Volume 16, Issue 2, July 2005
The Nurse Practitioner SIG Newsletter is underwritten through a grant from Amgen Inc.
Coordinator's Corner
New Coordinator Encourages Nurse Practitioners to Mentor Others

Wendy H. Vogel, MSN, FNP, AOCN®
Bristol, TN

I am honored to be your new Nurse Practitioner (NP) SIG coordinator! I want to thank Diane Cope, PhD, ARNP, BC, AOCN®, for her leadership during the past two years. ONS has 1,600 NPs and, as of March 2005, our SIG is now more than 900 strong! We had 55 people attend the SIG meeting at Congress this year, which was a wine and cheese event sponsored by the Femara® group of Novartis Pharmaceuticals. The minutes from this meeting can be viewed on the NP SIG Virtual Community. We have several workgroups that are gearing up for a great year, and we need your help. A communiqué explaining the workgroups will be coming out soon. Send an e-mail message to me or the chairperson of the workgroup to become part of the team.

I think you will enjoy this issue of our newsletter. Jean Rosiak, RN, MSN, OCN®, AOCNP, relates her feelings about being a new oncology NP after many years of being an oncology nurse. As a young graduate nurse, I remember reading an article in Nursing titled "Nurses: Are We Eating Our Young?" (Meissner, 1986). It described situations we see too often in the nursing field. I'd like to think that we are different in the field of oncology. Am I dreaming? Reach out to a new NP or NP student this week. Encourage a high-school student to consider nursing as a career. Let someone follow you for a day and see what NPs really can do. Join the mentorship program and be a resource for a new oncology NP. If you are the one who is new to oncology, join the mentorship program. We can pair you with a "seasoned" NP in oncology who will assist you as you grow into your practice.

The Nurse Practitioner SIG Newsletter is produced by members of the
Nurse Practitioner SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  July 2005

Coordinator's Corner
New Coordinator Encourages Nurse Practitioners to Mentor Others

Wendy H. Vogel, MSN, FNP, AOCN®
Bristol, TN

I am honored to be your new Nurse Practitioner (NP) SIG coordinator! I want to thank Diane Cope, PhD, ARNP, BC, AOCN®, for her leadership during the past two years. ONS has 1,600 NPs and, as of March 2005, our SIG is now more than 900 strong! We had 55 people attend the SIG meeting at Congress this year, which was a wine and cheese event sponsored by the Femara® group of Novartis Pharmaceuticals. The minutes from this meeting can be viewed on the NP SIG Virtual Community. We have several workgroups that are gearing up for a great year, and we need your help. A communiqué explaining the workgroups will be coming out soon. Send an e-mail message to me or the chairperson of the workgroup to become part of the team.

I think you will enjoy this issue of our newsletter. Jean Rosiak, RN, MSN, OCN®, AOCNP, relates her feelings about being a new oncology NP after many years of being an oncology nurse. As a young graduate nurse, I remember an article in Nursing titled "Nurses: Are We Eating Our Young?" (Meissner, 1986). It described situations we see too often in the nursing field. I'd like to think that we are different in the field of oncology. Am I dreaming? Reach out to a new NP or NP student this week. Encourage a high-school student to consider nursing as a career. Let someone follow you for a day and see what NPs really can do. Join the mentorship program and be a resource for a new oncology NP. If you are the one who is new to oncology, join the mentorship program. We can pair you with a "seasoned" NP in oncology who will assist you as you grow into your practice.

In this issue, you also will learn a little about ginger as an alternative treatment for nausea and vomiting. This literature review was shared with us by Michelle Cappiello, RN, MSN.

Deborah R. Heim, RN, MSN, ARNP, AOCN®, represented the NP SIG and ONS recently at the American Academy of NPs' annual Leadership Fellowship Program in Washington, DC. Her report from this meeting should be of interest to all of us. Many things are going on in the legislature that can affect our practice as NPs. I would passionately urge you to join ONStat, ONS's grass roots network. This will enable you to receive e-mail messages whenever we need to act on issues that are pertinent to our practice or issues that affect our patients. You will be directed to the legislative action center Web site, where you can click and send a prewritten e-mail message to your own legislators. It couldn't be easier. We must keep abreast of what is happening in Washington.

