Download newsletter Greater Kalamazoo Area Chapter September, 2002

newsletter
Greater Kalamazoo Area Chapter
President's Message
Ann Temple, Membership Chair

Dear Members:
Well my year as your President has begun, WOW, a little
overwhelming. This organization is for you the members
so if there is anything I can do to get you involved or to
pass along new ideas please contact me.
For all of you a little background on me. I received my
nursing degree from U of M so of course, my blood flows
blue and gold. I worked at Battle Creek Health Systems
for 4 years as a nurse on the floor on the
Medical/Surgical/Oncology floor. I was then enticed to
come over to the West Michigan Cancer Center and work
in the Research Department. I have now been in this
Department about 7 years. Time really flies. My life is
balanced out by my two children Zachary-3 yrs and
MacKenzie-9 months.
I have been a Board Member of this organization as your
Membership Chairperson and then as your President
Elect. As your President I would like to see this
organization become more useful to each of you. Our
chapter has placed itself on the Virtual Community on the
ONS website to hopefully get information to you in a more
timely fashion. Obtaining all of your e-mail addresses will
help get information to you faster and save on the cost of
stamps.
Doreen Scholly, President

Membership corner
#1 Membership -- This is a reminder that your local
chapter dues are due in September. They remain at $15.
You will need to again fill out an updated information
form. The check should be made out to Greater
Kalamazoo Area ONS. If you are currently a member you
will receive one in the mail. If you are not a member,
application forms will be available at the September 26th
meeting. If you would like an application before the
meeting, please contact me at the West Michigan Cancer
Center, (269) 373-7444.
#2 Scholarships -- The Greater Kalamazoo Area ONS will
be offering scholarships this year for local and national
memberships. If you are interested, please submit a short
letter describing your job and request for a scholarship.
These may be submitted to Ann Temple, West Michigan
Cancer Center, 200 N. Park St., Kalamazoo MI 49007.
Greater Kalamazoo Area ONS
Fall Kickoff Meeting
You're Invited ....
To a National Audiovisual Web Conference
Thursday, September 26, 2002
Dinner at 6 PM; Program From 7-8 PM
Kalamazoo Center for Medical Studies (KCMS)
1000 Oakland Drive, Kalamazoo
"Hormonal Therapy for Breast Cancer"
Featuring Dr. Deborah Armstrong
Assistant Professor, Medical Oncology
Johns Hopkins University School of Medicine
and Lillie D. Shockney, RN, BS, MAS
Director, Education & Outreach, Johns Hopkins Breast
Center
RSVP by September 20 to Nancy White at (269) 373-7433
(A positive RSVP confirms your attendance
except for emergencies)
This one hour program offers continuing education credits
through national ONS. Program supported by a grant
from AstraZeneca to the ONS Foundation Center for
Leadership, Information and Research (CLIR)
Members free; Non-members $10 B pay at the door
Greater Kalamazoo ONS into computer age
Please visit ONS online, choose virtual community. While
in virtual community, search for the Greater Kalamazoo
Area chapter page. Please see what needs to be added or
changed. In the near future my hope is to have the
newsletter posted here as well as any ground-breaking
news for all of you to review. If you have any suggestions,
please contact me at [email protected] or call me at 269373-7488.

September, 2002 -- Page 1
Instructions for entering Virtual Community
on ONS Online:
1.
2.
3.
4.
5.
6.
Go to www.ons.org on the Internet
In the left-hand column, choose AChapters
Virtual Community@
Under AVirtual Community@ choose AFind a
Chapter@
Click on the State of Michigan
Scroll down to Greater Kalamazoo, choose
AVirtual Chapter@
Educational features houses the newsletter section

Doreen Scholly
Colony Stimulating Factors, Beyond Neutrophil Recovery.
2.4 contact hours.
Total Anemia Care. 3.0 contact hours.
Discovering the Options: Hematopoietic Growth Factors
and the Oncology Patient. 1.7 contact hours.
Cancer Clinical Trials: The In-Depth Program. 2.4 contact
hours.
Joan Westendorp

Clinical trials are NOT more costly than
standard care
According to the 2000 Annual Meeting of the American
Society of Clinical Oncology (ASCO), there is evidence
that proves that caring for patients on clinical trials is no
more costly than providing standard care, although
insurance companies and other health care providers
would dispute this claim.
CEUs
Need to renew your OCN and need CEUs? See the ONS
web pages. They have some great online continuing
education opportunities. I have used a couple of them and
they are excellent. The online CEUs are usually sponsored
by pharmaceutical companies and are very nicely done.
