Editor's Message
Maintain Your Enthusiasm for Nursing All Year Round, Not Just at Congress

Meghan Brennan, RN, MSN, ONP, OCN^®
Brookline, MA
meghan.brennan@cytyc.com

Every year, I attend Congress (the 2003 meeting was my ninth in a row) and get energized and excited about all of the possibilities for nurses, including jobs, research, and public service. I go to session after session and listen to the new and creative ways that we are caring for patients and molding medicine and public policy. I read posters and think about the innovative research that nurses are participating in and developing. I attend focus group meetings and my SIG networking/planning meeting where enthusiasm is bubbling over about interesting topics to submit. I go back to my hotel room from Congress every day thinking about ways to change healthcare legislation and influence the nursing job market, research, and new nurses, freshly graduated. Finally, exhausted from all of the mind expansion and weight expansion from the food and parties, I board a plane and head home. Throughout the flight, I think about the contributions I intend to make related to my nursing community, especially ONS. Unfortunately, the closer I get to landing, the more my head fills with the things that I have to get done at home and work. My enthusiasm starts to fade, and, two weeks later, I am reminded gently that ONS dues are up for renewal and Congress topic submissions are pending. I haven’t made a dent in the nursing community, I haven’t helped or molded anything, and, even worse, I realize I left my excitement and enthusiasm on the tarmac at the airport. I have fallen off the enthusiasm bandwagon.

How do we combat this? How do we keep up the enthusiasm and excitement once we land on terra firma? How do we continue on our path of helping and molding? I considered this long and hard and realized the best way is to join a SIG.

By attending the meetings at Congress, I learned that everyone is just as busy, if not more so, than I am; however, we all are part of a great group that provides support and inspiration. I got a quick e-mail from a fellow SIG member about a topic submission; we started communicating back and forth, and I was back on the helping and molding bandwagon. I do not want to fall off again, but I know that if I do start to slip off or get knocked out when I hit a bump, I can get back on by simply clicking on the SIGs Virtual Community or calling or e-mailing one of my SIG members.

One SIG membership now is included with your ONS membership, but I would and have gladly paid for this membership many years knowing that, in a group of more than 30,000 specialized nurses, a smaller group works in my area and understands the dilemmas associated with the job; this smaller group’s enthusiasm is contagious. So, my editor’s message is this: If you find that you too have slipped off the bandwagon and need a boost back on, get on the SIGs Virtual Community, e-mail or call a member, read our SIG newsletter, or find members to communicate with and let their enthusiasm help you back on board. You will find yourself helping and molding in no time!

Back to SIG Newsletter front page

New Internal Radiation Device Offers Five-Day Treatment for Breast Cancer

Linda Howie, RN
Charleston, SC
howie@radonc.musc.edu

Hazelmarie Huff, RN, MSN, OCN^®
Mt. Pleasant, SC
huffh@musc.edu


The MammoSite^® Radiation Therapy System (Proxima Therapeutics, Inc., Alpharetta, GA) is a recently approved internal radiation device for the treatment of breast cancer after a patient undergoes lumpectomy or surgical removal of a cancerous tumor. In addition to minimizing radiation exposure to healthy tissue, this system shortens the course of treatment to five days compared to six or seven weeks with the standard treatment method.

This new procedure received U.S. Food and Drug Administration clearance on May 6, 2002. Initially, only 30 medical centers nationwide were authorized to offer the treatment. This was controlled by the product’s manufacturer, Proxima Therapeutics, Inc., because of the need for specialized training of surgeons and radiation oncologists involved in the use of the MammoSite catheter.

Prior to the development and approval of the MammoSite catheter, brachytherapy for the management of breast cancer was not widely accepted. The previous treatment included placement of several rods horizontally through the breast tissue. This was very cumbersome, left significant disfiguring scars, and did not allow for treatment targeted at the tumor bed (Jenrette, 2003).

Advantages to this treatment include a five-day treatment interval and a reduction in side effects related to radiation treatments such as fatigue, tissue damage, and redness of the skin. Patients receive two treatments daily for five days; these treatment sessions last approximately 10 minutes. Candidates for this new treatment are usually women whose cancer is diagnosed in early stages with a tumor that is 2–3 cm or smaller that is not too close to the skin or chest wall (American Society of Breast Surgeons, 2003; Arthur, Vicini, Kuske, Wazer, & Nag, 2003).

