I hope you all had a very happy holiday season. It doesn't seem possible, but spring will be here before we know it. With spring comes ONS Congress. Congress has some changes that I think will make the experience better. The SIG meetings are one of the changes. Instead of being held the afternoon of the first day of Congress, the SIG meetings will be divided into two groups. Group 1 will meet Thursday afternoon, and group 2 will meet Friday afternoon. The Neuro-Oncology SIG will meet Friday from 4:30–6:30 pm. The meeting room has not been assigned, but look for the information on the Neuro-Oncology's page on the SIGs Virtual Community and in the Congress syllabus. Many ONS members belong to more than one SIG. With the meetings divided, each member may have a chance to explore another SIG of interest and also attend one of which he or she is a member. Another change for the Neuro-Oncology SIG is that we will not have a hospitality and networking event prior to Congress as we have the past two years. A networking session is planned as part of the SIG Planning and Networking Meeting.

I want to hear your ideas and comments. I have received the surveys and would like to explore some of the comments made by the entire membership. I know we all cannot attend Congress. Some must stay in the clinics to care for patients. I do want the entire SIG membership to have input into the SIG's strategic plan. You may find the plan on the SIGs Virtual Community. The strategic plan is due for an update this year. Review it, and give me your input. Please e-mail your comments and ideas at any time. I am your elected official and need to know your thoughts.

Currently, a regional plan for mentorship is being developed. The country will be divided into geographic regions. Mentors will be identified from the responses to the surveys. If you are interested in mentoring but did not indicate such on your survey, please e-mail me.

The role of mentors is not fully developed but will include identification of informal, regional speakers bureaus and will notify members of conferences or seminars of interest in their regions. Members will be responsible to notify mentors of meetings scheduled in their institutions or communities. Knowing about every educational opportunity in a region is difficult. I have been asked several times about educational activities in my city sponsored by pharmaceutical companies that I did not attend because I was not aware of them. If it happens to me, I'm sure it happens to others also. The mentorship program will be an opportunity for the SIG to partner with local institutions to promote educational activities of interest to the SIG membership. Nurses would become more visible in our communities also.

If you are attending Congress, please e-mail me so that I know to look for you. I hope to meet each of you in Boston. Remember, my e-mail is crhoton@cccoutreach.com.

Welcome New Members

What Do You Want to Read About?

Please e-mail me with suggested topics as well as authors for future issues of the newsletter. I want to provide the membership with up-to-date, useful information, and I need your help to do so! Please e-mail me at kara.penne@duke.edu with any suggestions.

Congratulations to Fellow SIG Members

Deborah Allen, RN, FNP, AOCNP, and the Triangle Chapter of ONS in North Carolina were awarded a $3,500 Symptom Management Educational Program grant sponsored by Merck and Co. Allen will present a program focused on the neuro-oncology patient population on March 21, 2006, to the Triangle Chapter in the Raleigh/Durham area of North Carolina.

Don't forget to attend "Neurologic Complications of Cancer Patients: Seizures and Leptomeningeal Disease" at Congress 2006. I am sure the session will be very informative.

Clinical Corner
Primary Central Nervous System Lymphoma

Primary central nervous system lymphoma (PCNSL), a high-grade, non-Hodgkin lymphoma, once was considered uncommon but now is being diagnosed more. The rising incidence has been noted in patients with HIV/AIDS and others with compromised immune function, including recipients of solid organ transplants and patients using long-term corticosteroids. The causative factors include the rising incidence of HIV/AIDS as well as an increase in the number of organ transplants performed each year. Most concerning is a concomitant increase in the incidence of PCNSL in immunocompetent patients. The etiology for the increase is unknown. Presenting symptoms most often include neurologic defects and signs of intracranial pressure. The median survival for immunocompetent individuals is approximately three months without treatment. Prognostic factors include increased age and poor performance status (Laperriere et al., 1997). When PCNSL is suspected, the initial evaluation should include a chest x-ray or computed tomography scan of the chest, abdomen, and pelvis and routine blood tests (complete blood count with differential and serum chemistries) to exclude disease sites outside of the central nervous system. Testing for HIV also should occur to rule out AIDS-associated PCNSL. If no other disease sites are found, tissue should be obtained via biopsy. Lumbar puncture for cytology, magnetic resonance imaging of the complete spine, and ophthalmologic examination should be completed as well for other central nervous system involvement.

Standard therapy has included radiation therapy, which provides median survival of 14 months (Nelson et al., 1992). Radiotherapy was the standard treatment for many years, producing a response rate of 60%–65% and notable neurologic improvement in most cases. Unfortunately, the majority of patients relapse in a few months. A median survival of 14 months and a five-year survival of 3%–26% are the results produced by treatment with radiotherapy alone. The introduction of chemotherapy has consistently improved length of survival; however, the prognosis of PCNSL still is dismal.

