Assessment and management of metastatic bone cancer in emergency departments.

A cancer diagnosis in emergency departments (EDs) is often associated with advanced or metastatic cancer. Patients with bone metastases have a complex range of physical and psychological needs. Meeting the needs of patients with cancer is an important part of the role of emergency nurses, but evidence suggests that they often do not feel adequately prepared to provide effective care for this patient group. This article uses a case study of a patient who presented to an ED with metastatic cancer in his right lower limb, to provide an overview of bone metastases, including the relevant anatomy, pain management and psychological support. The article also outlines the signs and symptoms of bone metastases and discusses patient assessment, symptom management and available treatments.

The Ever-Changing World of Limb Salvage Surgery for Malignant Bone Tumors.

The treatment of malignant bone tumors, also called bone sarcomas, has changed dramatically over the past 50 years owing to the advances in chemotherapy, immunotherapy, targeted therapy, radiation, prosthetic technology, and surgical advances. There are 3 main primary bone cancers: osteosarcoma, Ewing's sarcoma (or Ewing's family of sarcoma), and chondrosarcoma. Before advances in limb preservation techniques and before the development of prosthetic replacement, the treatment for a malignant bone tumor of the extremity was amputation. This article discusses the progression of surgical treatment of malignant bone cancers.

A randomized clinical trial of the efficacy of a self-care intervention to improve cancer pain management.

BACKGROUND: The undertreatment of cancer pain remains a significant clinical problem. OBJECTIVE: The aim of this randomized controlled trial was to evaluate the efficacy of the PRO-SELF Pain Control Program that was modified for Norwegian cancer patients in decreasing pain and increasing opioid intake compared with control care. INTERVENTIONS/METHODS: Oncology outpatients with pain from bone metastasis were randomized into the PRO-SELF (n = 87) or control (n = 92) groups. A nurse visited patients in the PRO-SELF group in their home at weeks 1, 3, and 6 and conducted telephone interviews at weeks 2, 4, and 5. Patients in both groups completed a daily diary of pain intensity ratings and analgesic intake. RESULTS: For both groups, significant decreases in pain intensity scores and in hours per day in pain (both, P < .001) were found over the 6 weeks of the study. However, no significant group × time interactions were found for any of the pain measures. In both groups, total dose of opioid taken increased over time. However, no significant group × time interactions were found for changes over time in the total dose, around-the-clock dose, or as-needed dose of opioid analgesics taken. CONCLUSIONS: Possible reasons for the lack of efficacy include an inadequate dose of the psychoeducational intervention, inadequate changes in analgesic prescriptions, and/or the impact of attention provided to the control group. IMPLICATIONS FOR PRACTICE: Coaching, nursing support, and the use of a pain diary may be important interventions to reduce pain intensity.

Analysis of risk factors for central venous catheter-related complications: a prospective observational study in pediatric patients with bone sarcomas.

BACKGROUND: The incidence of central venous catheter (CVC)-related complications reported in pediatric sarcoma patients is not established as reports in available literature are limited. The analysis of risk factors is part of the strategy to reduce the incidence of CVC complications. OBJECTIVE: The objective of this study was to determine the incidence of CVC complications in children with bone sarcomas and if defined clinical variables represent a risk factor. METHODS: During an 8-year period, 155 pediatric patients with bone sarcomas were prospectively followed up for CVC complications. Incidence and correlation with clinical features including gender, age, body mass index, histology, disease stage, and use of thromboprophylaxis with low-molecular-weight heparin were analyzed. RESULTS: Thirty-three CVC complications were recorded among 42 687 CVC-days (0.77 per 1000 CVC-days). No correlation between the specific clinical variables and the CVC complications was found. A high incidence of CVC-related sepsis secondary to gram-negative bacteria was observed. CONCLUSIONS: The analysis of CVC complications and their potential risk factors in this sizable and relatively homogeneous pediatric population with bone sarcomas has led to the implementation of a multimodal approach by doctors and nurses to reduce the incidence and morbidity of the CVC-related infections, particularly those related to gram-negative bacteria. IMPLICATIONS FOR PRACTICE: As a result of this joint medical and nursing study, a multimodal approach that included equipping faucets with water filters, the reeducation of doctors and nurses, and the systematic review of CVC protocol was implemented.

Tough courage: Oncology Nursing Forum addresses childhood cancer then and now.

Cancer is a devastating diagnosis for anyone, but none more so than for children and their parents--so many questions to be asked, so much information to sift through and absorb, and so many difficult decisions to be made. It is no wonder that a diagnosis of childhood cancer is often met with fear, anger, guilt, and feelings of being overwhelmed, yet also a determined resilience on the part of families to do whatever it takes to help their child get well again (Rishel, 2010).

Bone metastases: assessment, management and treatment options.

