ONS Connect - September 2008 - (Page 6)

JuSTiN [By Deborah McBride, RN, MSN, CPON ®, Contributing Editor] End-of-life Conversations reduce Costs in final weeks of life O life care expenditures of $304,539,932 between individuals who had end-of-life discussions and those who did not. Zhang, B., Wright, A.A., Nilsson, M.E., Huskamp, H.A., Maciejewski, M.L., Earle, C.C., et al. (2008, May). Associations between advanced cancer patients’ end-of-life conversations and cost experiences in the final week of life [Abstract 9530]. Presented at the American Society of Clinical Oncology Annual Meeting, Chicago, IL. nly 37% of patients with advanced cancer report having end-of-life care discussions with their oncologists, according to a recent study. In the study, end-of-life discussions between patients with advanced cancers and physicians were associated with lower rates of aggressive interventions. Patients were interviewed at baseline and followed through death. Costs for intensive care unit stays, daily hospice care, and aggressive procedures (e.g., ventilation, resuscitation) received in the last week of life were aggregated. Of the 603 patients, 188 (31.2%) reported end-of-life discussions with physicians at baseline. The aggregate costs of care were $2,097 for patients who reported the discussions compared with $2,970 for patients who did not. Patients who reported end-of-life discussions did not differ in sociodemographic characteristics, psychological measures, treatment preferences, attitudes toward doctors, or terminal illness acknowledgment. According to the authors, if the results were extrapolated to the national level, based on the number of U.S. cancer deaths per year, the data suggest a difference in end-of- who were randomized to receive chemotherapy in the original trial. Patients predicted to have aggressive disease experienced the greatest benefit from chemotherapy with a 67% reduction in risk of death, whereas chemotherapy did not reduce the risk of death in patients designated as low risk. Tsao, M.S., Zhu, C., Ding, K., Strumpf, D., Pintilie, M., & Meyerson, M. (2008, May). A 15-gene expression signature prognostic for survival and predictive for adjuvant chemotherapy benefit in JBR.10 patients [Abstract 7510]. Presented at the American Society of Clinical Oncology Annual Meeting, Chicago, IL. Genes may predict lung Cancer aggressiveness ccording to researchers, a set of 15 genes (a gene signature) may predict the aggressiveness of early-stage non-small cell lung cancer and identify patients who might benefit most from chemotherapy after surgery. The study is a follow-up analysis of a trial by the National Cancer Institute of Canada Clinical Trials Group (conducted in collaboration with the U.S. National Cancer Institute) which showed a significant survival benefit from the anticancer drugs vinorelbine and cisplatin in patients with stage I and II non-small cell lung cancer who had their tumors surgically removed. Researchers performed a genetic analysis of tumor tissue from 133 of the 482 patients from the original study who had banked frozen tumor samples available. They first identified the 15-gene signature in 62 patients with early-stage non-small cell lung cancer who did not receive adjuvant chemotherapy and used it to predict which patients had aggressive cancers with a high risk of recurrence and death (31 patients) and which had less-aggressive disease and a low risk of recurrence (31 patients). They then applied the signature to 71 patients A Enzyme linked to Tumor Growth esearchers have identified an enzyme that enables cancer cells to consume the large quantities of glucose they need to fuel uncontrolled growth. The enzyme, pyruvate kinase, comes in two forms, but the research found that one, PKM2, enabled accelerated glucose consumption. When the cancer cells were found to switch to the other form of pyruvate kinase in the laboratory by knocking out production of PKM2, their growth was curbed. PKM2 was found in all of the cancer cells that the researchers examined. Because it is not found in most healthy adult tissues and it is critical for tumor formation, the enzyme is a possible target for cancer therapy. Researchers do not know whether the findings can be applied to human cancers outside the laboratory, so more research is needed before cancer treatment that target this process are tested. However, a drug called DCA, which is believed to act on this pathway, is currently undergoing testing. Christofk, H.R., Vander Heiden, M.G., Wu, N., Asara, J.M., & Cantley, L.C. (2008). Pyruvate kinase M2 is a phosphotyrosine-binding protein. Nature, 452(7184), 181–186. R 6 ONS CONNECT September 2008

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ONS Connect - September 2008 Contents Editor's Note Just In Advances in Prostate Cancer Treatment A Year in the Life - Month Nine Web Connect Capitol Connection Manage Infusion Reactions From Cetuximab Notice Nursing Now Caregiver Care Oropharyngeal Cancer in Men Associated with HPV Working for You Calendar of Events Staying on Top

ONS Connect - September 2008

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