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DallasNews
Dallas Chapter of the
Oncology Nursing
Society
Virtual Volume 2, Issue 3
March 2008

The New Year started out with a big celebration and over 104 members
attended the Dallas Chapter ONS 25th year anniversary dinner. Big thanks to
member Linda Vozzella and her committee for coordinating the annual Dallas
Chapter dinner. The evening was filled with enthusiasm and reminiscing about
the past, present, and future of oncology nursing. The dinner began with
musical CD of past chapter events, and members. It was delightful to review
the clothes and hair styles and age progression for long-time members! For
Dallas Chapter ONS member Ann Collins-Hattery, RN, MS, AOCN, ARNP
presented “What We’ve Done Right!”
Ann identified how far we have come through determination, collaboration,
education and passion for the practice of oncology nursing and the families
and patients we care for. What a talented, compassionate and funny group we
are! My big “AH Hah moment” while listening to Ann’s talk and all the
comments around the room is that it seems like it is not so much the big
things we do: Evidence base practice, care plans, collaboration with peers,
rather it’s the little things. A touch on someone’s shoulder, stopping and
talking even just briefly with patients or simply a word of encouragement to a
colleague that makes the biggest difference! Ann challenged members to
continue doing the things we do right making all the difference in the field of
oncology.
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Inside this issue:
President’s Corner
1-2
National News
3
Member Feature
4
Scholarship Info
5
GINA Update
5
Book Feature
6
ONS Foundation
Recipient
6
Genes & Things
7-8
Click on scrapbook for more pictures of
the anniversary dinner
The Dallas Chapter elections are in and the 2008 board is established!
We welcome all the new and returning board members:
Margaret Rhoads is the new elected Vice-President, Brenda Casey is the new
membership chair, Bijue Chang is the new Nominating Chair, and Ben Garcia is the
new Secretary.
We also welcome returning board members: Nancy Thompson President, Joni
Mokry, Treasurer, Myra Johnson, Director at Large, Linda Cole, Program Chair, Tara
Fedric, Director at Large, Rebecca Goodman, Foundation/Scholarship Chair, Pat
Wilson, Assistant Foundation/Scholarship, Marilyn Early, Government Liaison,
Michelle Gray, Assistant Newsletter Editor, and Millie Arnold, Newsletter Editor and
Chapter Virtual Community.

 The Philadelphia theme is “Declare Yourself”!
All Dallas Chapter members are encouraged to notify me if you’re attending so we can
schedule a Dallas Chapter evening for networking and dinner! Please RSVP to either my
telephone number 972-446-1028 or email [email protected]
Active membership in a professional organization involves networking! Join us for a fun
evening and with your local ONS chapter!
Nancy
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National ONS News


Connect with 6,200 of your colleagues at the ONS 33rd Annual Congress, May 15-18 in
Philadelphia. Sessions are offered in various tracks and practice levels, offering something for
everyone. Worth up to 20 contact hours, you’re sure to gain valuable knowledge that will enhance
your nursing practice and improve patient care. Plus if you register by April 3, you can save
$100 through an early-bird discount. http://www.ons.org/Meetings/congress08/register.shtml


Applications are now being accepted for the ONS Leadership Development Institute being held
October 23-26 in Atlanta, Georgia. LDI will teach you how to take an active role as a leader in
your job and in your field. You’ll enhance your leadership skills so that you can help ensure that
oncology nurses remain a driving force in cancer care. Applications are due June 3.
http://www.ons.org/Meetings/ldi08/index.shtml


Recognize all that you do during Oncology Nursing Month. Set aside some time in May to
celebrate you and your colleagues for your dedication and commitment to your patients and your
profession. You deserve it! http://www.ons.org/nursingmonth08/


Timely oncology-related news and information about ONS is just a click away with the new
online ONS Connect. This enhanced, user-friendly version of the popular ONS news magazine
makes keeping up with the latest in oncology nursing easier than ever.
http://www.nxtbook.com/nxtbooks/ons/connect_200803/


Cancer care encompasses many subspecialties. ONS special interest groups put you in touch with
other members practicing in the same area as you so you can share ideas and knowledge with
each other. All members can join one SIG for free. http://sig.vc.ons.org/