The insertion of the catheter can occur in one of two ways: at the time of the initial lumpectomy or by a percutaneous technique through the previous incision up to 10 weeks after the lumpectomy is performed. The MammoSite catheter has multiple lumens made of silicone elastomer. The central lumen is used for the radioactive seed pathway during treatment. The outer lumen is the balloon that is filled with saline to hold the device in place. A computed tomography scan or an ultrasound is used to verify proper placement. Treatment cannot begin for a few days after placement to allow for any air in the cavity to be absorbed. Dosimetry for treatment uses isodose curves. Simulation is repeated each day prior to treatment to ensure the integrity of the balloon.

As with any cancer treatment, this therapy is not ideal for all patients with breast cancer. Identification of appropriate patients for this treatment is important. Some guidelines for identification follow.

• Tumors that are 2–3 cm or smaller
• Three or fewer positive lymph nodes
• Diagnosis of invasive ductal carcinoma, lobular carcinoma, and ductal carcinoma in situ
• Skin separation of 5–7 mm from the balloon surface

Member Interview
Meet Your Coordinator-Elect: Joanne Lester
Meghan Brennan, RN, MSN, ONP, OCN^®
Brookline, MA
meghan.brennan@cytyc.com


Joanne Lester, MSN, RNC, CNP, AOCN^®, currently is a nurse practitioner specializing in breast cancer in the Division of Surgical Oncology at Arthur G. James Cancer Hospital and Research Institute at Ohio State University (OSU) in Columbus. She has been in practice at OSU since 1994 and resides in Columbus. She is happily married with two sons—a family that keeps her quite busy. In addition to her current position, Joanne serves as an auxiliary clinical instructor in the College of Nursing at OSU. Joanne comes to her SIG leadership position with a great deal of experience in clinical medicine and research specializing in the arena of surgery. She has been a medical and surgical nurse, an oncology coordinator, and a clinical manager as well as a distinguished speaker and author.

Joanne started her education as an undergraduate at Saint Mary’s College in Notre Dame, IN, and received her bachelor’s degree in nursing. She continued to grow both clinically and intellectually by broadening her education at the master’s level. She received her degree, a master’s of science in nursing, primary health care of adults, nurse practitioner, from Indiana University–Purdue University.

Joanne has been published multiple times and has been an invited speaker too many times to count. She brings years of clinical skill and leadership to the Surgical Oncology SIG. Joanne has been a committed member to ONS as well as its local chapters since 1985. She has served the Society as a local chapter treasurer, president, and scholarship chair. She has worked collaboratively on the ONS Foundation Awards Review Team and the Advanced Practice/Standards Work Group. She is an active member of the Nurse Practitioner and Surgical Oncology SIGs as well as the Rural Health and Breast Care Focus Groups.

In addition to all of the current philanthropic affiliations, the Susan G. Komen Breast Cancer Foundation, American Cancer Society, Boy Scouts of America, the USU Service Board, speaking engagements, and family commitments, Joanne has found time to serve as our coordinator-elect. I met with Joanne, and she shared her thoughts on the Surgical Oncology SIG.

Meghan: What prompted you to join the Surgical Oncology SIG?

Joanne: I joined Surgical Oncology SIG in an effort to network with nurses working with and caring for surgical patients. Since I took on the position I currently have with the Division of Surgical Oncology, I wanted to meet other people who share the same clinical focus.

Meghan: What keeps you an active member of the SIG?

Joanne: The interaction I am afforded by being a member. I really enjoy connecting with the other nurses.

Meghan: What prompted you to take on a leadership role with the SIG?

Joanne: I decided to be involved in the leadership aspect of the Surgical Oncology SIG to continue the work of previous leaders. I believe that if we all take part and share in the responsibilities, a number of projects can be recognized. I have always valued the knowledge, expertise, and sharing of wisdom of those before me. I feel we all have the responsibility to give back as we become more experienced in our fields.

Meghan: What are your plans for the future of the Surgical Oncology SIG?

Joanne: I plan to continue working on the various projects in progress, including encouraging the membership and recruitment of additional members, networking, promoting interaction of members of the SIG outside of Congress activities, and enhancing the development of the Breast Care Focus Group toward its SIG development with support and guidance.

Meghan: What would you advise new ONS members or new nurses who are interested in joining a SIG?

Joanne: New nurses should be encouraged to join SIGs for two reasons: First, it’s free, and second, it presents an excellent opportunity for learning and networking. All ONS members should accept the challenge and become involved in at least one SIG and focus group.

So, there you have it Surgical Oncology SIG members: your coordinator-elect. She is a woman devoted to oncology nursing and the enhancement of the nurse’s role. She has much in the way to offer this group, and I am sure Joanne will lead us to a successful future as a SIG in the ONS community.

