Using simulation to assess chemotherapy competency.

Simulation with lifelike mannequins is used in schools of nursing and hospital-based education as a method of teaching clinical content, enhancing clinical skills, applying theory to practice, and validating competency. It provides a safe learning environment to enhance nurses' clinical judgment and critical thinking skills in an increasingly complex care environment. Simulation can be used in the practice setting with experienced nurses to teach or reinforce complex information and allow the learner to practice without devastating consequences. Medical-surgical units in some institutions have dedicated beds for patients with cancer but may not be a full oncology unit. Evaluating chemotherapy and biotherapy competency is difficult when extensive time periods exist between chemotherapy administrations. One method for assessing annual chemotherapy competency is to use simulation.

Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy- and radiotherapy-induced diarrhea.

Diarrhea is a common side effect of chemotherapy regimens, particularly fluorouracil- and irinotecan-based therapies and abdominal and pelvic radiation regimens. Diarrhea can cause depletion of fluids and electrolytes, malnutrition, dehydration, and hospitalization, all of which can lead to cardiovascular compromise and death. Therefore, diarrhea can interfere with and detract from cancer treatment by causing dosing delays or reductions. Evidence supports pharmacologic interventions such as loperamide and octreotide as recommendations for practice. Emerging evidence suggests that probiotics are likely to be effective, but more extensive research is warranted as the field evolves. Soluble fiber supplements are likely to be effective for treating chemotherapy- or radiotherapy-induced diarrhea; however, additional research is needed because the type and dose of soluble fiber most effective in treating and preventing these types of diarrhea are unknown. This article is limited to recommendations for chemotherapy- and radiotherapy-induced diarrhea. The chemotherapy regimens included in most of the studies reviewed were the commonly used regimens containing drugs such as fluorouracil, cisplatin, adriamycin, and irinotecan.

Monoclonal antibodies and side-effect management.

Monoclonal antibodies are increasingly becoming a standard part of clinical cancer treatment. Eight monoclonal antibodies are approved by the Food and Drug Administration for the treatment of cancer in the United States. Oncology nurses are expected to be familiar with these agents, their indications, and their adverse effects, to provide appropriate care and symptom management to patients receiving these agents, and to adequately educate patients and families about these treatments and their specific and overlapping side effects. Monoclonal antibody mechanisms of action and indications, infusion guidelines, and symptom management are outlined in this article.

Anti-angiogenesis in cancer therapy.

OBJECTIVE: To review tumor angiogenesis, identify potential targets for anti-angiogenic cancer therapy, and highlight certain anti-angiogenic agents in clinical trials. DATA SOURCE: Research articles, abstracts, review articles, and book chapters. CONCLUSION: Tumor angiogenesis is a complex, multistep process that provides a target for antineoplastic therapy whereby tumor neovasculature is interrupted at various steps in the angiogenic process. Clinical trials are investigating the application and efficacy of anti-angiogenic agents. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must continually increase their knowledge with the onset of newer, targeted agents. This will provide a background for educating and caring for the patient who is receiving anti-angiogenic therapy.

Cancer vaccines.

OBJECTIVE: To provide a review of cancer vaccines, how they work, and the current state of the science underlying these treatments. DATA SOURCES: Research studies, review articles, book chapters, personal communications. CONCLUSION: Vaccines have been studied in a variety of malignancies; however, melanoma has provided the best tumor model for vaccination. Clinical trials continue to investigate the optimal vaccine, route, and immunization schedule. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must grasp a widening array of therapeutic options for cancer patients. The educational needs of the patient will be better met through a thorough understanding of basic concepts of newer cancer therapies.