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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 oncology 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 oncology 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 anemia in patients with cancer.
  • Identify the role anemia plays in reducing efficacy of radiotherapy.
  • Describe the efficacy of currently available therapies for anemia.

ACCREDITATION STATEMENT
The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's 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: June 15, 2006.
Expiration date: June 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

Theresa Wicklin Gillespie, PhD, MA, BSN
Assistant Professor
Department of Surgery and Winship Cancer Institute
Emory University School of Medicine
Clinical Associate Professor
Nell Hodgson Woodruff School of Nursing
Emory University
Atlanta, Georgia
Dr Gillespie reports receiving honoraria from Amgen Inc. and Genentech.

Brenda K. Shelton, MS, RN, CCRN, AOCN
Critical Care Nurse Specialist
Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins Hospital
Baltimore, Maryland
Ms Shelton reports serving as a consultant for Amgen Inc., Bristol-Myers Squibb, and ImClone; and receiving honoraria from Amgen Inc., Bristol-Myers Squibb, Glaxo Wellcome, ImClone, Novartis, and Pfizer 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 Gillespie—darbepoetin alfa, epoetin alfa.
Ms Shelton—erythropoietin alfa.
All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Johns Hopkins Advanced Studies in Nursing provides disclosure information from contributing authors, lead presenters, and participating faculty. Johns Hopkins 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
MiKaela Olsen, RN, MS, OCN, Jerry L. Spivak, MD, and Scott W. Possley, PA-C, MPAS

Anemia is a common clinical problem among patients with cancer, resulting from host- and treatment-related factors.1 Data have demonstrated that anemia reduces patient quality of life (QOL) and duration of survival.2,3 Comprehensive management and prevention of anemia in patients with cancer requires careful assessment of risk factors, etiologic factors, analysis of clinical findings, and prompt intervention.4 Several alternative therapeutic options have been added to the clinician's armamentarium for the treatment of chemotherapy-related anemia as concerns over the safety and availability of allogeneic red blood cell transfusions have increased.5 Despite these advances, the trigger point for therapeutic intervention and the impact of mild or moderate anemia on patient QOL remain controversial topics in the oncology community and have prompted variations in supportive care practice. In response, the American Society of Clinical Oncology (ASCO), in conjunction with the American Society of Hematology (ASH), and the National Comprehensive Cancer Network (NCCN)4 have established recommendations for the use of erythropoietic agents in their supportive care guidelines.6,7

In Part 3 of our Johns Hopkins Advanced Studies in Nursing series on supportive care, we discuss new advances in the management of anemia in patients with cancer.  This issue opens with a review article by Brenda K. Shelton, MS, RN, CCRN, AOCN, in which she describes the etiology of and current therapeutic options for patients with cancer and treatment-related anemia. She also examines the ASCO/ASH and the NCCN supportive care guidelines and identifies additional supportive nursing measures.

Then, in a clinician interview, Theresa Wicklin Gillespie, PhD, MA, BSN, contributes her thoughts about the essential contributions of oncology nurses and oncology physician assistants in patient management and the implementation of supportive care for individuals with chemotherapy-related anemia.

To close this issue, Ms Shelton and Dr Gillespie each contribute case studies demonstrating how chemotherapy-related anemia can impact patient management and the importance of using the supportive care guidelines.

We continue our effort to bring you the most up-to-date supportive care information and hope you find the content in this issue of Johns Hopkins Advanced Studies in Nursing beneficial in your treatment of patients with cancer. 

REFERENCES

1. Tas F, Eralp Y, Basaran M, et al. Anemia in oncology practice: relation to diseases and their therapies. Am J Clin Oncol. 2002;25:371-379.
2. Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer. 2001;91:2214-2221.
3. Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol. 1997;34:13-19.
4. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Cancer- and Treatment-Related Anemia. Version 2.2005.
5. Stasi R, Amadori S, Littlewood TJ, et al. Management of cancer-related anemia with erythropoietic agents: doubts, certainties, and concerns. Oncologist. 2005;10:539-554.
6. Rizzo JD, Lichtin AE, Woolf SH, et al. Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. J Clin Oncol. 2002;20:4083-4107.
7. Rizzo JD, Lichtin AE, Woolf SH, et al. Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. Blood. 2002;100:2303-2320.

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.

*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 Healthcare Medical Centers, 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.





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.