Volume 12, Issue 1, February 2008
Coordinatorís Message
Epigenetics Reshape Cancer Treatment and Oncology Nursing

Jennifer T. Loud, RN, MSN, CRNP
Derwood, MD

A quick search of the New York Times Health Section and it is immediately clear that genetics has become a part of our everyday lives. Since July 2007, more than 50 articles were published on genetics or on how genetic information affects our lives. From basic science to disease prevention to health prediction, genetics and genetic information have become more common.

In oncology, epigenetic information is now being integrated into the treatment of cancer. Epigenetics is defined as the study of heritable changes in gene function that occur without a change in the DNA sequence. Epigenetics is reshaping the way scientists look at traditional genetics.

An example of using epigenetic information for cancer treatment is demonstrated by the use of decitabine, or 5-aza-2’-deoxycytidine, for patients with myelodysplastic syndrome (MDS). Decitabine’s mechanism of action in MDS is as a demethylating agent. Decitabine incorporates into DNA and inhibits DNA methyltransferase, resulting in hypomethylation of DNA and intra-S-phase arrest of DNA replication.
Oncology nurses are at the cutting edge of integrating genetic information into patient care. From evaluating family history to providing patient education about gene-targeted therapies, oncology nurses enhance patient understanding, decision making, and treatment with their up-to-date knowledge in genetics.

Your membership in the Cancer Genetics SIG signifies your interest and support for ongoing professional development in cancer genetics. A recent survey of our membership identified several members who wish to contribute their knowledge, time, and experience to improve the overall functioning of the Cancer Genetics SIG. Thank you for volunteering your time, and I encourage other members to think about becoming more involved. Consider investing some time to work with the newsletter, Virtual Community, award nominations, membership recruitment, legislative activities, project development, mentorship, poster development, research, or meeting planning.

Please contact me via e-mail at loudj@mail.nih.gov to get more involved.
The Cancer Genetics SIG Newsletter is produced by members of the
Cancer Genetics SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  February 2008

Donít Miss This Once-in-a-Lifetime Opportunity: Summer Genetics Institute

The National Institutes of Health/National Institute of Nursing Research (NINR) currently are accepting applications for the 2008 Summer Genetics Institute (SGI) (June 8–August 1). The deadline to apply is March 3.

The intensive, two-month summer research training program covering molecular genetics. According to the NINR Web site, “The purpose of the SGI is to develop and expand the research capability among graduate students and faculty in schools of nursing, and to develop and expand the basis for clinical practice in genetics among advanced practice nurses.”
Participants reside at the National Institutes of Health in Bethesda, MD, during the program and receive both classroom and laboratory teaching. Program graduates receive 12 hours of doctoral-level college credit.

To learn more about the program and to apply, click here.

For more information on the “lived experience”, refer to the February 2007 article, “NIH Fellow, Summer Genetics Institute: Could That Be ME?” by ONS Genetics SIG member Patricia Kelly. Several ONS Cancer Genetics SIG members are SGI graduates and would be happy to help interested SIG members with their application. The SGI coordinator, Francine H. Nichols, PhD, RNC, FAAN, is available for questions by e-mail at nicholsf@mail.nih.gov or by telephone at 202-255-6922. (See below for ONS online tools to help with writing a research proposal/application.)
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Special Interest Group Newsletter  February 2008

ONS Offers Online Tools for Nurse Researchers

The ONS Web site provides valuable resources for nurse researchers. Be sure to check out the Research Area (www.ons.org/research) to find out information on the ONS research agenda, funding opportunities, grant writing resources, and links to helpful research-related Web sites. The ONS Evidence-Based Practice Resource Area (http://onsopcontent.ons.org/toolkits/evidence) offers general information and strategies for using evidence to solve clinical problems. The ONS Outcomes Resource Area (www.ons.org/outcomes/index.shtml) provides information about evidence-based oncology nursing interventions and patient outcomes.

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Special Interest Group Newsletter  February 2008

News You Can Use From the National Cancer Institute

More Accurate Method of Estimating Invasive Breast Cancer Risk in African American Women Developed
A new model for calculating invasive breast cancer risk, called the CARE model, has been found to give better estimates of the number of breast cancers that would develop in African American women 50–79 years of age than an earlier model that was based primarily on data from White women. Both models were designed to be used by healthcare professionals and should either be used by them or in consultation with them. Researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and their collaborators reported on the study methodology and results, published online in the Journal of the National Cancer Institute on November 27, 2007.

