New therapeutic options in colon cancer: focus on oxaliplatin

Colon cancer is the third leading cause of cancer death in the United States and the second leading cause in the Northern, Central, and Southern Americas. Appropriate treatment depends on the stage of malignancy, which is determined using the tumor-lymph node-metastases system. In stage III disease, adjuvant chemotherapy increases disease-free and long-term survival following surgery, and chemotherapy is the mainstay of treatment for advanced disease. New therapies are being evaluated, including oxaliplatin, a third-generation platinum analogue approved as first- and second-line therapy for metastatic colorectal cancer in Europe; the drug shows great promise combined with 5-fluorouracil/leucovorin or with irinotecan. The dose-limiting toxicity of oxaliplatin is neurologic, which can be acute or chronic; this can be prevented or reduced in some cases through patient education. Nurses play a critical role in education concerning prevention and management of oxaliplatin-related side effects.     

Cellular immunotherapies for prostate cancer.

Prostate cancer is currently the most commonly diagnosed malignancy, and the second leading cause of cancer-related death, in men in the United States. Most deaths from prostate cancer are due to metastatic disease that no longer responds to androgen deprivation. There have been several advances within the last decade leading to the approval of new agents for treating patients with castration-resistant prostate cancer. However, these agents can have significant side effects, and the average survival benefit from chemotherapy has been modest. Results from several clinical trials have suggested that immune-based therapies may have clinical benefits in patients with prostate cancer with significantly fewer adverse events. These new therapies, however, pose new potential benefits and risks. We review here two cellular immunotherapies furthest in clinical development for prostate cancer, and discuss the potential challenges to the treating oncologist with the possible advent of these new therapies.     

Milk thistle: is there a role for its use as an adjunct therapy in patients with cancer?

The use of complementary and alternative medicine (CAM) is common among patients with cancer. Many of these patients use CAM therapies to decrease the risk of late effects that are sometimes associated with cancer therapy. Certain classes of effective anticancer agents can induce short- and long-term toxicity to the liver. Currently, there are no safer alternatives to these medications. Milk thistle (Silybum marianum) is a botanical that may be useful in the prevention or treatment of liver dysfunction in patients undergoing anticancer therapy.     

Primary care of the mastectomy patient

Breast cancer is the leading form of cancer and a common chronic illness in women. The prevention, diagnosis and management of the disease involves a need for information, support and ongoing physical care which can best be coordinated by a primary care provider. This article reviews current surgical and adjuvant therapies and their side effects. The role of the nurse practitioner in monitoring and meeting mastectomy patients' needs during and after treatment is also discussed.     

Cancer prevention: a new era beyond cyclooxygenase-2

The seminal epidemiological observation that nonsteroidal anti-inflammatory drugs (NSAIDs) prevent colon and possibly other cancers has spurred novel approaches to cancer prevention. The known inhibitory effect of NSAIDs on the eicosanoid pathway prompted studies focusing on cyclooxygenase (COX) and its products. The increased prostaglandin E2 levels and the overexpression of COX-2 in colon and many other cancers provided the rationale for clinical trials with COX-2 inhibitors for cancer prevention or treatment. Their efficacy in the prevention of sporadic colon and other cancers remains unknown; one COX-2 inhibitor has been withdrawn because of side effects, and there are concerns about whether these effects are class-specific. There is evidence to suggest that COX-2 may not be the only or ideal eicosanoid pathway target for cancer prevention. Six sets of observations support this notion: the relatively late induction of COX-2 during carcinogenesis; the finding that NSAIDs may not require inhibition of COX-2 for their effect; the modest effect of coxibs in cancer prevention; that currently available coxibs have multiple non-COX-2 effects that may account for at least some of their efficacy; the possibility that concurrent inhibition of COX-2 in non-neoplastic cells may be harmful; and the possibility that COX-2 inhibition may modulate alternative eicosanoid pathways in a way that promotes carcinogenesis. Given the limitations of COX-2-specific inhibitors and the biological evidence mentioned above, we suggest that targets other than COX-2 should be pursued as alternative or complementary approaches to cancer prevention.     

