Mitochondria-related gene expression changes are associated with fatigue in patients with nonmetastatic prostate cancer receiving external beam radiation therapy

BACKGROUND

Cancer-related fatigue (CRF) is associated with negative health outcomes and decreased health-related quality of life; however, few longitudinal studies have investigated molecular-genetic mechanisms of CRF.

OBJECTIVE

The objective of this study was to describe relationships between mitochondria-related gene expression changes and self-reported fatigue in prostate cancer patients receiving external beam radiation therapy (EBRT).

METHODS

A prospective, exploratory, and repeated-measures design was used. Self-report questionnaires and peripheral whole-blood samples were collected from 15 patients at 7 time points. Baseline data were compared against 15 healthy controls. The Human Mitochondria RT Profiler PCR Array was used to identify differential regulation of genes involved in mitochondrial biogenesis and function.

RESULTS

Compared with baseline, there were significant increases in fatigue scores (P = .02-.04) and changes in mitochondria-related gene expression (P = .001-.05) over time. Mean fatigue scores were 1.66 (SD, 1.66) at baseline, 3.06 (SD, 1.95) at EBRT midpoint, 2.98 (SD, 2.20) at EBRT completion, and 2.64 (SD, 2.56) at 30 days after EBRT. Over time, 11 genes related to mitochondrial function and structure were differentially expressed. Of these 11 genes, 3 (BCL2L1, FIS1, SLC25A37) were more than 2.5 fold up-regulated, and 8 (AIFM2, BCL2, IMMP2L, MIPEP, MSTO1, NEFL, SLC25A23, SLC25A4) were greater than 2-fold down-regulated. Furthermore, 8 genes (AIFM2, BCL2, FIS1, IMMP2L, MSTO1, SLC25A23, SLC25A37, SLC25A4) were significantly associated with the changes in fatigue scores.

CONCLUSION

This study provides preliminary evidence that 8 mitochondrial function genes were significantly associated with fatigue in prostate cancer patients during EBRT.

IMPLICATIONS FOR PRACTICE

These findings identify possible pathways and early biomarkers for targeting novel interventions for CRF.

PSA spike after brachytherapy For localized prostate cancer

A common concern for patients who have undergone treatment for prostate cancer and their families is an elevation or spike in the PSA level following definitive treatment. A number of factors can be responsible for this, but often the PSA spike may be benign. An informed health care worker can reasonably assess whether this is the case, and can help to alleviate the fears of the patient and his family.

The use of oral transmucosal fentanyl citrate during high-dose-rate gynecologic brachytherapy

Gynecologic brachytherapy is a form of cancer treatment in which radioactive sources are placed into the pelvic organs via specialized applicators. Traditional low-dose-rate (LDR) brachytherapy has been performed over several days in a hospital setting. Since the 1990s, high-dose-rate (HDR) brachytherapy has been used increasingly because of its decreased treatment time, outpatient administration, and equal or superior efficacy compared with LDR treatment. However, the management of procedural pain in the radiation oncology setting has not been studied extensively. The purpose of this article is to discuss the use of oral transmucosal fentanyl citrate (OTFC) for the management of pain during gynecologic HDR brachytherapy. OTFC provides noninvasive, rapid analgesia with a low incidence of side effects and may be appropriate for other forms of procedure-related cancer pain.

Advances in Radiation Treatment of Patients With Breast Cancer

Breast cancer is the most commonly diagnosed cancer among women in the United States. Approximately half of all patients diagnosed with early-stage breast cancer receive conservative breast surgery followed by consolidative radiation treatment. A number of technologic advances have been made in radiation therapy planning and treatment that minimize early and late toxicities and may improve treatment outcomes. Among these are (a) the treatment of patients with large or pendulous breasts or cardiopulmonary disease in the prone position, (b) intensity-modulated radiation treatment, which delivers precise, highly conformal radiation dose distributions within the breast by using computerized inverse treatment planning and intensity-modulated radiation beams to produce the required dose distribution, and (c) brachytherapy, which is the placement of a radioactive source within the lumpectomy bed. These advances are gaining national recognition and are available at many institutions. Nurses play a vital role in educating patients; therefore, nurses must have the information they need to inform their patients about these advances. The information in this article will allow nurses to help patients understand the anticipated treatment and related side effects and make informed decisions.