To develop a new model that would more accurately assess an African American woman’s chance of developing breast cancer, researchers in the CARE study examined data from 1,607 African American women with invasive breast cancer and 1,637 African American women of similar ages who did not have breast cancer. The factors used in the model were age at first menstrual period, number of first-degree relatives (mother or sisters) who had breast cancer, and number of previous benign breast biopsy examinations. A woman’s age at the birth of her first child, a risk factor for White women, did not improve prediction in African American women and so was not included in the model. Risk was calculated by combining information on these factors with African American rates of new invasive breast cancer from NCI’s Surveillance, Epidemiology and End Results Program and with national mortality data.

To test the accuracy of the model, researchers compared data in the CARE model with data from the 14,059 African American women aged 50–79 in the Women’s Health Initiative (WHI) study who had no prior history of breast cancer. From the risk factor profiles for breast cancer that were collected at entry into the WHI, the researchers used the CARE model to estimate the number of women who would be expected to develop invasive breast cancer and found that the model predicted that 323 would be affected, close to the 350 breast cancers in African American women that actually occurred during the WHI follow-up.

According to Mitchell H. Gail, MD, from the NCI, the lead author of this study, “The CARE model predicted the numbers of breast cancer diagnoses well overall, and in most categories.”

It should be noted that the CARE model, like the BCRAT, needs to be approached with caution or avoided for certain special populations. These models should not be used for women with a previous history of breast cancer. The models tend to underestimate risk in women who have received radiation to the chest and in women who are known to carry mutations associated with increased risk of breast cancer, such as mutations in the BRCA1 and BRCA2 genes. Although the CARE model has not yet been incorporated into the BCRAT on the NCI Web site, NCI plans to have the tool updated by the spring of 2008.


Gail, M.H., Costantino, J.P., Pee, D., Bondy, M., Newman, L., Selvan, M., et al. (2007). Projecting individualized absolute invasive breast cancer risk in African American women. Journal of the National Cancer Institute, 99, 1782–1792.

Paclitaxel Benefit May Depend on HER2 Status
Data from the Cancer and Leukemia Group B (CALGB) clinical trial CALGB 9344, first reported in 1998, showed a significant increase in disease-free and overall survival with the addition of paclitaxel to chemotherapy with doxorubicin and cyclophosphamide for women with lymph node-positive breast cancer. However, a new retrospective analysis of the data, published in the October 11 New England Journal of Medicine, indicates that only the subset of women with HER2-positive disease actually benefited from the addition of paclitaxel.

The CALGB investigators randomly selected 1,500 of the 3,121 women who originally participated in the trial and examined tissue samples from 1,322 of them. They tested the samples for HER2 and estrogen-receptor (ER) status and compared disease-free survival between women whose cancer was HER2-positive/ER-negative, HER2-positive/ER-positive, and HER2-negative/ER-positive.

Although the addition of paclitaxel improved disease-free survival for women with HER2-positive tumors regardless of ER status, “paclitaxel did not benefit patients with estrogen-receptor-positive, HER2-negative cancers,” stated the authors. The group of women with HER2-negative/ER-positive cancers accounted for more than half the participants in CALGB 9344.

“Our studies suggest that [patients with HER2-negative/ER-positive cancer] could avoid the toxic effects associated with adjuvant paclitaxel when given after doxorubicin plus cyclophosphamide,” concluded the authors.

However, they explained, because these results are based on a retrospective analysis not planned for in the original design of the trial, the “results require validation before adoption into clinical practice.”

“This is not a call to abandon taxanes for this group of patients,” said Dr. Anne Moore from Weill Cornell Medical College in an accompanying editorial. Other taxane drugs or treatment schedules may still benefit patients with HER2-negative/ER-positive cancer, she explained, and analysis of other trial results based on HER2 and ER status will be important.

More Genetic Markers Found for Prostate Cancer Risk
Evidence that prostate cancer risk can be inherited has increased dramatically in 2007, with several major studies locating markers in the q24 band of chromosome 8. New results from researchers at Wake Forest University School of Medicine identified two regions in this area of the chromosome where genetic variants occurred more frequently in a case-control study of 1,563 European American men with prostate cancer. The study was published in the October 17 Journal of the National Cancer Institute.