Mechanisms of resveratrol in the prevention and treatment of gastrointestinal cancer

Gastrointestinal (GI) cancer is one of the leading causes of cancer-related deaths worldwide. According to the Global Cancer Statistics, colorectal cancer is the second leading cause of cancer-related mortality, closely followed by gastric cancer (GC). Environmental, dietary, and lifestyle factors including cigarette smoking, alcohol intake, and genetics are the most important risk factors for GI cancer. Furthermore, infections caused by Helicobacter pylori are a major cause of GC initiation. Despite improvements in conventional therapies, including surgery, chemotherapy, and radiotherapy, the length or quality of life of patients with advanced GI cancer is still poor because of delayed diagnosis, recurrence and side effect. Resveratrol (3, 4, 5-trihydroxy-trans-stilbene; Res), a natural polyphenolic compound, reportedly has various pharmacologic functions including anti-oxidant, anti-inflammatory, anti-cancer, and cardioprotective functions. Many studies have demonstrated that Res also exerts a chemopreventive effect on GI cancer. Research investigating the anti-cancer mechanism of Res for the prevention and treatment of GI cancer has implicated multiple pathways including oxidative stress, cell proliferation, and apoptosis. Therefore, this paper provides a review of the function and molecular mechanisms of Res in the prevention and treatment of GI cancer.     

Complementary and alternative medicines for use in supportive care in pediatric cancer

Introduction Complementary and alternative medical practices (CAM) are being used by increasing numbers of children with cancer. Discussion Recent surveys report CAM use prevalence rates of 24–90% in children with cancer. Interest in supporting children through the side effects or stress of conventional treatment has been described as one of the major motivating factors for the use of CAM therapies. Research is difficult secondary to the complexity of the therapies and lack of standardization. However, several research studies investigating CAM therapies for supportive care in children with cancer are ongoing. Information on several studies in progress through the Children’s Oncology Group and other institutions will be reviewed. Conclusion The progress made in the development of these studies demonstrates that CAM therapies can be investigated for their supportive care roles in the therapy of children with cancer. Presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto, Canada, June 2006.     

The Effects of Stimulation of Acupressure Point P6 on Postoperative Nausea and Vomiting: A Review of Literature

Nonpharmacologic techniques including TAES; P6 acupoint injections; acustimulation with ReliefBand, SeaBand, or Acuband; plain acupressure; and acupressure with electrical stimulation have all shown antiemetic effectiveness for prevention of PONV. These modalities are desirable with regard to ease of administration, rapid onset of action, cost effectiveness, and incidence of side effects. All of these are ideal complements for the patient at high risk or as alternatives for the patient at low to moderate risk for PONV. Because all antiemetic pharmacologic therapies produce side effects, there is a distinct advantage of using nonpharmacologic antiemetic techniques, such as stimulation of acupressure points, instead of pharmacologic therapies. According to the reviewed literature, acupressure applied to P6 was as effective as pharmacologic antiemetic medications for the prevention and treatment of PONV in adults. The most effective method was bilateral stimulation before the induction of anesthesia. Research involving acupressure stimulation of the P6 acupoint in pediatric patients was too inconsistent to establish generalizations regarding effectiveness for management and prevention of PONV.Based on the information from this review, the authors would suggest that perianesthesia nurses and nurse anesthetists include one or more of the methods of stimulating acupoint P6 as a complement to antiemetics in patients with more than a 70% risk of PONV or as an alternative to antiemetics in patients who have less than a 70% risk for PONV. Because the cost of acupressure bands and instruction in their use is so economical, both hospital and outpatient settings using anesthesia might be willing to support their use for a trial period.     

Biofield therapies in cardiovascular disease management: a brief review

Though there have been advances over the last 30 years in the therapeutic approaches to cardiovascular disease (CVD), heart disease and stroke remain the leading cause of mortality and morbidity worldwide. Many medical therapies for CVD are associated with a number of side effects, often leading patients to seek non-pharmacological treatments to complement standard care. Referred to as complementary and alternative medicine (CAM), these therapies consist of a heterogeneous group of modalities used in addition to conventional health care. Biofield therapies exist within this CAM domain and involve the direction of healing energy to facilitate general health and well-being by modifying the energy field. What follows is a brief overview of three biofield therapies developed or used within the field of nursing (Therapeutic Touch, Reiki, and Healing Touch), surveying the use of these interventions for individuals with CVD, and outcomes that may impact CVD risk factors and health-related quality of life.     

