Autologous stem cell transplant: an overview.

Autologous stem cell transplantation increasingly is used as a treatment modality for selected hematologic and solid tumors. Autologous stem cell transplant comprises either autologous bone marrow transplant (ABMT) or peripheral blood stem cell transplant (PBSCT). ABMT and PBSCT enable patients to receive potentially lethal doses of chemotherapy or radiation therapy and rescue them with a viable source of new blood cells. Supportive measures, including blood product, growth factor, and antibiotic administration, and the expanded clinical expertise of ambulatory and home care nurses have allowed an increasing portion of this process to be performed outside of an acute care setting. The shift of care to an ambulatory or home setting will become the standard, rather than the exception, in the near future. A brief review of major implications for nurses is delineated.

Quality of family life: exploration of a concept.

Research on the family's response to illness has not been characterized by deliberate attention to quality of family life issues. Most work in the field has been directed toward conceptualizing and measuring coping behaviors and impact. Conclusions regarding quality of family life must be inferred from measures not explicitly designed to measure this concept. The quality of family life is as elusive a concept as is quality of life for the individual. Theoretical and methodological approaches must be developed and tested. Oncology nurses have the potential to influence the quality of family life within the cancer experience.

Ethical issues in clinical research.

A variety of ethical issues can arise from clinical trials. Personal biases of the health care professional, socioeconomic constraints of the patient, and lack of collaboration and communication between the nurse and the research team create ethical dilemmas. In resolving these dilemmas, it is the responsibility of the oncology nurse to ensure that the principles of autonomy, beneficence, and justice are preserved.

Informed consent: an overview.

Informed consent is a process, not an isolated incident. It therefore requires that health care professionals approach the process with expert knowledge, open communication, and a willingness to participate in shared decision-making. Table 2 identifies the major ethical and legal issues of informed consent. Legal precedents and professional collaboration will be necessary to further define and refine informed consent. The complexity of treatment regimens, potential system toxicities, and the chronicity of the disease process have fostered the development of a multidisciplinary team approach to the care of oncology patients. Therefore, collaboration is essential to meet the demands of the informed consent process and provide an optimal environment for the oncology nurse to intervene actively as a patient advocate.

A phase I clinical trial of recombinant interleukin-2 by periodic 24-hour intravenous infusions.

Recombinant interleukin-2 (rIL-2) (NSC# 600664; Hoffmann-La Roche, Inc., Nutley, NJ) was studied in a phase I clinical trial in 33 patients with advanced, measureable cancer of the colon or malignant melanoma, Eastern Cooperative Oncology Group (ECOG) performance status O-1, and no prior chemotherapy or radiotherapy. The goal of the study was to identify a dose and schedule of IL-2 to generate maximal immune modulation with tolerable toxicity. Such a regimen might allow the addition of other treatment modalities and/or prolonged treatment duration in later trials. Each patient received IL-2 as a continuous 24-hour infusion once weekly for 4 weeks and then twice weekly for 4 weeks. Five treatment groups received from 10(3) U/m2 to 3 x 10(7) U/m2 per 24-hour infusion. The maximal tolerated dose was 3 x 10(7) U/m2/d twice weekly. Patients treated twice weekly at 1 x 10(7) and 3 x 10(7) U/m2/d had immune modulation in terms of lymphocytosis, eosinophilia, increased natural killer (NK) activity, and elevated numbers of peripheral blood mononuclear cells expressing CD16, OKT10/Leu-17, and Leu-19 surface markers. Endogenous generation of peripheral blood lymphokine-activated killer (LAK) activity was demonstrated by lysis of NK-resistant Daudi targets, in patients treated at 3 x 10(7) U/m2/d. Biochemical and hematological abnormalities were moderate and reversible. Clinical toxicity included hypotension, myalgia, arthralgia, stomatitis, fever, fatigue, nausea, headache, chills, diarrhea, and oliguria at high doses. Cardiovascular toxicity was tolerable for most patients and reversed after IL-2 was stopped. Two of six melanoma patients at 3 x 10(7) U/m2/d achieved partial responses by the end of the eighth week. This IL-2 schedule appears to produce potentially clinically useful immune enhancement with tolerable toxicity.