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| Volume
16, Issue 2, July 2005 |
| The Radiation SIG Newsletter is supported through an educational grant to ONS. |
| Coordinator’s Corner Radiation SIG Makes a Splash at Congress Elise Carper, RN, MA, APRN-BC, AOCN® New York, NY ecarper@chpnet.org Well, the Pirates of the Caribbean attended the 2005 ONS Congress in force! They were seen lurking outside the opening ceremony in pirate costumes, urging all radiation oncology nurses to come to the Radiation SIG planning/networking meeting. It seemed to have worked. Approximately 200 people attended, many visiting a SIG meeting for the first time. Thank you to all of the pirates who dressed up, helped set up, and cleaned up at the meeting. And, of course, thanks to our fetching pirate MC, Gigi Moore-Higgs, ARNP, MSN, AOCN®.
Marilyn L. Haas, PhD, RN, CNS, ANP-C, started the planning/networking meeting by welcoming everyone and thanking the SIG’s supporters, in ONS and in the industry. A special recognition and thank you went to Congress Chair Tracey Gosselin-Acomb, RN, MSN, AOCN®. This was followed by the appearances of several ONS national leaders: ONS Chief Executive Officer Pearl Moore found time in her extremely busy schedule to attend the meeting and gave a lovely speech about how important the Radiation SIG is to ONS. She thanked the SIG and Marilyn for the support the SIG has shown to the national organization and the ONS Foundation. Next up was ONS President Karen Stanley, RN, MSN, AOCN®, FAAN. Karen reiterated the value of the Radiation SIG to ONS and again commended Marilyn and the SIG for the impressive accomplishments of the past year. She is a wonderfully funny and natural speaker and definitely was a crowd-pleaser! |
The Radiation SIG Newsletter is produced by members of the Radiation SIG and ONS staff and is not a peer-reviewed publication. |
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| Special Interest Group Newsletter July 2005 |
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Coordinator’s
Corner Well, the Pirates of the Caribbean attended the 2005 ONS Congress in force! They were seen lurking outside the opening ceremony in pirate costumes, urging all radiation oncology nurses to come to the Radiation SIG planning/networking meeting. It seemed to have worked. Approximately 200 people attended, many visiting a SIG meeting for the first time. Thank you to all of the pirates who dressed up, helped set up, and cleaned up at the meeting. And, of course, thanks to our fetching pirate MC, Gigi Moore-Higgs, ARNP, MSN, AOCN®. Marilyn L. Haas, PhD, RN, CNS, ANP-C, started the planning/networking meeting by welcoming everyone and thanking the SIG’s supporters, in ONS and in the industry. A special recognition and thank you went to Congress Chair Tracey Gosselin-Acomb, RN, MSN, AOCN®. This was followed by the appearances of several ONS national leaders: ONS Chief Executive Officer Pearl Moore found time in her extremely busy schedule to attend the meeting and gave a lovely speech about how important the Radiation SIG is to ONS. She thanked the SIG and Marilyn for the support the SIG has shown to the national organization and the ONS Foundation. Next up was ONS President Karen Stanley, RN, MSN, AOCN®, FAAN. Karen reiterated the value of the Radiation SIG to ONS and again commended Marilyn and the SIG for the impressive accomplishments of the past year. She is a wonderfully funny and natural speaker and definitely was a crowd-pleaser! ONS Foundation Board Member Catherine Burke, MS, APRN-BC, ANP, AOCN®, spoke about what the Foundation is and how it supports research, scholarships, grants, money awards for travel to Congress, and excellence awards for some of the amazing individuals in ONS. (Please see the related article by Marilyn about radiation oncology award winners). She then announced how pleased the Foundation was with the Radiation SIG’s challenge to the other ONS SIGs to meet or beat our fundraising during Congress. Last year, we raised more than $400 at the planning/networking meeting by selling red “bucks,” which were placed on the Foundation wall. This year, we plan to raise much more and have challenged other SIGs as well. With the financial support of Varian Medical Systems (which provided red “running reactor” caps), SIG members ran and walked the Fun Run on Saturday morning, again raising money for the Foundation. ONS Health Policy Associate Ilisa Halpern, MPP, spoke about the need for all of us to get involved in the political process and urged members to join ONStat (http://www.ons.org//lac/onstat.shtml). Diane Scheuring, ONS member services manager, who is responsible for the ONS Virtual Community, described the Radiation SIG Web page and what information can be found there. Finally, Kris Lefebvre, MSN, RN, AOCN®, spoke about the radiation course for nonradiation therapy nurses and the trainer course, in which radiation nurses learn to teach the radiation course. (This issue of The Boost features a related article about the course). After the guest speakers, the planning/networking meeting minutes from Congress 2004 were reviewed and approved, as were the 2004 annual report and the 2005 Radiation SIG Strategic Plan. Current SIG leaders were introduced, the various SIG member award winners were introduced and praised, and an update on the Radiation Oncology Nurse Enhancing Excellence project, also known as RONEE, was given. Volunteer activities and projects were described, including a request for volunteers for the competencies, care plans, and mentorship work groups. Please contact me if you are interested. The meeting ended with a raffle of more than 30 state baskets contributed by SIG members. Thanks to all who took the time to choose state items, pack them up, and carry them to the meeting. Your contribution was appreciated. The planning/networking meeting was only one aspect of SIG-related activity at Congress this year. Congratulations to all SIG members who presented sessions. Congratulations to SIG Newsletter Co-Editor Mary Ellyn Witt, RN, MS, AOCN®, for receiving honorable mention for her articles on xerostomia. Finally, Marilyn received a plaque and thanks for her tireless efforts on behalf of the SIG in the past two years. What a vibrant, productive, and exciting group! Together, all of you have supported the group and added to our knowledge and ability to care for patients. On behalf of the SIG, thank you!