Blood and marrow transplantation (BMT) is a complex, potentially life-saving therapy used to
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treat malignancies, including leukemia, aplastic anemia, multiple myeloma, immune deficiency
disorders and lymphomas such as Hodgkin disease. It is important to know where to find
information on the treatment. ONS offers a variety of resources on BMT, including:
ONS BMT Clinical Resource Area http://www.ons.org/clinical/treatment/transplantation.shtml
ONS BMT Patient Resource Area http://www.ons.org/patientEd/Treatment/blood.shtml
The ONS BMT Resource Directory http://www.ons.org/clinical/treatment/directory.shtml
_______________________________________________________________________
Who would you like
to feature in the
Membership Feature
next Membership
Feature?
Contact Millie Arnold, editor at
[email protected]
Or
Michelle Gray, co-editor at
[email protected]
BiJue Chang, RN, MSN, CCRC, OCN sometimes called “BJ” was born in
Taiwan and arrived in the United States in 1980 to study at Texas Woman’s
University (TWU). She met her husband, David a program engineer, in
Dallas and has been married since 1983. BiJue has three daughters who
range from ages 22, 19, and 16. Her eldest daughter, Jessica, is a senior
majoring in biochemistry at the University of Texas in Austin, TX. Jessica
has been accepted for a 5-year graduate scholarship program in
Biochemistry at Harvard University. Her middle daughter, Christina, is a
freshman business major at UT Austin. BiJue’s youngest daughter,
Tiffany, loves to play the violin is a high school 10th grader.
BiJue chose nursing when her mother had surgery and graduated with
nursing diploma from Taipei in 1977. Three years later she took a 24 hour
flight to Dallas, Texas where she has remained as a transplanted Texan!
BiJue earned her BS in 1983 and her MSN in 1989 from TWU. She worked
in the general medicine unit at Parkland for 6 years and in the marrow
transplant unit at Baylor University Medical Center for 16 years. BiJue
presently works at Baylor Plano as a supervisor in the oncology unit.
BiJue has been a nurse for over 31 years and continues to love teaching and
caring for patients and families in the field of oncology! Oh yes, she has
also graciously accepted the position of Nominating Chair for the Dallas
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Chapter ONS.
One of BiJue’s patients describes her oncology nursing practice best in his
book Memoirs of a Winner that’s featured in this month’s newsletter. He
said, “BiJue, a native of Taiwan, a naturalized US citizen, with a Master’s
in Nursing from TWU, proved to be the person most caring, humble,
considerate and truly interested in each patient’s life of any healthcare
worker I ever met…”
_____________________________________________________________________________________________


The Dallas Chapter ONS board is re-examining the application
process for free scholarships for members. New application
information will be forthcoming! Until then the application instructions
remain the same as follows:
 Open your chapter’s virtual website
 Click on “News”
 Click on “Scholarship”
________________________________________________________



On Wednesday, March 5th the US House of Representatives passed Genetic Information Nondiscrimination Act (GINA) as part of the Paul Wellstone Mental Health and Addiction Equity
Act of 2007 introduced by Representative Patrick Kennedy (D-RI), requiring health
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insurance companies to offer benefits for mental health and substance-related disorders
under group health plans. President George W. Bush has previously stated his intention to
sign a genetic protection bill into law if it hit his desk, now announced certain oppositions
to both GINA and the Kennedy Bill in a policy statement. GINA is designed to prohibit
health insurance companies and employers from discriminately using genetic information
against consumers and employees. If passed GINA would prohibit group health plans and
health insurers from denying coverage or raising premiums for health individuals based on
a genetic predisposition for developing a disease in the future. Oncology nurses are
wonderful patient advocates. Dallas ONS members are encouraged to volunteer with your
local Government Liaison, Marilyn Early, at [email protected] and join
ONStat to become informed about patient related legislative topics. Submitted by Millie
Source: GenomeWeb Daily News @ www.genomeweb.com

