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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