ONS Connect - October 2008 - (Page 20)

fivEmiNuTEiNSERviCE As seen in the CliniCal Journal of onCology nursing Manage Patients With Non-Small Cell Lung Cancer [By elisa Becze, BA, ONS Staff Writer] L ung cancer has been and continues to be the leading cause of cancer-related death in the United States since the 1950s for men and 1987 for women, so oncology nurses need to understand the disease and how to manage it. A recent article by Suzanne Walker (2008) outlines the current updates in the management and treatment of non-small cell lung cancer (NSCLC), which is the most prevalent histologic type of lung cancer, accounting for more than 80% of lung cancer cases. Genomics becomes a consideration with lung cancer as treatments shift toward targeted therapies. . . . Predictive modeling has been used to study treatment resistance and response. chances for successfully quitting through interventions such as prescribing pharmaceutical agents (e.g., nicotine replacement therapy, bupropion, varenicline). Chemoprevention with antioxidants has been studied, but the therapy has not been shown to prevent lung cancer; rather, two studies found that beta carotene supplementation actually increased the risk of lung cancer in smokers. Treatment of NSClC Treatment for early-stage I, II, and certain stage III NSCLC involves surgery, followed in some cases by adjuvant chemotherapy. Cisplatin-based chemotherapy has been found to be more effective than carboplatin treatments. Chemotherapy, radiation, and surgery are the typical treatment regimen for patients with locally advanced stage IIIA NSCLC. Patients with stage IIIB cancers are not candidates for surgery, so they receive chemotherapy and concurrent radiation. Advanced NSCLC may require two treatment options. For initial therapy, combination chemotherapy has been found to be superior to best supportive care in patients with stage IIIB cancer with malignant pleural effusion and in patients with stage IV disease. Effective combinations for initial therapy include gemcitabine and carboplatin; gemcitabine and paclitaxel; and bevacizumab, paclitaxel, and carboplatin. For second-line Etiology of lung Cancer Patients with lung cancer commonly experience coughing, dyspnea, chest pain, hoarseness, anorexia, weight loss, and fatigue. See Table 1 for a list of common symptoms and interventions for management. NSCLC is typically diagnosed with a transbronchial or transthoracic needle biopsy, and staging is done with computed tomography/positron emission tomography, bone scans, and magnetic resonance imaging of the brain. Currently, no screening tests exist for lung cancer, although several imaging methods are being studied. Most lung cancer cases are caused by smoking or inhalation of secondhand smoke, although a smaller number of cases may be hereditary or caused by dietary deficiencies or environmental exposure to agents such as radon or asbestos. Researchers agree that the most effective prevention for lung cancer is quitting smoking. Nurses can improve patients’ Key Definitions Adenocarcinoma: represents about 40% of non-small cell lung cancer cases; typically present in the lung periphery and may metastasize rapidly to the liver, adrenal glands, bones, or brain Bronchioaveolar carcinoma: a form of adneocarcinoma that typically presents in a multifocal inflammatory pattern Squamous cell carcinoma: typically centrally located and often results in endobronchial obstruction and hemoptysis Five-Minute In-Service is a monthly feature that offers readers a concise recap of a full-length article published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Updates in Non-Small Cell Lung Cancer” by Suzanne Walker, CRNP, MSN, AOCN®, which was featured in the August 2008 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons. org. Photocopying of this article for educational purposes and group discussion is permitted. 20 ONS CONNECT OctOber 2008

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ONS Connect- October 2008 Contents Editor's Note Just In Up Front You Tell Us Up Close &�Professional Web Connect Five-Minute In-Service Capitol Connection Caregiver Care Straight Talk New Treatments, New Hope Working for You Calendar of Events Staying on Top

ONS Connect - October 2008

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