Venous Thromboembolism in Patients With Cancer Part I: Survey of Oncology Nurses' Attitudes and Treatment Practices for Ambulatory Settings

Evaluation of hospital nurses' perceived knowledge and practices of venous thromboembolism assessment and prevention

Venous thromboembolism (VTE) is a preventable cause of hospital death. Bedside registered nurses (RNs) are a key group that can be the first to recognize risks of patients in acute care settings. The purpose of this study was to identify bedside hospital RNs' perceived knowledge of VTE, their assessment practices, their self-efficacy in conducting VTE prevention care, and their perceived barriers to performing VTE risk assessment. An anonymous web-based survey on VTE risk assessment and prevention was conducted with RNs who provided direct patient care at two hospitals. RNs who were not directly involved in bedside patient care such as managers and educators were excluded. A total of 221 RNs completed the survey. Most participants rated their overall knowledge of VTE risk assessment between "good" (44%) and "fair" (28%). VTE assessment frequencies performed by participants varied widely. Participants reported high confidence in their ability to educate patients and families about VTE symptoms, prevention, and treatments. Participants were least confident in their own ability to conduct a thorough VTE risk assessment. Greater self-reported VTE knowledge was associated with greater VTE assessment frequency and self-efficacy for VTE preventive care. The most common perceived barriers in performing VTE risk assessment were lack of knowledge (21%) and lack of time (21%). The findings demonstrate a substantial need for focused education about VTE prevention for hospital nurses and support for hospital systems to monitor VTE care. Despite the Joint Commission emphasis on VTE risk assessment in all hospitalized patients, there remains a gap between current, evidence-based recommendations for VTE prevention and reported nursing practices.

Thalidomide as palliative treatment in patients with advanced secondary glioblastoma

BACKGROUND

For its numerous abilities including sedation, we have been using thalidomide (TH) as the 'last therapeutic option' in patients with advanced gliomas. We noticed that a small subgroup, i.e. patients with secondary glioblastoma (GBM, whose GBM has evolved over several months or years from a less malignant glioma), survived for prolonged periods. Therefore, we retrospectively evaluated the outcomes of patients with secondary GBM treated with TH at our centre.

PATIENTS AND METHODS

Starting in the year 2000, we have studied 23 patients (13 females, 10 males, with a median age of 31.5 years) with secondary GBM who have received palliative treatment with TH 100 mg at bedtime. All patients had previously undergone radiotherapy and received at least 1 and up to 5 regimens of chemotherapy.

RESULTS

The median duration of TH administration was 4.0 months (range 0.8-32). The median duration of overall survival after the start of TH therapy was 18.3 months (range 0.8-57). Eleven patients with secondary GBM survived longer than 1 year. Symptomatic improvement was most prominent in the restoration of a normal sleep pattern.

CONCLUSION

The palliative effects of TH, especially the normalization of a sleep pattern, were highly valued by patients and families. The prolongation of survival of patients with secondary GBM has not been reported previously.

Therapeutic Options for the Treatment of Cancer-Associated Thrombosis

OBJECTIVE

To provide oncology nurses with an understanding of therapeutic options for cancer-associated thrombosis, strategies to prevent recurrence, and practical issues in patient management.

DATA SOURCES

Primary and tertiary literature and the author's clinical experience.

CONCLUSION

Oncology nurses monitor patients throughout the care continuum for signs and symptoms indicating vascular thromboembolism and need to know the steps to take to expedite an accurate diagnosis and ensure prompt treatment.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses must keep informed about the evolving evidence that leads to practice changes. They should be able to teach patients about therapeutic options and their potential for improving outcomes.

Antivascular endothelial growth factor monoclonal antibody therapy: a promising paradigm in colorectal cancer

Angiogenesis plays an important role in tumor growth and development. Vascular endothelial growth factor (VEGF) is one of the most potent proangiogenic factors and therefore is an ideal target in colorectal cancer therapy. Bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) is a humanized monoclonal antibody, designed to directly target VEGF. The agent has shown promising activity in preclinical and phase I and II studies and is well tolerated compared with conventional cytotoxic chemotherapy. The U.S. Food and Drug Administration recently approved bevacizumab in combination with 5-fluorouracil-based chemotherapy as first-line therapy for patients with metastatic colorectal cancer. The approval was based on phase III data demonstrating that patients treated with bevacizumab plus chemotherapy survived approximately five months longer compared with patients treated with chemotherapy alone. This article will focus on the role of VEGF in tumorigenesis and summarize the available data on the use of bevacizumab in the treatment of metastatic colorectal cancer.