Phase I trial and pharmacologic trial of sequences of paclitaxel and topotecan in previously treated ovarian epithelial malignancies: a Gynecologic Oncology Group study.

PURPOSE: A phase I and pharmacologic study to evaluate the feasibility of administering paclitaxel (PTX) in combination with topotecan (TPT) without and with granulocyte colony-stimulating factor (G-CSF) in women with recurrent or refractory ovarian cancer. PATIENTS AND METHODS: TPT was administered as a 30-minute infusion daily for 5 days and PTX was given as a 24-hour infusion (PTX-24) either before TPT on day 1 or after TPT on day 5. Each patient received both schedules on an alternating basis every 3 weeks. Sequential dose escalation of TPT or PTX-24 without and with G-CSF resulted in five dosage permutations of TPT/PTX (mg/ m2): 0.75/135 without G-CSF and 0.75/135, 1.25/135, 1.50/135, and 1.25/170 with G-CSF. RESULTS: Twenty-two patients received 109 courses of therapy. Dose-limiting myelosuppression consistently occurred at the first TPT/PTX-24 dose level (0.75/135 mg/m2) in the absence of G-CSF support. Although the addition of G-CSF resulted in reduced rates of complicated neutropenia, the incidences of dose-limiting neutropenia and thrombocytopenia were unacceptably high after the doses of either TPT or PTX-24 were increased. Paired analysis showed similar hematologic toxicities between the two sequences of drug administration. The pharmacologic behavior of both TPT and PTX-24 was not altered by drug sequencing. Major antitumor responses occurred in 40% of patients with measurable and assessable disease, including 45% and 9% of patients with potentially cisplatin-sensitive and -resistant tumors, respectively. CONCLUSION: The recommended doses of TPT on a daily times-five schedule combined with PTX-24 in these patients were 0.75 mg/m2/d and 135 mg/m2, respectively, with G-CSF support. Although this dose of PTX has significant single-agent activity in ovarian cancer, the dose of TPT is much lower than the TPT dose at which single-agent activity has been observed. Due to the inability to administer near relevant single-agent doses of both drugs in combination, as well as the requirement for G-CSF support, further evaluations of this regimen in women with refractory or recurrent ovarian cancer are necessary before it can be recommended for previously treated patients in this setting.

Development of a nursing research utilization program in a clinical oncology setting: organization, implementation, and evaluation.

PURPOSE/OBJECTIVES: To describe a research utilization program in the nursing department of a National Cancer Institute-designated comprehensive cancer center, including prerequisites for its development, its relationship to the department's nursing research program, the research utilization model used in the program, and evolution, evaluation, and future directions of the program. DATA SOURCES: Computerized literature searches; published articles, abstracts, and books; personal communications; departmental, committee, and task force meetings; nursing grand rounds; workshops; and inhouse surveys of nursing staff. DATA SYNTHESIS: Review and use of available information led to a comprehensive, multicomponent, departmental research utilization program that addressed issues raised in both the literature and in clinical practice. CONCLUSIONS: The nursing department was able to implement a research utilization program under the aegis of its research program that was consistent with the department's philosophy, goals, and organizational structure. Although many challenges and issues arose, ongoing evaluation measures indicate wide acceptance, successful implementation and direct influence on practice. IMPLICATIONS FOR NURSING PRACTICE: With strong administrative support, a departmental nursing research utilization program that enables participation of nursing staff and results in research-based practice and professional development can be implemented.

A survey of research-related activities and perceived barriers to research utilization among professional oncology nurses.

PURPOSE/OBJECTIVES: To identify nursing staff members' current research-related activities, knowledge of research utilization, and perceived barriers to using research in practice. DESIGN: Descriptive, cross-sectional survey design with self-report questionnaires. SETTING: National Cancer Institute-designated comprehensive cancer center located in a mid-Atlantic metropolitan area. SAMPLE: Convenience sample of 82 registered nurses employed in the cancer center who completed and returned the questionnaire; the majority had baccalaureate degrees or higher, were an average of 33 years old, were nurses for a mean of 8.8 years, and worked at the center a mean of 5.6 years. METHODS: Four-part, 38-item, self-report questionnaires were distributed to nursing staff and a leadership group by members of the departmental Nursing Research Committee; respondents returned completed questionnaires to designated locations in the center. MAIN OUTCOME MEASURES: Knowledge and attitudes about research utilization, perceived barriers to using research in practice, and current research-related activities. FINDINGS: Most respondents were familiar with the concept of research utilization and found research to be of value to their practice. They cited a number of barriers to using research findings and reported little participation in research-related activities. Advanced clinical practitioners with master's degrees tended to participate more frequently in research-related activities. CONCLUSIONS: Although nurses appeared to be aware of research utilization and value it, they perceived barriers to using research findings in practice and did not routinely participate in research-related activities. The findings support other research in this area and reveal educational needs. IMPLICATIONS FOR NURSING PRACTICE: The findings provided baseline information for a departmental research utilization program and suggested strategies and activities that could be incorporated into the program.

Ovarian cancer.

Prevention, early detection, morbidity, and survival issues continue to challenge health professionals involved in the care of women with ovarian cancer. While advances in diagnosis, staging, and treatment have been made, survival rates remain grim. Continuing research in the areas of screening, diagnosis, and treatment is the key to improved survival. The hope of new drug therapy, such as cisplatin-taxol regimens, intraperitoneal therapy, immunotherapy, and bone marrow transplantation, needs further investigation to become reality. As new and potentially more toxic regimens are developed, the nurse must be knowledgeable about the therapies and adverse effects, and maintain a high level of clinical expertise in order to teach the patient, reinforce information, clarify misconceptions, and provide the patient with supportive physical and emotional care.

Stillbirth: maternal and fetal evaluation.

Stillbirth occurs in approximately 1% of all pregnancies and, therefore, unfortunately, is an experience that most physicians caring for pregnant women will face in their professional careers. Because stillbirth is such an unpleasant and traumatic experience, a detailed evaluation is often deferred. The most common cause of stillbirth is believed to be chronic fetal hypoxia or asphyxia. However, this may not always be obvious initially. Therefore, the physician must be prepared to provide a complete evaluation. A protocol is provided to aid in that task. Obviously, not all the tests and studies described need to be performed in every case; a tailored evaluation, if possible, is always preferable.