Complementary alternative treatments used by patients with cancer in eastern Turkey

Interest in complementary-alternative medicine therapies is growing rapidly in Turkey. Therefore, the purpose of this research was to determine the types and prevalence of alternative therapies used by the patients with a diagnosis of cancer, and to determine factors influencing the choices of their therapies in Erzurum, Turkey. Approximately 10-minute face-to-face interviews were conducted with each subject in the radiation oncology department. The factors associated with the use of alternative therapies after a diagnosis of cancer were assessed by chi-square analysis. The findings indicated that complementary-alternative medicine therapies were used by 41.1% of the subjects after their diagnosis, and that all of the alternatives they used were herbs. The most commonly used herb was stinging nettle leaf (urtica dioica) or seed of nettle. Almost all (93.2%) of the herbs used were nettle. In general, especially the women and the younger patients of both genders were more likely to be using alternative therapies. There was no difference in demographic and cancer characteristics between users of alternative therapy and nonusers. More than the half of the patients using alternative therapies (54.5%) reportedly did not discuss the use of herbs with their healthcare professionals. Most of the patients using stinging nettle and other herbs therapies reported that they had heard about the use of herbs from friends or relatives (52.3%), or from the other patients in this clinic (43.2%). This study found that there is a high prevalence of alternative therapies used by patients with cancer in eastern Turkey. The use of these alternative therapies requires that nursing professionals rethink staff competency, patient assessment, and patient-focused care. Communication between patients and healthcare professionals should initiate dialogues on this topic for a better understanding of patient choices with regard to treatment options.     

Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects

To find holistic treatment with effective pain relief and few side effects, Americans spend billions of dollars annually on complementary and alternative medicine, including herbal therapies. Despite extensive use, the lack of regulatory scrutiny of these herbal supplements contributes to the paucity of reliable clinical data assessing their efficacy and safety. This review summarizes the existing studies investigating the efficacy of herbal therapies as a treatment for pain. Possible side effects, potential drug–herb interactions, and information about common herbal therapies are also summarized. MEDLINE, AMED, and the Cochrane Library databases were searched for the period from January 1966 to June 2005. Uses, dosages, routes of administration, and side effects were summarized. Strength of empirical evidence also was evaluated. This review found few well-controlled clinical studies. Furthermore, these studies documented limited efficacy of herbal therapies to treat pain. The information presented here may be used to further educate nurses and patients on the use of herbal therapies as well as direct future research efforts.     

Future directions of CAM research in pediatric oncology.

Children with cancer are using complementary and alternative medicine (CAM) to relieve symptoms, reduce side effects of treatment, and cope with the emotional aspects of having a life-threatening illness. Parental decisions about using CAM should be based on studies of efficacy and safety. Unfortunately, little evidence of efficacy is available for the majority of CAM therapies. This article discusses the methodological challenges to conducting CAM research in children and the evidence needed to support integrative medicine in pediatric oncology.     

Mesenchymal stem cells in chemotherapy‐induced peripheral neuropathy: A new challenging approach that requires further investigations

Chemotherapeutic drugs may disrupt the nervous system and cause chemotherapy‐induced peripheral neuropathy (CIPN) as side effects. There are no completely successful medications for the prevention or treatment of CIPN. Many drugs such as tricyclic antidepressants and anticonvulsants have been used for symptomatic treatment of CIPN. Unfortunately, these drugs often give only partial relief or have dose‐limiting side effects. Thus, the treatment of CIPN becomes a challenge because of failure to regenerate and repair the injured neurons. Mesenchymal stem cell (MSC) therapy is a new attractive approach for CIPN. Evidence has demonstrated that MSCs play important roles in reducing oxidative stress, neuroinflammation, and apoptosis, as well as mediating axon regeneration after nerve damage in several experimental studies and some clinical trials. We will briefly review the pathogenesis of CIPN, traditional therapies used and their drawbacks as well as therapeutic effects of MSCs, their related mechanisms, future challenges for their clinical application, and the additional benefit of their combination with pharmacological agents. MSCs‐based therapies may provide a new therapeutic strategy for patients suffering from CIPN where further investigations are required for studying their exact mechanisms. Combined therapy with pharmacological agents can provide another promising option for enhancing MSC therapy success while limiting its adverse effects.     