And speaking of keeping "abreast," I have shared some information about prophylactic mastectomy in high-risk patients in a literature review. I feel strongly about cancer prevention and hope you find this article useful.

Many opportunities exist for you to get involved with your NP SIG. This SIG will be as valuable and effective as you make it! I look forward to working with all of you during the next two years. Feel free to contact me at wvogel@charter.net with your suggestions, ideas, and comments. Here's hoping you have a great day!

Meissner, J.E. (1986). Nurses: Are we eating our young? Nursing, 16, 51–53.

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Special Interest Group Newsletter  July 2005

Leadership Fellowship Provided Opportunity to Influence Public Policy

Deborah R. Heim, RN, MSN, BC, AOCN®
Fort Myers, FL

I was privileged to represent the ONS Nurse Practitioner (NP) SIG at the American Academy of NPs (AANP) Leadership Fellowship Program held in Washington, DC, from March 29—31, 2005. The purpose of this program was to provide an opportunity for NP leaders to meet, hear from, and network regarding important NP issues with insiders in Washington.

AANP Director of Health Policy Jan Towers, PhD, CRNP, FAANP, led the program. Attendance was limited to 20 participants, who came, literally, from the entire country. Thirteen states were represented: California, Delaware, Florida, Hawaii, Iowa, Kentucky, Louisiana, Maine, New York, North Dakota, Ohio, Texas, and Washington.

Issues of concern to NPs were presented by Towers and discussed by the group. The relationship between the issues and the legislative process in Washington was explained. We then had the opportunity to meet with staff members in the Congressional offices to present the concerns and seek support for our viewpoint.

Title VIII provides funding for advanced practice NP education programs. Consideration is being given to cutting the money for NP education, so as we met with staffers, we emphasized that in this era of spiraling medical care costs and the shortage of professional nurses and primary care providers, the need to prepare NPs is acute; that NPs provide high-quality, cost-effective care; and that NPs serve vulnerable populations, assist in strengthening the public health infrastructure in our communities, and serve as first responders in the case of local and national disasters. It also was pointed out that because NPs do not have access to graduate medical education funds, Title VIII appropriations are the only federal source of funding for the preparation of NPs.

The Federal Employee's Compensation Act (FECA) covers workers' compensation for federal employees. Physicians, podiatrists, dentists, clinical psychologists, optometrists, and chiropractors are identified as authorized providers, but NPs are not. NPs diagnose and treat injuries and illnesses covered by FECA, but because they are not listed as providers, patients must seek care from other providers, often in more costly practice sites, adding cost and time to receiving treatment. Congressional staff members were asked to encourage the senators and representatives to add NPs to the list of authorized providers.

Even though federal Medicaid rules do not prohibit NPs from being listed as primary care providers (PCPs) in Medicaid managed care programs, states have been given permission to request waivers that allow them to exclude NPs from PCP panels. As a result, patients have been denied access to NP providers and primary care services in general. In the case of already functioning practices, this has resulted in the reassignment of patients and the dismantling of clinics. Staffers were reminded again that NPs provide high-quality care, often in underserved areas, and that our educational programs emphasize the provision of care to patients who have limited resources. The message to the senators and representatives is this: The language that allows states to exclude NPs from PCP panels need to be deleted.

NPs are authorized to provide medical services to residents of long-term care facilities. However, the initial rules and regulations are still in place that require that a physician make the admitting visit to a patient in a skilled nursing facility. This means that patients do not receive adequate and timely care in these settings. NPs are permitted to perform the admitting physical examination in many other settings and, as noted, provide high-quality, cost-effective care. A change is needed in the Medicare Conditions of Participation for NPs to be able to perform the admitting examination of a patient in a skilled nursing facility.