Presently the following are online B check them out today!
Chemotherapy-Induced Nausea and Vomiting: The Past,
the Present and the Future. 2.0 contact hours.
Rethinking the Management of the ANew@ Elderly Patient
Interleukin-2: A Paradigm for Developing Nursing
Strategies for Patient Management. 2.2 contact hours.
Dendritic Cells: The Sentry Cells of the Immune System.
2.5 contact hours
Clinical Perspectives for Skeletal Complications of
Malignancy. 1.8 contact hours.
Current Therapies and Future Directions in the Treatment
of non-Hodgkin=s Lymphoma. 2.0 contact hours
The latest evidence, from two studies that analyzed
treatment costs at large cancer centers, backs up research
published earlier this year. The new studies also lend
credence to calls by patient advocates, cancer researchers
and others for insurance companies and Medicare to pay
for routine care costs for patients enrolled in clinical trials.
Studies have been conducted and future studies have
started to look at the costs of patients on clinical trials vs.
patients receiving standard care. Several studies have
proved that the costs are approximately the same and
several studies have proved that participating in a clinical
trial was less costly.
In 2000, Medicare began covering beneficiaries' patient
care costs in clinical trials. Many private insurance
companies have made formal agreements with the National
Cancer Institute (NCI) to provide their beneficiaries with
access to NCI-sponsored cancer clinical trials. During
President Clinton's term, legislation passed that made
clinical trials an option for patients and made many
insurance companies pay for that care. It is important to
know what an insurance company defines as care per a
clinical trial or experimental treatment. Therefore, it is
important to have the financial counselors at your health
care center verify with insurance companies what they will
and will not pay for.
Managing Chemotherapy-Induced Hematologic Toxicities:
Cycle After Cycle. 2.0 contact hours.
It is important also, whether or not you are looking to
standard treatment or a clinical trial, that as a patient you
are aware of the treatment you may receive and what is
involved in the follow up care necessary to make sure your
treatment is working well for you.
A Targeted Approach to Treating Acute Myelogenous
Leukemia: Bridging Treatment Options. 1.6 contact hours
If ever a claim with an insurance company is denied, please
contact the financial counselor as soon as possible. A good
Radioimmunotherapy: A New Option for Patients with
Low-Grade non-Hodgkin=s Lymphoma. 1.6 contact hours
September, 2002 -- Page 2
publication is "What Cancer Survivors Need to Know
About Health Insurance". This can be obtained from the
National Coalition of Cancer Survivors, 1010 Wayne Ave.,
5th Floor, Silver Spring MD 20910. Ph. (301) 650-8868.
Web address http://www.cansearch.org.
Medical advances
advanced NHL. These results demonstrate that further
therapy is both feasible and potentially effective following
Zevalin treatment in NHL. ASCO 2002 abs. #1064
Results of a retrospective study suggest that venous
thrombosis (VT) is a significant complication of
peripherally inserted central catheters (PICC) that until
now has been underestimated. Among 2,063 patients with
PICC lines over a 2-yr. period, 51 (2.47%) developed a
total of 52 episodes of upper extremity VT associated with
the catheter. Of these 52 episodes, 29 (55.8%) were deep
and 23 (44.2%) were superficial. Two patients had
pulmonary embolism (PE) in association with thrombosis.
VT patients were younger, more likely to have a history of
prior deep VT, be discharged to a skilled nursing facility,
and to have received amphotericin B therapy.
Symptomatic VTs, some of which are associated with
serious sequelae like PE, occur in a small percentage of
patients who receive outpatient parenteral antibiotics via
PICC lines. Asymptomatic VTs also occur and while most
are superficial, they may progress to deep VT. The authors
state that the incidence of PICC-related VT in their study
was disturbing enough to prompt them to initiate a
prospective trial. Preliminary results indicate that the
actual thrombosis rate is much higher. Clin Infect Dis
34:1179-1183, 2002. 
From ASCO, 2002
The long awaited results of the head to head comparison of
letrozole (L) 2.5 mg daily vs. anastrozole (A) 1 mg daily as
second-line treatment in postmenopausal women with
advanced breast cancer were presented at ASCO. Patients
had positive ER and/or PgR status (48%) with the
remainder being hormone status unknown. A significant
difference favoring L was seen in overall response rate
(19.1% vs. 12.3%, p=0.014, odds ratio 1.70), but the
primary end point of TTP (5.7 months for both L and A),
TTF (time to treatment failure), duration of response,
duration of clinical benefit, and overall survival showed no
significant differences. ASCO 2002 abs. #131
A retrospective analysis of 100 patients with HER-2
positive metastatic breast cancer shows that continued
Herceptin treatment after disease progression on an initial
Herceptin-containing regimen was well tolerated alone and
in combination with a wide variety of chemotherapeutic
and hormonal agents. Response rates to the first and
second Herceptin regimens were 36% and 30%,
respectively; TTP from the 1st Herceptin dose was 24 wks
and from the initiation of the 2nd regimen was 16 wks.
