Response to "Treatment-Induced Ovarian Insufficiency and Early Menopause in Breast Cancer Survivors".

We thank Esch and Schadewald (2023) for their excellent article, "Treatment-Induced Ovarian Insufficiency and Early Menopause in Breast Cancer Survivors," which described the many symptoms that can occur subsequent to tre.

Sexual Dysfunction: Common Side Effect.

For sexual dysfunction, standards of care are based on emerging evidence-based practice. Sexuality is an integral part of quality of life that can be radically altered by the adverse effects of cancer therapies. Following treatment, sexual dysfunction can arise from physical and psychological changes in body image and self-concept, altered sense of attractiveness, physical discomfort, and emotional distress, diminishing overall quality of life. Therefore, identification and management of sexual dysfunction are vital components of survivorship care.

Hot Flashes: Clinical Summary of the ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer.

Cancer-related hot flashes are often a lasting and distressing side effect of hormone-blocking therapies that are most often experienced by women with breast cancer and men with prostate cancer treated with these therapies. Hot flashes have been defined as a sensation of heat that may be accompanied by facial flushing, perspiration, chills, heart palpitations, night sweats, and feelings of anxiety. The frequency and intensity of hot flashes can cause fatigue and sleep disturbances that diminish quality of life and reduce adherence with prescribed therapies that block estrogens or androgens. Hot flashes are reported to be significantly more frequent and severe in women treated for breast cancer than in women undergoing natural menopause. They also commonly occur in men treated for prostate cancer with surgical or chemical castration to block the synthesis of androgens that can fuel cancer growth.

ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer.

PURPOSE: Hot flashes are a common and troublesome side effect of surgery or endocrine therapy. They may lead to physical and psychological distress and negatively affect quality of life. This clinical practice guideline presents evidence-based recommendations for pharmacologic, behavioral, and natural health product interventions for treatment-related hot flashes in patients with breast or prostate cancer. METHODOLOGIC APPROACH: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of hot flashes. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the evidence and make recommendations. FINDINGS: The panel agreed on 14 pharmacologic, behavioral, and natural health recommendations. IMPLICATIONS FOR NURSING: Conditional recommendations include the use of antidepressants rather than no treatment, physical activity rather than no treatment, and the avoidance of gabapentin and dietary supplements in the treatment of hot flashes. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/ons-guidelines-hot-flashes-supplementary-material.

Hot flash management: update of the evidence for patients with cancer

Hot flashes are a distressing symptom frequently experienced by survivors of breast cancer or prostate cancer who are receiving estrogen or androgen-deprivation therapies. The frequency and intensity of hot flashes can lead to diminished quality of life and decreased adherence with prescribed antineoplastic therapies. This evidence-based review synthesizes and updates the findings of the highest quality evidence-based studies of interventions to manage hot flashes resulting from cancer therapies in patients with breast or prostate cancer since the initial Putting Evidence Into Practice review of hot flashes in 2011. Recent studies involving a variety of pharmacologic and nonpharmacologic interventions were evaluated and, as reported in 2011, the drugs gabapentin and venlafaxine were the only therapies rated as likely to be effective. In addition, a strong placebo effect was noted in several studies that included a placebo intervention and should be considered when reviewing interventions for hot flashes.

Tamoxifen benefits and CYP2D6 testing in women with hormone receptor-positive breast cancer.

Cancer intervention strategies have been increasingly focused on developing therapies that are personalized and tailored to each individual's unique genetic profile. Evolving understanding of the metabolism and pharmacogenomics of tamoxifen, an early example of targeted therapy for women with hormone receptor-positive breast cancer, has created decision-making challenges for healthcare providers and their patients. This article reviews the pharmacology of tamoxifen, the genetics and physiology of the CYP2D6 enzyme system that has important effects on tamoxifen metabolism, and subset data analyses from large controlled, clinical trials that cast new light on previously held beliefs about the utility of CYP2D6 genotyping for predicting tamoxifen effectiveness and improved breast cancer outcomes in women with early-stage, hormone receptor-positive breast cancer.

Putting evidence into practice: evidence-based interventions for hot flashes resulting from cancer therapies.

Survival rates for people treated for breast or prostate cancer have increased steadily since 2000, which has been attributed to advances in early detection and improvements in treatments. However, breast and prostate cancer therapies that target estrogen and testosterone production are associated with hormone-deprivation symptoms--most commonly hot flashes--that may have a significant negative impact on quality of life. Compared to the healthy population, hot flashes occur most often in these two groups, so the authors conducted a literature search specifically for evidence-based interventions to manage hot flashes experienced by women treated for breast cancer and men treated for prostate cancer. The interventions reviewed were divided into two broad categories--pharmacologic and nonpharmacologic interventions--and categorized according to Oncology Nursing Society weights of evidence. Most of the interventions were rated effectiveness not established or lower; however, two drugs, venlafaxine and gabapentin, were rated likely to be effective. In addition, the placebo effect was noted to produce a high percentage of positive results in mitigating hot flashes.

The sexuality discussion: tools for the oncology nurse.

Receiving a cancer diagnosis and experiencing the effects of antineoplastic therapies can have a devastating effect on a person's emotional, physical, and psychological well-being and a significant negative effect on sexual desire and function. Oncology nurses are the ideal healthcare professionals to assess the sexual health status of their patients and to intervene to sensitively address sexuality issues. Having this discussion can be uncomfortable for both nurses and patients, but using communication tools can help nurses gain confidence in their abilities to address sexuality concerns in an effective and comfortable manner and to provide patients with useful information and insights.

SPIKES: a framework for breaking bad news to patients with cancer.

SPIKES is an acronym for presenting distressing information in an organized manner to patients and families. The SPIKES protocol provides a step-wise framework for difficult discussions such as when cancer recurs or when palliative or hospice care is indicated. Each letter represents a phase in the six-step sequence. S stands for setting, P for perception, I for invitation or information, K for knowledge, E for empathy, and S for summarize or strategize. Breaking bad news is a complex communication task, but following the SPIKES protocol can help ease the distress felt by the patient who is receiving the news and the healthcare professional who is breaking the news. Key components of the SPIKES strategy include demonstrating empathy, acknowledging and validating the patient's feelings, exploring the patient's understanding and acceptance of the bad news, and providing information about possible interventions. Having a plan of action provides structure for this difficult discussion and helps support all involved.

You are special: recognizing the gifts you bring to oncology nursing.

To raise awareness about the need to recognize and celebrate the unique gifts and qualities nurses bring to oncology, the Oncology Nursing Society (ONS) Nominating Committee thought that discussing the many contributions of oncology nurses would be enlightening and empowering. This article originally was offered by the authors as a presentation at the ONS 29th Annual Congress in May 2004.