Gemcitabine: a new approach to treating pancreatic cancer.
PURPOSE/OBJECTIVES: To review the clinical benefit and nursing considerations of the new anticancer agent gemcitabine hydrochloride in the treatment of patients with pancreatic cancer. DATA SOURCES: Peer-reviewed publications, books. DATA SYNTHESIS: Unsatisfactory tools for assessment of pancreatic cancer have led to the development of a novel end point, "clinical benefit," to assess improvements in disease-related symptoms and performance status. The first clinical studies to use this end point assessed gemcitabine, Results showed that 24% of patients on gemcitabine were clinical benefit responders compared to 5% of patients on 5-fluorouracil (5-FU). In patients refractory to 5-FU, 27% showed a clinical benefit response to gemcitabine. CONCLUSIONS: Gemcitabine provides significantly better clinical benefit than standard treatment for pancreatic cancer. IMPLICATIONS FOR NURSING PRACTICE: Clinical benefit assessments rely on oncology nurses to classify the response to treatment in addition to managing the side effects.
Irinotecan hydrochloride: drug profile and nursing implications of a topoisomerase I inhibitor in patients with advanced colorectal cancer.
Dana Farber Cancer Institute, Boston, MA, USA.
PURPOSE/OBJECTIVES: To review the drug profile and nursing implications of the topoisomerase I inhibitor irinotecan hydrochloride. DATA SOURCES: Published articles, abstracts, professional communications, drug manufacturer, and professional clinical experience with irinotecan clinical studies. DATA SYNTHESIS: Irinotecan, one of the first topoisomerase I inhibitors to gain wide clinical use, has exhibited activity in several malignancies. In June 1996, the United States Food and Drug Administration approved its use in patients with metastatic colorectal cancer refractory to fluorouracil (5-FU)-based therapy. The recommended starting dose is 125 mg/m2 administered as a weekly infusion for four weeks followed by a two-week rest period. The most common and clinically significant adverse events include diarrhea, neutropenia, and nausea and vomiting. Other adverse events include alopecia and fatigue. CONCLUSIONS: Irinotecan has significant activity in patients with 5-FU-refractory colorectal cancer. This drug is well tolerated and easily administered in an outpatient setting. The most common adverse events are well characterized and are reversible upon treatment discontinuation or dosage reduction. In particular, diarrhea, the most common toxicity, is manageable with use of appropriate dose modification and rigorous administration of loperamide at the first signs of diarrhea. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to focus on identifying and managing adverse effects based on individual patient tolerance. Nurses have an important role to play in patient education and follow up in order to minimize toxicity. Patient care concerns include management of diarrhea and nausea and vomiting, neutropenia with related risk of infection, and fluid and electrolyte imbalances.
Gender differences in the dimensions of quality of life.
Dibble SL. Padilla GV. Dodd MJ. Miaskowski C.
Department of Physiological Nursing, University of California, San Francisco, USA.
PURPOSE/OBJECTIVES: To explore gender differences and similarities in the dimensions of quality of life (QOL). DESIGN: Secondary analysis of the Multidimensional Quality of Life Scale--Cancer Version (MQOLS--CA) data from two different research studies. SETTINGS: Multiple outpatient oncology sites. SAMPLE: The typical female participant (n = 254) was 58 years old (SD +/- 11.3) with 14 years of education, married/partnered (64%), Caucasian (88%), and diagnosed with breast (47%) or colorectal (16%) cancer. The typical male participant (n = 222) was 60 years old (SD +/- 14) with 14.3 years of education, married/partnered (69%), Caucasian (85%), and diagnosed with colorectal (31%) or prostate (13%) cancer. METHODS: Factor analytic procedures and reliability testing. MAIN RESEARCH VARIABLES: QOL as measured by the MQOLS-CA, gender. FINDINGS: For women, two factors emerged from the analysis procedures-psychosocial well-being (7 items) and physical competence (6 items). For the men, two different factors emerged--vitality (8 items) and personal resources (4 items). None of the cancer-specific items from the MQOLS-CA loaded on any of the factors for either gender. CONCLUSIONS: Measurement of QOL requires gender-specific questions to accurately address the dimensions of the concept of QOL in females and males. IMPLICATIONS FOR NURSING PRACTICE: Additional research is warranted to replicate these findings. Gender-specific interventions could then be developed and tested to maximize the QOL of all patients.
Hereditary nonpolyposis colon cancer: genetic basis, testing, and patient-care issues.
University of Pennsylvania School of Nursing, Philadelphia, USA.
PURPOSE/OBJECTIVES: To describe the general mechanisms of cancer development and the specific genetic basis for hereditary nonpolyposis colon cancer (HNPCC); to discuss methods of genetic testing, surveillance, and management guidelines; and to review relevant psychosocial issues. DATA SOURCES: Published papers, research reports, and books. DATA SYNTHESIS: Colorectal cancer is one of the most common neoplasms in humans and perhaps the most frequent form of hereditary neoplasia. HNPCC has an autosomal dominant pattern of inheritance with variable but high penetrance estimated to be about 90%. HNPCC underlies 0.5%-10% of all cases of colorectal cancer. CONCLUSIONS: An understanding of the mechanisms behind the development of HNPCC is emerging, and genetic presymptomatic testing, now being conducted in research settings, soon will be available on a widespread basis for individuals identified at risk for this disease. Complex medical, nursing, legal, ethical, and psychosocial issues demand oncology nurses' attention and understanding. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses in all settings play an integral role assisting patients in (a) understanding their genetic risk status and the implications of genetic testing, (b) making decisions regarding HNPCC genetic predisposition testing, and (c) understanding the meaning of DNA test results. Nurses also may assist patients in understanding and complying with recommended surveillance and management issues.