ASCO 2002 abs. #207
99 patients treated for NHL with 90-Y ibritumomab
tiuxetan (Zevalin) who later developed progressive disease
were treated subsequently with a variety of regimens
(single alkylating agents, CHOP, ESHAP, DHAP, and high
dose therapy with stem cell transplant) achieving response
rates comparable to those obtained with salvage therapy in

These 2 abstracts present results of trials using oral
capecitabine (Xeloda) with intravenous agents as first line
therapy for metastatic colorectal cancer. Xeloda plus
oxaliplatin in 96 patients with objective response rates
55%, median TTP 7.4 months, 1 yr. survival 67%, and
safety profile similar to OX plus infusional 5FU/LV (#531).
Xeloda plus irinotecan (Camptosar) in 33 patients
produced an overall response rate of 48% (#643). ASCO
2002 abs. #531 and #643
A phase II trial of wkly paclitaxel plus carboplatin as first
line therapy in advanced ovarian cancer (80 patients; 76%
stage III, 21.5% IV) suggests that this new therapeutic
approach is well tolerated and efficacious (overall RR
76.2%, CR 50.8% and PR 25.4% with initially elevated
CA-125 normalized by end of treatment in 78%). ASCO
2002 abs. #811
Darbepoetin alfa (Aranesp) has 8 more sialic acid residues
in its biochemical structure than epoetin alfa resulting in a
longer serum half-life that in turn allows less frequent
dosing. The efficacy and safety of q 3 wk & q 4 wk
administration of the new agent in anemia (Hb  11
gm/dL) solid tumor patients receiving chemotherapy was
tested in a placebo-controlled trial. Response of Hb
increase of  2 gm/dL or an Hb of  12 gm/dL was
achieved with both q 3 wk & q 4 wk schedules (given very
infrequently compared with rHuEPO). These well
tolerated dosing intervals allow for 1 per cycle
administration in patients receiving chemotherapy. ASCO
2002 abs. #1421
Toxicity data from an ongoing phase III trial comparing
standard q 3 week docetaxel (D) with weekly D as second
line treatment for advanced NSCLC show that both
outpatient regimens are well tolerated, and that weekly D
is particularly attractive due to lack of severe toxicity.
Arm A: D at 75 mg/m2 q 3 weeks; arm B: D 35 mg/m2
weekly X 3 followed by 1 week off (1 cycle = 28 days);
patients in both arms receive 6 cycles maximum. Toxicity
data available for 45 patients. Treatment was DCed for
tumor progression in 64% of patients and a full 6 cycles
was given to 18% of patients. Grade 3 / 4 toxicity: arm A
neutropenia 4.5%, infection 9%, and myalgia 13.5%; arm
B: only myalgia 9%. No patients had grade 3 / 4
neurotoxicity and no hospitalizations due to toxicity were
required. ASCO 2002 abs. #1228
To determine factors associated with a febrile neutropenia
(FN) event during CHOP chemotherapy, a historical case
series of 577 NHL patients who received this treatment
September, 2002 -- Page 3
was retrospectively reviewed. 160 patients experienced a
FN event, defined as having a temp. of > 100.6F and an
ANC of < 1000/mm3. Results: majority of FN events (74%)
occur in the first 2 cycles of therapy and 50% of first FN
episodes occurred by day 14 of cycle. Elderly (>65 yrs.)
patients accounted for 62% of FN events. A greater
proportion of patients with FN (93%) were targeted to
receive  80% of average relative dose intensity (ARDI)
than patients without FN (85%; p<0.05). Time to first FN
was shorter among older patients (p=0.0002). The risk of
Excerpts from CURE (Cancer Updates, Research &
Education), summer issue, vol. 1 no. 2 / 2002:
Hormones, pure and simple for treating advanced breast
cancer B On April 25, 2002, the FDA approved a new
hormonal agent for the treatment of women with advanced
stage breast cancer that has become resistant to Tamoxifen.