NPs proved reimbursable care to patients as Medicare Part B providers, rendering, ordering, and referring for services under our own provider identification and unique physician identification numbers. But we are unable to refer patients for home health care or hospice care, being forced to find a physician to sign orders at an additional cost for these services. A language change or an expanded interpretation of the word "physician" is needed in Part A, Section 1814, of the Medicare law.

Many other issues were brought up, including drug importation, malpractice caps, and U.S. Food and Drug Administration (FDA) regulation of tobacco.

Because this program took place during the week after Easter, all senators and representatives were on break. However, their offices were open and staff members were available. Each program attendee was given an afternoon to meet with staff in offices representing his or her home state. We were armed with printed materials explaining what an NP is, scope of practice, cost effectiveness, and quality of service. We discussed the issues noted previously and answered questions. Because I was representing ONS, I also brought up the current and potential affect on care of patients with cancer related to changes in Medicare reimbursement for chemotherapy administration. From the reports given by all of the NPs at our debriefing, most staffers were very receptive and we were confident that they would adequately present our concerns to the congressional representatives.

In addition to extensive discussion of these legislative concerns, panel presentations were offered on a number of topics. Staff members from various congressional offices sat on panels that covered appropriations; Medicaid, State Children's Health Insurance Program, rural health, malpractice, FECA and other health issues referred to the Senate Health, Education, Labor and Pensions Committee; and Medicare and health issues referred to the Senate Finance and House Ways and Means Committee. Representatives from U.S. Pharmacopeia, the Bureau of Health Professions at the Department of Health and Human Services, Centers for Medicare and Medicaid Services, and FDA also gave individual presentations.

In all, it was an extremely informative and busy two days of networking, learning, and sharing information and experiences. All participants took an active role in the discussions. This article is an attempt to convey just some of what took place. Many thanks go to the AANP for offering a scholarship to this event to the ONS, and to the ONS for choosing me as the representative to attend.

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Special Interest Group Newsletter  July 2005

From Expert to Novice . . . and the Long Road Back

Jean Rosiak, RN, MSN, APRN, BC, AOCNP
Waukesha, WI

People often say, "You can't teach an old dog new tricks." I'm happy to report that those who say this are wrong. But I have to admit that many times I have feared that they were right! The road is not an easy one at 50+ years of age when trying to develop the skills of an adult nurse practitioner (NP). Though I have been an oncology nurse for 30 years, I found acclimating to the mentality and knowledge base of primary care a major adjustment, not to mention the return to the academic setting. It truly was an exercise in persistence. I went from being the "expert" to being a student—quite a change!

In May 2004, I successfully completed my course of study and earned a master's degree in nursing. I was amazed that they let me graduate when I thought I knew so little. I was somewhat reassured by articles describing the challenges of the first year of practice of NPs (Brown & Olshansky, 1997, 1998; Roberts, Tabloski, & Bova, 1997). Maybe I'm not the first who has felt so incompetent. I can relate to the "imposter phenomenon" described by Arena and Page (1992). I am saddened by anecdotal reports of so many NPs that they cried every day of the first year of their practice. I didn't want my first year as a legitimate practitioner to be that way.

I had a stable job with a medical oncology practice, so finding a job was not an issue. I intended to remain with the practice, but surprisingly, soon after graduation, I hit roadblocks from the very person who had been the greatest supporter of my education. Suddenly this person was threatened by my ability to provide the same services that a physician provides. Comments like "no one wants to see a NP instead of the doctor!" and obvious attempts to find errors in my diagnoses, judgment, and orders blindsided me. Eventually, I realized that I needed to find an environment that was more supportive and appreciative of NPs.

Much soul searching made me examine what I intended to do with the rest of my professional life and find meaning in what had come before. God knows how many (or few) years I may have. At age 51 and in our business, I realized how precious, fragile, and short life may be. So I wanted it to be fulfilling and meaningful.

