Clinical journal of oncology nursing
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The use of oral chemotherapy is expected to more than double in the next several years. With the increase in use of oral chemotherapy and in patient responsibility, the role of the oncology nurse must change to ensure proper management. Nurses must teach patients how to correctly and safely take oral chemotherapy, help manage side effects, and research and monitor complications such as medication and food interactions, cost issues, safety, and patient adherence.
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This article reviews clinical data on adjuvant trastuzumab (Herceptin, Genentech, Inc.) for patients with HER2-positive early breast cancer. Published articles were searched via PubMed (1985-2009), and abstracts were located from meeting books or search engines of congress Web sites (1994-2009). ⋯ Trastuzumab has a favorable safety profile; levels of cardiac dysfunction were acceptable in all adjuvant trials, and cardiac dysfunction was manageable in most cases. Awareness of the clinical data will help nurses identify patients eligible for adjuvant trastuzumab, familiarize them with treatment and cardiac monitoring plans, and provide them with information to help advise, treat, and support patients from diagnosis through completion of therapy.
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Palliative care that provides specialized attention to pain and symptom management is important for patients with cancer. Palliative care aims to reduce pain and other symptoms through an interdisciplinary approach involving physicians, nurses, social workers, and other members of the healthcare team. ⋯ One way to implement early palliative interventions is the establishment of an ambulatory care clinic dedicated to palliative care. This article describes the experience of an outpatient palliative care clinic at a large teaching hospital by using case studies to highlight the benefits of ambulatory palliative care and concluding with recommendations for research.
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Randomized Controlled Trial Multicenter Study
Managing neutropenia in older patients with cancer receiving chemotherapy in a community setting.
Older patients with cancer who may be more susceptible than younger patients to the myelosuppressive effects of chemotherapy undergo dose delays and reductions that can compromise treatment outcomes. Incidence of neutropenic complications and suboptimal chemotherapy delivery can be reduced with prophylactic colony-stimulating factors; however, their use in older patients with cancer has not been well studied. ⋯ The study showed that older patients with cancer can be treated safely with optimal doses of chemotherapy with appropriate supportive care. Nurses, key collaborators in providing supportive care, can take an active role in identifying older patients who may benefit from pegfilgrastim in all cycles of chemotherapy.
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Any patient receiving an agent that targets microtubules (e.g., taxanes, vinca alkaloids, epothilones) is at some risk for encountering peripheral neuropathy. This article provides tools and discussion to aid nurses in managing peripheral neuropathy in their patients through early identification and education. Some patients are at higher risk than others based on their chemotherapeutic regimen, pretreatment history, and comorbidities. ⋯ Patients who experience moderate or severe neuropathy may require a dose reduction or delay until symptoms resolve; these patients may need a lower dose for the next treatment cycle. No known agents have proven to prevent or treat severe neuropathy more effectively than regular neurologic examinations, early intervention, and patient education. In this respect, nurses can make a substantial difference in the impact of neuropathy on treatment efficacy and patients' quality of life.