Gary Ward Scott has is a journalist with over
50 years of varied experience in newspapers,
public information and technical publications.
Mr. Scott’s book Memoirs of a Winner offers
reflections of his cancer journey with a
diagnosis of metastatic melanoma and
participation in a Melanoma Vaccine Trial. He
graciously acknowledged not only his
surgeon, medical oncologist, but also his
clinical trial nurse, BiJue Chang. In his own
words, “I’ll always be grateful to her for the
confidence she gave me.” Mr. Scott’s book is
available on his new website,
http://www.memoirsofawinner.com
Mr. Scott provided verbal approval to feature
his book for the DallasChapter ONS
newsletter. Submitted by Millie Arnold






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As most Oncology nurses I am passionate and compassionate about my career
choice and have been for almost 25 years; so when our local chapter President
recommended I apply for an ONS Foundation award it felt right. The application
was a matter of following directions, completing a form, and writing a 350 word
assay about how I demonstrate
“innovation in responding to
challenges in every day
practice, and made a
difference for the
patient/family, institution
and/or fellow healthcare
professional”.
Sounds simple, right?
Well, it is simple because
this is what all of us do on a
daily basis! It is a matter of
completing the paperwork
and waiting for a response.
A congratulatory email
was received last week and
I received the award of $1,000
to help defray expenses for
rd
attending the 33
ONS Congress! I share this
experience to encourage others to apply for ONS Foundation awards! This is
why the national ONS Foundation was established to support Oncology nurses
for education and research endeavors. If I can do it; anyone can! Go for it!
Millie



