Who is a survivor? Am I a survivor? Are you a survivor? What does a survivor need? How can community oncologists help? These are among the many questions a community oncologist can expect to hear during the course of treating a cancer patient, from the diagnosis, through the decisions about therapy, at all stages of treatment, and well into aftercare and follow-up. A “patient” used to be someone in active treatment, and a “survivor” was someone who had been free of disease for 5 years. More recently, Ellen Stoval of the National Coalition for Cancer Survivorship noted that the term “cancer survivor” can be used “to describe anyone who has been diagnosed with cancer as well as caregivers and loved ones of those diagnosed with the disease.”1 Her broader perspective more accurately captures the multifaceted nature of survivorship...
*For a PDF of the full article, click on the link to the left of this introduction.
Who is a survivor? Am I a survivor? Are you a survivor? What does a survivor need? How can community oncologists help? These are among the many questions a community oncologist can expect to hear during the course of treating a cancer patient, from the diagnosis, through the decisions about therapy, at all stages of treatment, and well into aftercare and follow-up. A “patient” used to be someone in active treatment, and a “survivor” was someone who had been free of disease for 5 years. More recently, Ellen Stoval of the National Coalition for Cancer Survivorship noted that the term “cancer survivor” can be used “to describe anyone who has been diagnosed with cancer as well as caregivers and loved ones of those diagnosed with the disease.”1 Her broader perspective more accurately captures the multifaceted nature of survivorship...
*For a PDF of the full article, click on the link to the left of this introduction.
Who is a survivor? Am I a survivor? Are you a survivor? What does a survivor need? How can community oncologists help? These are among the many questions a community oncologist can expect to hear during the course of treating a cancer patient, from the diagnosis, through the decisions about therapy, at all stages of treatment, and well into aftercare and follow-up. A “patient” used to be someone in active treatment, and a “survivor” was someone who had been free of disease for 5 years. More recently, Ellen Stoval of the National Coalition for Cancer Survivorship noted that the term “cancer survivor” can be used “to describe anyone who has been diagnosed with cancer as well as caregivers and loved ones of those diagnosed with the disease.”1 Her broader perspective more accurately captures the multifaceted nature of survivorship...
*For a PDF of the full article, click on the link to the left of this introduction.
Primary prostate and colorectal carcinomas represent the most common primary cancers in men in the United States;1 however, rarely do the two cancers present within the same patient, and only anecdotal reports have identified synchronous presentation.2–6 Although a primary surgical approach has been described in most of those reports, 2–4 we here report the successful use of preoperative chemoradiotherapy followed by rectal tumor resection in the community setting for a patient with synchronous presentation of primary prostate and rectal carcinomas.
Click on the PDF icon at the top of this introduction to read the full article.
Primary prostate and colorectal carcinomas represent the most common primary cancers in men in the United States;1 however, rarely do the two cancers present within the same patient, and only anecdotal reports have identified synchronous presentation.2–6 Although a primary surgical approach has been described in most of those reports, 2–4 we here report the successful use of preoperative chemoradiotherapy followed by rectal tumor resection in the community setting for a patient with synchronous presentation of primary prostate and rectal carcinomas.
Click on the PDF icon at the top of this introduction to read the full article.
Primary prostate and colorectal carcinomas represent the most common primary cancers in men in the United States;1 however, rarely do the two cancers present within the same patient, and only anecdotal reports have identified synchronous presentation.2–6 Although a primary surgical approach has been described in most of those reports, 2–4 we here report the successful use of preoperative chemoradiotherapy followed by rectal tumor resection in the community setting for a patient with synchronous presentation of primary prostate and rectal carcinomas.
Click on the PDF icon at the top of this introduction to read the full article.
With the introduction of tyrosine kinase inhibitor (TKI) therapy and the development of more sensitive monitoring techniques, the management of patients with chronic myeloid leukemia (CML) has evolved considerably over the last decade. In this review, we summarize the available literature evaluating the safety and efficacy of the TKIs imatinib, dasatinib, and nilotinib for information relevant to patient management to provide insight into long-term management of CML patients who receive TKI therapy. We suggest that these developments in treatment have expanded the role of oncology nurses, who can help address new issues that have arisen for patients learning to adapt to a chronic condition. The essential practice of monitoring, the critical importance of medication adherence, the safety profile of the three available TKIs, strategies for supportive care related to adverse events, drugdrug and drug-food interactions, and family planning are important aspects of long-term patient management...