I didn't want my first year to be a miserable memory, but like so many other NPs that I have spoken with, that's partially what it turned out to be. But thanks to the support of so many of my NP colleagues, I had many opportunities to express my concerns and get advice from those who had traveled this road before me. They helped me to examine where I was and where I wanted to be and helped me figure out how to get there. They supported me during my move from a toxic situation to a more healthy and fulfilling environment.

I am now a "seasoned" NP with one whole year of experience. Oncology is where my heart is and where I always will stay. I am a NP at a comprehensive breast health center and continue to benefit from the experience of my colleagues locally and from ONS nationally who work in oncology and breast health and have been an invaluable source of emotional and educational support. I have achieved national certification as an adult NP and advanced oncology certified NP, as well as prescriptive privileges in my state. I no longer feel obligated to say I am a "new" NP.

I want to appeal to other NPs to help mentor new NPs through that difficult first year. By participating in the NP SIG Mentoring Program, we can help others enter a new role. We also can help established NPs who are transitioning into new roles to develop their niche. Learning from the experiences and mistakes of others and having the support of someone who truly understands is so helpful.

I gained so much from the informal mentoring of my colleagues, and I truly believe that I would not have arrived so successfully in a better place without their support. I'd love to make a difference in how these experiences go for other NPs, both new and established. By offering a formal mentoring program through our SIG, we can be a resource for those who may not have available support locally. Please join our NP SIG in establishing a mentoring program to help others' experiences be more positive.

For information about the SIG Mentorship Program, contact Kathy Sharp, RN, MSN, APRN-BC, AOCNP, at mulekat@charter.net.

Arena, D.M., & Page, N.E. (1992). The imposter phenomenon in the clinical nurse specialist role. Image: Journal of Nursing Scholarship, 24, 121-125.

Brown, M.A., & Olshansky, E.F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. Nursing Research, 46(1), 46-51.

Brown, M.A., & Olshansky, E. (1998). Becoming a primary care nurse practitioner: Challenges of the initial year of practice. Nurse Practitioner, 23(7), 46-66.

Roberts, S.J., Tabloski, P., & Bova, C. (1997). Epigenesis of the nurse practitioner role revisited. Journal of Nursing Education, 36(2), 67-73.

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Special Interest Group Newsletter  July 2005

Complementary and Alternative Medicine: The Use of Ginger in Oncology Practice

Michelle Cappiello, RN, MSN
Cheshire, CT

Name: Known as ginger root, Canada snakeroot, Indian ginger, or Vermont snakeroot

Oncology-related indications: Chemotherapy-induced nausea and vomiting or postoperative nausea and vomiting; possible cancer prevention

Other indications: Motion sickness, nausea and vomiting during pregnancy, heartburn/indigestion, anti-inflammatory (rheumatoid and osteoarthritis), migraines, appetite stimulant, and cold remedy

Description/mechanism of action: Ginger's underlying antiemetic activity is unknown. Researchers believe that ginger acts directly on the gastrointestinal tract and that it does not involve or affect the central nervous system. The two active ingredients in ginger are shagoal and gingerol. These ingredients are believed to suppress gastric contraction while increasing gastrointestinal mobility and spontaneous peristaltic activity. They also have an antiserotonin effect and scavenging activity against free radicals that cause emesis. Gingerol and shagoal also have been found to have the effects of analgesic, antipyretic, antitussive, antiulcer, hypotensive, cardiovascular depressant, mutagenic, prostaglandin suppression, and relief for enteromobility sickness.

Side-effect profile: Side effects are rarely seen but include inhibition of platelet aggregation, which may lead to prolonged bleeding and decreased cholesterol levels.

Review of the literature: Two significant studies have found ginger to be an effective postoperative antiemetic for women undergoing laparoscopic gynecologic surgery (Phillips, Ruggier, & Hutchinson, 1993) and major gynecologic surgery (Bone, Wilkinson, Young, & Charlton, 1990). Both determined that 1 gram of powdered ginger rhizome was similar to 10 mg of oral metoclopramide in decreasing the frequency of nausea and vomiting after the respective surgery.

