ONS Connect - October 2008 - (Page 21)

therapy, agents such as docetaxel, pemetrexed, and erlotinib have been approved for use in patients with NSCLC. Patients with advanced disease who are not interested in receiving active therapies should be referred to hospice as early as possible. Although the median length of hospice enrollment for patients with lung cancer has been increasing, now an average of 24–34 days, 22% of patients with the disease are enrolled within only seven days of death. future Trends Genomics becomes a consideration with lung cancer as treatments shift toward targeted therapies. Erlotinib plus bevacizumab is being studied in clinical trials. Each of those targeted agents has a different mechanism of action, so the combination therapy is promising. Sunitinib and sorafenib also are in clinical trials for the treatment of lung cancer. The anti–vascular endothelial growth factor receptor agents have already been approved for renal cell carcinoma; in addition, sunitinib is approved for use in gastrointestinal stromal tumors and sorafenib is approved for hepatocellular carcinoma. Predictive modeling has been used to study treatment resistance and response. Researchers have identified a DNA repair protein, excision repair cross-complementation group 1 (ERCC-1), that may be a cause of cisplatin resistance. Two studies found that patients with ERCC1–positive tumors did not experience a survival benefit from adjuvant cisplatin chemotherapy but ERCC-1–negative patients did. Ribonucleotide reductase subunit M1 (RRM1), a tumor-suppressor gene also involved with DNA synthesis and repair, also appears to impact the effectiveness of gemcitabine chemotherapy. Patients with low levels of RRM1 experi- table 1. common symptoms in non-small cell Lung cancer and interventions to Manage them Symptom Dyspnea Intervention Immediate-release opioids, oxygen therapy, benzodiazepines for anxiety, cool air or fans, stress reduction, relaxation techniques, and support for patients and families Exercise, screening for and managing treatable causes (i.e., anemia, pain, depression, and thyroid dysfunction), energy conservation and activity management, patient education, sleep measures, relaxation techniques, and massage Opioids, non-narcotic cough suppressants (benzonatate), assessment and treatment of underlying causes (i.e., gastroesophageal reflux disease, bronchospasm, and infection), and steroids if secondary to radiation pneumonitis Usually mild and self-limiting; bronchoscopic procedures and radiotherapy Nonsteroidal anti-inflammatory drugs or acetaminophen, opioids, non-narcotic adjuvant medications, corticosteroids, palliative radiation, and bisphosphonates Assessment and treatment of underlying causes (i.e., nausea or vomiting, pain, depression, and thyroid dysfunction), nutritional counseling, oral supplements, exercise, and pharmacologic management (e.g., megestrol acetate, corticosteroids for short-term use) Fatigue Cough Hemoptysis Pain Anorexia or cachexia Note. From “Updates in Non-Small Cell Lung Cancer,” by S. Walker, 2008, Clinical Journal of Oncology Nursing, 12(3), p. 593. Used with permission. enced a greater response to treatment. Patients with epidermal growth factor receptor (EGFR) mutations have been found to have improved response rates to EGFR inhibitors. Findings like these are leading the way to the development of specific genetic blueprints that may one day predict a patient’s response to a variety of agents. ✱ Walker, S. (2008). Updates in non-small cell lung cancer. Clinical Journal of Oncology Nursing, 12(3), 587–596. Free cne is Available With the Full CJon Article For more information on nonsmall cell lung cancer or to access the free continuing nursing education credits associated with the original article, view the full article online at http://ons.metapress.com/ content/br30367672731415/full text.pdf. OctOber 2008 ONS CONNECT 21 http://ons.metapress.com/content/br30367672731415/fulltext.pdf http://ons.metapress.com/content/br30367672731415/fulltext.pdf http://ons.metapress.com/content/br30367672731415/fulltext.pdf

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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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