Recognizing the Need for Oncology Education in Canadian Baccalaureate Nursing Programs.

There is a critical need for quality oncology education in Canadian baccalaureate nursing programs considering the vast amount of cancer diagnoses and deaths in the Canadian population, as well as the likelihood that all nurses will care for oncology patients in various settings. The incidence and mortality of cancer within the Canadian population impact the need to incorporate an all-inclusive view of cancer care into baccalaureate nursing curriculums and develop nurse leaders in oncology at this level. Currently, Canadian nursing programs are generalist programs and provide little oncology content especially in the clinical setting. It is essential that baccalaureate nursing programs examine strategies to incorporate a comprehensive view of cancer care into programs to ensure that baccalaureate nursing students meet the entry to practice competencies to care for patients across the cancer care trajectory.

Lenalidomide and metronomic melphalan for CMML and higher risk MDS: a phase 2 clinical study with biomarkers of angiogenesis.

Metronomic, low dose chemotherapy may have anti-angiogenic effects and augment the effects of lenalidomide in MDS and CMML. We evaluated the clinical efficacy, tolerability and anti-angiogenic effects of melphalan 2mg and lenalidomide 10mg for 21 days/28 in CMML (n=12) and higher risk MDS (n=8) patients in a prospective phase II study. The primary endpoint was overall response and secondary endpoints included survival, progression-free survival, toxicity and biomarkers of angiogenesis. The median age was 73 years, 55% were pretreated and transfusion dependent. The overall response rate was 3(15%) of 19 evaluable patients but 25% in CMML and 33% in pCMML. Dose reductions and/or delays were common due to myelosuppression. Transient spikes in circulating endothelial cells that declined below baseline were seen in responders and patients with CMML, suggesting anti-angiogenic activity. In conclusion, lenalidomide and metronomic low dose melphalan demonstrate signals of clinical and possible anti-angiogenic activity in patients with pCMML that require future validation. This trial was registered at clinicaltrial.gov under # NCT00744536.