Ginger also has been studied for its effectiveness in reducing chemotherapy-induced nausea and vomiting; however, mixed results have been found. Most data that currently are available have been retrieved from animal studies. In Suncus murinus (Asian musk shrews), ginger extract has exhibited significant protection of cyclophosphamide-induced emesis (Yamahara, Rong, Naitoh, Kitani, & Fujimura, 1989). When studied in dogs, ginger extract also revealed protection from cisplatin-induced emesis (Sharma, Kochupillai, Gupta, Seth, & Gupta, 1997). Until recently, only one study reported the effect of ginger for reducing chemotherapy-induced emesis in humans (Pace, 1987). Then Meyer, Schwartz, Crater, and Keyes (1995) found that taking ginger prior to the administration of 8-methyloxypsoralen could substantially reduce nausea in patients undergoing photophoresis. More recently, Manusirivithaya et al. (2004) looked at the antiemetic effect of ginger in patients with gynecologic cancer receiving cisplatin. They found that the addition of ginger to a standard antiemetic regimen of metoclopramide had no advantage in reducing nausea or vomiting in the acute phase of emesis. However, they did believe that ginger might have some effectiveness in the delayed phase of cisplatin-induced emesis.

Evidence also exists that ginger may have some anticancer effects (Grant & Lutz, 2000). Burton (2003) reported that evidence was found that ginger might prevent cancer. Gingerol was fed to mice that were injected with human colon cancer cells, and tumors in the mice treated with ginger took longer to appear and were less invasive than the tumors in the mice that were not treated. No human studies have looked at ginger's ability to slow or prevent tumor development, and further investigation into this area is warranted.

Several studies have shown the efficacy of ginger in treating its other indications, such as motion sickness, indigestion, arthritic symptoms, and nausea and vomiting during pregnancy. More specifically, ginger is an alternative and complementary therapy that has shown great promise in the field of oncology. However, the number of studies that show evidence and prove that ginger plays a role in prevention of nausea and vomiting in humans is inadequate. Most of the results are from animal studies in which ginger extract was used. These results may not be consistent with studies in humans or with administration of the raw plant. Therefore, further research is needed to determine the definite value and role of ginger not only in postoperative and chemotherapy-induced nausea and vomiting but also in the prevention of cancer.

Bone, M.E., Wilkinson, D.J., Young, J.R., & Charlton, S. (1990). Ginger root-A new antiemetic. Anaesthesia, 45, 669-671.

Burton, A. (2003). Chemoprevention: Eat ginger, rub on pomegranate. Lancet, 4, 715.

Grant, K.L., & Lutz, R.B. (2000). Ginger. American Journal of Health-System Pharmacy, 57, 945-947.

Manusirivithaya, S., Sripramote, M., Tangjitgamol, S., Sheanakul, C., Leelahakorn, S., Thavaramara, T., et al. (2004). Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. International Journal of Gynecological Cancer, 14, 1063-1069.

Meyer, K., Schwartz, J., Crater, D., & Keyes, B. (1995). Zingiber officinale (ginger) used to prevent 8-MOP associated nausea. Dermatology Nursing, 7, 242-244.

Pace, J.C. (1987). Oral ingestion of encapsulated ginger and reported self-care actions for the relief of chemotherapy-associated nausea and vomiting. Dissertations Abstracts, 47, 3297-3298.

Phillips, S., Ruggier, R., & Hutchinson, S.E. (1993). Zingiber officinale (ginger)-An antiemetic for day case surgery. Anaesthesia, 48, 715-717.

Sharma, S.S., Kochupillai, V., Gupta, S.K., Seth, S.D., & Gupta, Y.K. (1997). Antiemetic efficacy of ginger (Zingiber officinale) against cisplatin-induced emesis in dogs. Journal of Ethnopharmacology, 57, 93-96.