*For a PDF of the full article, click on the link to the left of this introduction.
With the introduction of tyrosine kinase inhibitor (TKI) therapy and the development of more sensitive monitoring techniques, the management of patients with chronic myeloid leukemia (CML) has evolved considerably over the last decade. In this review, we summarize the available literature evaluating the safety and efficacy of the TKIs imatinib, dasatinib, and nilotinib for information relevant to patient management to provide insight into long-term management of CML patients who receive TKI therapy. We suggest that these developments in treatment have expanded the role of oncology nurses, who can help address new issues that have arisen for patients learning to adapt to a chronic condition. The essential practice of monitoring, the critical importance of medication adherence, the safety profile of the three available TKIs, strategies for supportive care related to adverse events, drugdrug and drug-food interactions, and family planning are important aspects of long-term patient management...
*For a PDF of the full article, click on the link to the left of this introduction.
With the introduction of tyrosine kinase inhibitor (TKI) therapy and the development of more sensitive monitoring techniques, the management of patients with chronic myeloid leukemia (CML) has evolved considerably over the last decade. In this review, we summarize the available literature evaluating the safety and efficacy of the TKIs imatinib, dasatinib, and nilotinib for information relevant to patient management to provide insight into long-term management of CML patients who receive TKI therapy. We suggest that these developments in treatment have expanded the role of oncology nurses, who can help address new issues that have arisen for patients learning to adapt to a chronic condition. The essential practice of monitoring, the critical importance of medication adherence, the safety profile of the three available TKIs, strategies for supportive care related to adverse events, drugdrug and drug-food interactions, and family planning are important aspects of long-term patient management...
*For a PDF of the full article, click on the link to the left of this introduction.
Renal cell carcinoma (RCC) continues to exert a substantial disease burden. Increasing knowledge of the molecular signaling pathways associated with renal cancer has led to the development of targeted therapies for advanced RCC, including several antiangiogenic agents designed to inhibit development of abnormal blood vessels that sustain tumor growth. Axitinib is an investigational antiangiogenic agent that targets vascular endothelial growth factor receptors 1, 2, and 3. In phase II studies, axitinib elicited significant response rates in patients with advanced RCC refractory to cytokines or sorafenib. In a phase III study of axitinib versus sorafenib in patients with metastatic RCC, axitinib demonstrated clinically significant improvement in progression-free survival compared with sorafenib. As with other targeted agents, side effects associated with axitinib, such as hypertension, fatigue, and diarrhea, can negatively affect the patient’s physical and emotional states and quality of life, thus jeopardizing adherence to and the effectiveness of the treatment plan. Clinicians should be aware of side effects that may occur during treatment and manage them proactively. Nurses should educate patients about possible side effects and their management before axitinib treatment is initiated. Management strategies include early reporting of the symptoms, regular clinic visits and laboratory tests, ongoing review of concomitant medications, and prompt treatment of side effects and follow-up to assess the effectiveness of interventions, which could include treatment interruption and/or dose reduction. These approaches would help maximize the patient adherence to therapy, quality of life, and clinical outcomes.
*For a PDF of the full article, click on the link to the left of this introduction.
Renal cell carcinoma (RCC) continues to exert a substantial disease burden. Increasing knowledge of the molecular signaling pathways associated with renal cancer has led to the development of targeted therapies for advanced RCC, including several antiangiogenic agents designed to inhibit development of abnormal blood vessels that sustain tumor growth. Axitinib is an investigational antiangiogenic agent that targets vascular endothelial growth factor receptors 1, 2, and 3. In phase II studies, axitinib elicited significant response rates in patients with advanced RCC refractory to cytokines or sorafenib. In a phase III study of axitinib versus sorafenib in patients with metastatic RCC, axitinib demonstrated clinically significant improvement in progression-free survival compared with sorafenib. As with other targeted agents, side effects associated with axitinib, such as hypertension, fatigue, and diarrhea, can negatively affect the patient’s physical and emotional states and quality of life, thus jeopardizing adherence to and the effectiveness of the treatment plan. Clinicians should be aware of side effects that may occur during treatment and manage them proactively. Nurses should educate patients about possible side effects and their management before axitinib treatment is initiated. Management strategies include early reporting of the symptoms, regular clinic visits and laboratory tests, ongoing review of concomitant medications, and prompt treatment of side effects and follow-up to assess the effectiveness of interventions, which could include treatment interruption and/or dose reduction. These approaches would help maximize the patient adherence to therapy, quality of life, and clinical outcomes.
