The decision to prematurely terminate a trial of R-HuEPO due to thrombotic events

Recombinant human erythropoietin (r-HuEPO) corrects cancer-related anemia and, thereby, improves quality of life. The purpose of the present study was to measure the impact of erythropoietin on hemoglobin and mood state in patients with metastatic breast cancer and mild anemia (Hgb < 12.0 g/dL). Women were randomized to receive usual care (G1) or usual care plus r-HuEPO (G2). Usual care included transfusions as necessary and fatigue education. R-HuEPO was begun at 40,000U subcutaneously per week. At 4 weeks, the dose was increased to 60,000U if Hgb had not increased > or = 1.0 g/dL. The drug was discontinued at 8 weeks if hemoglobin improvement was < 1.0 g/dL. The study was terminated early (n = 27, G1 = 13, G2 = 14) when 4/14 (28.5%) subjects in G2 developed thrombotic events (deep vein thrombosis [DVT] in 1; DVT plus pulmonary embolism [PE] in 1; DVT plus PE 1 month after drug discontinuation in 1; and brachial vein thrombosis with infected Mediport in 1). In all four patients, Hgb levels were normal at the time of the event. No patient in G1 developed a thrombotic event. There were no significant differences in demographic characteristics or current chemotherapy regimen in G1 vs. G2. The decision to terminate the trial was made after considerable deliberation. The increased incidence of thrombotic events in the r-HuEPO (G2) arm of this study exceeds that in prior studies in this population and prior r-HuEPO trials. This may relate to the administration of r-HuEPO in this high-risk population, but the small sample size and possible predisposing risk factors preclude definitive conclusions.

Cognitive function and quality of life in interferon therapy for melanoma

The purpose of this pilot study was to describe short- and long-term changes in cognitive function and quality of life in patients with melanoma receiving interferon (IFN) alpha-2b. This study used a three-group, repeated measures design in which cognitive function and quality of life were evaluated prior to initiation of treatment at 3-month intervals during treatment and 3 months following the completion of treatment. The sample consisted of 16 adults with Stage II or III melanoma, randomized to one of three treatment groups. Participants in Arm A received high-dose IFN alpha-2b, those in Arm B received low-dose IFN alpha-2b, and those in Arm C received no therapy (control). No significant changes in cognitive function were detected. In participants in Arm A, there was a significant deterioration in the physical well-being dimension of quality of life from baseline to 3 months after beginning therapy.

The development of a Family Caregiver Cancer Education Program

BACKGROUND

Recent years have seen an escalating trend toward early discharge of hospital patients, resulting in increasing numbers of patients being cared for at home by family members. Fear and anxiety concerning the well-being of the patient, the inability to provide adequate care, the cost of cancer treatment, and the anticipation of emotional stress are major factors that can contribute to the difficulty of this transition.

METHODS

The Family Caregivers Cancer Education Program has been funded by the Pennsylvania Department of Health, Cancer Control Program to address these issues. This program encompasses education and support for caregivers as well as the Local Instructor Course to provide nurse and social worker teams with materials, information, and support to offer the caregiver course within their areas. Focus groups were conducted to determine course content.

RESULTS AND CONCLUSIONS

Participant evaluations demonstrate that caregivers who attend the course feel less overwhelmed and better able to cope with the caregiver experience.

Reaching out to the African American community through innovative strategies

PURPOSE/OBJECTIVES

To describe the University of Pittsburgh Cancer Institute's African American Cancer Program, including innovative strategies that were used, barriers that were encountered, an evaluation of each component, and future directions and implications.

DATA SOURCES

Published articles, references from bibliographies, census data, personal contact, unpublished data.

DATA SYNTHESIS

Cancer morbidity and mortality is higher among African Americans than Caucasians. The University of Pittsburgh Cancer Institute pilot-tested four interventions to increase awareness, provide education and early detection opportunities, and overcome barriers to cancer care among African Americans.

CONCLUSION

Constant presence, cultural sensitivity, and repetition are necessary to overcome the barriers to increased awareness and behavioral changes in the African American community. A more formalized evaluation component is necessary to draw definitive conclusions.

IMPLICATIONS FOR NURSING PRACTICE

To develop cancer prevention and education programs that meet the unique needs of African Americans, nurses must be aware of barriers and cultural differences.

Gaps and contract: evaluating the diffusion of new information. Part I. A description of the strategy

Time and fiscal constraints on oncology nurses require that continuing education programs yield demonstrable benefit to the clinician, the institution, and patient outcomes. This article describes "gaps and contract," a strategy that provides nurses with a tool to transfer knowledge from theory to practice, in a measurable form. The framework for this strategy lies within the concept of innovation diffusion. This strategy was used by two universities collaborating to educate 912 oncology health professionals in 38 continuing education programs. Part II of this article will describe the measurement of this strategy.

Gaps and contract: evaluating the diffusion of new information. Part II. The measurement of the strategy

This article is the second of a two-part series describing "gaps and contract," a strategy that provides nurses with a mechanism to transfer knowledge from theory into practice in a measurable format. Two universities under contract from the Pennsylvania state cancer plan used this strategy to evaluate the effectiveness of a cancer continuing education program. Two hundred seventy-four (274) contracts from one setting and 205 from a second setting are described. Recommendations for using this strategy to measure the efficacy of cancer continuing education programs are included.