Currently, high-dose methotrexate is the initial treatment of choice. The New Approaches to Brain Tumor Therapy CNS Consortium conducted a multicenter, phase II study of single-agent, IV methotrexate in newly diagnosed patients with non-AIDS-related PCNSL and reported modest toxicity with a radiographic response proportion (74%) comparable to more toxic regimens. Although PCNSL is a rare disease, all oncology nurses need basic knowledge of the disease process, treatment, side effect management, and nursing implications. When combined with whole-brain radiotherapy, methotrexate is a highly effective treatment modality, but the combination causes an unacceptably high incidence of severe, permanent neurotoxicity, particularly in patients older than 60. Rituximab and temozolomide are being used in combination to treat relapsed PCNSL. Enting, Demopoulos, DeAngelis, and Abrey (2004) reported a 53% response rate, median overall survival of 14 months, and median progression-free survival of 7.7 months. The dosing regimen included a dose intensification of temozolomide, ranging from 100–200 mg/m² on days 1 through 7 and 15 through 21 per 28-day cycle. A 20%–30% grade 3 hematologic toxicity was reported, and the researchers determined that the temozolomide would need to be reduced to less than 150 mg/m². Formal phase I dose escalation data are unavailable for combination rituximab and temozolomide; however, current data suggest that the maximum tolerated dose of temozolomide given on days 1 through 5 in a 28-day cycle in combination with rituximab 375 mg/m² on day 1 is probably 150 mg/m². The lack of renal toxicity in rituximab and temozolomide is an important issue for older patients and those with renal dysfunction. Further research is needed to clarify the efficacy and optimal dosing of the regimen.

Treatment for PCNSL with whole-brain radiation or high-dose methotrexate has been linked with subsequent neurotoxicity of varying severity. Cognitive function and quality of life must be assessed at baseline and followed closely throughout treatment. They are critical factors in treatment decisions. Another potential side effect of methotrexate is development of diffuse leukoencephalopathy. It is manifested as diffuse white matter hyperintensities on T2 weighted magnetic resonance imaging or white hypodensities on computed tomography. The changes are associated with cognitive decline, including confusion and altered mental status.

References

Enting, R.H., Demopoulos, A., DeAngelis, L.M., & Abrey, L.E. (2004). Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide. Neurology, 63, 901–903.

Laperriere, N.J., Cerezo, L., Milosevic, M.F., Wong, C.S., Patterson, B., & Panzarella, T. (1997). Primary lymphoma of brain: Results of management of a modern cohort with radiation therapy. Radiotherapy and Oncology, 43, 247–252.

Nelson, D.F., Martz, K.L., Bonner, H., Nelson, J.S., Newall, J., Kerman, H.D., et al. (1992). Non-Hodgkin's lymphoma of the brain: Can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. International Journal of Radiation Oncology, Biology, Physics, 23(1), 9–17.

Pharmacy Corner
Methotrexate

Indication: Methotrexate is approved by the U.S. Food and Drug Administration for psoriasis, rheumatoid arthritis, nonmetastatic osteosarcoma, and other neoplastic diseases.

Mechanism of action: Methotrexate interferes with DNA synthesis, repair, and cellular replication. Actively proliferating tissues such as malignant cells, bone marrow, fetal cells, buccal and intestinal mucosa, and cells of the urinary bladder generally are more sensitive to the effects of methotrexate. When cellular proliferation in malignant tissues is greater than in most normal tissues, methotrexate may impair malignant growth without irreversible damage to normal tissues.

Life-threatening complications: renal toxicity, hepatotoxicity, severe (sometimes fatal) bone marrow suppression, interstitial pneumonitis, stomatitis, opportunistic infections including pneumocystis carinii pneumonia, tumor lysis syndrome, and congenital abnormalities

Potential side effects: nausea, vomiting, diarrhea, stomatitis, pancytopenia, acute elevated transaminases, liver fibrosis, and cirrhosis

Dosage: Recommended dosage varies based on disease.

Nursing implications: Monitor blood counts, urine pH (must be greater than 8.0), neurologic changes, signs of occult infection, and mouth care.

Time to Review the Neuro-Oncology SIG’s Strategic Plan

It is time to review and renew the SIG's strategic plan. The SIG's officers would love input from members. Please review the plan and send feedback to SIG Coordinator Carolyn Rhoton, RN, MS, OCN^®, CCRC, at crhoton@cccoutreach.com.

What’s Going on Where You Are?

SIG Newsletter Editor Kara Penne, RN, MSN, ANP, AOCNP, would like to include clinical trial information in the newsletter as a regular column. Please e-mail trials in which you are participating to kara.penne@duke.edu. Let's share our knowledge and treatment options.

News From National

Did You Miss Congress 2005?
At Congress 2005, Mary Lovely, RN, PhD, presented a session titled "End-of-Life Issues for Patients With Primary or Metastatic Brain Tumors." The session can be accessed by clicking here.

Access Articles About Evidence-Based Practice
If you have questions about evidence-based practice, check out www.ons.org/evidence for information and resources.