*For a PDF of the full article, click on the link to the left of this introduction.
Renal cell carcinoma (RCC) continues to exert a substantial disease burden. Increasing knowledge of the molecular signaling pathways associated with renal cancer has led to the development of targeted therapies for advanced RCC, including several antiangiogenic agents designed to inhibit development of abnormal blood vessels that sustain tumor growth. Axitinib is an investigational antiangiogenic agent that targets vascular endothelial growth factor receptors 1, 2, and 3. In phase II studies, axitinib elicited significant response rates in patients with advanced RCC refractory to cytokines or sorafenib. In a phase III study of axitinib versus sorafenib in patients with metastatic RCC, axitinib demonstrated clinically significant improvement in progression-free survival compared with sorafenib. As with other targeted agents, side effects associated with axitinib, such as hypertension, fatigue, and diarrhea, can negatively affect the patient’s physical and emotional states and quality of life, thus jeopardizing adherence to and the effectiveness of the treatment plan. Clinicians should be aware of side effects that may occur during treatment and manage them proactively. Nurses should educate patients about possible side effects and their management before axitinib treatment is initiated. Management strategies include early reporting of the symptoms, regular clinic visits and laboratory tests, ongoing review of concomitant medications, and prompt treatment of side effects and follow-up to assess the effectiveness of interventions, which could include treatment interruption and/or dose reduction. These approaches would help maximize the patient adherence to therapy, quality of life, and clinical outcomes.
*For a PDF of the full article, click on the link to the left of this introduction.
The anti-HER2 monoclonal antibody trastuzumab works by binding to subdomain IV of the HER2 extracellular domain, thereby blocking HER2 cleavage; stimulating antibody-dependent, cell-mediated cytotoxicity; and preventing ligand-independent, HER2- mediated mitogenic signaling. Pertuzumab is an anti- HER2 monoclonal antibody that binds to subdomain II of the HER2 extracellular domain, preventing HER2 from dimerizing with other ligand-activated HER receptors; like trastuzumab, pertuzumab also stimulates antibodydependent cell-mediated cytotoxicity. Pertuzumab’s binding at a different HER2 epitope than trastuzumab represents a complementary mechanism of action that provides more comprehensive inhibition of HER2 signaling when the two agents are used together; the combination has been shown to produce greater antitumor activity than either agent alone in HER2-positive tumor models...
*For a PDF of the full article, click in the link to the left of this introduction.
The anti-HER2 monoclonal antibody trastuzumab works by binding to subdomain IV of the HER2 extracellular domain, thereby blocking HER2 cleavage; stimulating antibody-dependent, cell-mediated cytotoxicity; and preventing ligand-independent, HER2- mediated mitogenic signaling. Pertuzumab is an anti- HER2 monoclonal antibody that binds to subdomain II of the HER2 extracellular domain, preventing HER2 from dimerizing with other ligand-activated HER receptors; like trastuzumab, pertuzumab also stimulates antibodydependent cell-mediated cytotoxicity. Pertuzumab’s binding at a different HER2 epitope than trastuzumab represents a complementary mechanism of action that provides more comprehensive inhibition of HER2 signaling when the two agents are used together; the combination has been shown to produce greater antitumor activity than either agent alone in HER2-positive tumor models...
*For a PDF of the full article, click in the link to the left of this introduction.
The anti-HER2 monoclonal antibody trastuzumab works by binding to subdomain IV of the HER2 extracellular domain, thereby blocking HER2 cleavage; stimulating antibody-dependent, cell-mediated cytotoxicity; and preventing ligand-independent, HER2- mediated mitogenic signaling. Pertuzumab is an anti- HER2 monoclonal antibody that binds to subdomain II of the HER2 extracellular domain, preventing HER2 from dimerizing with other ligand-activated HER receptors; like trastuzumab, pertuzumab also stimulates antibodydependent cell-mediated cytotoxicity. Pertuzumab’s binding at a different HER2 epitope than trastuzumab represents a complementary mechanism of action that provides more comprehensive inhibition of HER2 signaling when the two agents are used together; the combination has been shown to produce greater antitumor activity than either agent alone in HER2-positive tumor models...