Advanced Practice Nursing in Radiation Oncology

OBJECTIVES

To discuss the roles of advance practice nurses in radiation oncology.

DATA SOURCES

Published articles and textbooks, personal communications, and authors' experience.

CONCLUSION

Radiation oncology advance practice nurses (NP and CNS) are becoming essential members of the multidisciplinary team, with distinct roles and responsibilities. Providing direct patient care, involvement in specialized procedures, and conducting initial and/or follow-up visits allows advance practitioners to become more involved with patients undergoing radiation therapy.

IMPLICATIONS FOR NURSING PRACTICE

As more combined modalities are being offered to patients undergoing oncology treatments and the complexity of patients are becoming more difficult, advance practice nurses can add value to the workload, quality patient care, and make a difference in patient's lives.

Factors affecting patient selection for prostate brachytherapy: what nurses should know

Prostate brachytherapy is a proven treatment for clinically localized prostate cancer; however, many clinicians have multiple misconceptions regarding patient selection criteria. Although most patients are candidates for the procedure, contraindications do exist. This article examines criteria for patient selection and the need for adjuvant therapies, proposes management philosophies, and discusses the impact of each on treatment decisions. Nurses' role in the decision-making process and how they can facilitate patients and families in making informed choices also are discussed. Clinical studies seek to further define patient selection criteria and examine optimal choices for adjuvant treatment and isotope preference. Expanding the knowledge base of nurses helps enhance patient care.

Nursing considerations in brachytherapy-related erectile dysfunction

Following definitive local treatment for early-stage prostate cancer, preservation of erectile function has been assumed to be most likely following brachytherapy. However, recent studies have demonstrated that brachytherapy-related erectile dysfunction (ED) is more common than initially reported. The exacerbation of brachytherapy-related ED is closely related to several clinical, treatment, and dosimetric parameters including pre-implant erectile function and radiation dose to the proximal penis. The majority of patients with brachytherapy-induced ED respond favorably to oral erectogenic agents.

High-dose brachytherapy for treating prostate cancer: nursing considerations

Radiation oncology nurses must be adequately educated on the care and management of patients and families undergoing high-dose rate brachytherapy for early-stage prostate cancer. The application of advanced assessment skills, while incorporating the treatment aspects of radiation, provides a framework for standards of nursing practice in this field. Current methodologies of radiation therapy are recommended for overall professional growth and improvement of patient care.

Understanding Stereotactic Radiosurgery for Intracranial Tumors, Seed Implants for Prostate Cancer, and Intravascular Brachytherapy for Cardiac Restenosis

Our 21st century has moved us into a world of technology never imagined. The aim of our article is to move oncology nurses beyond the realm of external beam radiation therapy. We chose to present 3 modalities of high precision that are infiltrating the everyday world of radiation therapy. Stereotactic radiosurgery for intracranial brain tumors and brachytherapy for prostate cancer require an expanded knowledge base for nursing to deliver excellent patient care. Cardiac patients receiving radiation seeds is new in the world of oncology nursing. These patients are unique but they are now a part of our world. Expanding our knowledge base to include a radiation procedure in cardiac care does bring us beyond the world of external beam radiation. Patients often seek information from nurses. Having an understanding of the basic principles and techniques will enable oncology nurses to educate patients. The purpose of this article is to explain the procedure of stereotactic radiosurgery, brachytherapy for prostate cancer, and intravascular brachytherapy for cardiac restenosis. Our discussion will include selection criteria, potential sides effects and risks, and nursing care.

Advances in brachytherapy: new approaches to target breast cancer

Advances in breast brachytherapy techniques have led to the development of new approaches for treatment of patients with early-stage breast cancer. This article reviews the indications, clinical utility, and nursing interventions for the Mammosite Radiation Therapy System (Proxima Therapeutics, Alpharetta, GA) and INTRABEAM (Photoelectron Corporation, North Billerica, MA) radiation therapy system. Each uses a slightly different approach to provide definitive radiotherapy to the breast tumor bed following excision. Radiation oncology nurses should have an understanding of how each system works to provide optimal care as it pertains to education, side effect management, and catheter care for patients receiving each of these types of radiotherapy. These innovative alternatives will greatly reduce required treatment time if clinical studies find them to be equivocal or superior to traditional radiation therapy techniques. These treatment approaches also may make radiation treatments more convenient for women with early-stage breast cancer.

