting a prudent diet would significantly decrease the number of colorectal cancer diagnoses for those people with no other risk factors (ie, inherited genetic abnormality, inflammatory bowel disease, personal history of colonic polyps). Further, a 2007 study published in the Journal of the American Medical Association (Meyerhardt JA, et al. JAMA. 2007;298[7]:754-764) showed that colorectal patients with the highest intake of a Western-pattern diet, characterized by high intakes of red meat, sugar desserts, high fat, and refined grains, have a three-fold increase in cancer recurrences and mortality.

Given that a prudent diet has other health benefits, including, but not limited to, reducing obesity, and subsequently, the risk of hypertension, diabetes, and heart disease, I see no downside to adopting the type of diet discussed in the study. I recommend it for anyone looking to decrease their colorectal cancer risk or just looking to improve their overall health.

Find out more >>> Prudent Diet May Help Prevent Colorectal Adenomas in Black Women

Chemotherapy in Octogenarians

Lea Ann Biafora, MS, RN, OCN®, CPHQ

Assistant Director, Senior Medical Liaison

Xcenda, St. Petersburg, FL

Elderly patients (mid-70s and older) with NSCLC are more likely than their younger counterparts to receive a single chemotherapeutic agent, not the general standard of care—a platinum or taxane-based doublet regimen with or without an added biologic agent. However, as the first wave of baby boomers is set to become octogenarians, we can expect a uniquely different elderly patient: a healthier, more driven, independent, and educated healthcare consumer who actively participates in his or her care.

Therefore, the traditional or “typical” approach to treating these patients must continue to be tested and evaluated. As discussed in the above article, this approach has been tested for its efficacy and safety in an important multicenter, phase III study (IFCT-0501) comparing carboplatin and paclitaxel doublet chemotherapy regimens (the standard of care) to monotherapy regimens in elderly patients (aged 70-89 years) with advanced or metastatic NSCLC. The study met its primary endpoint of overall survival (OS), with a median OS benefit of 4.1 months in the doublet arm.

These findings offer important evidence that elderly patients with advanced or metastatic disease be considered for standard treatment despite increased toxic effects (most frequent: neutropenia and asthenia). Further, reconsideration of how the current standards of therapeutic care are applied to elderly NSCLC patients is necessary, as oncology care continues its transformation to become more personalized through genomic testing and targeted treatment approaches. With the rapid advancements in lung cancer and the entry of technologies and targeted agents, it is essential that we better understand the mechanism of action and its implications as side effects arise so that we may educate our patients and sharpen our patient assessment skills.

It is within this historic collision of medical science and generational patient shifts that we find opportunities for the nursing profession and for nursing research, some of which should include:

• Nursing participation in conducting quality-of-life studies related to the elderly cancer population.
• Nursing development/contribution of clinical guidelines to help develop new standards of care that incorporate both the physical and psychosocial aspects of a patient’s history to help guide selection of treatment.
• Nursing development of patient advocacy materials to promote shared decision-making.

Find out more >>> Adjusting Chemotherapy in Octogenarians With NSCLC