*For a PDF of the full article, click in the link to the left of this introduction.
Background Little is known about the impact of myelodysplastic syndromes (MDS) on the quality of life (QoL) of those living with the disease.
Objectives To explore the impact of MDS on the quality of life of those living with the disease.
Methods Seventy patients with MDS participated in five focus groups conducted throughout the United States. Transcripts from recordings of focus group sessions were coded and emerging themes identified using thematic analysis.
Results Findings revealed a multifaceted description of how MDS affects QoL. MDS was found to cause a substantial and sustained decrease in ability to function. QoL was adversely affected by work expended on managing the disease. The emotional impact was often viewed as more problematic than the physical impact; emotional reactions included shock, anger, depression, and anxiety. In contrast, spiritual well-being was often enhanced, with a renewed appreciation for life, relationships, and faith.
Limitations The method of subject recruitment may have limited participation to individuals who are more proactive in obtaining information about their illness. The focus groups convened only once, thus purposive sampling and repeated assessments were not possible.
Conclusions MDS has a substantial, often negative impact on patients' lives and clinicians should be cognizant of this impact. Attention must be directed at providing more comprehensive support for the patient throughout the illness trajectory.
Click on the PDF icon at the top of this introduction to read the full article.
Background Little is known about the impact of myelodysplastic syndromes (MDS) on the quality of life (QoL) of those living with the disease.
Objectives To explore the impact of MDS on the quality of life of those living with the disease.
Methods Seventy patients with MDS participated in five focus groups conducted throughout the United States. Transcripts from recordings of focus group sessions were coded and emerging themes identified using thematic analysis.
Results Findings revealed a multifaceted description of how MDS affects QoL. MDS was found to cause a substantial and sustained decrease in ability to function. QoL was adversely affected by work expended on managing the disease. The emotional impact was often viewed as more problematic than the physical impact; emotional reactions included shock, anger, depression, and anxiety. In contrast, spiritual well-being was often enhanced, with a renewed appreciation for life, relationships, and faith.
Limitations The method of subject recruitment may have limited participation to individuals who are more proactive in obtaining information about their illness. The focus groups convened only once, thus purposive sampling and repeated assessments were not possible.
Conclusions MDS has a substantial, often negative impact on patients' lives and clinicians should be cognizant of this impact. Attention must be directed at providing more comprehensive support for the patient throughout the illness trajectory.
Click on the PDF icon at the top of this introduction to read the full article.
Background Little is known about the impact of myelodysplastic syndromes (MDS) on the quality of life (QoL) of those living with the disease.
Objectives To explore the impact of MDS on the quality of life of those living with the disease.
Methods Seventy patients with MDS participated in five focus groups conducted throughout the United States. Transcripts from recordings of focus group sessions were coded and emerging themes identified using thematic analysis.
Results Findings revealed a multifaceted description of how MDS affects QoL. MDS was found to cause a substantial and sustained decrease in ability to function. QoL was adversely affected by work expended on managing the disease. The emotional impact was often viewed as more problematic than the physical impact; emotional reactions included shock, anger, depression, and anxiety. In contrast, spiritual well-being was often enhanced, with a renewed appreciation for life, relationships, and faith.
Limitations The method of subject recruitment may have limited participation to individuals who are more proactive in obtaining information about their illness. The focus groups convened only once, thus purposive sampling and repeated assessments were not possible.
Conclusions MDS has a substantial, often negative impact on patients' lives and clinicians should be cognizant of this impact. Attention must be directed at providing more comprehensive support for the patient throughout the illness trajectory.
Click on the PDF icon at the top of this introduction to read the full article.
Determinants of Physical Activity in Palliative Cancer Patients: An Application of the Theory of Planned Behavior
Affective attitude, self-efficacy, and intention were the strongest correlates of total physical activity levels, and younger and normal/underweight participants did more physical activity.
Original research
Determinants of Physical Activity in Palliative Cancer Patients: An Application of the Theory of Planned Behavior
Sonya S. Lowe, MD, MSc
,
,
Sharon M. Watanabe, MD,
Vickie E. Baracos, PhD,
Kerry S. Courneya, PhD
Department of Symptom Control and Palliative Care, The Division of Palliative Care Medicine, Department of Oncology, and the Faculty of Physical Education and Recreation, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
Received 23 March 2011. Accepted 29 July 2011. Available online 12 October 2011.
http://dx.doi.org/10.1016/j.suponc.2011.07.005, How to Cite or Link Using DOI
Increasing evidence points to the theory of planned behavior as a useful framework to understand physical activity behavior in cancer patients.