Led by Drs. S. Lilly Zheng and Jielin Sung and funded in part by NCI, the researchers genotyped 18 single nucleotide polymorphisms (SNPs) in the 8q24 region and looked for the presence of these SNPs in gene panels of prostate tumor tissue taken from the patients, as well as samples from 576 control subjects without cancer. One SNP, called rs6983267, had recently been identified in NCI’s Cancer Genetic Markers of Susceptibility (CGEMS) study. A second set of SNPs found close to rs1447295 was previously identified as a risk marker for more aggressive disease.

What is important and novel, said the authors, is that the risk associated with each of these SNPs is additive. Because their occurrence was not linked, “the risk alleles at each are common, [and] these loci together may account for substantially more prostate cancer than previously appreciated,” they noted. More than one-third of patients had SNPs at one or both locations. If the SNPs were found at one location, risk was increased 70%; if found at both locations, 168%.

In an editorial, Drs. Sharon A. Savage and Mark H. Greene of NCI’s Division of Cancer Epidemiology and Genetics noted that this study was bolstered by access to publicly available prepublication data from CGEMS, exemplifying the value of innovative data sharing policies. “We hope that a policy of more liberal early access to datasets of this kind will soon become the accepted standard worldwide,” they wrote.
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Special Interest Group Newsletter  February 2008

ONS Cancer Genetics SIG Members Take the Podium at ONS Institutes of Learning

Congratulations to the following Cancer Genetics SIG members who presented at the fall 2007 ONS Institutes of Learning.

Lisa Aiello-Laws
Pain Management Literacy in Cancer Patients and Their Families
Julie Eggert
Research “Jeopardy”: Planning Multi-Site Projects
Gail Hurt
Exploring Hereditary Gynecologic Cancers
Jennifer Loud and Karen Roesser
Overcoming Genetics Illiteracy: Speaking "Geneticese" Fluently

Bring the 2007 IOL and APN Conference Home!
Sessions from the 2007 Institutes of Learning and Advanced Practice Nursing Conference are available for purchase on MP3 audio CD-ROM or as downloadable media. Sessions feature speakers’ PowerPoint presentations synchronized with the session audio. Place your order online now.

Want to Submit an Abstract for Congress 2008?
Congress 2008 is just around the corner, and with it is an exciting opportunity to release the cutting-edge or innovations. We want to hear from you! Submit your abstract now for the ONS 33rd Annual Congress, May 15-18, in Philadelphia, PA.

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Special Interest Group Newsletter  February 2008

Resources for Patient and Family Education

The following are valuable resources for patient and family education. The ONS Cancer Genetics SIG thanks Dale Halsey Lea, MPH, RN, CGC, FAAN, health educator, Education and Community Involvement Branch, Genomic Healthcare Branch, National Human Genome Research Institute, National Institutes of Health, for updating our membership with new resources.

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Special Interest Group Newsletter  February 2008

New Institute of Medicine Report on Psychosocial Care for Patients With CanceróImportant Information for All SIGs

The Institute of Medicine (IOM) convened a special committee to look at the delivery of psychosocial services to patients with cancer and their families and identify ways to improve provision of care. The recently released results (November 2007) are published in Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs available at www.nap.edu.

The findings stated that many patients with cancer have psychosocial needs. Although the supply of services is insufficient to address all patient needs, untapped resources exist, frequently at no additional cost. Patients, however, are often unaware of these resources. The committee proposed that all components of the healthcare system incorporate attention to patients’ psychosocial needs into their practice. This new standard of care recommends that all cancer care should ensure the provision of appropriate psychosocial services by

  • Facilitating effective communication between patients and providers
  • Identifying patients’ psychosocial health needs
  • Designing and implementing a plan that
    • Links patients with needed psychosocial services
    • Coordinates biomedical and psychosocial care
    • Engages and supports patients in managing their illness and health
  • Systematically following up on, reevaluating, and adjusting plans.
ONS is joining the American Psychosocial Oncology Society (APOS) in disseminating this important report at a special session of the upcoming APOS Conference (February 2008), which will generate discussion among multidisciplinary healthcare professionals to plan strategies for implementing the new IOM recommendations.
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Special Interest Group Newsletter  February 2008

Call for Reviewers

The Clinical Journal of Oncology Nursing (CJON) is looking for reviewers. For more information, click here.

