Volume 17, Issue 1, March 2006
The Nurse Practitioner SIG Newsletter is underwritten through a grant from Amgen Inc.
     
Coordinator's Corner
Upcoming Conferences Offer Opportunity to Get Involved With the SIG


Wendy H. Vogel, MSN, FNP, AOCN®
Bristol, TN
wvogel@charter.net

At this time of year, Nurse Practitioner (NP) SIG members start to look ahead to the next ONS Congress. We are meeting in Boston, MA, for the 31st Annual Congress, and I hope to see you all there! Our SIG planning/networking meeting will be on Thursday, May 4, from 5:15–6:30 pm, and we are planning a wine and cheese reception. Stay tuned for a communiqué with more details. We also will have a panel discussion for advanced practice nurses (APNs) about the Doctorate of Nursing Practice on Saturday, May 6. I am sure all of you will be most interested in this session. The panel will consist of an NP, a clinical nurse specialist (CNS), a doctoral student, and a member of the American Association of Critical Care Nurses. You will want to attend this session, and remember to bring all of the questions you want to ask.

We also must think ahead toward the first Oncology APN Conference in November. Be sure to check this one out, because it will be a great conference for APNs. We will have sessions on professional roles, specific cancers, symptom management, genetics, and palliative care. Barbara Holmes Gobel, RN, MS, AOCN®, the CNS SIG coordinator, and I are co-leading the conference team, and we are so pleased with the speakers the team has recruited thus far. Our keynote speaker is Peter Bjerkerot, RN, BSN, OCN®, an oncology nurse consultant who is sure to bring some humor to an enthusiastic opening ceremony. You won't want to miss this conference. Because of space limitations, enrollment will be limited to the first 700 participants, so enroll early.

I couldn't miss this opportunity to congratulate Mary Beth Singer, MS, APRN, BC, AOCN®, for receiving the 2006 ONS Excellence in Pain Management Award. Also, Jeanie Rosiak's, RN, MSN, APRN, BC, AOCN®, article, "From Expert to Novice...and the Long Road Back," published in the July 2005 NP SIG Newsletter, has been nominated for the SIG Best Newsletter Article award. Congratulations, ladies!

I want to remind you of the work groups that we would like you to consider joining. The work groups and the chairperson of each group are as follows.

  • Mentoring Work Group: Kathy Sharp, MSN, APRN-BC, AOCNP, mulekat@charter.net
  • Legislative Work Group: Wendy Vogel, MSN, FNP, AOCN®, wvogel@charter.net
  • Membership Work Group: no identified chair
  • Archives Work Group: Barb Biedrzycki, RN, MSN, AOCN®, CRNP, npbiedrzycki@aol.com
  • Education Work Group: no identified chair
  • Nominating Work Group: no identified chair
  • Meeting Planning: Candace Schiffer, MSN, ANP-C, AOCNP, candance@arenaonc.com

I would like to see us form some special short-term project work groups as well—does anyone have any ideas? In addition, I would urge you to consider writing a short article for our newsletter this year. Please contact Barb Biedrzycki, RN, MSN, AOCN®, CRNP, our lead editor, at npbiedrzycki@aol.com for more details.

Enjoy the newsletter, and I hope to see you at Congress!

 
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  March 2006
 
   

It Just Keeps Getting Better: Recap of the 2005 Oncology Nurse Practitioner Conference

Heather Brumbaugh, RN, MSN, ANP, AOCN®
Durham, NC
brumb001@mc.duke.edu

In November 2004, ONS held the first Oncology Nurse Practitioner (NP) Conference in Nashville, TN, in conjunction with the Institutes of Learning (IOL) to share resources. Because of the success of the first conference, ONS decided that a second conference would be held with IOL in 2005. I had been a team member on the planning committee for the first conference and was asked to be the team leader for the second. I was very excited to participate and work to build on what we had learned from the first conference. The first challenge was selecting the other team members. The wonderful news was that we had nearly 30 NPs across the country who were interested in participating! Along with Laura Fennimore, RN, MSN, and Kris LeFebvre, MSN, RN, AOCN® from ONS, we selected Brenda Brien, RN, MSN, APRN-BC, Jormain Cady, ARNP, MS, AOCN®, and Mary Beth Singer, MS, APRN, BC, AOCN®. Bridget Cahill, MS, APN, also joined the team as the NP SIG representative.