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| Special Interest Group Newsletter July 2005 |
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Radiation Nurses Honored at Congress Two radiation oncology nursing awards were presented to members of the Radiation SIG at Congress in Orlando, FL. Carrie Daly, RN, MS, AOCN®, won the Excellence in Radiation Therapy Nursing Award (supported by Varian Medical Systems). This is a long-standing award that has been presented since 1994. It recognizes experts in the field of radiation who have contributed to the field through publications, presentations, research, and peer review and those who have made significant contributions to professional and patient education, clinical practice, and nursing research. Carrie earned her nursing degrees at Rush University in Chicago, IL, and began her career in oncology nursing at Rush Presbyterian St. Luke’s Medical Center. Later, she became the first oncology clinical nurse specialist at InterCommunity Cancer Center, a freestanding radiation oncology clinic in Lisle, IL. Carrie then worked at Wyler’s Children’s Hospital of the University of Chicago Hospital as the pediatric hematology/oncology clinical nurse specialist. Currently, she is the oncology clinical nurse specialist in radiation oncology at St. Joseph Hospital, where her duties include patient education, symptom management, and counseling. She also is the facilitator of a monthly breast cancer support group, oncology education courses, and a yearly cancer survivors’ day, and she assists the hospital as the skin and wound care nurse. She volunteers yearly at a two-week summer camp for children with cancer.
Carrie has been a consultant and researcher for several pharmaceutical companies. She has presented papers and given lectures nationally and internationally on oncology-related topics. She also has written and published numerous articles on oncology-related topics in journals such as the Oncology Nursing Forum, Cancer Nursing Journal, and Seminars in Oncology Nursing. She is an active member of ONS and a member of Sigma Theta Tau. The second ONS Foundation award was the ONS Excellence in Care of the Radiation Therapy Patient Award (supported by MedImmune). This is the first year for the award, which supports and recognizes an oncology nurse for quality symptom management offered to patients treated in a radiation therapy department. The candidate must be a registered, professional staff nurse with at least five years of radiation oncology nursing experience and a member of ONS and the ONS Radiation SIG. The person must demonstrate evidence of significant contributions to quality symptom management for patients treated with radiation therapy, participate in continuing education to strengthen his or her knowledge about radiation and oncology nursing practice, share information learned from continuing education offerings, contribute to evidence-based practice changes in his or her work setting, participate in patient education activities, and serve as a role model for excellence in symptom management for patients receiving radiation therapy. The Radiation SIG is very grateful to have supporters who recognize the high-quality care that radiation oncology nurses provide to patients.
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Marilyn
L. Haas, PhD, RN, CNS, ANP-C |
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More Recognition of Excellence in Nursing  Mary
Ellyn Witt, RN, MS, AOCN®Chicago, IL mwitt@radonc.uchicago.edu Congress 2005 was buzzing with recognition for excellence among our colleagues. Marilyn L. Haas, PhD, RN, CNS, ANP-C, Sandra Aardsma, RN, BSN, OCN®, and Jayne Waring, RN, BSN, OCN®, received well-deserved honors. Marilyn received the Connie Henke Yarbro Excellence in Cancer Nursing Mentorship Award. The purpose of the award is to recognize and support excellence in the mentorship of oncology nurses. The award is named for the first ONS Foundation president, Connie Henke Yarbro. Marilyn received a $2,500 award and a plaque. Many of us have felt mentored by Marilyn, and her professional life is an example for all of us to respect and admire. It is a joy to see her receive this recognition. Jayne was the recipient of an ONS Foundation Scholarship. She received $1,000 toward expenses at Congress. Congratulations to all three outstanding members. The SIG is proud of the excellence in the group.
