CE: Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns.

: Background: Many antineoplastic (chemotherapeutic) drugs are known or probable human carcinogens, and many have been shown to be reproductive toxicants in cancer patients. Evidence from occupational exposure studies suggests that health care workers who have long-term, low-level occupational exposure to antineoplastic drugs have an increased risk of adverse reproductive outcomes. It's recommended that, at minimum, nurses who handle or administer such drugs should wear double gloves and a nonabsorbent gown to protect themselves. But it's unclear to what extent nurses do. PURPOSE: This study assessed glove and gown use by female pregnant and nonpregnant nurses who administer antineoplastic drugs in the United States and Canada. METHODS: We used data collected from more than 40,000 nurses participating in the Nurses' Health Study 3. The use of gloves and gowns and administration of antineoplastic drugs within the past month (among nonpregnant nurses) or within the first 20 weeks of pregnancy (among pregnant nurses) were self-reported via questionnaire. RESULTS: Administration of antineoplastic drugs at any time during their career was reported by 36% of nonpregnant nurses, including 27% who reported administering these drugs within the past month. Seven percent of pregnant nurses reported administering antineoplastic drugs during the first 20 weeks of pregnancy. Twelve percent of nonpregnant nurses and 9% of pregnant nurses indicated that they never wore gloves when administering antineoplastic drugs, and 42% of nonpregnant nurses and 38% of pregnant nurses reported never using a gown. The percentage of nonpregnant nurses who reported not wearing gloves varied by type of administration: 32% of those who administered antineoplastic drugs only as crushed pills never wore gloves, compared with 5% of those who administered such drugs only via infusion. CONCLUSION: Despite longstanding recommendations for the safe handling of antineoplastic and other hazardous drugs, many nurses-including those who are pregnant-reported not wearing protective gloves and gowns, which are considered the minimum protective equipment when administering such drugs. These findings underscore the need for further education and training to ensure that both employers and nurses understand the risks involved and know which precautionary measures will minimize such exposures.

Pregnancy in a Patient With a Malignant Brain Tumor Taking Temozolomide: Case Report and Review of the Literature.

Temozolomide (TMZ), an alkylating agent used in the treatment of malignant gliomas, is a pregnancy category D medication that is not advised for use in pregnant women. We report the case of a 19-year-old woman with anaplastic oligodendroglioma (high-grade glioma) who became pregnant during maintenance chemotherapy consisting of TMZ 200 mg/m(2) administered 5 days monthly. The TMZ was immediately discontinued after she developed a positive pregnancy test. She delivered a full-term healthy baby boy with no prenatal or perinatal complications. Adolescents and young adults with brain tumors are often sexually active and should receive intensive and repeated anticipatory guidance regarding contraception while receiving chemotherapy. Pediatric oncology nurses are in a unique position to provide this education for patients and ensure that young women have appropriate pregnancy testing prior to chemotherapy administration.

Perioperative management of pheochromocytoma/paraganglioma: is there a state of the art?

Pheochromocytoma and paraganglioma are rare tumors of sympathetic or parasympathetic origin, presenting with a highly variable clinical picture. Rarity, as well as biological, clinical, and genetic heterogeneity are barriers to initiate prospective studies that help to establish clinical guidelines. The best management of these patients relies on the experience of a multidisciplinary team. The ultimate outcome can benefit from adequate pre-surgical evaluation and treatment as well as an accurate post-surgical follow-up. Long-term follow-up is mandatory in all patients, but is particularly important in specific familial cases such as those with an SDHB mutation where the risks of recurrence are higher. The surgical approach varies depending on tumor size, location, and surgeon's personal attitude and experience. In this paper, we summarize recommendations, based mostly on authors' and other experts' personal experiences, for the best possible management of patients prior, during and after surgery, as well as when pheochromocytoma is diagnosed during pregnancy.

Prognosis of breast cancer during pregnancy: evidence for nursing care / O prognóstico de câncer de mama na gravidez: evidências para o cuidado de enfermagem / El pronóstico de cáncer de mama en el embarazo: evidencias para la atención de enfermería

This integrative review analyzed evidence available in the literature concerning the prognosis of breast cancer during pregnancy. The following databases were used for selecting studies: PubMed, CINAHL and LILACS. A total of 240 primary studies were identified; 13 papers were included in the integrative review’s sample after reading the titles and abstracts and according to the established inclusion and exclusion criteria. There is evidence indicating that pregnancy does not worsen the evolution of breast cancer and a poor prognosis is related to late stage tumors. Among the gaps identified in the studied theme, the need for further studies addressing nursing care provided to pregnant women with breast cancer is highlighted in order to promote improved care in the context of health care.

O presente estudo teve como objetivo analisar as evidências disponíveis na literatura sobre o prognóstico de câncer de mama na gravidez. O método de revisão adotado foi a revisão integrativa. Para a seleção dos estudos primários, utilizaram-se as bases de dados PubMed, CINAHL e LILACS. Na busca, foram identificados 240 estudos primários, após a leitura dos títulos e resumos e, frente aos critérios de inclusão e exclusão estabelecidos, 13 artigos foram incluídos na amostra da revisão integrativa. Na síntese do conhecimento produzido, há evidências que indicam que a gestação não piora a evolução do câncer de mama e o mau prognóstico está relacionado ao estadiamento tardio do tumor. Dentre as lacunas identificadas, sobre o tópico investigado, destaca-se a necessidade de condução de estudos direcionados para a assistência de enfermagem, prestada à mulher grávida, com câncer de mama, para promover a melhoria do cuidado no contexto da atenção à saúde.