Objective
Our primary aim was to examine the demographic, medical, and social–cognitive correlates of physical activity in palliative cancer patients.
Methods
A cross-sectional survey was administered to advanced cancer patients aged 18 years or older with a clinician-estimated life expectancy of less than 12 months and Palliative Performance Scale >30%, from outpatient palliative care, oncology clinics, and palliative home care.
Results
Fifty participants were recruited. Correlates of total physical activity levels were affective attitude (r = 0.36, P = .011), self-efficacy (r = 0.36, P = .010), and intention (r = 0.30, P = .034). Participants who reported 60 minutes or more of total physical activity daily reported significantly higher affective attitude (M = 0.9, 95% confidence interval [CI] 0.26–1.6, P = .008) and self-efficacy (M = 0.8, 95% CI 0.0–1.5, P = .046). Participants <60 years of age (M = 343, 95% CI −7 to 693, P = .054) and who were normal or underweight (M = 333, 95% CI −14 to 680, P = .059) reported higher weekly minutes of total physical activity.
Limitations
Our small sample may not be representative of the total palliative cancer population.
Conclusions
Affective attitude, self-efficacy, and intention were the strongest correlates of total physical activity levels, and younger and normal/underweight participants did more physical activity.
Affective attitude, self-efficacy, and intention were the strongest correlates of total physical activity levels, and younger and normal/underweight participants did more physical activity.
Affective attitude, self-efficacy, and intention were the strongest correlates of total physical activity levels, and younger and normal/underweight participants did more physical activity.
Original research
Determinants of Physical Activity in Palliative Cancer Patients: An Application of the Theory of Planned Behavior
Sonya S. Lowe, MD, MSc
,
,
Sharon M. Watanabe, MD,
Vickie E. Baracos, PhD,
Kerry S. Courneya, PhD
Department of Symptom Control and Palliative Care, The Division of Palliative Care Medicine, Department of Oncology, and the Faculty of Physical Education and Recreation, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
Received 23 March 2011. Accepted 29 July 2011. Available online 12 October 2011.
http://dx.doi.org/10.1016/j.suponc.2011.07.005, How to Cite or Link Using DOI
Increasing evidence points to the theory of planned behavior as a useful framework to understand physical activity behavior in cancer patients.
Objective
Our primary aim was to examine the demographic, medical, and social–cognitive correlates of physical activity in palliative cancer patients.
Methods
A cross-sectional survey was administered to advanced cancer patients aged 18 years or older with a clinician-estimated life expectancy of less than 12 months and Palliative Performance Scale >30%, from outpatient palliative care, oncology clinics, and palliative home care.
Results
Fifty participants were recruited. Correlates of total physical activity levels were affective attitude (r = 0.36, P = .011), self-efficacy (r = 0.36, P = .010), and intention (r = 0.30, P = .034). Participants who reported 60 minutes or more of total physical activity daily reported significantly higher affective attitude (M = 0.9, 95% confidence interval [CI] 0.26–1.6, P = .008) and self-efficacy (M = 0.8, 95% CI 0.0–1.5, P = .046). Participants <60 years of age (M = 343, 95% CI −7 to 693, P = .054) and who were normal or underweight (M = 333, 95% CI −14 to 680, P = .059) reported higher weekly minutes of total physical activity.
Limitations
Our small sample may not be representative of the total palliative cancer population.
Conclusions
Affective attitude, self-efficacy, and intention were the strongest correlates of total physical activity levels, and younger and normal/underweight participants did more physical activity.
Original research
Determinants of Physical Activity in Palliative Cancer Patients: An Application of the Theory of Planned Behavior
Sonya S. Lowe, MD, MSc
,
,
Sharon M. Watanabe, MD,
Vickie E. Baracos, PhD,
Kerry S. Courneya, PhD
Department of Symptom Control and Palliative Care, The Division of Palliative Care Medicine, Department of Oncology, and the Faculty of Physical Education and Recreation, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
Received 23 March 2011. Accepted 29 July 2011. Available online 12 October 2011.
http://dx.doi.org/10.1016/j.suponc.2011.07.005, How to Cite or Link Using DOI
Increasing evidence points to the theory of planned behavior as a useful framework to understand physical activity behavior in cancer patients.