Back to SIG Newsletter front page

 

Radiofrequency Ablation Is a Valuable Surgical Technique

Joanne Lester, MSN, RNC, CNP, AOCN^®
Grove City, OH
lester-1@medctr.osu.edu


Pain relief, improvement of sleep apnea, resolution of atrial fibrillation, disappearance of hematuria, ablation of liver metastasis, and breast cancer elimination . . . these various outcomes are related to radiofrequency ablation (RFA) of tissue. RFA, a type of electrical energy, has been in use for decades. In simple terms, high-energy radio frequency sound waves are used to create heat at a specified temperature resulting in tissue death in a prescribed location.

RFA is considered a surgical procedure during which an ablation probe is placed directly into the unwanted tissue. This placement can occur through an open incision, via laparoscope, with a percutaneous approach, or via a small skin nick with ultrasound or computed tomography guidance. Depending on the targeted area, a number of outwardly curved electrodes (tiny wires in the shape of an umbrella) exits from the end of the probe carrying the electrical stimulation, resulting in friction of tissue. This friction creates heat, thereby killing tissue, typically within a few minutes. The amount of tissue destroyed is directly dependent on the size of probe, temperature obtained, and length of time the tissue is heated. RFA generally is intended to destroy small areas of unwanted tissue, sparing surrounding healthy tissue. Depending on the overall type of surgery, RFA often can be performed with local anesthesia with or without conscious sedation or monitored anesthesia care assistance. RFA typically is an outpatient procedure.

The most common types of tumors treated are liver malignancies, such as primary hepatocellular carcinomas or metastatic liver disease. Some experience has been gathered ablating renal, adrenal gland, prostate, bone, and lung tumors. Small, localized breast cancers have been treated in clinical trials with anticipated long-term outcomes similar to lumpectomy. RFA may be an option for tumors that are considered inoperable, difficult to access, or so small that a less invasive procedure successfully could treat the problem.

Advantages of RFA include a decreased risk of tissue bleeding because of heat cautery, a decreased level of anesthesia for the procedure (unless an open abdominal approach is used), decreased tissue healing related to tiny access incisions, overall decreased pain, and a shorter hospital stay. As with any surgical procedure, a small risk of infection exists; occasionally, skin burns may occur. In addition, clinical trials need to be completed to ensure safety and efficacy in various tumor types. Follow-up scans often are performed to monitor disease and measure success of the procedure. RFA can be performed more than once in the same location for recurrent problems or incomplete resolution after the initial procedure.
Will we someday be explaining this surgical approach as heat, boil, and dissolve? Stay tuned to future clinical trials and opportunities for your patients.

Back to SIG Newsletter front page

Surgical Oncology SIG Sponsored a Session at Congress

The Surgical Oncology SIG sponsored an instructional session at the ONS 28th Annual Congress in Denver, CO, on May 1. The session, “Looking for Zebras in the Herd: Unusual Abdominal Tumors,” was coordinated and presented by JoAnn Coleman, RN, MS, ACNP, AOCN^®, and copresented by Patti Palmer, RN, MS, AOCN^®, and Patricia Kal Sauter, RN, ACNP, CMT.

Pictured (from left) are Patricia Kal Sauter, JoAnn Coleman, and Patti Palmer.

Back to SIG Newsletter front page

Surgical Oncology SIG Officers

Coordinator Jean Wainstock, MS, APRN, BC, FNP, AOCN® Ellis Fischell Cancer Center 115 Business Loop 70W Columbia, MO 65203-3244 573-884-6989 (O) 573-884-6054 (fax) mailto:wainstockj@health.missouri.edu Coordinator-Elect Joanne Lester, MSN, RNC, CNP, AOCN® 6360 Rising Sun Dr. Grove City, OH 43123-9059 614-871-1199 (H) 614-293-0031 (fax) lester-1@medctr.osu.edu

Editor Meghan Brennan, RN, MSN, ONP, OCN® 20 Chapel St., #B408 Brookline, MA 02446-7474 617-232-7378 (H) 978-266-3006 (fax) mailto:meghan.brennan@cytyc.com ONS Publishing Division Staff Leslie McGee, BA Staff Editor 412-859-6291 lmcgee@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.

ONS Membership/Leadership Team Contact Information
Angie Stengel, BA, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diedrea White, BA, Manager of Member Relations and Diversity Initiatives
dwhite@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
ONS Online: www.ons.org