Breast cancer pledge helps to improve services.

Specialist nurses at York Teaching Hospital NHS Foundation Trust are providing one-to-one support to patients with secondary breast cancer, in co-operation with two charities.

Second primary peristomal carcinoma: a case study.

Literature has highlighted that peristomal skin problems are common among ostomists (Williams et al, 2010); however, peristoma metastases are considered to be very rare. Peristomal metastases tend to manifest as cutaneous or subcutaneous nodules, or as a rash on the anterior abdominal wall (Lyon and Smith, 2001), and are therefore easily mistaken for a more common stoma complication. The role of the specialist nurse in stoma care is crucial to recognizin unusual skin lesions and referring appropriately for further assessmet and treatment. Highlighting the need for education and sharing of clinical skills, this article explores the care of a patient who was diagnosed with a second primary peristomal adenocarinoma. The patient has consented to the use of this case study, and, to maintain confidentiality, his name has been changed.

Preventing second cancers in cancer survivors.

PURPOSE/OBJECTIVES: To provide a systematic review of the secondary prevention practices of cancer survivors guided by the Interaction Model of Client Health Behavior. DATA SOURCES: Articles published in peer-reviewed journals from 1996-2007. DATA SYNTHESIS: Despite their increased risk for second cancers, few cancer survivors maintain regular follow-up with a clinician knowledgeable of late effects. Cancer screening rates for cancer survivors are below optimal levels recommended for the general population. Multiple antecedents explain survivors' health practices. Few tested interventions are available to promote secondary prevention practices among cancer survivors. CONCLUSIONS: Cancer survivors are less likely to adopt secondary prevention practices than individuals without a cancer history. IMPLICATIONS FOR NURSING: Nurses can encourage cancer survivors to adopt secondary prevention practices by providing positive reinforcement, support, and education. As more comprehensive, evidence-based guidelines for longitudinal care become available, nurses will be able to provide care to survivors with greater confidence and certainty.

Tertiary prevention: implications for improving the quality of life of long-term survivors of cancer.

OBJECTIVE: To provide an overview of the incidence, epidemiology, and appropriate screening for second primary malignancies, as well as the nursing implications of tertiary cancer prevention. DATA SOURCES: Published review articles, book chapters, research reports, and the clinical experience of the author. CONCLUSION: Many persons successfully treated for malignancy are at risk for a second malignancy. This risk is related to shared risk factors, genetic predisposition, and the toxic effects of therapy. Persons particularly at risk are those who have been successfully treated for breast, gynecologic, colorectal, skin, and lymphoma malignancies. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be knowledgeable regarding the principles of tertiary prevention, be able to identify persons at risk, and provide appropriate patient education and psychosocial support on how to manage the risk and detect second malignancies early.

Chemotherapy-induced secondary malignancies.

Changes in chemotherapy protocols have influenced the risk and rate of secondary malignancies in high-risk populations. The alkylating agents, topoisomerase inhibitors, and anthracycline agents pose the highest risk of initiating carcinogenesis. Normal cells that are especially sensitive to chemotherapy and most likely to begin carcinogenesis include those of the bone marrow, hair follicles, and the epithelial cells of the gastrointestinal tract. Thus, the development of secondary hematologic cancers such as leukemia and lymphoma pose the greatest risk to adult and childhood cancer survivors. Lifelong surveillance is recommended.

The role of the primary care advanced practice nurse in evaluating and monitoring childhood cancer survivors for a second malignant neoplasm.

The purpose of this literature synthesis was to (a) identify second malignant neoplasms found in childhood cancer survivors and (b) make recommendations for the advanced practice nurse's role in the primary care setting regarding health promotion activities and surveillance strategies for survivors across the life span. The database search produced 73 research articles published in English between 1990 and 2000 that were significant to the purpose of the study. The results identified genetic or familial factors, radiation therapy, and chemotherapy as risk factors for later developing a second malignant neoplasm. Each theme was analyzed, and guidelines were developed for primary care advanced practice nurses which integrated health promotion and surveillance activities for this patient population.

Lymphomas: long-term sequelae and survivorship issues.

OBJECTIVES: To provide a review of long-term sequelae of lymphoma and its treatment, with emphasis on second malignancies, survivorship issues, rehabilitation, and quality of life. DATA SOURCES: Review articles, research studies, and book chapters pertaining to late effects of treatment of lymphomas and to rehabilitation and quality of life for survivors of Hodgkin's disease or non-Hodgkin's lymphoma. CONCLUSIONS: Overall, the outlook for survivors of the lymphomas is positive. The risk of developing second malignancies as long-term sequelae, although relatively low, and the need for physical and psychological health maintenance, warrant lifetime follow-up and support. IMPLICATIONS FOR NURSING PRACTICE: Nurses have a key role in preparing patients for survivorship. By fostering a philosophy and program of rehabilitation that begins at the time of diagnosis, nurses can assist survivors of lymphoma to achieve quality of life.