A progress report on reimbursement of biotherapy: prospects for the 1990s

Reimbursement of cancer care associated with clinical trials continues to be a growing national concern. Cancer organizations have taken many actions to draw attention to an economic force with the potential to seriously hamper oncology research. Strategies are described that could prove useful to cancer care professionals as they attempt to influence reimbursement policies.

Trends in chemotherapy administration

Oncology nurses must respond to the challenges provided by the outpatient administration of chemotherapy. They must design and implement cancer care systems for the future that focus on the patient and family and are efficient, effective, and delivered at reasonable cost.

Unmet needs of persons with cancer in Pennsylvania during the period of terminal care

A stratified random sample of recent cancer deaths was drawn from the Pennsylvania death registry, and 433 family members or close friends were interviewed concerning unmet needs during the last month of life. It was estimated that 72% of persons who died of cancer in Pennsylvania experienced at least one unmet service need during this period. The most frequently reported was help with activities of daily living, estimated at 42% of cancer deaths, involving over 11,000 persons each year in the state. There were significantly more unmet needs during the terminal period, compared with just after diagnosis, in activities of daily living, obtaining health care, transportation, and problems with medical staff. Our findings indicate a need to increase a broad range of support programs during the terminal period, especially of home-care services.

A comparison of problems reported by persons with cancer and their same sex siblings

Problem reporting rates of 180 persons with cancer (PWC) were compared with those of their closest in age same sex cancer-free siblings living outside their households for the same time periods. PWC had significantly higher reporting rates for physical, activities of daily living, nutrition, and emotional problems and a significantly lower rate for family problems. Sibling problem reporting rates, which indicate the likelihood that PWC would have experienced similar problems without a diagnosis of cancer, were highest for physical, emotional, employment, and family problems suggesting that noncancer factors are especially likely to play a role in those types of problems. Regression analyses showed that female and younger PWCs tended to report more problems than their siblings suggesting that they were more affected by cancer and its treatments than were other types of PWC.

Unmet psychological, social, and economic needs of persons with cancer in Pennsylvania

Six hundred twenty-nine persons with cancer (PWC) selected from the Pennsylvania Cancer Registry plus 397 nonprofessional (support) persons involved in their care (SP) were interviewed to determine their views of the unmet psychological, social and economic needs of PWC. The most frequently mentioned unmet need was for help in dealing with emotional problems (estimated at 25% of PWC state-wide). Other unmet need estimates ranged from 14% for financial to 4% for transportation, with 59% of PWC reporting at least one unmet need. Characteristics of PWC reporting unmet needs included being younger, a history of emotional problems, a chronic illness in addition to cancer, more advanced stage at diagnosis, and a diagnosis of lung cancer. The percent of PWC and CP reporting unmet needs were very similar. These findings indicate that more effective screening for psychosocial problems and referral to supportive services is needed.

A Survey of Neuroscience Nurses

This survey identified and described the characteristics and perceptions of neuroscience nurses as well as the basic and master's level curriculum relating to neuroscience theory and clinical components. The major sources of stress as perceived by neuroscience nurses were identified, categorized and prioritized in accordance with their present roles. The information in this survey can be used to guide future studies on neuroscience nurses. More must be learned about the neuroscience nurse so that nurse educators and administrators can provide the necessary resources to facilitate learning and coping. This is essential to insure the provision of high standards of patient care.

Care of the patient receiving radiation therapy

External radiation therapy, or teletherapy, is the use of ionizing radiation to destroy cancer cells. Clinical use of ionizing radiation as treatment for cancer began with the discovery of x-rays in 1895, the identification of natural radioactivity (radium) in 1896, and the first reported cure of cancer, a basal cell epithelioma, induced by radiation in 1899. Initially, radiation was administered as a single large dose and produced severe, life-threatening side effects. The basis for the use of ionizing radiation in daily increments for a period of weeks was provided by Regaud in 1922; ten years later, Coutard clinically developed the method of dose fractionation, which remains in use today. Although the use of ionizing radiation as a treatment is over eighty years old, only in recent years have advancements in its clinical application been based on research related to the biologic effect of radiation on human cells. To effectively care for the patient prior to, during, and at the completion of external radiation therapy, the nurse must know the physical and biologic basis of external radiation therapy and its clinical application.

Nutritional needs of cancer patients

Individuals with cancer share many similar nutritional problems, regardless of the primary site of the malignant neoplasm. The presence of protein-calorie malnutrition is the most common secondary diagnosis in cancer and is frequently the cause of death. To date, the inability of health care professionals to halt or adequately control the severity of protein-calorie malnutrition in the individual with cancer indicates that the syndrome is more complex than inadequate ingestion of nutrients. The presence and severity of protein-calorie malnutrition in individuals with cancer cannot be attributed to one factor. The disease, treatment modalities, and complications of therapy all contribute to its development.