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| Special Interest Group Newsletter July 2005 |
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Intensity Modulated Radiation Therapy Improves Treatment for Prostate Cancer Jennifer C. Cash, ARNP, MS, OCN®Sarasota, FL brachyRN@aol.com An increasing number of men now are choosing radiotherapy for treatment of localized and advanced prostate cancer because of similar cure rates to radical prostatectomy and the potential for decreased risk of incontinence and impotence. The greatest challenge for radiation oncologists treating prostate cancer is in attaining the highest probability of cure with the least amount of morbidity. Numerous dose-escalation studies have been performed in the past decade and have demonstrated lower recurrence rates for patients receiving higher doses of radiation. However, the most significant issue has been in achieving more precise targeting of tumor sites to avoid increased morbidity. The most advanced form of three-dimensional conformal radiation therapy is intensity modulated radiation therapy (IMRT). IMRT has revolutionized the delivery of radiation therapy by permitting dose escalation with precise targeting of tumors while minimizing exposure of adjacent normal tissue through sophisticated computer optimization algorithms that also address site-specific treatment problems. Modern radiotherapy has evolved from techniques that were not site-specific using visual anatomy and hand-drawn blocking measures. Radiation oncology then evolved to two-dimensional (or conventional) therapy, three-dimensional therapy, and currently IMRT. Two-dimensional radiotherapy consisted of delivery of a single beam from one to four directions with simple setups of a “four-field box” technique designed from simulator films and calculated on a two-dimensional treatment planning system. Three-dimensional, or computed tomography-based (CT-based) planning, allowed for accurate dose calculations to irregular shapes, with the design of treatment portals based on a beam’s eye-view projection of the target volume with a specified margin, but the method still was limited in the ability to make certain corrections to treatment fields and still relied on human influence to define treatment parameters. IMRT differs from two-dimensional and three-dimensional techniques in that it allows for variance in the intensity of the radiation beam across the area targeted by the beam. IMRT has the capability of modifying the dose of radiation that a tumor receives while treatment is being delivered. Rather than one beam, the radiation beam is divided into multiple beams, or beamlets, that deliver different intensities to individual beams. By modulating the numbers of fields and the intensity in each field, greater control of the dose distribution is available. The two technologies that achieve this goal of uniform distribution are inverse treatment planning and automated treatment delivery tools (multileaf collimators [MLCs]). Three-dimensional therapy consists of forward planning that uses set fields and adjustment of dose weighting and delivery by manual trial and error to redefine the final treatment plan, thought to be accurate within 7-10 mm. Inverse treatment planning, used for IMRT, uses CT imagery of pelvic anatomy with identification of target volumes and normal tissue on each 1-2 mm slice of the CT scan (or with a magnetic resonance imaging scan). A radiation prescription then is designed to identify maximum dose to the target volume with the minimum dose to surrounding structures, considered to be accurate within 1-3 mm. The designated planning system then computes the best possible plan using 1 x 1 cm beamlets to maximize dose to the target (prostate with possible seminal vesicle and lymph nodes) while minimizing dose to the rectum, bladder, penile bulb, and hips. Dose volume histograms allow a physician to know the exact volume of tissue receiving a specific dose of radiation. Sequential clinical evaluation by a radiation oncologist and physicist refines the plan throughout the treatment process. IMRT is delivered using an MLC that consists of 40 leaves, or apertures, that project a 1 x 1 cm field size at the isocenter and shift to form specific patterns and block the beam at specified areas. Collimator leaves are opened and closed while the gantry is rotating to deliver the desired beam intensity prescription. The devices replace the hand-made lead alloy blocks used in conventional radiation therapy. Digitally reconstructed radiographs are obtained to verify patient setup before the first treatment session. Custom-molded alpha cradles for the lower body can decrease patient movement during treatment, as well as rectal balloon immobilization and prone positioning to minimize prostate motion. Other quality-assurance methods of B-mode acquisition targeting or sonar ray, a noninvasive ultrasound imaging system for daily localization of the prostate, and real-time portal imaging verification systems also may be used to reduce setup errors. The Memorial Sloan Kettering Cancer Center, Fox Chase Cancer Center, and Baylor College of Medicine, among others, have found that patients treated with IMRT, in comparison to those receiving three-dimensional or conventional radiation, not only achieved higher prostate doses with subsequent increased disease-free survival (8-12 year follow-up) but also experienced an approximate 80% decrease in acute and chronic Radiation Therapy Oncology Group grade 2 