Esta revisión integradora de la literatura objetivó analizar las evidencias disponibles en la literatura sobre el pronóstico del cáncer de mama durante el embarazo. La selección de los estudios primarios fue realizada en las bases de datos PubMed, CINAHL y LILACS; se identificaron 240 estudios primarios. Después de la lectura de los títulos y resúmenes y establecimiento de los criterios de inclusión y exclusión, 13 artículos fueron incluidos en la muestra de la revisión integradora. En la síntesis del conocimiento producido hay evidencias que indican que el embarazo no empeora la evolución del cáncer de mama y el pronóstico malo está relacionado con la estadificación clínica tardía del tumor. Entre las lagunas en el tópico investigado hay que resaltar la necesidad de realizar estudios sobre la atención de enfermería prestada a mujeres embarazadas con cáncer de mama para mejoría del cuidado en el contexto de la atención a la salud.

Prognosis of breast cancer during pregnancy: evidence for nursing care.

This integrative review analyzed evidence available in the literature concerning the prognosis of breast cancer during pregnancy. The following databases were used for selecting studies: PubMed, CINAHL and LILACS. A total of 240 primary studies were identified; 13 papers were included in the integrative review's sample after reading the titles and abstracts and according to the established inclusion and exclusion criteria. There is evidence indicating that pregnancy does not worsen the evolution of breast cancer and a poor prognosis is related to late stage tumors. Among the gaps identified in the studied theme, the need for further studies addressing nursing care provided to pregnant women with breast cancer is highlighted in order to promote improved care in the context of health care.

Cancer and pregnancy: a health care dilemma.

When cancer occurs during pregnancy, a conflict exists between the family's hopes and dreams for the future and the reality of the diagnosis of a potentially terminal illness. The nurse has a pivotal role in the assessment and management of the pregnant oncologic patient's physical and emotional health. The perinatal nurse must assure that the care experienced by the family balances the reality of a potentially life-threatening illness with the joy that accompanies the birth of a baby.

Abnormal cervical cytology in pregnancy: a laboratory and clinical dermatologic perspective.

The dermatologic examination of the pregnant woman with abnormal cervical cytology can be a challenge to the clinician. This article explores both the laboratory and clinical examinations and the special issues of each that are affected by pregnancy. The technique of obtaining an adequate Pap test as well as guidelines on managing the abnormal Pap result will be addressed. Normal and abnormal colposcopic findings are described with reasons why they may be more difficult to differentiate in pregnancy. As long as no invasive cancer is found, the pregnancy may proceed with continued surveillance. Postpartum regression rates of intraepithelial neoplasia are high.

Perceived concerns of pregnant women with breast cancer treated with chemotherapy.

PURPOSE/OBJECTIVES: To identify concerns of women who had received chemotherapy for breast cancer while pregnant. DESIGN: Exploratory, descriptive, retrospective pilot study. SETTING: Large cancer center in the Southwestern United States. SAMPLE: Six women (mean age of 35.5 years) who had been treated for breast cancer while pregnant within the previous five years. METHODS: Mailed survey using a demographic form and the Bandyk Concerns Questionnaire--a 30-item Likert-type scale. MAIN RESEARCH VARIABLES: Concerns about the effects of breast cancer treatment on the pregnancy and the fetus. FINDINGS: The primary concern was "living to see my child grow up." Of least concern was "other people's opinion of me." CONCLUSIONS: Although an informational pamphlet was written based on these results, more extensive examination of the special group of patients is needed to draw any conclusions. IMPLICATIONS FOR NURSING PRACTICE: Nurses are in a good position to offer accurate information to women who must make the choices involved with receiving chemotherapy during pregnancy and to support the women during and after the treatment and the child's birth.

Breast cancer and pregnancy: implications for perinatal care and fetal outcomes.

The diagnosis of breast cancer has a profound impact on women and their families. Although relatively uncommon, breast cancer associated with pregnancy is gaining attention as more women choose to delay pregnancy. The perinatal nurse must combine a knowledge of breast cancer and its treatment with an understanding of how this treatment will influence current and future pregnancies. Of critical importance are the roles of educator and patient advocate. This clinical review will discuss the natural history of breast cancer associated with pregnancy, its diagnosis and treatment, and the nursing implications for maternal and fetal care.

Choroidal melanoma.

Choroidal melanoma is a rare and deadly cancer. Nursing care for these patients involves ophthalmic clinical expertise as well as psychosocial and emotional support. Although past research has been helpful in determining the prognosis of these patients, it is impossible to predict with certainty which patients have tumors or nevi that will grow, will compromise their vision, or will kill them. Providing emotional support, establishing a good rapport with the patients and their support persons, and encouraging patients to schedule and adhere to their mutually agreed on follow-up appointments are nursing interventions that may save or prolong a patient's life.

Chemotherapy and pregnancy.

There are still unanswered questions concerning long-term effects of intrauterine exposure to antineoplastics. It is possible that a mechanism of follow-up such as a national registry could be formalized. Although pregnancy in the women with cancer is a rare event, it may occur more frequently in the future. The nurse must be knowledgeable concerning the issues in decision-making and confident in his or her ability to mobilize resources for the patient and family. Overall, the use of cytotoxic agents during the first trimester offers the greatest potential for spontaneous abortion and fetal malformations. In contrast, chemotherapy administered in the second and third trimesters appears to offer minimal risk. What effect this exposure will have on future generations is only speculative. It would be safer if fetal drug exposure could be avoided completely, but when this is not prudent and the mother's life is at stake, careful consideration and thoughtful guidance is appropriate for the pregnant patient with cancer.