Cancer cells from a primary tumour can spread to other parts of the body through the bloodstream or the lymphatic system. Bone metastases are common in multiple myeloma, where 70-80% of patients have bone metastases at diagnosis. They are also a common feature in solid tumours such as breast, lung, prostate, thyroid and renal carcinomas. The median survival in patients with bone metastases from breast cancer is 24 months; 20% of patients survive for 5 years or more. Pain is the most common symptom of bone metastases, which can often be severe and difficult to control. This article will discuss normal bone physiology and explain the changes that occur when cancer cells spread to bone. It will outline the signs and symptoms of bone metastases and discuss patient assessment, symptom management and treatment options, including different bisphosphonates. The physical and psychological impact of bone metastases should not be underestimated and nurses are well placed to improve the quality of life of patients.

Home-based zoledronic acid infusion therapy in patients with solid tumours: compliance and patient-nurse satisfaction.

PURPOSE: This study aimed to explore patient and nurse satisfaction, compliance with best practice, technical feasibility and safety of home infusion of the bisphosphonate zoledronic acid (ZOL). METHODS: This was a prospective 1-year survey of home ZOL therapy (4 mg Zometa, 15-min i.v., every 3-4 weeks) in patients with bone metastases secondary to a solid malignancy. A physician questionnaire, nurse satisfaction/feasibility questionnaire and patient satisfaction questionnaire were administered at several time-points. RESULTS: Physician participation rate was 56.5% (87/154). Physicians enrolled 818 patients visited by 381 predominantly community nurses. Of the 788 case report forms received, 763 met inclusion criteria. Patient characteristics were as follows: median age, 68 years (30-95); M/F, 40/60; ECOG-PS 0 or 1, 78.6%; and primary tumour site, breast (55.2%), prostate (28.4%), lung (7.2%) or other (9.4%). Nurse satisfaction rates were high: organisation of home ZOL therapy, 90.9%; ease of infusion, 96.7%; patient-nurse relationship, 97.5%; and relationship with hospital staff, 73%. Patient satisfaction was also very high (95.3%). The main reasons were quality of the nurse-patient relationship (57.6%), less travel/waiting (68.8%), home environment (52.9%) and less disruption to daily routine (36.6%). ZOL therapy was well tolerated, the discontinuation rate due to adverse events (including deaths whether related to diseases progression or not) was 33.6%. The incidence of osteonecrosis of the jaw was 0.6% and of fractures, 0.2%. Practitioner compliance with best practice was 76.7-83.7% for recommended and/or tolerated dosage, 73% for dental hygiene checks at inclusion and 48-56% thereafter, 66% for pre-infusion hydration, and often undocumented for calcium/vitamin D supplementation. CONCLUSIONS: Home ZOL therapy was well tolerated. Both patient and nurse satisfaction were very high. However, better compliance with best practice should be encouraged.

Taking the lead: sharing best practice in intravenous bisphosphonate use in urological cancers.

PURPOSE: Bisphosphonates relieve metastatic bone pain, prevent, reduce and delay skeletal morbidity in metastatic bone disease and are recommended in European guidelines but safety concerns, specifically renal dysfunction and osteonecrosis of the jaw, necessitate specific precautions when administered intravenously. Pan-European guidance for nurses at the forefront of patient-focussed cancer care is required to minimise patient risk. METHODS: A panel of urology and oncology nurses from seven European countries collaborated to decide what constituted best practice for bisphosphonate administration when indicated for prevention of skeletal-related events in patients with advanced urological malignancies. RESULTS: The panel agreed that urology, oncology, and home-care nurses who are at the forefront of patient-focussed care are well placed to ensure best practice is followed but across Europe nurses have insufficient training on bisphosphonate administration for urological cancers. Based on extensive clinical experience in administering bisphosphonates the panel propose best practice for identifying those patients who could benefit, for example those with bone pain or at risk of fracture, and for minimising risk of adverse events by checking renal function, adjusting dosing, ensuring adequate hydration, and regularly assessing dental health, as well as providing information and support. CONCLUSIONS: Sharing this best practice across Europe could assist nurses who care for patients with urological cancers and bone metastases or indeed those caring for cancer patients in general, to take the lead, or at least be aware of what is the best practice that helps to ensure effective and safe IV bisphosphonates administration to patients under their care.

[Teaching a teenager approaching the end of life]. / Enseigner auprès de l'adolescent en fin de vie.

When a teenager is diagnosed with a life-threatening condition, priority is given to the provision of care, but the continuation of the adolescent's education is also encouraged, through the hospital school. Thereby, like all children of his age, Issem, suffering from an osteosarcoma, will sit his secondary school exams and will be supported to the end by his teachers. Personal accounts.

Experience of newly diagnosed patients with sarcoma receiving chemotherapy.