Our first meeting was held at the ONS National Office in Pittsburgh, February 25–27, 2005. We used results from the 2004 ONS Oncology NP Conference as well as our own experiences to identify areas of need and interest. We started with ideas that had worked the first year and also tried to come up with creative ways to improve the conference. By the end of the weekend, we had narrowed the topics, filled in the schedule, and identified potential speakers. It was a lot of work but also a great deal of fun. As was the case in 2004, I found it exciting that, again in 2005, we all had similar ideas as to what we wanted and needed for a continuing education conference.

One of the challenges was identifying the speakers. We wanted to be sure to invite people with expertise on the topics as well as speaking experience. And because we had a limited budget to work with, reimbursement for their time and effort was an issue. We tried to identify NPs or clinical nurse specialists (CNSs) with the expertise to deliver a presentation that would address our learning needs. After we left Pittsburgh, we returned to our usual busy lives and worked on contacting speakers and conveying to them what we envisioned for the presentations they were asked to deliver.

As summer came, we breathed a small sigh of relief because we thought things were coming together. Then, the day the brochures went out, the planned keynote speaker told us he was unavailable! We quickly had a conference call to discuss other options. After a week of scrambling, we moved our closing speaker to the opening spot and found a speaker to address the controversial Doctorate of Nursing Practice for the closing.

On November 10, the conference opened in Phoenix, AZ, with Suzanne Gordon, an award-winning journalist and author, giving a thought-provoking presentation followed by a book signing. During the next two days of the conference, many topics were covered and, although we knew it was not possible to include every issue or to please everyone, we believed we had chosen a wide enough variety of sessions to meet the educational needs of most attendees. Topics covered included

  • Plenary sessions on advances in radiology, advocacy and health policy, and pain management
  • Breakout sessions on topics such as peripheral neuropathy, sexuality, polypharmacy, collaborative practice, steroids, hypersensitivity reactions, late effects, and sickle cell disease
  • Informal roundtable discussions that included the addition of a topic relating to the Gulf Coast after Hurricane Katrina so that NPs from that area could share their experiences with others.

The conference was very well attended, and several sessions had to turn people away because the room was full. Fortunately, the sessions were repeated so all who wanted to attend had the opportunity to do so. I was excited to hear attendees comment on the improvement from the first year, and I encouraged them to give suggestions for the following year so that we can continue to improve the conference. I am looking forward to next year when we combine with CNSs for an APN conference.

 
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Special Interest Group Newsletter  March 2006
 
   

Electronic Interview
SIG Member Shares Her Experience at the Oncology Nurse Practitioner Conference

Annette W. Kuck, RN, MS, CS, AOCN®
Minneapolis, MN
kuckhouse@aol.com

Coeditor's Note. Annette W. Kuck, RN, MSN, CS, AOCN®, a Nurse Practitioner (NP) SIG member and attendee at the 2005 Oncology NP Conference, volunteered for this electronic interview to provide NP SIG members who were unable to attend the conference with an unbiased perspective on the conference. If you have questions about the conference, please e-mail the NP SIG coordinator or one of the coeditors.

Why were you satisfied with the Oncology NP Conference?
The Oncology NP Conference offered an opportunity for advanced practice nurses (APNs) to come together to network about clinical practice and professional issues. Some of the educational sessions were aimed at advanced practice issues such as differentiating the different types of skin reactions or managing patients with steroid-induced hyperglycemia. Others addressed professional issues such as advocacy, publishing, and the nursing practice doctorate. This resulted in a well-rounded educational forum for advancing clinical knowledge and NP professionalism. Non-APN conferences address many of the same issues, but the oncology NP conference is likely to cover differential diagnosis, critical thinking, and prescription authority issues. It also offered an opportunity for NPs to network before, during, and after the conference. Certainly for this conference, the nursing practice doctorate was the hot topic, and it was helpful to learn more about the current proposal.

Provide an example or two of the educational content that was especially useful.
Lisa Schulmeister, RN, MS, CS, OCN® provided a very visual and clinically relevant presentation on skin rashes and reactions. With the influx of new chemotherapy agents that cause skin reactions, the ability to describe and differentiate skin rashes versus reactions is critical. Rowena Schwartz, PharmD, gave an entertaining but practical talk on polypharmacy. Older patients with multiple medical diagnoses in addition to cancer present pharmacological challenges to healthcare providers. Tracy Gosselin-Acomb, RN, MSN, AOCN®, gave an update on advances in radiation oncology that affect the overall care of patients with cancer.

Why should an oncology NP who has never been to the Oncology NP Conference consider attending next year?
The 2006 conference will be aimed at advanced practice nursing, for both clinical nurse specialists (CNSs) and oncology NPs. Attendance is beneficial for networking with other APNs in both specialties, and the smaller scale of the conference, along with the efforts of the SIG members, make this easier to accomplish than at the ONS Congress. The educational sessions are more specific to APNs than to basic oncology. A participant must look at his or her own personal goal of attending the conference to determine whether the APN conference versus the broader, varied topics of Congress is the right fit.