For many years the only anti-estrogen therapy available was
Nolvadex (Tamoxifen). However, Tamoxifen is not considered
to be a Apure@ anti-estrogen because it can have growth
stimulating effects on the endometrium, the lining of the
uterus. Some patients develop resistance to the inhibitory
effects of Tamoxifen. For many years, researchers looked for
an alternative antiestrogen therapy, one that would be a Apre@
anti-estrogen, lacking stimulatory properties. That search came
to fruition with the FDA approval of Faslodex (fulvestrant), an
agent that not only hinders the function of the hormone
receptors on the breast cancer cells, but also causes these
receptors to be destroyed. The approval of Faslodex was based
on data that showed it was equivalent to another hormonal
agent called Arimidex (anastrozole). However, other data,
recently released at the 2002 ASCO meeting, show that
Faslodex may offer an additional advantage, the ability to
prolong the time until the tumor progresses. Faslodex is given
by injection once per month and is expected to be widely
available by the end of May 2002. Most of the side effects
reported during treatment with Faslodex are mild and similar
to those experienced during menopause, such as hot flashes.
There is also a small risk of developing blood clots. Patients
taking Faslodex, or any other hormonal agents should not
smoke for this reason. Additional studies are ongoing to
determine if Faslodex is effective for women with advanced
breast cancer who have not yet been treated with Tamoxifen.
To learn more about Faslodex, visit www.faslodex.com.
Triple teaming colon cancer B Last year significant media
attention was directed to a new combination of drugs that
prolonged life for patients with colon cancer. Nicknamed
ATriple Drug Therapy@, this combination included Camptosar
(irinotecan), fluorouracil and folinic acid (also known as
leucovorin) and was one of the first regimens to demonstrate
longer survival for patients with metastatic colorectal cancer.
Oxaliplatin is a newer agent currently being tested in
colorectal cancer patients. It is administered as a short infusion
every two or three weeks. At the 2002 ASCO meeting, Richard
Goldberg, MD, from the NCCTG, reported a trial that
compared to Triple Drug Therapy regimen to a new regimen
that included oxaliplatin with fluorouracil and folinic acid
first FN was associated with: older age (>65) relative risk
(RR) 1.65, renal disease (RR 1.91), heart disease (RR 1.54),
baseline anemia (< 12g/dL; RR 1.44), ARDI > 80% (RR
2.41), and not receiving prophylactic CSF (RR 2.13).
Conclusions: Older patients with NHL have a greater risk
of FN and primary prophylaxis with CSF was associated
with reduced risk of FN in this population. ASCO 2002
abs. #1430

(known as Folfox). A preliminary analysis showed that Folfox
could be a good option for advanced colorectal cancer, with
good results seen in terms of producing tumor shrinkage, in
prolonging the time until cancer progression, and in
prolonging survival. Folfox was also associated with fewer
side effects than the Triple Drug Therapy, particularly severe
diarrhea. At this time the FDA recommends Triple Drug
Therapy as its approved option for metastatic colorectal cancer
patients. Oxaliplatin is approved for use only in Europe and
Asia. However, trials in the United States that could lead to the
approval of oxaliplatin are nearing completion and discussions
are ongoing between the manufacturer and the FDA to make
oxaliplatin available to more patients on a compassionate basis
until it is approved for widespread use. For more about the
results, visit www.cancer.gov under AColon and Rectal Cancer
Updates@ or see the ASCO website at www.asco.org.
Double trouble for lung cancer B For many years doctors
have relied on the use of Adoublets@ to treat patients with lung
cancer. These doublets, so called because they include two
chemotherapy drugs, were based on the premise that if one
chemotherapy drug was good, then two might be even better.
Most of the doublets include paraplatin (carboplatin) or
platinol (cisplatin) based on studies in the 80=s that showed
these agents could prolong survival for patients with advanced
lung cancer. Today, the most popular doublet used in the
United States is the combination of Taxol (paclitaxel) and
Paraplatin. However, until recently studies had never
conclusively shown that there was an advantage to using 2
drugs instead of only 1. Addressing this issue was important
because there was concern that using 2 drugs could lead to
increased side effects as well. To answer these questions,
CALGB undertook a trial in patients with lung cancer to
compare Taxol/Paraplatin therapy to therapy with Taxol alone.
The results, presented at the 2002 ASCO meeting in May,
showed that treatment with the doublet significantly improved
survival over treatment with Taxol alone for these patients
with advanced disease. However, it was also seen that there
was an increase in severe side effects as well, which could
mean that some patients may not tolerate doublet therapy. To
learn more about the most widely recommended and newest
treatments for advanced lung cancer, visit the APatient=s
Guide: Advanced Lung Cancer@ on the ASCO website at
www.asco.org/people/rs/html/m_patguidelung.htm.