Continuous video recording: a new clinical research tool for studying the nursing care of cancer patients

AIM

The aim of this study was to clarify issues around the patient-nurse interaction during pulsed dose rate (PDR) brachytherapy.

BACKGROUND

Cancer diagnosis, response and survival rates as well as the side-effects of radiation therapy are well described in international literature. However, no scientific data apparently exist on the reactions and behaviour of cancer patients during stressful irradiation treatments nor on nursing performance in these situations. The study involved gynaecological and anal cancer patients. Treatment needles (10-20 cm) were implanted in the tumours of these patients during the PDR brachytherapy. This treatment was administered during a 15-30-minute period each hour, for a duration of 30-60 hours. Patients were partially isolated and immobilized, and typically positioned on the back or side. In preparation for the therapy, patients had to fast and drink sparingly. Observation and nursing care could only be performed during pauses in the treatment.

METHOD

This paper is based on 142 hours of continuous video recording of patients undergoing PDR brachytherapy. Data were collected on five patients and 17 nurses.

FINDINGS

The study shows that nurses were with patients for approximately 1/4 of the available time. The majority (75%) of any communication with patients centred around physical care. Although patients were in a stressful situation, they did not anticipate receiving any psychological support from nursing staff. Patients showed individual patterns of behaviour and coping.

CONCLUSIONS

Continuous video recording, as a research tool can document accurately interaction and behaviour between cancer patients and nursing staff. Video recording discloses examples of both eminent and negligent nursing care and as such can be a useful tool for instruction and for future research. The credibility, validity and limitations of using video recording are discussed.

The experience of women receiving brachytherapy for gynecologic cancer

PURPOSE/OBJECTIVES

To explore and document the lived experience of receiving low-dose rate brachytherapy for gynecologic cancer.

DESIGN

Qualitative method based on phenomenology.

SETTING

Radiation treatment facility in a cancer-care setting in Toronto, Ontario, Canada.

SAMPLE

Ten women between the ages of 36 and 75 (x = 59.2) receiving low-dose rate brachytherapy for cancer of the cervix or endometrium.

METHODS

Verbatim data were analyzed manually using Giorgi's method of analyzing qualitative data.

FINDINGS

Three themes emerged from the data: (a) women's experiences with brachytherapy were embedded within the complete context in which treatment was given, shaped by personal, environmental, and treatment-related factors, (b) the discomfort that women experienced during brachytherapy was perceived as a totality of symptoms including but not limited to pain, and (c) the brachytherapy experience was characterized by an intense focus on time and tensions embedded in issues related to time.

CONCLUSIONS

When dealing with the brachytherapy treatment, women are concerned with the context in which the treatment is provided and the care that is associated with the treatment. Different and unique strategies assist women to get through treatment. Supportive nursing interventions can be implemented easily in the nursing care plan for women undergoing brachytherapy.

IMPLICATIONS FOR NURSING PRACTICE

The aspects of nursing care that women perceive as positive, such as competence level of the nurse, symptom management, and providing information in sensory terms, should be strengthened. Alternatively, aspects of nursing care that are perceived negatively by women should be changed. Nurses have to avoid situations that will prolong the time of brachytherapy treatment. Nurses should support women in using coping strategies that assist them in getting through the brachytherapy treatment.

The role of urinary assessment scores in the nursing management of patients receiving prostate brachytherapy

Nearly all patients experience some degree of urinary irritative or obstructive symptoms following brachytherapy for definitive treatment of early-stage prostate cancer. The American Urological Association (AUA) Symptom Index is a tool developed to measure urinary function and can be incorporated into postoperative nursing management. When this questionnaire is administered at regular intervals following surgery, the patient's urinary status can be assessed quickly and treatment changes made according to symptoms, with resultant improvement in comfort levels. The postoperative use of the AUA index is recommended for all nurses who care for patients undergoing prostate brachytherapy.

Nursing management of patients receiving brachytherapy for early stage prostate cancer

New technologies used in the area of prostate brachytherapy have resulted in a resurgence of interest in this modality of therapy for early stage prostate cancer. Results of prostate brachytherapy have been reported to be as favorable as radical prostatectomy. Nursing care is multifaceted and necessitates a thorough understanding of brachytherapy techniques, sequelae, and radiation safety.