Yamahara, J., Rong, H.Q., Naitoh, Y., Kitani, T., & Fujimara, H. (1989) Inhibition of cytotoxic drug-induced vomiting in suncus by a ginger constituent. Journal of Ethnopharmacology, 27, 353-355.

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Special Interest Group Newsletter  July 2005

Prophylactic Mastectomy in High-Risk Patients: Keeping “Abreast” of Recent Literature

Wendy H. Vogel, MSN, FNP, AOCN®
Bristol, TN

A patient at high risk for breast cancer has three options for early detection and risk reduction. These options are increased surveillance, chemoprevention, and prophylactic surgery. Studies suggest that prophylactic mastectomy may infer up to 90% risk reduction for breast cancer (Newman et al., 2000). The benefits of prophylactic mastectomy relative to chemoprevention are not known because no prospective randomized studies have compared the two strategies (Newman et al.).

Prophylactic mastectomy may be effective in preventing a breast cancer in high-risk women as well as those with a known BRCA mutation (Metcalfe, 2004; Rebbeck et al., 2004). Hartmann et al. (1999) was able to quantify a 90% reduction in breast cancer risk with prophylactic mastectomy in medium- to high-risk women. They estimated an 81%–94% reduction in breast cancer mortality with prophylactic mastectomy. A survival advantage appears to exist in young women who have a BRCA mutation (Houshmand, Campbell, Briggs, McFadden, & Al-Tweigeri, 2000). Prophylactic mastectomy may improve longevity in BRCA mutation carriers, but this must be balanced against the impact on quality of life (Newman et al., 2000).

Choosing whether to perform a prophylactic mastectomy should be a multidisciplinary decision. Detailed counseling should be completed, and patients should understand the limitations of the procedure and the need for postoperative surveillance (Sakorafas & Tsiotou, 2000). Patients also should be well informed about alternative strategies such as chemoprevention and increased surveillance.

In a recent Cochrane study (Lostumbo, Carbine, Wallace, & Ezzo, 2004), 23 studies were reviewed and analyzed. No randomized or nonrandomized controlled trials were found. Most of these studies were either case series or cohort studies. Thirteen studies looked at the effectiveness of bilateral prophylactic mastectomy, and six studies assessed contralateral prophylactic mastectomy. No study assessed all-cause mortality. These studies demonstrated that bilateral prophylactic mastectomy was effective in reducing the incidence of and death from breast cancer. However, the authors concluded that more rigorous prospective trials are needed, and ideally these trials would be randomized.

A paucity of data existed for indications for contralateral prophylactic mastectomy. Data did indicate that although contralateral mastectomy does appear to reduce the incidence of cancer in the contralateral breast, not enough evidence existed to say that it improved survival. McDonnell et al. (2001), Peralta et al. (2000), and Schrag, Kuntz, Garber, and Weeks (1997) all concluded that contralateral prophylactic mastectomy provides risk reduction for patients at high risk for contralateral breast cancer.

Frost et al. (2000) reported that most women are satisfied with prophylactic mastectomy, and positive outcomes from this surgery included decreased emotional concern about developing breast cancer and generally favorable psychological and social outcomes. This still has to be weighed, however, against the irreversibility of the decision, potential problems related to implants and reconstruction, and adverse psychological and social outcomes in some women. Comprehensive genetic risk assessment programs can play a significant role in the management of patients who are considering prophylactic surgery for perceived high risk of breast cancer (Morris, Johnson, Krasikov, Allen, & Dorsey, 2001).

Prophylactic oophorectomy also has been shown to decrease the risk for breast and ovarian cancer. Retrospective and prospective studies have shown breast cancer risk reduction after both prophylactic oophorectomy and mastectomy (Dowdy, Stefanek, & Hartmann, 2004). Decision analysis of prophylactic mastectomy and oophorectomy for BRCA-positive patients have shown that life expectancy can be extended up to five years (Levine & Gemignani, 2003).