A roadblock to tumor growth B Malignant mesothelioma,
closely associated with a history of exposure to asbestos,
develops from the sac lining the chest (pleural cavity) or the
abdomen (peritoneum). The incidence of malignant pleural
September, 2002 -- Page 4
mesothelioma in the Western world has increased and new
chemotherapy agents are being tested since no standard
therapy has emerged for the treatment of this disease. Alimta
(pemetrexed), which acts by inhibiting cellular proteins that
stimulate cancerous cells to grow, is the first new agent for
treatment of malignant mesothelioma to emerge in several
decades. Early studies of Alimta alone or in combination with
other standard chemotherapy agents such as Platinol or Paraplatin have been published and have shown that Alimta
exhibits antitumor activity in patients with malignant mesothelioma. The results of a large phase III trial in previously unCutting off the food supply to kidney cancer B Kidney
cancer cells have a voracious appetite for nutrients and other
factors in the blood, so maintaining a good blood supply is
critical for the tumor to survive and grow. Avastin
(bevacizumab), a monoclonal antibody, does just that by
blocking the actions of VEGF, a substance that stimulates the
growth of new blood vessels. By blocking VEGF, Avastin
decreases the tumor=s blood supply, starving the tumor and
potentially leading to decreased growth. Drugs like Avastin
that block the growth of new blood vessels are known as
angiogenesis inhibitors. At the 2002 ASCO meeting, James
Yang, MD, from the National Institutes of Health, reported
that Avastin, although it caused a reduction in tumor size in
just 8% of patients, was able to slow metastatic kidney cancer
from progressing. Patients who received Avastin had their
cancers under control for longer periods of time than those
who took a placebo. The main side effects of Avastin are
headache and increased blood pressure which is usually only
seen at higher doses. At the doses used in this study, side
effects were minimal. In a second presentation at ASCO, Eric
Rowinsky, MD, reported that a second antibody therapy,
called ABX-EGF was effective for patients with kidney
cancer. ABX-EGF is a new antibody that blocks cell growth
through the EGF receptor, a protein expressed on kidney
cancer cells that helps them grow uncontrollably. In this trial,
ABX-EGF halted cancer growth or caused tumor shrinkage in
half of the patients. The primary side effect was a mild skin
rash. More data about this new antibody are expected early in
2003. To learn more about Avastin in kidney and other tumor
types, visit the Genentech website at www.gene.com. More
information about ABX-EGF can be found at
www.abgenix.com. To learn more about starving the tumor see
March 2002, CURE at www.curetoday.com.
Custom-made therapy for lymphoma B Anyone who has
ever had anything custom-made knows that there is nothing
that matches so well as something designed especially for you.
But could the same be true of lymphoma therapy? Lymphoma
cells are special because they each carry a unique identifying
protein, known as an idiotype, that is specific to the tumor cell,
and specific to the person who has that cancer. Because of this,
since the early >80s researchers have been able to make
vaccines to stimulate the patient=s body to eradicate
lymphoma. These vaccines are specific to one individual
person=s tumor only, which causes that person=s immune
system to attack and destroy lymphoma cells. However, the
time and expense, as well as the difficulty generating this
therapy made it unattainable for many patients. Large-scale
treated patients with malignant pleural mesothelioma comparing cisplatin with or without Alimta were reported at the
May 2002 ASCO meeting. Over 450 mesothelioma patients
were enrolled in this study and were given treatment with
either cisplatin alone or cisplatin and Alimta. Most patients
received supplemental folic acid and vitamin B12 to minimize
side effects associated with Alimta. Patients treated with
Alimta and cisplatin lived about 33% longer than those who
received cisplatin alone. Alimta is not yet commercially
available in the U.S. More information about Alimta can be
found at www.alimta.com.
clinical trials, required before the FDA could approve such an
approach, were difficult to do. However, a new technology,
called HiGET could soon change all that. In the past vaccines
required large biopsies from the patients from which they
obtain lives cells to create the vaccine. Hi-GET, a new way of
developing patient-specific lymphoma vaccines, is efficient
and makes generating lots of vaccines for many individual
patients feasible because it requires a smaller biopsy sample
from the patient and allows the researcher generating the
vaccine to freeze the sample or manipulate in whatever way
necessary. Lymphoma vaccines generated by Hi-GET were
recently tested in a phase II trial and showed 67% of patients
with low-grade lymphomas were able to develop specific antilymphoma immune responses. The vaccine prevented the
patient=s disease from progressing for about 4-5 years, as
compared to chemotherapy that usually keeps disease under
control between 1-3 years. Based on these results, a phase III
trial is ongoing that will study the efficacy of the lymphoma
vaccine for patients with low-grade non-Hodgkin=s
lymphoma. For more information e-mail
[email protected] or visit www.genitope.com.

