Volume 23, Issue 2, August 2012
Coordinator's Message
Working Together

Tamika Turner, MS, NP-C, AOCNP®
Indianapolis, IN

I am so very humbled to be representing the Nurse Practitioner (NP) SIG of ONS. I have been an oncology nurse since November 1999 and a nurse practitioner since December 2005. I work in an academic institution taking care of inpatient adults undergoing bone marrow transplant. I also teach associate student nurses part-time. I always have felt that my true calling was to help care for patients diagnosed with cancer. It fills my heart with joy to know that I am making a difference in their journeys through cancer.

I am very grateful to ONS for being a wonderful supportive organization and resource to oncology nurses all over the world. I want the NP SIG to be a strong network for oncology nurse practitioners. This only can happen if we all work together to reach this goal. I urge you all to get involved at any level and share your skills and pearls of wisdom with all of us. Please feel free to make suggestions of what you would like to see or what you need from the SIG. Let us support each other to make the role of oncology nurse practitioners more defined and visible around the world.

I look forward to working with you all.

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  August 2012

Call for Articles

Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Hello. I am excited to be the newsletter editor for this great group of nurse practitioners. We always are in need of content for the newsletter. Please consider writing a brief report of an interesting patient, an interesting presentation of an illness, or any other topic that you feel would be of interest to this particular specialty. Topics can be across a broad range of subjects. If you are in school, consider using a paper that you worked on for a class assignment as a newsletter article. Even if you have an idea that you would like to nurture, we would be glad to help!

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Special Interest Group Newsletter  August 2012

Malignant Melanoma in Older Men
An Important Issue for All Nurse Practitioners

Karen Congelio, ACNP-BC, DNP
Pittsburgh, PA

Melanoma is a malignancy of pigment-producing cells (melanocytes) located predominantly in the skin. The sequence of events in which normal melanocytes transform into melanoma cells is poorly understood but assumed to be a progressive process involving a genetic mutation causing susceptibility to the carcinogenic effects of ultraviolet radiation. This multifactoral development appears to be related to the following risk factors: excessive sun exposure in childhood, family history of melanoma, history of changing nevi of the skin, and, most importantly, older age (40-70 years old) (Geller et al., 2002).

Thin melanoma lesions can be cured with surgical intervention after early diagnosis, but limited therapeutic options exist for the treatment of thick metastatic melanoma. The 2009 Melanoma Staging and Classification Guidelines recommend that melanomas greater than 1.01 mm or greater than 0.76 mm with more than one mitosis undergo sentinel lymph node biopsy along with wide excision (Balch et al., 2009). This recommendation is based on preliminary evidence suggesting that an associated 10% risk of metastasis into sentinel nodes is associated with this lesion thickness.

Men have a unique risk profile for melanoma. The mortality rates of melanoma have been disproportionate for men aged 55 years and older. Men are the only group that consistently experience increases in overall incidence of melanoma with age (Geller et al., 2002). Men aged 60 years and older have a four-fold higher incidence of melanoma compared to women in the same age bracket (Swetter, 2012). Over the past 10 years, the incidence of thicker tumors at diagnosis has increased only in men aged 60 years and older (Geller et al., 2002). Early detection of abnormal nevi among women and younger men has increased. A reason for this may be that older men are less likely to obtain skin evaluations (Geller et al., 2002). Literature suggests that older men may benefit the most from earlier skin evaluations; however, older men may be the most resistant to traditional educational messages promoting prevention and early detection (Schwartz et al., 2002).

Educational campaigns regarding melanoma risk and sun protection have increased knowledge regarding skin cancer prevention and early detection (Green, Williams, Logan, & Struton, 2011). These campaigns have been in place for a number of years, starting with the recognition of the relationship between ultraviolet light exposure and skin cancer in the 60s and 70s. This education often has targeted younger people in order to encourage lifelong healthy habits and may not be appropriate for older individuals or men.