Oncology Nurses Worldwide Bridges Cultural Gaps
In an ongoing effort to increase communication and awareness among nurses who treat patients with cancer, ONS has developed the Oncology Nurses Worldwide program.

ONS has members from 55 different countries, and the program was designed to create communication bridges among countries and cultures. The communication will bring the worldwide cancer care community closer while offering opportunities to share best practices.

Nurses interested in participating in the Oncology Nurses Worldwide program should visit http://onwvc.ons.wego.net/ for more detailed information and to fill out an application.

Quality Programming Will Make Congress 2006 the Best Yet
As the number one conference for oncology nurses, the ONS 31st Annual Congress will give you the knowledge you need to enhance your practice and improve patient care. You'll get the latest cancer care information and earn about 23.1 contact hours. For more information, visit www.ons.org/meetings/congress06/.

Earn Continuing Education Credit on a Caribbean Cruise
Registrations are being accepted for the "CE at Sea" cruise scheduled for October 15–22, 2006. Join your colleagues in the Caribbean for fun, sun, and education. Earn 14.4 contact hours while on a cruise ship. Cabin space is limited. Registrations will be made on a first-come, first-served basis, so don't delay. Register at http://onsopcontent.ons.org/Meetings/CEatSea/index.shtml.

ONS Releases Results of Member Survey on Medicare Cancer Care Cuts
ONS conducted a survey of its members in the first quarter of 2005 to learn about oncology nurses' perceptions and experiences with the implementation of the cancer-related provisions of the Medicare Modernization Act. Visit www.ons.org/lac/news_headline.shtml for complete information on the results.

Earn Valuable Rewards Through the ONS Member-Bring-a-Member Campaign
Get rewarded for spreading the good news about your society. Participation is easy. Just tell your colleagues about the many benefits of ONS membership and invite them to join ONS. You only need to recruit one member to earn your initial reward. Visit www.ons.org/membership/mbam.shtml for details.

Free Webcast on Oral Mucositis
A common and debilitating complication of cancer chemotherapy and radiotherapy, oral mucositis is a condition that all oncology nurses must know how to prevent and treat. "Mucositis: More Than Just Mouth Sores" will provide you with the information that you need. Upon successful completion, 1.2 contact hours will be awarded. Learn more at http://onsopcontent.ons.org/Education/Webcasts/Mucositis/.

Unique Research Opportunity Available for Advanced Practice Nurses
The ONS Foundation is offering the Research Grant-Writing Education Mentorship Program for master's-prepared nurses who have an idea for a research project but need guidance and education on developing a research proposal and submitting it for funding to the ONS Foundation Small Grants Program. For more information, visit www.ons.org/research/news.shtml.

Second Edition of Psychosocial Nursing Care Is on Sale Now
The newly revised and expanded, second edition of Psychosocial Nursing Care Along the Cancer Continuum details the psychosocial impact of cancer on a variety of patient populations and their families. Order your copy at http://esource.ons.org/ProductDetails.aspx?sku=INPU0554.

New Book Highlights Nutritional Issues in Cancer Care
Nutritional Issues in Cancer Care, authored by RNs and registered dietitians, is a new, practical guide on nutrition for healthcare professionals involved in the day-to-day management of patients in all phases of cancer care. Go to http://esource.ons.org/ProductDetails.aspx?sku=INPU0564 to order your copy today.

Get Connected with New List Serves
With the new ONS List Serves, you can go online to ask a question, post a comment, and open a dialogue with colleagues throughout the world. The ONS List Serves are provided as a forum for members to exchange information on topics ranging from chemotherapy to survivorship. Go to http://listserv.ons.wego.net/ to get started.

ONS Wins 2005 American Journal of Nursing Book of the Year Award
ONS is pleased to announce that the American Journal of Nursing (AJN) has awarded Nursing Management: Principles and Practice, edited by Mary Gullatte, with the prestigious 2005 AJN Book of the Year Award in the Nursing Management and Leadership category. For more information on the book and to buy a copy, click on http://esource.ons.org/ProductDetails.aspx?sku=INPU0553.

ONS Research Agenda for 2005-2009 Is Available
Learn what ONS's research priorities are for the next three years at www.ons.org/research/information/agenda.shtml.

ONS Katrina Resource Page
Thanks to all ONS members who have contributed to the recent hurricane relief efforts. With your help, displaced members have been offered support, jobs, and housing all over the United States. For more information about how you can still help, please visit the ONS Katrina Resource Page at www.ons.org/katrina.shtml.

Membership Information

• 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://sig.ons.wego.net, 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 (www.ons.org).
• Select "Membership" from the tabs above.
• Then, click on "Chapters, SIGs & Virtual Communities."
• Scroll down to "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.

• 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 screen, 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.

Neuro-Oncology SIG Officers

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angela Stengel, MS, CAE, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diane Scheuring, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

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
866-257-4ONS
412-859-6100
www.ons.org