How many times have you hung a pint of
blood and not really thought about it?
Here are some Ablood trivia@ to think about:
Out of every 100 people:
1 is AB3 are AB+
2 are B9 are B+
6 are A34 are A+
7 are O38 are O+
1.
2.
3.
4.
September, 2002 -- Page 5
What common chemical added to blood keeps it
from clotting until it is ready to be transfused to a
patient?
What common chemical added to blood greatly
increases its storage time without adversely
affecting the quality?
When and how was the first administration of
blood given?
What was the nickname of the Queen of England
and Ireland who reigned from 1553-1588 (a
cocktail is also named after her)?
5.
6.
7.
8.
9.
10.
Which ancient culture, believing that blood had
magical powers, painted their bodies with it and
bathed their kings in it as part of their tribal
rituals to appease the gods?
In ancient times, what profession became known
by the name of an animal they frequently
employed in their work?
When were the four blood types identified in
humans?
Which RH factor is most needed, RH+ or RH-?
What is the origin of the red & white striped pole
designating a barbershop?
What English aristocrat believed that bathing in
blood would keep her young (which may have
contributed to the beginning of the vampire
legend)?
11.
12.
13.
14.
15.
16.
17.
What blood type did Mr. Spock of Star Trek
have?
What nation has popularized the belief that blood
type is an indicator of personality traits?
What percentage of a person=s body weight is
blood?
What percentage of Chinese people have RH+
blood?
People with which blood type must receive only
their own specific type, even in an emergency?
How many blood types do cats have?
How many blood types to cows have?
(Answers on page 7)

Side effects of chemotherapy
Cancer patients get inadequate care for pain: panel.
Bethesda, Maryland (Reuters Health) B Pain, fatigue and
depression are under treated in cancer patients even
though many good therapies are available, according to a
draft statement released at a state-of-the-science
conference sponsored by NIH. AFear of cancer and its
consequences must be ameliorated,@ said Dr. Donald L.
Patrick, chair of the panel that drafted the statement.
ACancer pain, depression, and fatigue are under treated
and this is unacceptable. There are effective strategies to
(treat) these problems, and all patients should have access
to them.@
The 13-member panel, which included practicing
physicians and academicians as well as an epidemiologist, a
social worker and a cancer survivor, laid out a series of
recommendations for assessing and treating the three
conditions as well as directions for future research on the
subject. But panel members said the most important thing
the statement could do is raise awareness of these
problems. AThere are no major lightning bolts from this
panel,@ Dr. Carolyn B. Hendricks, a panel member and
breast cancer specialist there, said in an interview. ABut
it=s the first time there=s been a focus on these
symptoms.@
The treatment of depression in cancer patients isn=t that
different from the treatment of depression in other people,
the panel noted. Cancer patients can be helped by a variety
of antidepressants, as well as by psychiatric and
psychological therapy. But there is little evidence to
substantiate the use of alternative depression treatments,
and few clues as to what works well for special populations
such as children and the elderly, they said.
There are few treatments available for cancer-related
fatigue. One potential therapy, erythropoietin alpha, is
known to reduce the prevalence of chemotherapy-induced
anemia, and several studies suggest that the improvement
in anemia results in decreased fatigue, said Patrick, who is
director of the social and behavioral sciences program at
the University of Washington in Seattle.
Pain management was the subject of some discussion
during the meeting. In its draft statement, the panel
endorsed the Athree-step analgesic ladder@ developed by
the World Health Organization (WHO), that calls for
cancer patients to start out on the lowest level of the ladder
B nonsteroidal anti-inflam-matory drugs (NSAIDs) such as
aspirin and ibuprofen B before proceeding to a
combination of NSAIDs plus weak opioids like codeine if
their pain worsens. The final Arung@ on the ladder is
strong opioids such as morphine for severe pain.
But Christine Maiskowski, president of the American Pain
Society (APS) and chair of the physiological nursing
department at the University of California, San Francisco,
said that thinking about pain management has evolved
beyond the WHO=s model, although it was a good start.
