Managing adverse events associated with sorafenib in renal cell carcinoma.

Sorafenib, a multi-targeted kinase inhibitor, is approved in Europe for the treatment of patients with advanced renal cell carcinoma whose treatment with an interferon or interleukin-2-based therapy has previously failed, or who are unsuitable for such therapy. Unlike some first-generation anti-cancer therapies, sorafenib is generally associated with moderate and manageable adverse events. Some of the most common adverse events include a hand-foot skin reaction, diarrhoea and rash. As nurses provide an interface between the patient and the clinical team, it is important that they understand how sorafenib-related adverse events impact on patients. It is equally vital that nurses are able to recognize and manage these adverse events. Our experience has shown that with patient education, early reporting, monitoring and treatment, the adverse events of sorafenib therapy can be easily and effectively managed. Optimal adverse event management helps ensure treatment compliance and ensures that patients receive maximum benefit from therapy.

Intervening with alopecia: exploring an entrepreneurial role for oncology nurses.

This article discusses the development of an innovative role for oncology nurses in assisting patients with their personal information and image needs that arise from alopecia secondary to the treatment of cancer. An independent oncology nursing consultative service was initiated after a survey of patients was conducted (N = 40) to assess alopecia knowledge, needs, and referral source. Nurses (N = 16) attending a local Oncology Nursing Society (ONS) chapter meeting were surveyed to assess their intervention patterns and knowledge of hair and scalp care during hair loss. To respond to needs identified through the surveys, the consultative service developed a patient education program and booklet, as well as professional education sessions. Management and evaluation of this practice continues to provide a learning experience.

The symptom experience of alopecia.

OBJECTIVES: To examine the physiology and pathophysiology of loss of hair, the impact of alopecia on the patient, nursing and self-care interventions, and available resources. DATA SOURCES: Published articles pertaining to alopecia and personal experiences of coping with alopecia. CONCLUSIONS: Hair loss often is the most traumatic side effect for cancer patients. It causes depression, loss of self-confidence, and humiliation in men and women of all ages. Too few studies exist to make a definitive recommendation for scalp hypothermia and the use of scalp tourniquets. The major controversy and issue to consider with these hair-preservation techniques is scalp metastases. Further studies are needed to identify the impact of alopecia on patient self-image and quality of life. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions should be directed toward helping the patient and family adapt to and cope with alopecia. Patient education, identification of available resources, and supportive listening are therapeutic interventions.

Hair loss in children and adolescents.

No other body system is more exposed to the public eye than the skin and the hair. Pediatric nurse practitioners (PNPs) frequently encounter patients in their practice settings with the complaint of "hair loss." The most often diagnosed causes of hair loss include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. This article defines these conditions, explores the causes for them, and describes the incidences. Emphasis is placed on the PNP's role on making a differential diagnosis based on the presenting clinical manifestations, patient history, and laboratory testing. Treatment for these conditions as well as nursing goals and PNP interventions for management and family education also are discussed.

Hair-raising. The latest news on male-pattern baldness.

The initiating event in balding seems to be an abnormal sensitivity to the male sex hormones. In addition, a multifactorial model is emerging in which hormones affect the hair follicle in a way that causes it to be perceived as a foreign body by the immune system, which then mounts an attack. Several new classes of agents have the potential to treat hair loss. More than 40 U.S. and several hundred foreign patents have been issued for hair-loss treatment agents. As is common in dermatology, no single agent works universally against hair loss, so the treatment process is often one of trial and error.

Capecitabine-based combination therapy for breast cancer: implications for nurses.

PURPOSE/OBJECTIVES: To review available data and implications for nurses of combination regimens containing capecitabine for metastatic breast cancer. DATA SOURCES: Peer-reviewed publications or abstracts from major oncology conferences and reviews of capecitabine focusing on nursing implications. DATA SYNTHESIS: Capecitabine has proven efficacy in combination with docetaxel and is under evaluation in the neoadjuvant, adjuvant, and metastatic settings in combination with several oral and IV chemotherapeutic and biologic agents. CONCLUSIONS: Capecitabine-containing regimens demonstrate high activity in a range of settings but typically have more complex safety profiles, dose-modification schemes, and scheduling requirements than monotherapy. IMPLICATIONS FOR NURSING: Patients need to be aware of a wider range of likely side effects and should understand that they have been prescribed combination therapy rather than more simple, single-agent treatments because of its potential to improve outcome.