We conducted a study utilizing an established clinical database of men aged 40 to 70 years diagnosed with melanoma in order to identify precipitating factors leading to a dermatological evaluation of abnormal nevi. A two-year retrospective chart review from a large dermatologic practice was assessed. Male patients more than 40 years of age with nevi ultimately diagnosed with melanoma were identified. Two hundred and fourteen men met criteria for review. Age, risk factors, tumor thickness, and precipitating events for seeking treatment at diagnosis were abstracted. Male patients greater than 60 years of age demonstrated thicker tumors at diagnosis (p = .000), no lifetime use of sunscreen (p = .000), and more frequent referral for lesion evaluation by primary care physicians rather than significant others (p = .000) as compared to younger men. These findings illustrate the need for all clinicians to closely assess older men for nevi that may appear suspicious and refer them for biopsy.

Balch, C.M., Gershenwald, J.E., Soong, S.J., Thompson, J.F., Atkins, M.B., Byrd, D.R., & Buzaid, A.C. (2009). Final version of 2009 AJCC melanoma staging and classification. Journal of Clinical Oncology, 27(36), 6199-6206. doi:10.1200/JCO.2009.23.4799

Geller, A.C., Sober, A.J., Zhang, Z., Brooks, D.R., Miller, D.R., Halpern, A., & Gilchrest, B.A. (2002). Strategies for improving melanoma education and screening for men ≥ 50 years. Cancer, 95(7), 1554-1561. doi:10.1002/cncr.10855

Green, A., Williams, G., Logan, V., & Struton, G. (2011). Reduced melanoma after regular sunscreen use: Randomized trial follow-up. Journal of Clinical Oncology, 29(7), 257-263. doi:10.1200/JCO.2010.28.7078

Schwartz, J.L., Wang, T.S., Hamilton, T.A., Lowe, L., Sondak, V.K., & Johnson, T.M. (2002). Thin primary cutaneous melanomas. Cancer, 95(7), 1562-1568. doi:10.1002/cncr.10880

Swetter, S.M. (2012). Cutaneous melanoma. Medscape. Retrieved from http://emedicine.medscape.com/article/1100753-overview

Geller, A.C. (2009). Educational and screening campaigns to reduce deaths from melanoma. Hematology/Oncology Clinics of North America, 23(3), 515-527. doi:10.1016/j.hoc.2009.03.008

Geller, J., Swetter, S.M., Leyson, J., Miller, D.R., Brooks, K., & Geller, A.C. (2006). Crafting a melanoma educational campaign to reach middle-aged and older men. Journal of Cutaneous Medicine and Surgery, 10(6), 259-268.

Torrens, R., & Swan, B.A. (2009). Promoting prevention and early recognition of malignant melanoma. Dermatology Nursing, 21(3), 115-122.

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Special Interest Group Newsletter  August 2012

Actual Body Weight Chemotherapy Dosing

Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Longstanding practice traditions regarding chemotherapy dosing for patients who are obese has capped dosing at a body surface area of 2.0 or used ideal body weight to calculate the optimal chemotherapy dose. As of May, the American Society of Clinical Oncology recommends that chemotherapy dosage should be calculated based on actual body weight. The clinical guideline offers evidence that limiting dosing results in inadequate treatment for patients who are obese and that dosing according to actual weight does not increase side effects (Griggs et al., 2012). Additionally, racial disparity seen specifically in breast cancer survival is hypothesized to be due to capped chemotherapy dosing in African American women (Griggs, Sorbero, Stark, Heininger, & Dick, 2003).

An expert consensus panel made the following evidence-based recommendations (Griggs et al., 2012).

1. Actual body weight should be used when selecting cytotoxic chemotherapy doses regardless of obesity status. This particularly is true when chemotherapy is given with a curative intent. Toxicity is not expected to increase, but if it does, modifications to dosing should occur, as with all patients receiving chemotherapy.

2. If dosing modifications are necessary, the full dose of the chemotherapy should be resumed when the toxicity is resolved. No special dose reductions should be done after the resolution of toxicity for patients who are obese.

3. Full weight-based chemotherapy dosing for patients with cancer who are morbidly obese is subject to appropriate consideration of other comorbid conditions. The panel states that literature regarding the morbidly obese is very limited. This dosing must be done very carefully.

4. Although the efficacy of fixed dosing is not clear, itis appropriate when it is used for concern of toxicity rather than a weight-based consideration. The drugs under consideration specifically are chemotherapy drugs that induce neuropathy.

5. The panel recommended further research into the role of pharmacokinetic information in patients who are obese. The issue of drug clearance in patients who are obese requires more research in prospective randomized studies.