Because of the current status of reconstruction techniques, total mastectomy is the preferred prophylactic procedure (Ghosh & Hartmann, 2002; Gray, Artioli, & Olopade, 2004; van Geel, 2003). Total mastectomy is a more definitive procedure, although recent reports show that some patients are undergoing subcutaneous, nipple-sparing procedures. Even with total mastectomy, small amounts of breast tissue can remain in the axilla, inframammary fold, and skin flaps. This could potentially develop into breast cancer; therefore, the risk of breast cancer cannot be completely eradicated. Studies have reported the development of breast cancer following subcutaneous mastectomies (Hartmann et al., 1999; Pennisi & Capozzi, 1989; Willemsen, Kaas, Peterse, & Rutgers, 1998). Rebbeck et al. (2004) studied 483 patients with BRCA mutations following prophylactic mastectomy. The women had one of four procedures: total mastectomy, subcutaneous mastectomy, modified radically mastectomy, or radical mastectomy. Two women developed breast cancer following their prophylactic surgeries. A conclusion could not be drawn about the most effective surgery, but these two women did receive less aggressive procedures (Ault, 2004). According to a review of the literature, most of the research that reports follow-up on subcutaneous mastectomies has been reported in patients with breast cancer, not patients at high risk for breast cancer. Patients should be made aware of the differences of risk reduction between total mastectomy and less aggressive surgeries.

Follow-up after a prophylactic mastectomy is vital. Patients should perform regular monthly examination of the chest wall and have an annual clinical examination. If a patient has had a subcutaneous mastectomy, annual mammography should be strongly considered. This is an area of controversy, however, and should be researched further (Ghosh & Hartmann, 2002).

In summary, the decision to undergo prophylactic mastectomy to decrease breast cancer risk is difficult and complicated. Women need thorough education regarding their personal risk and all of the options available to them. Risks and benefits of each option should be examined in detail. Multidisciplinary input from the oncology nurse practitioner, oncologist, surgeon, plastic surgeon, genetic counselor, and mental health professional are crucial for a well-informed decision.

Ault, A. (2004). Prophylactic mastectomy substantially reduces cancer in BRCA 1/2 carriers. Retrieved February 28, 2005, from http://www.medscape.com/viewarticle/470788?src=search

Dowdy, S., Stefanek, M., & Hartmann, L. (2004). Surgical risk reduction: Prophylactic salpingo-oophorectomy and prophylactic mastectomy. American Journal of Obstetrics and Gynecology, 191, 1113–1123.

Frost, M., Schaid, D., Sellers, T., Slezak, J., Arnold, P., Woods, J., et al. (2000). Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA, 284, 319–324.

Ghosh, K., & Hartmann, L. (2002). Current status of prophylactic mastectomy. Oncology, 16, 1319–1325.

Gray, S., Artioli, G., & Olopade, O. (2004). Genetics in clinical cancer care: Prophylactic surgery in inherited cancer syndromes. PPO Updates, 18(2), 1–19.

Hartmann, L., Schaid, D., Woods, J., Crotty, T., Myers, J., Arnold, P., et al. (1999). Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New England Journal of Medicine, 240, 77–84.

Houshmand, S., Campbell, C., Briggs, S., McFadden, A., & Al-Tweigeri, T. (2000). Prophylactic mastectomy and genetic testing: An update. Oncology Nursing Forum, 27, 1537–1547.

Levine, D., & Gemignani, M. (2003). Prophylactic surgery in hereditary breast/ovarian cancer syndrome. Oncology, 17, 932–941.

Lostumbo, L., Carbine, N., Wallace, J., & Ezzo, J. (2004). Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database System Review, 2004, 4, CD002748.

McDonnell, S., Schaid, D., Myers, J., Grant, C., Donohue, J., Woods, J., et al. (2001). Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. Journal of Clinical Oncology, 19, 3938–3943.

Metcalfe, K. (2004). Prophylactic bilateral mastectomy for breast cancer prevention. Journal of Women's Health, 13, 822–829.