Prostate cancer treatment with radioactive seed implantation

Prostate cancer is the second leading cause of cancer death after lung cancer. The use of radioactive seeds (i.e., brachytherapy) to provide radiation therapy is one of the three recommended treatment options for localized carcinoma of the prostate. This technique places the radioactive source in close proximity to the malignancy and provides a predictable dose of radiation to a confined area, thus sparing nearby healthy tissue. The technique is performed under transrectal ultrasonography. Nursing care for the patient undergoing this ambulatory surgery procedure focuses on detailed preoperative instructions and highly technical intraoperative care, followed by individualized postoperative care.

Ultrasonically guided interstitial brachytherapy for prostate cancer: care of the patient in ambulatory surgery

The diagnosis of prostate cancer at any age can strike fear in a man and his family. One treatment for early stage prostate cancer that is gaining renewed popularity is ultrasonically guided permanent iodine-125 or palladium-103 interstitial brachytherapy or seed implantation. This procedure permits concentrated, accurate radiation to the prostate while reducing the probability of radiation injury to adjacent tissue. A well-tolerated outpatient procedure, it is associated with negligible complications, and is the most overall cost-effective treatment option for early stage prostate cancer today. Nurses who are knowledgeable about the treatment plan and procedure play a pivotal role in teaching, preparing, and caring for patients during all phases of the treatment process. Their care and reassurance help reduce anxiety for patients and families during a difficult time in their lives.

[Experiences of women in cesium brachytherapy]

The objective of the present study was to determine the main difficulties and problems experienced by patients submitted to sealed internal radiotherapy as well as to provide guidance for nurses to better perceive the difficulties experienced by the patients and act as an element of support while giving care. The problems and difficulties observed and reported by the patients were mainly related to the impositions of treatment, such as isolation, prohibition of visits, hospitalization, bed confinement, restriction of movements, use of the intracavity system, measures of radiological protection, use of a delay bladder tube, and limited personal hygiene. Fear related to treatment and anesthesia, partial or absent orientation and skin lesions were the complaints voiced by most of the patients in the present study. The role of the nurse is important in planning nursing care in sealed internal radiotherapy, especially when nurses understand the problems and difficulties experienced by women submitted to this treatment.

Strategies for overcoming nurses' fear of radiation exposure

Preparing an additional nursing unit to care for brachytherapy patients at our institution presented a challenge with regard to overcoming fears and misconceptions about radiation exposure. A collaborative effort among the nursing, radiation oncology, radiation safety, and social work departments was successful in educating and supporting the staff and overcoming potential barriers to providing quality care for patients receiving brachytherapy.

Comprehensive surgical radiation oncology

Surgical radiation oncology uses surgical procedures to deliver or assist in the delivery of radiation to a tumor or tumor bed after resection. Intraoperative radiation therapy (IORT) bypasses radiosensitive skin and superficial structures and allows radiation to be delivered directly to the surgically exposed tumor. Removable brachytherapy places radioactive material inside or close to a tumor through hollow catheters positioned inside the tumor. Permanent brachytherapy inserts encapsulated radioactive seeds through needles attached to a mechanical gun directly into the tumor during surgery. This article discusses radiation precautions associated with each type of therapy and describes the nursing care needed by patients undergoing liver transplant radiation therapy.

Endobronchial brachytherapy

Endobronchial brachytherapy is a palliative treatment primarily used for individuals with lung cancer. This article describes the brachytherapy and presents the nurse's role before, during, and after the procedure. Coordination between hospital staff--endoscopy department, pulmonologist, radiation oncologist, and radiology department--is important to assure the success of this procedure.

[Intracavity brachytherapy in uterine neoplasms]

The growing use of intracavity treatment of uterine neoplasia has not been accompanied in the Brazilian literature by articles appropriate for day-to-day consultation. Based on this fact we endeavour to transmit in this paper our experiences related to this therapy technique.