Objective
Our primary aim was to examine the demographic, medical, and social–cognitive correlates of physical activity in palliative cancer patients.
Methods
A cross-sectional survey was administered to advanced cancer patients aged 18 years or older with a clinician-estimated life expectancy of less than 12 months and Palliative Performance Scale >30%, from outpatient palliative care, oncology clinics, and palliative home care.
Results
Fifty participants were recruited. Correlates of total physical activity levels were affective attitude (r = 0.36, P = .011), self-efficacy (r = 0.36, P = .010), and intention (r = 0.30, P = .034). Participants who reported 60 minutes or more of total physical activity daily reported significantly higher affective attitude (M = 0.9, 95% confidence interval [CI] 0.26–1.6, P = .008) and self-efficacy (M = 0.8, 95% CI 0.0–1.5, P = .046). Participants <60 years of age (M = 343, 95% CI −7 to 693, P = .054) and who were normal or underweight (M = 333, 95% CI −14 to 680, P = .059) reported higher weekly minutes of total physical activity.
Limitations
Our small sample may not be representative of the total palliative cancer population.
Conclusions
Affective attitude, self-efficacy, and intention were the strongest correlates of total physical activity levels, and younger and normal/underweight participants did more physical activity.
Managing Side Effects of Tyrosine Kinase Inhibitor Therapy to Optimize Adherence in Patients with Chronic Myeloid Leukemia: The Role of the Midlevel Practitioner
In the last decade, the development of imatinib, a tyrosine kinase inhibitor, has brought about unprecedented change in the way newly diagnosed, chronic-phase chronic myeloid leukemia patients are treated.
How we do it
Managing Side Effects of Tyrosine Kinase Inhibitor Therapy to Optimize Adherence in Patients with Chronic Myeloid Leukemia: The Role of the Midlevel Practitioner
Megan Cornelison, MS, PA-C,
Elias J. Jabbour, MD,
Mary Alma Welch, MS, PA-C,
Received 2 May 2011. Accepted 5 August 2011. Available online 11 January 2012.
In the last decade, the development of imatinib, a tyrosine kinase inhibitor, has brought about unprecedented change in the way newly diagnosed, chronic-phase chronic myeloid leukemia patients are treated. Two next-generation tyrosine kinase inhibitors, nilotinib and dasatinib, were initially indicated for imatinib-resistant or imatinib-intolerant chronic myeloid leukemia patients and recently received approval from the Food and Drug Administration for treatment of newly diagnosed, chronic-phase chronic myeloid leukemia patients. In comparison with the previous standards of care, benefits with these three tyrosine kinase inhibitors have included more rapid response rates, increased survival, and fewer side effects. The improved long-term outcomes have altered the approach to management of chronic myeloid leukemia from a progressive fatal disease with a poor prognosis to a chronic condition similar to diabetes or hypertension. Prolonged survival increases the need for patient education, support, monitoring, and assistance with adverse event management. Even low-grade side effects can adversely affect patients' quality of life and, therefore, require prompt attention to prevent long-term complications or suboptimal outcomes. New evidence has indicated that patient adherence to tyrosine kinase inhibitor therapy is essential to successful treatment. Midlevel practitioners can help to optimize outcomes by educating patients regarding the importance of adherence, performing regular monitoring, helping patients to understand their test results, and aggressively managing treatment-related side effects.
In the last decade, the development of imatinib, a tyrosine kinase inhibitor, has brought about unprecedented change in the way newly diagnosed, chronic-phase chronic myeloid leukemia patients are treated.
In the last decade, the development of imatinib, a tyrosine kinase inhibitor, has brought about unprecedented change in the way newly diagnosed, chronic-phase chronic myeloid leukemia patients are treated.
How we do it
Managing Side Effects of Tyrosine Kinase Inhibitor Therapy to Optimize Adherence in Patients with Chronic Myeloid Leukemia: The Role of the Midlevel Practitioner
Megan Cornelison, MS, PA-C,
Elias J. Jabbour, MD,
Mary Alma Welch, MS, PA-C,
Received 2 May 2011. Accepted 5 August 2011. Available online 11 January 2012.