Morris, K., Johnson, N., Krasikov, N., Allen, M., & Dorsey, P. (2001). Genetic counseling impacts decision for prophylactic surgery for patients perceived to be at high risk for breast cancer. American Journal of Surgery, 181, 431–433.

Newman, L., Kuerer, H., Hung, K., Vlastos, G., Ames, F., Ross, M., et al. (2000). Prophylactic mastectomy. Journal of the American College of Surgeons, 191, 322–330.

Peralta, E., Ellenhorn, J., Wagman, L., Dagis, A., Andersen, J., & Chu, D. (2000). Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. American Journal of Surgery, 180, 439–445.

Pennisi, V., & Capozzi, A. (1989). Subcutaneous mastectomy data: A final statistical analysis of 1500 patients. Aesthetic Plastic Surgery, 13(1), 15–21.

Rebbeck, T., Friebel, T., Lynch, H., Neuhausen, S., van't Veer, L., Garber, J.E., et al. (2004). Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE study group. Journal of Clinical Oncology, 22, 1055–1062.

Sakorafas, G., & Tsiotou, A. (2000). Prophylactic mastectomy; evolving perspectives. European Journal of Cancer, 36, 567–578.

Schrag, D., Kuntz, K., Garber, J., & Weeks, J. (1997). Decision analysis-effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA 1 or BRCA 2 mutations. New England Journal of Medicine, 336, 1465–1471.

van Geel, A. (2003). Prophylactic mastectomy: The Rotterdam experience. Breast, 12, 357–361.

Willemsen, H., Kaas, R., Peterse, J., & Rutgers, E. (1998). Breast carcinoma in residual breast tissue after prophylactic mastectomy. European Journal of Surgical Oncology, 24, 331–332.

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Special Interest Group Newsletter  July 2005

Interested in Reviewing the Latest in Oncology-Related Resources? Consider Becoming an Oncology Nursing Forum Reviewer

The Oncology Nursing Forum's Knowledge Central Review Board is composed of oncology nurses who enjoy reading and evaluating newly released books, pamphlets, videos, CDs, DVDs, and Web sites that are relevant to oncology nursing. Reviewers are contacted by the column's associate editor when media specific to their content area are received. Previous experience as a reviewer is a plus but not necessary.

Reviewers are valued volunteers who contribute their professional knowledge and clinical expertise to the Oncology Nursing Forum and are credited for their reviews. Reviewers can keep the media once reviews are complete.

To learn more about serving as a reviewer or to request an application, call 412-859-6271 or e-mail pubONF@ons.org.

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Special Interest Group Newsletter  July 2005

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://sig.ons.wego.net/index.v3page;jsessionid=l5nhe8e4qt77?v2_group=0&p=4918, 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 “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 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.
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Special Interest Group Newsletter  July 2005

Nurse Practitioner SIG Officers

Coordinator (2005-2007)
Wendy Vogel, RN, MSN, FNP, AOCN®
405 Pettyjohn Rd.
Kingsport, TN 37664-4716
423-323-0715 (H)
423-968-2311 (O)

Ex-Officio (2005-2006)
Diane Cope PhD, ARNP-BC, AOCN®
605 Astarias Circle
Fort Myers, FL 33919-3247
239-437-3571 (H)
239-437-4444 (O)

Web Site Administrator
Bridget A. Cahill, RN, MS, APN, NPC
5145 N. Meade Ave.
Chicago, IL 60630-1826
773-775-9575 (H)
312-695-0316 (O)
312-695-6189 (Fax)


Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
709 W. Baker Ave.
Abingdon, MD 21009-1457
410-538-7946 (H)
410-614-6894 (O)

Deborah Heim, RN, MSN, BC, AOCN®
5150 Harborage Dr.
Fort Myers, FL 33908-45
42 239-466-4990 (H)
239-437-4444 (O)

ONS Publishing Division Staff
Elisa Becze, BA
Copy 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, Director of Membership/Leadership

Diane Scheuring, 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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