 
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Special Interest Group Newsletter  March 2006
 
   

Nurse Practitioner News

Nurse Practitioner SIG Nominates Article for the ONS National Best SIG Newsletter Article Award
Seven Nurse Practitioner (NP) SIG members reviewed the 2005 NP SIG Newsletter articles and chose "From Expert to Novice . . . and the Long Road Back" by Jean Rosiak, RN, MSN, BC, OCNP, of Waukesha, WI, as our nomination for the ONS SIG Best Article Award. Jean's article is a heart-warming reflection on the journey many NPs have traveled. If you'd like to review the article from the July 2005 issue of the NP SIG newsletter, visit the SIGs Virtual Community.

Articles Needed for CJON's Case Analysis Column
Are you looking for a writing opportunity? Do you have expertise in a specific primary care issue? The Clinical Journal of Oncology Nursing (CJON) has a column, titled Case Analysis, that reviews primary care issues seen in the oncology setting. Writers are needed for the column. If you have never written before, this is an excellent opportunity to get started. The associate editor is willing to mentor you in the writing process. If you are interested in this experience or want more information about the column, please contact CJON Associate Editor Joyce Marrs, MS, APRN-BC, AOCNP, at joycemrn@sbcglobal.net or 937-760-9824.

Newsletter Writers Wanted
If you are interested in writing a brief news report for one of the three annual NP SIG newsletters, please contact one of the coeditors as soon as possible (see SIG Officers page for all contact information). We are planning the content for the remaining two 2006 newsletters and want to be sure we save space for your article. Submissions may be as brief as 300 words or as long as 900, including references.

We are looking for news items that would be of interest to our NP readers. Perhaps you are involved in a novel care delivery, want to share your success with a clinical pearl, have ideas about mentoring, have valuable experience with the Medicare Modernization Act, or have other news that you'd like to share. The NP SIG newsletter is here for you to share your information with your oncology NP colleagues. You can help us fulfill the newsletter's goal by writing a brief report.

Published writing experience is not required. If your writing topic isn't fully developed, don't fret. The newsletter editorial team is looking forward to helping you get your information into the newsletter. Please run your topics by us, and we will work with you to develop your news item. Of course, we also accept fully developed news items written by seasoned writers.

 
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Special Interest Group Newsletter  March 2006
 
   

Clinical Update
Dermatologic Toxicities

Diane Cope, PhD, ARNP, BC, AOCNP
Fort Myers, FL
dgcope@comcast.net

Introduction
The recent discovery of epidermal growth factor receptor- (EGFR-) targeted therapies provides additional options in cancer treatments. Cetuximab (Erbitux™, ImClone Systems Inc., New York, NY) is a new U.S. Food and Drug Administration- (FDA-) approved targeted therapy for locally advanced or metastatic EGFR-positive colorectal cancer refractory to irinotecan-based chemotherapy. On March 1, 2006, the FDA gave cetuximab a new indication for head and neck cancer. It is approved for use in combination with radiation and also alone for platinum-based chemotherapy-refractory head and neck cancer. Erbitux targets and inhibits cellular processes that stimulate tumor growth and progression. As a result of the "targeted" action, patients experience fewer toxic side effects than generally seen with standard chemotherapy, such as nausea, vomiting, and hair loss.

Side effects characteristically seen with EGFR inhibitors are diarrhea and adverse skin reactions. Adverse skin reactions can include skin drying, fissuring, inflammation, nail disorders, and acneform skin rash. The exact etiology is not fully understood; however, EGFR is expressed in the epidermis and hair follicles, and EGFR inhibitors may interfere with signaling pathways in the skin (Busam et al., 2001; Perez-Soler & Saltz, 2005). This clinical update will discuss the more common side effect of dermatologic toxicities and will present assessment and treatment strategies.

Incidence
The acneform skin rash can occur in as many as 85%–90% of patients receiving EGFR inhibitors. The rash can range from mild to severe, with severe rashes covering 50% or more of the body surface area.

Clinical Presentation
The skin rash commonly affects the face, scalp, chest, and upper back and is mild to moderate with a papular appearance. The rash can appear within a few days or as long as three weeks after initiation of therapy (Yamamoto, Viale, & Zhao, 2004) and range from skin dryness to a mild macular or papular rash to a more severe, painful eruption of lesions and ulcers.