PURPOSE/OBJECTIVES: To examine symptom distress and quality of life (QOL) in newly diagnosed patients with sarcoma receiving chemotherapy. DESIGN: Pilot study; descriptive, quantitative. SETTING: Urban community cancer center in the northeastern United States. SAMPLE: 11 newly diagnosed patients with sarcoma. METHODS: Participants completed the Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General at baseline and on days 1, 15, and 21 of their chemotherapy treatment. MAIN RESEARCH VARIABLES: Symptom distress and QOL. FINDINGS: Fatigue was the most prevalent and pervasive symptom. Anxiety, well-being, lack of appetite, drowsiness, and depression were the most commonly reported symptoms during chemotherapy. QOL was negatively affected. The lowest mean score reported was for functional well-being. Outcome profiles for symptom distress increased over time, whereas QOL profiles decreased over time. Exploratory analyses of age, race, sex, and diagnosis group suggested differences that warrant further study. CONCLUSIONS: Overall, increasing symptom distress and reduced QOL over time were reported by patients with sarcoma during chemotherapy. Exploratory analysis by demographic variables and treatment group suggested the need for further research of predictors for symptom distress and QOL. IMPLICATIONS FOR NURSING: Clinical and research implications included the need for better understanding about symptom distress and QOL predictors in patients with sarcoma, as well as the evaluation of interventions directed to address this population's specific needs.

Living with a malignant musculoskeletal tumor: experiences of family caregivers.

PURPOSE: To describe the experiences of the family caregivers of patients with malignant musculoskeletal tumors. DESIGN AND METHODS: Descriptive qualitative approach using a semi-structured interview guide. SETTING: Orthopaedics Department of the Gulhane Military Medical Academy in Ankara, Turkey. A total of 11 family caregivers aged 25-62 years were recruited. RESULTS: The analysis revealed 5 themes: religious attributions in terms of the cause and treatment of the tumor, the effect of malignant tumor on daily life, the tendency to think positively and constructively and find meaning through caregiving, the anxiety about the prognosis of the malignant tumor, and the support received from significant others. CONCLUSION: It is important to develop effective nursing care to family caregivers of patients with malignant musculoskeletal tumor to understand the physical, emotional, and spiritual experiences in their lives.

Bisphosphonate-related osteonecrosis of the jaw in cancer patients: Implications for nurses.

PURPOSE: This paper reports a review of the literature with a specific focus on osteonecrosis of the jaw. Bisphosphonate drugs are commonly used in the treatment of bone disease secondary to myeloma and solid tumours, such as breast and prostate cancer. In the past few years, an uncommon but distressing condition known as osteonecrosis of the jaw (ONJ) has been detected in patients who are having bisphosphonate treatment, particularly the intravenous (IV) preparations. Osteonecrosis of the jaw results from bone exposure in the oral cavity with subsequent death of bone tissue (necrosis). METHOD: The review searched key databases including Medline, British Nursing Index, Cochrane, and meeting abstracts to ascertain the extent of literature in this field. RESULTS: Fourty-two articles were reviewed which described the clinical manifestations of ONJ, the reported incidence and clinical cases. CONCLUSION: The results indicate there is an emerging body of evidence in this field and nurses delivering bisphosphonates need to familiarise themselves with the current guidance to ensure risks are minimised for patients.

Caring for children and adolescents with osteosarcoma: a nursing perspective.

The nurse plays a vital role in caring for patients with osteosarcoma. From the very outset when the disease is explained to the patient and his/her family, the nurse provides comfort and support, as well as enhances and explains the information provided by the physician. All aspects of medical care are addressed, and he/she is frequently the first line of communication when the patient telephones and requests information or wishes to report a problem to the physician. He/She arranges and coordinates appointments to suit the patient's medical, and often social needs to provide comprehensive care with attention to detail. This communication will provide a perspective of the role assumed by the nurse in his/her effort to ensure total care of the patient and the family.

[A consideration of the support for terminal care at the private skilled nursing home].

The increase in the number of residents in elderly care facilities has developed into a growing demand for home-based terminal care rather than treatments at medical institutions. Like many others, the Active Life Toyonaka (private skilled nursing home) has received more requests from its residents for adequate terminal care. It is unfortunate, however, that quite a few residents are obliged to be hospitalized for medical reasons that result in death. The purpose of our study is to determine what a terminal care should be like in a private skilled nursing home. The study has been conducted with the focuse on the successful case of a 90-year-old male resident diagnosed as having prostate cancer with bone metastasis. Our study has concluded that the crucial factors for a better terminal care should go as follows: (1) Having good coordination with medical institutions, (2) Reporting every change in residents' condition and administering an immediate treatment for alleviating pains of the residents, (3) Providing the residents with comfortable life of less restraint on activities in home-based care, (4) Sharing the same information among the staff of all divisions who is in charge of residents (doctors, nurses, caregivers, etc.) and (5) Establishing relationships of mutual trust with residents and their families. Nurses, especially, need to play important roles as coordinators among all the personnel concerned.

All that holds: a story of healing.

Stories convey meaning and open us to the deep mystery of compassion. Stories are methodological tools in the aesthetic domain of nursing, paratelic ways of knowing that carry us beyond logic to a higher order of understanding. Through stories we are connected to each other and to ourselves. The purpose of this article is to tell the story of Valerie and her journey into healing through metastatic breast cancer. Holistic nursing as a process is contextually illuminated by creating a story within a story. This is an aesthetic work woven together from Valerie's narrative, an interview with her mother after Valerie's death, and from the author's own impressions. Literary quotations are used to highlight different sections of the story with metaphors that speak to the nature of healing. It is hoped that this story will open the reader to his or her own unique understanding of the meaning of healing.