Nursing care of the patient receiving high dose rate brachytherapy

Over the past few decades, a significant increase in the incidence of lung cancer has occurred. In the majority of patients, the failure to cure lung cancer is related in part to an inability to obtain locoregional control of the disease. Remote afterloading high dose rate (HDR) brachytherapy has tremendous potential as a way to increase treatment to the primary site of lung cancer and to improve palliative management of recurrent disease when conventional treatments have failed. Because remote afterloading is used, the medical staff is not exposed to ionizing radiation, and since the duration of treatment is short, HDR brachytherapy is convenient for the patient and can be delivered on an outpatient basis. Fifty-two patients were treated endobronchially for carcinoma of the lung at Parkview Regional Oncology Center in Fort Wayne, IN, between May 1, 1988, and September 1, 1990. Nursing care during treatment and recovery of these patients will be discussed in this paper.

Interstitially implanted I125 for prostate cancer using transrectal ultrasound

Prostate cancer is the third leading cause of death from cancer among men in the United States. Traditional treatments for prostate cancer are prostatectomy, external beam irradiation, and interstitial implantation of Iodine125 (I125) via laparotomy. These treatments are associated with significant morbidity and limitations. Based on experience with I125 interstitial implantation by transrectal ultrasound guidance for early-stage prostate cancer, it seems that this newer method of treatment has greater accuracy of placement and distribution of the isotope and has had few reported complications. The need for a surgical incision has been eliminated. Hospitalization time also has been decreased, creating the need for ambulatory and inpatient nurses to understand the importance of their respective roles in providing coordinated quality care for these patients. Nurses in these departments must have knowledge of the procedure, radiation safety, and common side effects related to the implant.

A stereotactic technique for volumetric interstitial implantation in the brain

Stereotaxis, a method of localizing a specific point using three dimensional coordinates, has greatly improved since the advent of computed tomography (CT). A simple, noninvasive stereotactic system which enables rapid, parallel placement of multiple interstitial catheters for treatment of malignant brain tumors has been developed. Departing from traditional stereotactic methods, the implantation procedure is performed in one stage--entirely in the CT suite. Perioperative nursing responsibilities include mastering the technical aspect of a high precision system as well as meeting the special needs of the patient undergoing this procedure. Initially developed for use in volumetric interstitial brachytherapy, the procedure is now being used in Phase II clinical trials of volumetric interstitial hyperthermia in the management of patients with intracranial malignancies.

Radiation therapy. Recent advances and nursing implications

Radiation therapy is one of the oldest treatments available for cancer management. Since the discovery of x-rays and radioactivity in the 1890s, patients have been treated with radiation. Advances in equipment and in the understanding of radiobiology permit delivery of effective doses of radiation to tumors while minimizing normal tissue damage. Recent advances in radiation have expanded the scope of treatment. Large-field, large-dose radiation, such as half-body treatment, permits treatment of metastatic disease in an effective and well-tolerated manner in patients too ill to travel for therapy. Total skin electron therapy has been successful in managing extensive skin disease. Hyperfractionated treatment is an experimental approach that attempts to achieve better tumor control by treating with two fractions per day. Intraoperative radiation is a conceptually sound but logistically cumbersome plan in which treatment is given in a single fraction at the time of surgery. Its full potential may be realized when the technical difficulties of administration can be overcome. Brachytherapy is the use of radioactive sources implanted directly into the tumor or in a cavity in proximity to the tumor. Techniques have improved in both surgery and radiation, which allow previously inaccessible sites such as the brain to be implanted. Early-stage breast cancer has been effectively managed with lumpectomy followed by radiation. Hyperthermia is the use of heat in conjunction with radiation. Heat has been found to enhance the effect of radiation and limit the repair of radiation damage. The properties of heat cause it to be more damaging to tumor cells than to normal ones. The ability to sensitize cancer cells to radiation and protect normal cells from radiation has been an ongoing research objective. Clinical trials are in progress to isolate effective, easily administered, and nontoxic compounds. The nurse caring for the patient receiving radiation must have an understanding of how radiation works and what the treatment goals are for the patient. Radiation is a difficult modality for patients to understand. Many fears and concerns are based on this lack of comprehension. The nurse must be prepared to describe the experience of receiving radiation and assist patients to anticipate and manage side effects. Patients need to know what to expect from therapy in terms they can understand. Recent advances and experimental treatments should be explained in terms of what is known including the rationale for the procedures.(ABSTRACT TRUNCATED AT 400 WORDS)