In the last decade, the development of imatinib, a tyrosine kinase inhibitor, has brought about unprecedented change in the way newly diagnosed, chronic-phase chronic myeloid leukemia patients are treated. Two next-generation tyrosine kinase inhibitors, nilotinib and dasatinib, were initially indicated for imatinib-resistant or imatinib-intolerant chronic myeloid leukemia patients and recently received approval from the Food and Drug Administration for treatment of newly diagnosed, chronic-phase chronic myeloid leukemia patients. In comparison with the previous standards of care, benefits with these three tyrosine kinase inhibitors have included more rapid response rates, increased survival, and fewer side effects. The improved long-term outcomes have altered the approach to management of chronic myeloid leukemia from a progressive fatal disease with a poor prognosis to a chronic condition similar to diabetes or hypertension. Prolonged survival increases the need for patient education, support, monitoring, and assistance with adverse event management. Even low-grade side effects can adversely affect patients' quality of life and, therefore, require prompt attention to prevent long-term complications or suboptimal outcomes. New evidence has indicated that patient adherence to tyrosine kinase inhibitor therapy is essential to successful treatment. Midlevel practitioners can help to optimize outcomes by educating patients regarding the importance of adherence, performing regular monitoring, helping patients to understand their test results, and aggressively managing treatment-related side effects.
How we do it
Managing Side Effects of Tyrosine Kinase Inhibitor Therapy to Optimize Adherence in Patients with Chronic Myeloid Leukemia: The Role of the Midlevel Practitioner
Megan Cornelison, MS, PA-C,
Elias J. Jabbour, MD,
Mary Alma Welch, MS, PA-C,
Received 2 May 2011. Accepted 5 August 2011. Available online 11 January 2012.
In the last decade, the development of imatinib, a tyrosine kinase inhibitor, has brought about unprecedented change in the way newly diagnosed, chronic-phase chronic myeloid leukemia patients are treated. Two next-generation tyrosine kinase inhibitors, nilotinib and dasatinib, were initially indicated for imatinib-resistant or imatinib-intolerant chronic myeloid leukemia patients and recently received approval from the Food and Drug Administration for treatment of newly diagnosed, chronic-phase chronic myeloid leukemia patients. In comparison with the previous standards of care, benefits with these three tyrosine kinase inhibitors have included more rapid response rates, increased survival, and fewer side effects. The improved long-term outcomes have altered the approach to management of chronic myeloid leukemia from a progressive fatal disease with a poor prognosis to a chronic condition similar to diabetes or hypertension. Prolonged survival increases the need for patient education, support, monitoring, and assistance with adverse event management. Even low-grade side effects can adversely affect patients' quality of life and, therefore, require prompt attention to prevent long-term complications or suboptimal outcomes. New evidence has indicated that patient adherence to tyrosine kinase inhibitor therapy is essential to successful treatment. Midlevel practitioners can help to optimize outcomes by educating patients regarding the importance of adherence, performing regular monitoring, helping patients to understand their test results, and aggressively managing treatment-related side effects.
Managing Side Effects of Tyrosine Kinase Inhibitor Therapy to Optimize Adherence in Patients with Chronic Myeloid Leukemia: The Role of the Midlevel Practitioner
Display Headline
Managing Side Effects of Tyrosine Kinase Inhibitor Therapy to Optimize Adherence in Patients with Chronic Myeloid Leukemia: The Role of the Midlevel Practitioner
Patients with advanced lung cancer experience a high symptom burden with great impact upon functional status and quality of life and poor long-term survival. Respiratory symptoms, like dyspnea, cough, and hemoptysis, are highly prevalent and cause profound distress at the time of diagnosis and as disease progresses. This review discusses common reversible causes of dyspnea and examines pharmacologic and nonpharmacologic approaches to symptom management of dyspnea, cough, and hemoptysis.
For a complete copy of the article, click on the PDF file at left.
Patients with advanced lung cancer experience a high symptom burden with great impact upon functional status and quality of life and poor long-term survival. Respiratory symptoms, like dyspnea, cough, and hemoptysis, are highly prevalent and cause profound distress at the time of diagnosis and as disease progresses. This review discusses common reversible causes of dyspnea and examines pharmacologic and nonpharmacologic approaches to symptom management of dyspnea, cough, and hemoptysis.
For a complete copy of the article, click on the PDF file at left.