APatients would come in without much consideration given
to the intensity of their pain,@ she said, noting that
treatment night not get started fast enough for patients in
severe pain.
The National Comprehensive Cancer Network, an
umbrella group of cancer centers, devised a new treatment
algorithm based on a 1-to-10 scale for self-reported pain.
AIf a patient=s pain is greater than 7, let=s treat it as an
emergency and get their pain under control,@ said
Maiskowski, who was not a panel member but lectured on
several topics during the 3-day conference. The APS is
now working on revising 1994 cancer pain treatment
guidelines put out by the Agency for Healthcare Research
and Quality to reflect this new line of thinking,
Maiskowski said.
The panel urged the research community to consider
alternatives to conventional cancer treatments. ALots of
my patients want non-pharmacological management of
their symptoms,@ Hendricks said. AThey want exercise
programs to help relieve their pain; they want massage;
they want nutritional therapy. They want better therapy
for these symptoms with fewer side effects.@
This article is from CancerSource.com web page that you
can connect to through the ONS web page. Check it out for
September, 2002 -- Page 6
more articles relating to oncology. CancerSource also has a
drug database that is very useful for new agents.

Here are some Do=s and Don=ts for coping
with cancer
Excerpts from The Human Side of Cancer by Jimmie C.
Holland, MD and Sheldon Lewis. These are great to
remember so we can help our patients.
Don=t believe the old adage that Acancer equals death.@
There are eight million survivors of cancer in the United
States today.
Don=t blame yourself for causing your cancer. There is no
scientific proof linking specific personalities, emotional
states or painful life events to the development of cancer.
Even if you may have raised your cancer risk through
Don=t feel guilty if you cannot keep a positive attitude all
the time, especially when you don=t feel good. Low periods
will occur, no matter how good you are at coping. There=s
no evidence that those periods have a negative effect on
your health or tumor growth. If they become frequent or
severe, however, seek help.
Don=t suffer in silence. Do use support and self-help
groups if they make you feel better. Leave a group that
makes you feel worse, but don=t try to go it all alone. Get
support from your best resources: family, friends, doctor,
clergy or those you meet in support groups who
understand what you are going through.
Don=t be embarrassed to seek counseling with a mental
health professional for anxiety or depression that
interferes with your sleep, eating, ability to concentrate, or
ability to function normally if you feel your distress is
getting out of hand.
Do use any methods that aid you in getting control over
your fears or upset feelings, such as relaxation, meditation
and spiritual approaches.
Do find a doctor who lets you ask all your questions and
for whom you feel mutual respect and trust. Insist on being
a partner with him/her in your treatment. Ask what side
effects you may expect and be prepared for them.
Anticipating problems often makes it easier to handle them
if they occur.
Don=t keep your worries or symptoms (physical or
psychological) secret from the person closest to you. Ask
this person to accompany you to visits to the doctor when
treatments are to be discussed. Research shows that people
often don=t hear or absorb information when anxious. A
second person will help you interpret what was said.
Do re-explore spiritual and religious beliefs and practices,
smoking or some other habit, there is no benefit to blaming
yourself or beating yourself up.
Do rely on ways of coping that helped you solve problems
and handle crises in the past. If you=ve been a talker, find
someone to talk with about your illness. If you=re an
inveterate nontalker you may find relaxation, meditation
or similar approaches helpful. The secret, however, is this:
Use whatever has worked for you before, but if what
you=re doing isn=t working, seek help to find other ways
to cope.
Do cope with cancer Aone day at a time.@ The task of
dealing with cancer seems less overwhelming when you
break it up this way and it also allows you to focus better
on getting the most out of each day, despite illness.
such as prayer, that may have helped you in the past. (If
you don=t consider yourself a religious or spiritual person,
garner support from any belief system or philosophy that
you value, such as humanism.) These beliefs may comfort
you and may even help you find meaning in the experience
of your illness.
Don=t abandon your regular treatment in favor of an
alternative or complementary treatment. Use alternative
treatments that do no harm and that can safely be used
along with your regular treatment. Be sure to tell your
doctor which complementary therapies you are using or
want to use, since some should not be used during
chemotherapy or radiation therapy treatments. Discuss the
benefits and risks of any alternative or complementary
treatments with someone you trust who can assess them
more objectively than you when you are under stress.
Psychological, social and spiritual approaches are helpful
and safe, and doctors encourage their use today.
Do keep a personal notebook with all your dates for
treatments, laboratory values, x-ray reports and general
status. Information is critical in cancer treatment, and no
one can keep it better than you.