The panel acknowledges that dosing to full body weight will be difficult for pharmacists and nurses who have practiced with weight-based chemotherapy caps in the past. The panel encourages communication regarding this issue and offers guidance for patients who are obese and receiving conflicting information regarding the safety of full body weight dosing. Read more about the guideline.

Griggs, J.J., Mangu, P.B., Anderson, H., Balaban, E.P., Dignam, J.J., Hryniuk, W.M., . . . Lyman, G.H. (2012). Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 30(13), 1553-1561. doi:10.1200/JCO.2011.39.9436

Griggs, J.J., Sorbero, M.E., Stark, A.T., Heininger, S., & Dick,W. (2003). Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Research and Treatment, 81(11), 21-31. doi:10.1023/A:1025481505537

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Special Interest Group Newsletter  August 2012

Journals Now Available in Digital Format

Did you know that the Clinical Journal of Oncology Nursing (CJON) and Oncology Nursing Forum (ONF) are now available in digital format? To access the digital editions, click on the journal you wish to view at http://www.ons.org/Publications and follow the instructions featured prominently in the top center of the page. The digital editions are a members-only benefit, so make sure you have your ONS username and password handy.

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Special Interest Group Newsletter  August 2012


RE:Connect is a blog written by oncology nurses on a variety of topics of interest to other nurses in the specialty, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses. This month on RE:Connect, you'll find the following new discussions.

As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

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Special Interest Group Newsletter  August 2012

Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service takes a look at how Studies Support Value of Exercise in Patients at Different Stages of Cancer.

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Special Interest Group Newsletter  August 2012

Do You Enjoy Writing?
Become an ONS Blogger

Join Patients and Caregivers on the Cancer Journey!
We're looking for oncology nurses to write for Traveling Companions, ONS's patient- and caregiver-focused blog. If you'd like to share your thoughts and comments to support patients and caregivers on the cancer journey, please e-mail us at socialmedia@ons.org for consideration.

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Special Interest Group Newsletter  August 2012

ONS Podcasts of Interest

ONF Podcasts
What coping strategies do patients use while receiving radiation treatments for head and neck cancer? When are physical side effects most problematic? What coping resources assist patients as they undergo treatment? During May's podcast, lead author Mary Ellen Haisfield-Wolfe, PhD, RN, OCN®, will answer these questions and discuss strategies to assist patients with head and neck cancer that were presented in her May 2012 ONF article "Perspectives on Coping Among Patients with Head and Neck Cancer Receiving Radiation." Previous research investigating head and neck cancer treatment found that patients' illness experiences include physical symptoms, side effects from treatment, symptom distress, and psychological distress. This qualitative study explores coping strategies and resources utilized by patients with laryngeal or oropharyngeal cancer over four time points during radiation with or without chemotherapy. (Listen to ONF podcasts!)

CJONPlus Podcasts
Older adults constitute the greatest percentage of cancer survivors in the country, with 61% being 65 years and older. Assessing older cancer survivors beyond chronological age to include changes in functional status is essential to help nurses anticipate cancer treatment impact and aide in planning individualized survivorship care.

This CJONPlus podcast features lead author Denice Economou, RN, MN, CNS, CHPN, discussing her June 2012 CJON article titled "Integrating a Cancer-Specific Geriatric Assessment Into Survivorship Care." (Listen to CJON podcasts!)

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Special Interest Group Newsletter  August 2012

Membership Information

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Special Interest Group Newsletter  August 2012

Nurse Practitioner SIG Officers

Coordinator (2012-2014)
Tamika Turner, MS, NP-C, AOCNP®
Indianapolis, IN

Ex-Officio (2012-2013)
Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Web Page Administrator
Open Position


Legislative Issues
Wendy H. Vogel, RN, MSN, FNP, AOCNP®
Bristol, TN

Barbara Biedrzycki, RN, MSN, CRNP, AOCNP®

ONS Copy Editor
Jessica Moore, BA, BS
Pittsburgh, PA

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 Specialist Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership & Component Relations Department Contact Information

Brian K. Theil, CAE, Director of Membership and Component Relations Department

Diane Scheuring, MBA, CAE, CMP, Manager of Member Services

Carol DeMarco, Membership Specialist—SIGs

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.

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