The National Cancer Program.

OBJECTIVES: To provide an understanding of the history, progress, and future of the National Cancer Program. DATA SOURCES: Published articles, reports, book chapters, and the National Cancer Institute (NCI) web site. CONCLUSIONS: The NCI is the largest agency for cancer research. The cancer incidence and burden remains significant in spite of many advances. Oncology nurses can contribute to the prevention and cure of cancer through an enhanced understanding of the NCI's program. IMPLICATIONS FOR NURSING PRACTICE: The NCI provides many opportunities for oncology nurses. Nurses can conduct NCI-sponsored research trials, serve on NCI advisory boards, and participate in clinical research. Nurses can advise patients and the public of the many resources available to patients from the NCI and assist patients with informed decision making.

Development of a short version of the Barriers Questionnaire.

Among the reasons that cancer pain is not controlled adequately are patient-related barriers. Patient beliefs that may contribute to poor outcome have been measured in previous research with the Barriers Questionnaire (BQ). The purpose of this study was to examine the internal consistency of a shortened version of the BQ. A sample of 217 outpatients with cancer completed a 17-item version of the scale. Factor analysis suggested two subscales, one reflecting beliefs about communication about pain and the other reflecting beliefs about the use of analgesics. Both subscales demonstrated adequate internal consistency. Beliefs did not differ between patients who had and those who had not experienced pain within the previous two weeks. Findings suggest the shortened BQ provides an internally consistent measure of two broad patient barriers to pain management.

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.

Intravenous immunoglobulin administration: an evaluation of vital sign monitoring.

PURPOSE/OBJECTIVES: To determine if adverse reactions to IV immunoglobulin G (IVIG) were being detected by nurses and frequent vital sign monitoring. DESIGN: Retrospective chart review. SETTING: Bone marrow transplant (BMT), medical oncology, and pediatric units and the outpatient clinic of a 720-bed hospital in middle Tennessee. SAMPLE: 62 charts of patients undergoing BMT who had received IVIG. METHODS/MAIN RESEARCH VARIABLES: Charts were reviewed for patient demographics, number and type of IVIG infusion, incidence of adverse reactions, and related information. FINDINGS: Nine reactions were documented out of 731 separate infusions. Only three reactions could be linked directly to IVIG infusion. Of the nine reactions, only four were detected by nursing personnel during vital sign monitoring. CONCLUSIONS: Nursing time devoted to frequent vital sign assessment does not seem to be warranted. Protocol for administration and monitoring of IVIG at this institution was changed to reflect these findings. IMPLICATIONS FOR NURSING PRACTICE: Frequent vital sign monitoring is advised for the initial IVIG dose. If no adverse reactions occur, only baseline vital sign monitoring is advised for subsequent infusions. Patients are taught to recognize and report symptoms of adverse reactions.

Selected complications of allogeneic bone marrow transplantation.

Patients receiving allogeneic bone marrow transplant experience multiple complications. Specifically, infection, renal complications, VOD, and GVHD can produce life-threatening toxicity. Many of the treatments cause further compromise of major organs. Astute nursing assessment and prompt interventions can decrease the severity experienced by the patient. Each of these complications requires ongoing study to develop new therapies for management.

Infection control in oncology patients.

In conclusion, the nurse caring for the patient with cancer must be acutely aware of the risk of infection. Many interventions are used in attempts to minimize or prevent infection. Once the patient becomes neutropenic, the risk of life-threatening infection increases dramatically. All nursing care is focused on treating infection and supporting the patient until bone marrow function returns.

Cutaneous toxicity associated with high-dose cytosine arabinoside.

High-dose cytosine arabinoside (HDAC) is used to treat adults with acute and chronic leukemia and non-Hodgkin's lymphoma. Although HDAC is associated with various toxicities, cutaneous toxicity in particular leads to alterations in comfort, interference with daily living activities, and increased risk of infection. The incidence of cutaneous toxicity ranges from 3%-72%. A review of the literature revealed a variety of terms describing this toxicity, which begins as erythema and progresses to painful swelling, bullae formation, and desquamation. The etiology is unclear, and the severity is related to the number of consecutive doses. Interventions specific to prevention and treatment of this toxicity were found to be minimal, with no interventions scientifically examined. The challenge for nurses is to explore measures that will minimize the complications, treat the manifestations, and document the impact of these problems on quality of life.

Current research in side effects of high-dose chemotherapy.

The toxicities of chemotherapy continue to hamper dose escalation of specific chemotherapeutic agents. The impact of dose intensification upon survival will be assessed as clinical studies continue. Strategies to support chemotherapy dose intensification include BMT, use of CSFs and antiemetic drug combinations. Advances in symptom management will hopefully enhance quality of life for patients, whereas the development of chemoprotectant agents may allow specific organ toxicities to be avoided.

Bone marrow transplantation.

BMT is an effective treatment for certain malignant and nonmalignant conditions. The source of the marrow is autologous or allogeneic. An allogeneic donor can be an HLA-matched related or unrelated donor. The patient undergoes intense chemoradiotherapy to remove remaining malignant cells and obliterate the immune system, thus allowing growth of the new bone marrow cells. Complications of conditioning therapy include pancytopenia and distinct organ toxicities. Astute nursing care is critical in managing the care of BMT patients. Assessment and numerous, interrelated interventions are required. Late complications of BMT relate to the conditioning therapy and to the transplant itself. As BMT becomes more readily available as a treatment, economic issues related to the cost of care and the allocation of resources challenge health care providers.

Options for postremission therapy in acute leukemia.

Remission induction therapy for patients with AML results in 65% to 75% CR with 20% prolonged DFS. Postremission therapy increases the incidence of prolonged DFS to more than 60%. Postremission therapy in AML consists of high-dose or intensive chemotherapy with or without BMT. Each therapy has significant toxicity and risk for the patient. Induction therapy for patients with ALL includes systemic and intrathecal chemotherapy with a 70% to 75% CR rate. Maintenance therapy continues for 2 to 3 years, and BMT is indicated for patients with early relapse or certain high-risk factors. Knowledgeable nurses provide much-needed emotional support for patients as they struggle to make the best decision for postremission therapy.

Grief response of the primary caregiver receiving bereavement follow-up care at home.

This study implies specific guidelines for intervention. It appears that bereavement follow-up may lessen the grief response at 13 months. Therefore, hospice programs should continue this valuable service. Follow-up interventions should focus on the factors which proved significant: rumination, loss of control, and death anxiety. The study also provided the beginnings of a risk assessment tool for bereaved individuals. Increased age was proved to be a risk factor related to a greater grief response. Although most of the literature indicates women are at a higher risk early in the bereavement period, this study showed that at a later time men expressed a greater degree of grief. The implications of the study include the need for ongoing education regarding the normal grief response and the physical and emotional manifestations of grief. The results of the study support emotional care for survivors as well as provision for appropriate referral resources as needed.