Answers to "blood trivia"
1.
Salt
2.
Sugar
3.
The early Egyptians and Romans prescribed it
orally as a life-giving tonic and to transmit youth
from donor to recipient.
4.
Bloody Mary (Mary Tudor)
5.
Aztecs
6.
Doctors used leeches to remove blood (which
supposedly removed demons thought to be the
September, 2002 -- Page 7
7.
8.
9.
10.
11.
12.
13.
cause of illness). Soon their patients started
referring to physicians as Aleeches@.
Blood transfusions were first attempted around
1600 by transfusing animal blood into humans B
with disastrous results. Then in the early 1800s an
English obstetrician, James Blundell, came up
with the idea of human blood for human beings.
The results were better, but still some patients
inexplicably died. Finally, in 1900, Karl
Landsteiner identified the four basic blood types,
and subsequently the success of blood transfusions
was significantly increased when patients were
transfused with their same blood type.
Both. A greater percentage of people have RH+,
so this means more RH+ donors are needed.
Fewer people have RH- blood so there are fewer
donors to provide this type when needed.
In the Middle Ages, bloodletting was a popular
cure for many ills, and barbers became known as
professional bloodletters. Red & white barber
poles symbolize the practice of hanging
bloodstained bandages outside their shops.
Mary Bathory
His blood type was T-negative.
Japan
7%
Leadership List:
President:
Doreen Scholly, West Michigan Cancer Center (WMCC)
(616) 373-7447
President Elect:
Marylynne Mundo, WMCC, (616) 373-7488
Past President:
Joan Lewis, Three Rivers Area Hospital Specialty Clinic
(616) 273-9691
Archives Chair: Laura Mullins, MSU/KCMS
Pediatric Hematology/Oncology - Bronson
(616) 341-6350
14.
15.
16.
17.
100%
OFour
Over 800
Membership Dues
Dues are $15 per year. You must be a member of national
ONS before becoming a local member. Please use the
application form in this newsletter to renew your membership
or make application for new membership.
Future ONS Congresses:
2003, May 1-4, Denver, CO
2004, April 29-May 2, Anaheim, CA
2005, April 28-May 1, Orlando, FL
2006, May 3-6, New Orleans, LA
Newsletter Suggestions
If you have an item for the newsletter or any comments,
contact Joan Westendorp, 373-7458 or Marybeth Peters at
373-7450. For questions regarding meeting times, places,
cancellations, etc., call Marybeth 373-7450 or any Board
member listed in this newsletter.
The Greater Kalamazoo Area Chapter ONS and the ONS
assume no responsibility for opinions expressed by authors.
Acceptance of materials does not indicate or imply
endorsement.
Health field related advertisements and help wanted
advertisements may be printed, if appropriate, for a fee which
will be placed in the ONS treasury.
Treasurer:
Nancy Henderson, WMCC, (616) 373-7475
Secretary/Public Issues: Trish DeKilder
Kalamazoo Hematology & Oncology
(616) 341-9200
Program Chair:
Nancy White, WMCC, (616) 373-7433
Nominating Chair:
Dona Lincoln, WMCC, (616) 373-7488
Membership Chair:
Ann Temple, WMCC, (616) 373-7425
Newsletter:
Joan Westendorp, WMCC, (616) 373-7458
Greater Kalamazoo Area Chapter ONS
Membership Application/Renewal
Requirements:
1.
2.
3.
September, 2002 -- Page 8
Must be a healthcare professional.
Must be a member of ONS national.
Chapter dues $15/year (Note: payment to renew membership is due
in September)
__________________________________________________
(Name)
________________________________________________
(E-mail address)
LPN RN Diploma BSN MSN
ADN OCN AOCN Other_______
(check those that apply)
National ONS member?
NP
Yes
Nat'l ONS member # __________
No
(this is required)
Exp. date __________
__________________________________________________
Today's date ____________________
_____________________________________________
(Home address)
Membership status: New Renew Active Student
Retired
__________________________________________________
(Home phone)
Active - open to health care professionals, nationally and internationally. Senior
- open to individuals who qualify for active membership and who have reached
the age of 65 yrs. Student - open to individuals enrolled full time in a health
care professional education program.
____________________________________________
_________________________________________________
(Work address - include title and/or department)
_________________________________________________
(Work phone)
September, 2002 -- Page 9
Mail application and chapter dues to:
Ann Temple, West Michigan Cancer Center
200 North Park St., Kalamazoo MI 49007
Make check payable to:
Kalamazoo ONS-Nancy Henderson