Effets cardiovasculaires graves des chimiothérapies,thérapies ciblées et des traitements immunosuppresseurs

Survival of cancer patients has dramatically increased with the development of new treatments such as targeted therapies. Nevertheless, physicians now face new challenges as identifying and addressing treatment toxicities. While infection remains the leading cause of intensive care unit (ICU) admissions in these patients, various cardiovascular toxicities may occur during multiple lines of chemotherapy and targeted therapies, with progressively higher cumulative doses. Anthracyclines cardiotoxicity was identified in 1950 and has been extensively reported. More recently, multiple cardiovascular side effects of targeted therapies (monoclonal antibodies and tyrosine kinase inhibitors) have been described, including severe hypertension, cardiac failure, arrhythmia, myocardial ischemia, and pericardial effusion. In addition, the risk of both venous and arterial thromboembolic events is increased with the use of chemotherapy and targeted therapies, which can lead to ICU admission in the severe forms or because of bleeding events related to anticoagulation therapy. Microvascular endothelial cell injuries induced by cancer therapies or immunosuppressive agents may be responsible for thrombotic microangiopathy or posterior reversible encephalopathy syndrome. Finally, acute hypersensitivity reactions to chemotherapy or monoclonal antibodies can cause changes in blood pressure or anaphylactoid shock in the most severe cases. Critically ill cancer patients who experienced chemotherapy-related cardiovascular events require the same therapeutic approach to the cardiopathic patients. Maximal intensive care support is justified as most of these toxicities are potentially reversible.     

Acupuncture for side effects of chemoradiation therapy in cancer patients

OBJECTIVE: To review strategies and recommendations to improve utilization of acupuncture treatment for side effects of chemoradiation therapy in cancer centers. DATA SOURCES: Research studies and articles, government reports, and author experience. CONCLUSION: Recent evidence in clinical research indicates that acupuncture is beneficial for chemotherapy-induced nausea, vomiting, and cancer pain. Other preliminary data also suggests acupuncture might be effective for chemotherapy-induced leukopenia, postchemotherapy fatigue, radiation therapy-induced xerostomia, insomnia, and anxiety. However, the utilization rate of acupuncture remains low despite the wide use of other complementary and alternative medical therapies among cancer patients. This low usage of acupuncture in cancer patients indicates a health care quality issue. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to increase their awareness of the available evidence in the use of acupuncture in the supportive care of cancer patients.     

The use of herbal therapies in pediatric oncology patients: treating symptoms of cancer and side effects of standard therapies.

Complementary and alternative medicine is increasing in use in the pediatric oncology population. Although there is a multitude of herbal therapies used, the focus of this article is a review of the literature addressing some herbal therapies used to treat the symptoms of cancer and side effects of traditional methods of treatment. Ginger is used in the treatment of nausea and vomiting. St. John's wort is successful in treating depression and anxiety. Echinacea is used as an immunostimulant. Herbal therapies in the pediatric oncology population are usually initiated and managed by parents. Many herbal therapies are beneficial, but some potential herb-drug interactions should be considered. This poses a challenge to the oncology nurse because herbal treatments are managed by the parents and pharmaceuticals are managed by the practitioner. Educating the patient, family, and practitioner is important in ensuring a thorough health history assessment and, subsequently, safe and effective herbal and pharmacological therapies.     

Improving patient meal satisfaction with room service meal delivery

Cancer and cancer therapies cause side effects that prevent patients from consuming adequate amounts of food. As evidenced by patient meal consumption studies conducted at patients' bedside, only 39 percent of patients surveyed consumed greater than 50 percent of their main entree. The Food and Nutrition Services Department at Memorial Sloan-Kettering Cancer Center used the organization's performance improvement process, STRAIGHT-A, to develop and execute a room service program designed to increase patient meal consumption and improve patient meal satisfaction A multidisciplinary task force developed policies and procedures and tested new menu items as part of the room service plan. After program implementation, 88 percent of patients surveyed consumed greater than 50 percent of their main entree.     

Nursing perspectives on fulvestrant for the treatment of postmenopausal women with metastatic breast cancer

Fulvestrant is an estrogen receptor antagonist indicated for the treatment of hormone receptor-positive metastatic breast cancer (MBC) in postmenopausal women with disease progression following antiestrogen therapy. Fulvestrant has a different mechanism of action than other hormonal therapies, including aromatase inhibitors and tamoxifen. In clinical trials of postmenopausal women with MBC, fulvestrant was effective and well tolerated compared to anastrozole after failure of tamoxifen. The monthly injection regimen of fulvestrant provides nurses with an additional opportunity to improve patient adherence to hormonal therapy, reinforce patient education, and monitor side effects. Several ongoing trials will elucidate the role of fulvestrant in the treatment of MBC. Issues that are being addressed in those trials include alternative doses and schedules, efficacy and safety in other patient populations, and the development of novel treatment combinations. This article provides oncology nurses with the knowledge needed to educate patients on the use of fulvestrant, to effectively administer this medication, and to prevent and manage potential side effects.