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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Emerging Trends In Cancer Therapy And Supportive Care: Practical Insights For Clinicians


GOAL
To provide oncology nurses and physician assistants with up-to-date information on their role in the treatment and management of patients with cancer-related anemia and neutropenia.

TARGET AUDIENCE
This activity is designed for oncology nurses and physician assistants. No prerequisites required.

LEARNING OBJECTIVES
The Institute for Johns Hopkins Nursing and Johns Hopkins University School of Medicine take responsibility for the content, quality, and scientific integrity of this CE activity. At the conclusion of this activity, the participant should be able to:

  • Define neutropenia in patients with cancer.
  • Discuss the impact of infections associated with neutropenia on tumor therapy regimes.
  • Describe the efficacy of currently available therapies for neutropenia.

ACCREDITATION STATEMENT
The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing CenterÕs Commission on Accreditation.The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Institute for Johns Hopkins Nursing designates this activity for a maximum of 0.6 contact hours. Claim only those contact hours actually spent in the activity.(50 minutes of contact = 1 contact hour.)

The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The estimated time to complete this educational activity: 30 minutes.
Release date: March 15, 2006. Expiration date: March 15, 2008.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Institute for Johns Hopkins Nursing and the Johns Hopkins University School of Medicine names implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
This program is supported by an educational grant from Amgen Inc.

Full Disclosure Policy Affecting CE Activities:
As a provider accredited by the American Nurses Credentialing Center (ANCC), it is the policy of The Institute for Johns Hopkins Nursing to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Directors and Participating Faculty reported the following:

PROGRAM DIRECTORS

MiKaela Olsen, RN, MS, OCN
Oncology and BMT Clinical Nurse Specialist
Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins Hospital
Baltimore, Maryland
Ms Olsen reports serving on the speakers' bureaus for Amgen Inc. and GlaxoSmithKline.

Scott W. Possley, PA-C, MPAS
Oncology and BMT Physician Assistant
New York Presbyterian Hospital
Weill Cornell Medical Center
New York, New York
Mr Possley reports holding stock in CuraGen Corporation; and receiving honoraria from Amgen Inc.

Jerry L. Spivak, MD
Professor of Medicine and Oncology
Johns Hopkins University School of Medicine
Director, Center for Chronic Myeloproliferative Disorders
The Johns Hopkins Hospital
Baltimore, Maryland
Dr Spivak reports serving as a consultant for Novartis and Roche Pharmaceuticals.

PARTICIPATING FACULTY

Christopher R. Friese, RN, PhD, AOCN
Research Fellow
Center for Outcomes and Policy Research
Dana-Farber Cancer Institute
Harvard School of Public Health
Boston, Massachusetts
Dr Friese reports serving as a consultant for Amgen, Inc; holding stock in Amgen Inc, Novartis, and Palatin; and receiving honoraria from Amgen Inc.


Notice: The audience is advised that articles in this CE activity contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Dr Friese–pegfilgrastim.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Nursing provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Nursing does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Emerging Trends In Cancer Therapy And Supportive Care: Practical Insights For Clinicians
A Five-Part Series
Part Two: Neutropenia Management

INTRODUCTION
MiKaela Olsen, RN, MS, OCN, Jerry L. Spivak, MD,  and Scott W. Possley, PA-C, MPAS

Chemotherapy-induced neutropenia (CIN) is the primary hematologic toxicity of many chemotherapy regimens. Neutropenia, with its ensuing complications, is a major dose-limiting toxicity associated with chemotherapy and is associated with significant clinical, economic, and quality-of-life (QOL) implications. Supportive care for neutropenia has made considerable advances in recent years with the introduction of granulocyte colony-stimulating factors (G-CSF). Clinical trials have demonstrated the safety and efficacy of G-CSFs, such as filgrastim and pegfilgrastim, for use in the reduction of chemotherapy-induced febrile neutropenia (FN). The American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have incorporated growth factor use into their supportive care guidelines; however, significant differences exist in their recommendations.1,2 Under ASCO guidelines, the common practice for patients receiving chemotherapy regimens with less than a 40%   risk of FN is to wait and see if FN occurs after the first cycle of chemotherapy.1 If it does, growth factors are given in later chemotherapy cycles. In contrast, the NCCN recently issued guidelines recommending prophylactic growth factor use in patients receiving chemotherapy regimens with a 20% or greater risk of developing FN.2 Despite these differences, both guidelines underscore the importance of identifying and treating patients at high risk of CIN.

In this second part of our Advanced Studies in Nursing series on supportive care, we focus our discussion on neutropenia management and feature a review article by Christopher R. Friese, RN, PhD, AOCN, in which he examines the consequences of FN and its current therapeutic options. He also examines ASCO and NCCN guidelines and evaluates the nursing implications associated with the new NCCN guidelines.

Also included in this issue is a clinician interview with Scott W. Possley, PA-C, MPAS, in which he discusses the role of mid-level healthcare providers in neutropenia management and how it impacts patients' QOL.

Finally, Dr Friese and Mr Possley each contribute case studies illustrating the serious implications of neutropenia and the importance of utilizing supportive care guidelines to reduce the risk of FN.

We hope you enjoy this issue of Advanced Studies in Nursing and find the features relevant to your clinical practice, helping you provide the highest quality of supportive care to your patients with cancer.

REFERENCES

1. Ozer H, Armitage JO, Bennet CL, et al. 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol. 2000;18:3558-3585.
2. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Myeloid Growth Factors in Cancer Treatment. Version 2.2005. Available at: http://www.nccn.com/professionals/physician_gls/PDF/myeloid_growth.pdf. Accessed December 8, 2005.

*Oncology and BMT Clinical Nurse Specialist, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, Maryland.
 Professor of Medicine and Oncology, Johns Hopkins University School of Medicine, Director, Center for Chronic Myeloproliferative Disorders, The Johns Hopkins Hospital, Baltimore, Maryland.

Oncology and BMT Physician Assistant, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.
Address correspondence to: MiKaela Olsen, RN, MS, OCN, Oncology and BMT Clinical Nurse Specialist, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, The Harry & Jeannette Weinberg Building, Suite 1100, 401 North Broadway, Baltimore, MD 21231. E-mail: olsenmi@jhmi.edu.

The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his/her article and all its contents.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.