Comprehensive Management of Respiratory Symptoms in Patients with Advanced Lung Cancer
Patients with advanced lung cancer experience a high symptom burden with great impact upon functional status and quality of life and poor long-term survival. Respiratory symptoms, like dyspnea, cough, and hemoptysis, are highly prevalent and cause profound distress at the time of diagnosis and as disease progresses. This review discusses common reversible causes of dyspnea and examines pharmacologic and nonpharmacologic approaches to symptom management of dyspnea, cough, and hemoptysis.
For a complete copy of the article, click on the PDF file at left.
PEER VIEWPOINT: Targeting the Symptoms of Lung Cancer, Not Just the Disease
Lung cancer accounts for a large percentage of cancer deaths worldwide. In the United States, an estimated 222,520 new diagnoses and 157,300 deaths associated with lung cancer were projected for 2010.
Targeting the Symptoms of Lung Cancer, Not Just the Disease
Lung cancer accounts for a large percentage of cancer deaths worldwide. In the United States, an estimated 222,520 new diagnoses and 157,300 deaths associated with lung cancer were projected for 2010.1 Even with the best approaches available to us today, median 5-year survival rates range from 10% to 15% in advanced disease.2 The majority of our efforts have been aimed at prolonging survival, focusing on optimizing tumor-specific options. Unfortunately, we are prone to overlook symptoms that negatively impact quality of life. McCannon and Temel highlight approaches to managing the respiratory symptoms associated with advanced lung cancer, explaining the pathophysiology behind the common symptoms and critiquing the evidence behind these management approaches.
The authors emphasize the fact that multiple causes contribute to respiratory symptoms in patients with lung cancer. It is essential to perform a thorough history and clinical evaluation in order to elucidate the underlying insult(s) and not simply assume symptoms are due to progressive disease. The table gives an excellent framework to guide the approach to these patients. Reversible causes should always be sought and aggressively treated.
Lung cancer accounts for a large percentage of cancer deaths worldwide. In the United States, an estimated 222,520 new diagnoses and 157,300 deaths associated with lung cancer were projected for 2010.
Lung cancer accounts for a large percentage of cancer deaths worldwide. In the United States, an estimated 222,520 new diagnoses and 157,300 deaths associated with lung cancer were projected for 2010.
Targeting the Symptoms of Lung Cancer, Not Just the Disease
Lung cancer accounts for a large percentage of cancer deaths worldwide. In the United States, an estimated 222,520 new diagnoses and 157,300 deaths associated with lung cancer were projected for 2010.1 Even with the best approaches available to us today, median 5-year survival rates range from 10% to 15% in advanced disease.2 The majority of our efforts have been aimed at prolonging survival, focusing on optimizing tumor-specific options. Unfortunately, we are prone to overlook symptoms that negatively impact quality of life. McCannon and Temel highlight approaches to managing the respiratory symptoms associated with advanced lung cancer, explaining the pathophysiology behind the common symptoms and critiquing the evidence behind these management approaches.
The authors emphasize the fact that multiple causes contribute to respiratory symptoms in patients with lung cancer. It is essential to perform a thorough history and clinical evaluation in order to elucidate the underlying insult(s) and not simply assume symptoms are due to progressive disease. The table gives an excellent framework to guide the approach to these patients. Reversible causes should always be sought and aggressively treated.
Targeting the Symptoms of Lung Cancer, Not Just the Disease
Lung cancer accounts for a large percentage of cancer deaths worldwide. In the United States, an estimated 222,520 new diagnoses and 157,300 deaths associated with lung cancer were projected for 2010.1 Even with the best approaches available to us today, median 5-year survival rates range from 10% to 15% in advanced disease.2 The majority of our efforts have been aimed at prolonging survival, focusing on optimizing tumor-specific options. Unfortunately, we are prone to overlook symptoms that negatively impact quality of life. McCannon and Temel highlight approaches to managing the respiratory symptoms associated with advanced lung cancer, explaining the pathophysiology behind the common symptoms and critiquing the evidence behind these management approaches.
The authors emphasize the fact that multiple causes contribute to respiratory symptoms in patients with lung cancer. It is essential to perform a thorough history and clinical evaluation in order to elucidate the underlying insult(s) and not simply assume symptoms are due to progressive disease. The table gives an excellent framework to guide the approach to these patients. Reversible causes should always be sought and aggressively treated.
