The importance of transcultural nursing in cancer care.

All patients around the time of cancer diagnosis are emotionally vulnerable. This sense of anxiety is further heightened for patients who are not fully integrated into the society in which they are receiving care because of the cultural shock and language barriers they may face. This article explores the author's experience of caring for a patient from China who was studying in the UK and was admitted with acute promyelocytic leukaemia. The patient had a limited grasp of English and was used to very different cultural norms. Bridging the cultural gap as outlined by Narayanasamy in the ACCESS model (2002) enabled the author to provide the important holistic nursing care that could be easily overlooked in these situations. There is a need for nurses to actively seek to understand cultural differences and take the opportunity to experience transcultural nursing.

Acute promyelocytic leukemia: an overview with implications for oncology nurses.

Acute promyelocytic leukemia (APL), once described as the form of leukemia with the highest mortality, is now the most potentially curable subtype of adult acute myeloid leukemia. A brief review of the history of APL will describe the advances in research and clinical practice and their impact on patient outcomes. Oncology nurses should familiarize themselves with the nuances of APL because of the critical role nurses play in providing support for patients. This article provides an overview of APL, including the epidemiology and pathophysiology that distinguishes APL from other types of acute leukemia. Clinical presentation and diagnostic workup for patients suspected of having APL will be reviewed, as will the treatment course. Nursing implications and management will be provided related to potential treatment complications specific to APL, including coagulopathies, differentiation syndrome, and QT prolongation with the use of arsenic trioxide, as will the side effects and complications that can occur in any patient with leukemia, such as infection, hyperleukocytosis, tumor lysis, and increased intracranial pressure.

Update on the diagnosis of and therapy for acute promyelocytic leukemia and chronic myelogenous leukemia.

PURPOSE/OBJECTIVES: To present information about recent Food and Drug Administration (FDA)-approved indications regarding drug therapy for acute promyelocytic leukemia (APL) and chronic myelogenous leukemia (CML) and about the nursing care of patients receiving these therapies and to review the significance of the use of polymerase chain reaction (PCR) assays in the management of patients with these leukemias. DATA SOURCES: Published articles, book chapters, and production information. DATA SYNTHESIS: Two agents with newly approved FDA indications are changing the focus of leukemia treatment from the cytotoxicity of specific drugs to the reversal of arrested maturation of myeloid cells. All-trans-retinoic acid (ATRA) induces remission in patients with relapsed or refractory APL. Interferon alfa (IFN-alpha) administered to patients with chronic-phase, Philadelphia-chromosome-positive CML produces improved survival rates and delays disease progression as compared to standard therapy. PCR assays are used with both of these diseases to confirm diagnosis, monitor response to these agents, and predict disease progression. CONCLUSIONS: The care of patients with leukemia continues to change as new agents such as ATRA and are approved for treatment and new assays such as PCR become available for diagnosis and treatment monitoring. IMPLICATIONS FOR NURSING PRACTICE: The nursing care of patients with leukemia requires keeping knowledgeable about the latest information regarding the molecular biology of the disease, the mechanism of action of newly approved agents, and the clinical implications of developing tests. This knowledge allows nurses to assimilate new therapies into practice, which, in turn, enables them to help patients to understand and cope with treatment through patient education and innovative interventions for symptom management.

Chronic myelogenous leukemia and acute promyelocytic leukemia: new bone marrow transplantation options.

PURPOSE/OBJECTIVES: To describe new bone marrow transplantation (BMT) options for chronic myelogenous leukemia (CML) and acute promyelocytic leukemia (APL), as well as their applications and prognoses, and to describe the role of the oncology nurse in caring for the BMT recipient and options for future nursing research. DATA SOURCES: Published articles, book chapters, and personal experience. DATA SYNTHESIS: Various pretransplant agents and methods are under investigation to improve the outcome and reduce the costs of allogeneic and autologous BMT and peripheral blood progenitor cell (PBPC) transplants. Preliminary results of current studies indicate that autologous BMTs and PBPC transplants have merit as a treatment option in patients with AML and require further research. For patients with APL, BMT usually is reserved for those who fail to achieve or relapse after achieving remission with chemotherapy. Preliminary data show that patients with CML and APL who receive a PBPC transplant engraft more rapidly with decreased morbidity and mortality. CONCLUSIONS: BMT options for patients with CML and APL continue to evolve as advances in pretransplant methods and symptom management become capable of improving the outcome, decreasing costs, and shifting patient care to the outpatient and homecare settings. IMPLICATIONS FOR NURSING PRACTICE: Understanding the marrow transplant options available to patients with CML and APL is essential for nurses. They must stay informed about ongoing improvements in pretransplant processes and symptom-management procedures that reduce BMT morbidity and mortality. Inpatient and outpatient nurses need to collaborate and participate in nursing research to find better ways of providing the best care possible for patients.

Diagnosis and management of acute promyelocytic leukemia with disseminated intravascular coagulopathy: a case study.

One of the less common leukemias, acute promyelocytic leukemia, is associated with disseminated intravascular coagulopathy (DIC). If patients are able to survive the DIC, there is hope for long-term survival in complete remission and a chance for cure. This case study reviews the disease, risk factors, treatment, and nursing care required by this patient population and compares it to the existing literature.