Assessment
Assessment of the acneform skin rash has been based on the Common Terminology Criteria for Adverse Events of the National Cancer Institute (see Table 1). It has been suggested that a more specific grading system is needed to better assess this distinct toxicity (Busam et al., 2001; Tsao, Garey, An, & Kim, 2003).

Prior to initiation of treatment, oncology nurses should perform a baseline dermatologic assessment (Krozely, 2004). This assessment should include documentation of patients' previous and current skin problems and a complete list of medications, including over-the-counter and alternative therapies, followed by a thorough skin examination.

After treatment has been initiated, weekly assessments should be performed because the rash can begin in two to three days and peak in two to three weeks.

Treatment
No controlled trials are studying the management of skin toxicities associated with EGFR-inhibitor therapy. Treatment should be based on the presenting skin rash and, once documented, should begin immediately. Suggested treatments for dermatologic toxicities, including the acneform skin rash, are summarized in Table 2.

Patient education should include information regarding the dermatologic toxicities and management of skin alterations. Patients should be instructed to avoid sun exposure and use sunscreen and told when to notify the healthcare provider. Over-the-counter acne medications should not be used because they contain benzoyl peroxide and may cause further drying effects to the skin.

Dosage reductions may be required for patients who experience severe acneform rash. With the first recurrence, treatment should be delayed for one to two weeks until improvement is seen. The treatment then can be resumed without a dosage reduction. For a second occurrence of severe acneform rash, treatment is again delayed for one to two weeks and resumed at a dosage reduction of 200 mg/m2. For a third recurrence, treatment is delayed for one to two weeks and resumed at 150 mg/m2. If a fourth occurrence of acneform rash is experienced, Erbitux is discontinued (ImClone Systems Incorporated & Bristol-Myers Squibb Company, 2004).

Conclusion
In most cases, the acneform skin rash is not severe and can be managed with topical and oral therapies. Oncology nurses play a key role in assessment, education, and prompt treatment to prevent significant complications and dose delays in therapy.

References

Busam, K.J., Capodieci, P., Motzer, R., Kiehn, T., Phelan, D., & Halpern, A.C. (2001). Cutaneous side effects in cancer patients treated with the antiepidermal growth factor receptor antibody C225. British Journal of Dermatology, 144, 1169-1176.

ImClone Systems Incorporated & Bristol-Myers Squibb Company. (2004). Erbitux (cetuximab) [Package insert]. Princeton, NJ: Bristol-Myers Squibb.

Krozely, P. (2004). Epidermal growth factor receptor tyrosine kinase inhibitors: Evolving role in the treatment of solid tumors. Clinical Journal of Oncology Nursing, 8, 163-168.

Perez-Soler, R., & Saltz, L. (2005). Cutaneous adverse effects with HER1/EGFR-targeted agents: Is there a silver lining? Journal of Clinical Oncology, 23, 5235-5246.

Tsao, A.S., Garey, J.S., An, K., & Kim, E.S. (2003). Understanding and managing toxicities related to epidermal growth factor receptor inhibitors. In Human Epidermal Growth Factor Receptors in Oncology (pp. 8-10). Dallas, TX: Physicians' Education Resource.

Wujcik, D. (2005). Targeting EFGR. Current Topics in Cancer, 2(1), 1-8.

Yamamoto, D.S., Viale, P.H., & Zhao, G. (2004). Severe acneiform rash. Clinical Journal of Oncology Nursing, 8, 654-656.

 
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Special Interest Group Newsletter  March 2006
 
   

ONS Releases Results of Survey of Members' Experience With Medicare Cancer Care Cuts

In collaboration with the Global Access Project and the Moran Company, 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 care related provisions of the Medicare Modernization Act. This survey was a follow-up to an earlier, less scientifically rigorous survey conducted by ONS of its members working in outpatient settings in 2004. The results of this survey are now posted on the ONS Web site.

 
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Special Interest Group Newsletter  March 2006
 
   

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, 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.
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  March 2006
 
   

Nurse Practitioner SIG Officers

Coordinator (2005-2007)
Wendy Vogel, RN, MSN, FNP, AOCN®
Kingsport, TN
wvogel@charter.net

Ex Officio (2005-2006)
Diane Cope PhD, ARNP-BC, AOCN®
Fort Myers, FL
dgcope@comcast.net

Coeditor
Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
Abingdon, MD
NPBiedrzycki@aol.com

  Coeditor
Deborah Heim, RN, MSN, BC, AOCN®
Fort Myers, FL
heimcats@yahoo.com

ONS Publishing Division Staff
Elisa Becze, BA
Copy Editor
ebecze@ons.org

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
astengel@ons.org
412-859-6244

Diane Scheuring, MBA, 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

 
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