Oncology Nurse Advisor Forum – June 2010

UNDERSTANDING EGFR WILD TYPE

What does EGFR wild type mean? — Ruth C. Gholz, RN, MS, AOCN, and colleagues at the Cincinnati VA Medical Center

Wild type can be applied to genetic material responsible for many cellular features, including the epidermal growth factor receptor (EGFR). It means “as found in nature,” in effect, the nonmutated gene. Lung cancer that has the EGFR wild type may respond poorly to medications known as EGFR inhibitors, whereas having mutations, especially exon 19 and 21, increases the response rate. The opposite can be true regarding the K-ras gene in colorectal cancers. where the wild type predicts a better response to EGFR inhibitors. — Donald Fleming, MD

AUC DOSING FOR CARBOPLATIN

Why is carboplatin dosing based on AUC (area under the curve)? —Pat Omara, RN, OCN, nurse manager, York, PA.

Because carboplatin is very toxic to the bone marrow, dosing this agent according to the area under the drug exposure curve (AUC) allows for better prediction of systemic exposure. This method of dosing also predicts for the degree of myelosuppression (Cancer Principles & Practice of Oncology: Pharmacology of Cancer Chemotherapy. 2008;35-39). — Jiajoyce R. Conway, DNP, FNP-BC, NP-C

SURVIVORSHIP CARE PLANNING

Do nurses participate in survivorship care planning? — Ruth C. Gholz, RN, MS, AOCN, and colleagues at the Cincinnati VA Medical Center

Survivorship care planning is a coordinated posttreatment plan between the cancer survivor and the oncology treatment team, primary care physician, and other health care professionals. Oncology nurses should most definitely be a part of the process. With the ever increasing survival of persons with cancer, survivorship care planning has become a crucial part of cancer care and formalized care plan programs are available. One particularly innovative program is known as OncoLife, a Web-based program developed at the University of Pennsylvania in Philadelphia that can be utilized by both nurses and physicians to design cancer survivorship care plans. — Donald Fleming, MD

VACCINATIONS FOR CANCER PATIENTS

What vaccines are appropriate or not appropriate for cancer patients?

Understandably, many cancer patients are worried about what vaccines they should or should not receive. Although the CDC recommends a flu shot annually for everyone older than 50 years and pneumococcal vaccination for those older than 65 years every 5 years, cancer patients, given their diminished immunity, should receive these vaccinations regardless of age. In addition, cancer patients should be immunized against tetanus every 10 years. Live-virus vaccines to be avoided include those for polio (oral type), measles, mumps, rubella, and yellow fever. — Rosemarie A. Tucci, RN, MSN ONA

From the June 01, 2010 Issue of Oncology Nurse Advisor