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Special Interest Group Newsletter  February 2008

Employment Opportunity

The Oncology Nursing Society is hiring a candidate who possesses the following to fill the role of Education Project Manager:

•   A self-starter to drive daily implementation of educational projects
•   An individual who can motivate volunteers and staff to collaborate and produce dynamic, innovative educational programs
•   An individual who is able to mentor speakers, develop key opinion leaders, and facilitate group work
•   An individual who demonstrates expertise in educational design

Oncology Nursing Society Education Project Managers:

•   participate in generative processes to design programs and strategies that will meet oncology nursing education needs
•   develop project timelines and recruit planning team members
•   employ principles of project management to plan and execute programs from conception through delivery and outcome measurement, ensuring completion according to the plan, within budget and on time.
•   generate all necessary reports and correspondence documenting program progress and outcomes and leads all status update meetings and reports about projects.

This position requires a strong degree of accountability for overall success in developing and delivering scientifically rigorous educational programming for the oncology nursing audience.

Submit resume and salary history to hrdept@ons.org.

Resumes without salary history will not be considered. EOE.
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Special Interest Group Newsletter  February 2008

Membership Information

SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc.
  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://ons.org/membership including
    • Educational opportunities for your subspecialty
    • Education material on practice
    • Calls to action
    • News impacting or affecting your specific SIG
    • Newsletters
    • Communiqués
    • Meeting minutes.

Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is

  • Log on to the ONS Web site (http://www.ons.org/).
  • Select "Membership" from the tabs above.
  • Then, click on "ONS Chapters and Special Interest Groups."
  • Scroll down to "Visit the ONS Special Interest Groups (SIG) Virtual Community" and click.
  • Now, select "Find a SIG."
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once the front page of your SIG’s Virtual Community appears on screen, select "New User" from the top left. (This allows you to create log-in credentials.)
  • Type the required information into the text fields as prompted.
  • Click "Join Group" (at the bottom right of the text fields) when done.

    Special Notices

    • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
    • If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.

Subscribe to Your SIG’s Virtual Community Discussion Forum

All members are encouraged to participate in their SIG’s discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so,

  • Select "Log In," located next to "New User," and enter your information.
  • Next, click on the "Discussion" tab on the top right of the title bar.
  • Now, select "Featured Discussion" from the left drop-down menu.
  • Locate and select "Subscribe to Discussion" inside the "Featured Discussion" section.
  • Go to "Subscription Options" and select "Options."
  • When you have selected and entered all required criteria, you will receive a confirmation message.
  • Click "Finish."
  • You are now ready to begin participating in your SIG’s discussion forum.

Participate in Your SIG’s Virtual Community Discussion Forum

  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on "Discussion" from the top title bar.
  • Select "Featured Discussion" from the left drop-down menu.
  • Click on any posted topic to view contents and post responses.

Sign Up to Receive Your SIG’s Virtual Community Announcements

As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.

  • From your SIG’s Virtual Community page, locate the "Sign Up Here to Receive Your SIG’s Announcements" section. This appears above the posted announcements section.
  • Select the "Click Here" feature, which will take you to a link to subscribe.
  • Once the "For Announcement Subscription Only" page appears on select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on "Next Page."
  • Because you have already joined your SIG’s Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click "Finish."
  • This will bring up a listing of your SIG’s posted announcements. Click on "My SIG’s Page" to view all postings in their entirety or to conclude the registration process and begin browsing.
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Special Interest Group Newsletter  February 2008

Cancer Genetics SIG Officers

Coordinator (2006-2008)
Jennifer Loud, RN, MSN, CRNP
Derwood, MD

Coordinator-Elect (2007-2008)
Lisa Aiello-Laws, RN, MSN, APN, C, APNG, AOCNS®
Cape May, NJ

Millie Arnold, RN, OCN®, CCRC
Medquite, TX


Patricia Kelly, RN, MS, CNS, AOCN®
Dallas, TX

ONS Publishing Division Staff
Amy Nicoletti, BA
Staff Editor

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Administrative Assistant Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, MS, CAE, Director of Membership/Leadership

Diane Scheuring, MBA, CMP, Manager of Member Services

Carol DeMarco, Membership/Leadership Administrative Assistant

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214

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