gastrointestinal toxicity, with no grade 3 or 4 toxicity. Doses to penile bulb and proximal penile tissues have been reduced by 40% when compared to three-dimensional methods, suggesting a potentially decreased impotency rate. However, no mature studies have been reported to confirm outcomes. Prostate doses with IMRT have been increased to 8,100-8,640 cGy as compared to 6,600-7,560 cGy with three-dimensional radiation. IMRT represents the most refined and precise form of radiotherapy delivered to the prostate that can provide the greatest amount of conformity of dose-to-target tissue while sparing dose-to-critical uninvolved structures such as the bladder, rectum, and penile structures. This higher dose to target translated to higher cure rates with lower treatment-related morbidity has shown IMRT to be a viable therapy in the long-term control and cure for patients with prostate cancer. Bibliography Bucci, M.K., Bevan, M.D., & Roach, M. (2005). Advances in radiation therapy: Conventional to 3D, to IMRT, to 4D, and beyond. CA: A Cancer Journal for Clinicians, 55, 117-134. Mohan, R., Low, D., Chad, K.S., & Dong, L. (2004). Intensity modulated radiation treatment planning, quality assurance, delivery, and clinical application. In C. Perez, E. Halpern, L. Brady, & R. Schmidt-Ullrich (Eds.), Principles and practice of radiation oncology (4th ed., pp. 314-335). Philadelphia: Lippincott Williams and Wilkins. Oh, C.E., Antes, K., Darby, M., Song, S., & Starkschall, G. (1999). Comparison of 2D conventional, 3D conformal, and intensity modulated treatment-planning techniques for patients with prostate cancer with regard to target-dose homogeneity and dose to critical uninvolved structures. Medical Dosimetry, 24(4), 255-263. Prostate Cancer Research Institute. (2004, August). Targeting for cure: Intensity modulated radiation therapy. PCRI Insights, 7(3), 2-11. Zelefsky, M.J., Fuks, Z., Hunt, M., Yamada, Y., Marion, C., Ling, C.C., et al. (2002). High dose intensity modulated radiation therapy for prostate cancer: Early toxicity and biochemical outcome in 772 patients. International Journal of Radiation Oncology, Biology, Physics, 53, 1111-1116.
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| Special Interest Group Newsletter July 2005 |
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Have You Thought About Being a Radiation Trainer?  Mary
Ann Robbins, RN, BSN, OCN®Hillsborough, NC robbins@radonc.duke.edu About 60% of all patients with cancer receive radiation therapy at some point during the disease course. Many nurses care for patients receiving radiation therapy outside of the radiation therapy department. For example, oncology nurses on inpatient units, nurses working in medical oncologists’ offices, and oncology nurses working for home-health agencies care for such patients. The ONS Radiation Therapy Course was developed to provide a review of the principles of radiation therapy, new radiation treatment modalities, and radiation therapy treatment side-effect management. The course is taught in one day and offers 8.4 hours of continuing education credits. To be a radiation trainer and teach the course, you must attend the ONS Radiation Therapy Trainer Course. The course is offered before Congress and the Institutes of Learning (IOL). Radiation trainer eligibility criteria include being an RN with a bachelor’s degree or higher, maintaining current ONS membership, having a minimum of three years of experience working in radiation, being a certified oncology nurse, and having presentation experience. For an overview of the Radiation Therapy Course presentation, click here. During the Radiation Therapy Trainer Course, participants learn about the content of the program and how to put on a program. Nurses who complete the course earn 4.5 contact hours. To maintain trainer status, trainers must maintain active ONS membership, conduct a minimum of one course per year, maintain a score of 2.5 or more on evaluations, and comply with course procedures. The next Train the Trainer course will be November 10, 2005, in Phoenix, AZ, in conjunction with IOL. A list of ONS Radiation Therapy Trainers and a calendar showing when and where courses are taught can be found on the ONS Web site. For more information, please contact the ONS Education and Cancer Care Issues Team at 866-257-4ONS, ext. 6240, or via e-mail eccit@ons.org.
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| Special Interest Group Newsletter July 2005 |
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Interested in Reviewing the Latest in Oncology-Related Resources?
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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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 areas are received. Previous
experience as a reviewer is a plus but not necessary. |
| Special Interest Group Newsletter July 2005 |
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Membership Information SIG Membership Benefits
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
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,
As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.
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| Special Interest Group Newsletter July 2005 |
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Radiation SIG Officers
Radiation SIG Leaders
Know someone who would like to receive a print copy of this newsletter? 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
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