  Adapted
with permission Linda Robinson, Genetic Counselor, UTSW & Millie 
According to the 2008 American Cancer Society’s (ACS) Facts and Figures colorectal
cancer (CRC) is the third most common cancer diagnosed in men and women and the
second leading cause of cancer related death in the United States. In 2008 it is
estimated that 48,810 men and women will be diagnosed with CRC and 49,960 will die
from this form of cancer. Since March is colorectal cancer awareness month this
edition of Genes and Things will focus on prevention and detection of CRC. ACS
recommends average risk individuals 50years and older should complete screening
tests to find polyps and cancer: flexible sigmoidoscopy every 5 years, colonoscopy
every 10 years, double contrast barium enema every 5 years or CT colonography
(virtual colonoscopy) every 5 years. ACS recommends an annual fecal occult blood test
(FOBT), fecal immunochemical test (FIT). ACS also recommends a stool DNA test
(sDNA) but no specific interval is recommended.
Screening recommendations are more frequent for individuals at increased or high risk.
High risk is identified as individuals with a history of colon polyps, a family or personal
history of colorectal cancer, a diagnosis of inflammatory bowel diseases (Ulcerative
colitis or Chron’s disease). High risk families include familial adenomatous polyposis
(FAP), or a diagnosis of hereditary non-polyposis colon cancer (also called Lynch
Syndrome). Most insurance companies including Medicare will cover part or all
screening tests depending on an individual’s risks factors. The following information
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is an excerpt from Linda Robinson’s publication focusing on Lynch Syndrome.
Hereditary non-polyposis colorectal cancer also called Lynch Syndrome
Lynch Syndrome (LS) is a genetic disorder that increases the risk of developing multiple
cancers. The lifetime risk for developing any form of cancer is about 90% for men, and
70% for women. Not every organ in the body is at increased risk for cancer. For
example, there is no increased risk for cancers of the lung, breast or prostate in this
disorder. (These cancers may occur, however, just as they do in the general
population.) The primary two organs at risk are the colon (and rectum), and the uterus.
There are other organs at risk, but not as severely as for these two sites.
The lifetime risk for developing colon cancer with a confirmed germline mutation for LS
is approximately 60% overall. It has been estimated that men have a 70% lifetime risk
for colorectal cancer, and women have a 40-50% lifetime risk. Initially it was thought
that the average age to develop a colorectal cancer for this population was in the mid40’s, but as larger registries have been analyzed, it is now apparent that the average
age is more likely in the mid-50s. The lifetime risk for developing a second primary
cancer is 30% within 10 years and 50% within 15 years, but this was based upon the
prior practice of only removing the segment of colon that contained the cancer.
Screening Recommendations: Screening recommendations for LS is a colonoscopy
every 1-2 years starting at age 25, or 10 years earlier than the youngest diagnosis in the
family. Colonoscopy is considered the standard of care because LS is associated with
tumors in the proximal colon. Approximately two thirds of the cancers occur above the
reach of the sigmoidoscope. Regular colonoscopy in LS mutation carriers has been
shown to significantly reduce the incidence of colon cancer.
Colon Surgery Recommendations: A subtotal colectomy with ileorectal anastomosis is
recommended in individuals with a colon cancer because of the high risk of
metachronous cancers. Prophylactic colectomy is generally not recommended for
individuals with LS who are at risk for colon cancer, because routine colonoscopy is an
effective preventive measure. However, if a person were unable to comply with regular
colonoscopy, preventive surgery would be a reasonable alternative.
Chemoprevention: At present there is no effective chemoprevention for LS. Research
with familial adenomatous polyposis (FAP) has shown the use of nonsteroidal antiinflammatory drugs (NSAIDs) reduce the number of adenomas and may lower the risk of
colon cancer. To date similar studies in individuals with LS have failed to show a similar
benefit.
Diet and Life Style: ACS recommends eating fruits, vegetables, whole grain foods,
limiting intake of high-fat foods, and at least 30 minutes of physical activity on 5 or more
days of the week. According to ACS managing these risk factors, can lower the risk of
developing colorectal cancer. Some studies also suggest that taking a daily
8
multivitamin containing folic acid or taking calcium and vitamin D can lower colorectal
cancer risk.
The lifetime risk of developing uterine cancer for LS mutation carriers is approximately
40-50% (and 60% in patients with mutations the MSH6 gene), and the risk for ovarian
cancer is approximately 10-12%. With proper management cancer in both organs can
be prevented.
Screening Recommendations: Once child-bearing is complete surgical management is
a reasonable option for LS mutation carriers since early detection screening strategies
of endometrial and ovarian cancer have not proven effective; however, for women who
have not finished childbearing the following screening program is recommended:
Screening
Age
Interval
Uterine biopsy
30 years
Annually
CA-125 tumor marker
30 years
Annually
Transvaginal ultrasound
30 years
Annually
The above screening recommendations are in addition to an annual Pap smear and
pelvic exam, neither of which is sensitive for early endometrial cancer
Uterine and Ovarian Surgery Recommendations: A total abdominal hysterectomy and
bilateral salpingo-oophorectomy (TAH-BSO) should be considered once childbearing is
complete. It has been demonstrated that this surgery will remove the risk for cancers of
these organs (which is not necessarily the case for other disorders, such as hereditary
breast/ovarian cancer). It is recommended that Lynch Syndrome mutation carriers
undergoing prophylactive TAH-BSO have a pre-operative uterine biopsy, and the uterus
is examined intra-operatively by a pathologist for unsuspected disease.
Chemoprevention: At present there are no current guidelines for chemoprevention of
LS; however, in the general population, oral contraceptive use has been associated
with decreasing the risk of uterine cancer by 50% and substantially decreasing the risk
of ovarian cancer.
Other Cancer Risks: Although the colon and uterus are the organs at greatest risk of
developing cancer in LS mutation carriers, other organs are also at increased risk for
developing cancer. If one family member is affect with a deleterious mutation for LS the
following screening interventions are recommended for extracolonic cancers. Some
experts recommend these interventions regardless of a documented LS germline
deleterious mutation in a family.
Cancer Site
Cancer Risk
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Intervention
Stomach
10%
Urinary Tract
4-5%
Other*
2-7%
Upper endoscopy (every 1-2 years)
starting at age 35 years
Annual Urine Cytology
No specific screening guidelines
currently exist
*Other cancer risks include hepatobiliary tract, brain, and small intestine
Sebaceous adenomas are associated with a variant of LS known as Muir-Torre
Syndrome. A dermatological exam is recommended every 6 months to a year since
multiple tumors develop.
LS is transmitted by dominant inheritance. First degree relatives (parents, siblings, and
children) are at 50% risk of carrying the familial mutation. Second degree relatives
(grandparents, aunts/uncles, grandchildren) are at 25% risk for carrying the same
familial mutation. All family members are encouraged to seek genetic counseling and
genetic testing to clarify risks.
Information related to the patient’s family members or other third parties may be
maintained in a separate file and excluded from a general release of information. See
GINA article to review legislation by the federal government to ban discrimination for
employment or health insurance for patients with Lynch Syndrome and other inherited
diseases.
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