Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN

Despite major advances in communication technologies, numerous hospitals and clinics still use overhead paging, intercoms, Walkie Talkies, and other antiquated methods to reach staff members. We all remember—and some of us still encounter&mdash;the crackle of the intercom and the garbled messages that usually followed, and most of us can recall instances when people being paged said that they did not hear their pages, while patients and visitors said that they heard every one. To improve communication at Memorial Sloan- Kettering Cancer Center (MSKCC), which is spread out over a 13-block area of Manhattan, a hands-free wireless communications system called Vocera® was introduced. This system, which features a small lightweight communications device that is worn on a lanyard or clipped on clothing, was found to reduce noise, decrease duplicity in communication equipment, and improve efficiency. You can learn more about this technology and how it was implemented at MSKCC in Gay Bailey’s article “Implementation of a Hands-free Wireless Communications Device in a Comprehensive Cancer Center”.

In our second nurse-authored article, Neil McElligott refers to Epocrates®, the mobile provider of drug, disease, and laboratory information, as a “helping hand for nurses.” As he notes in his article, it’s not humanly possible to recall the correct dose or know the side effects and contraindications of all of the currently available medications. Tools such as Epocrates enable nurses to quickly and easily locate up-to-date, comprehensive medical information via their computers, smartphones, and other personal data devices. Epocrates now also features a drug module for over-the-counter medications, which is a huge time-saver for healthcare providers and a possible life-saver for patients.

The Internet contains a vast amount of information. As Roxanne Williams-Truax notes in her Clinical Trials Observations, the Food and Drug Administration and the National Cancer Institute (NCI) sites are invaluable resources for nurses caring for patients enrolled in clinical trials. The NCI site contains the latest version of the Common Toxicity Criteria, which was developed to provide a unified language for classifying and grading side effects and treatment- related toxicities. Using these criteria, we can all speak the same “language” to identify and document toxicities and adverse events.

As Dr Lisa Marie Bernardo reminds us in the Fitness Forum, the Internet provides around-the-clock access to information, and she describes how Web-based information and tools, such as activity logs, can promote behavior change. Another site that patients with cancer and their families may find useful is 

, which provides free personalized Websites to people who are ill. The site allows guests to visit a patient’s Website to read journal updates and post messages. Caring Bridge provides a way for patients to communicate with many people at once, as opposed to having to respond to individual e-mail messages or phone calls.

It is interesting to see how communication and information technology has advanced in response to human needs, and the need for speed, up-to- date accurate information, and the ability to stay connected have all driven progress. It’s hard to imagine where things will go from here, but chances are that technologies will become even smaller, faster, and more immersive than they are now.

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Despite major advances in communication technologies, numerous hospitals and clinics still use overhead paging, intercoms, Walkie Talkies, and other antiquated methods to reach staff members. 

Can You Hear Me Now?

Caring for patients with cancer can be complex, especially when there is advanced disease; however, even patients who are considered cured or in remission have special considerations that may affect their future health, such as an increased risk of developing a new primary malignancy. The new malignancy sometimes results from a genetic predisposition or from prior cancer treatment with radiation or chemotherapy, but in many cases it may be avoidable. Did you know that smoking tobacco and consuming alcohol accounts for approximately 35% of second primary cancers in cancer survivors? Nurses can be instrumental in guiding their patients to making more healthful decisions, such as quitting smoking, reducing or eliminating alcohol consumption, eating healthfully, engaging in physical activity, and reducing stress. In our cover story, “New Primary Malignancies: Promoting Lifestyle Changes to Minimize Risk”, Guido R. Zanni, PhD, discusses the impact of lifestyle factors on the risk of new primary malignancies in cancer survivors. Lisa Marie Bernardo, PhD, discusses three mind- body fitness options that may help patients with cancer reduce stress levels and to be more active, both of which go a long way in improving health and outcomes.

It is estimated that only 3% to 5% of adult patients with cancer enroll in a clinical trial, yet these trials are crucial to advancing cancer care and improving outcomes. While many patients don’t enroll because they are unaware of a trial, in some cases fear prevents them from participating. Patients may be afraid that they will become a “guinea pig” or won’t receive active treatment. In Nurse to Patient, a new department that we are launching starting with this issue, you will find answers to some of the questions patients may have about clinical trials. This new department serves to provide you with an educational resource for your patients. If you’d like an electronic copy so that you can print copies for distribution to your patients or there is a topic you’d like to see covered in a future Nurse to Patient, please contact cloguidice@onclive.com.

Wishing you a joyous holiday season and a healthy and happy New Year!

Caring for patients with cancer can be complex, especially when there is advanced disease; however, even patients who are considered cured or in remission have special considerations that may affect their future health, such as an increased risk of developing a new primary malignancy.

Guiding Patients Toward Health

The majority of patients with cancer, including those who have completed treatments, experience symptoms related to their cancer or to treatments at some point during their cancer journey. One of the most commonly reported problems is fatigue, and it is estimated that approximately 90% of patients undergoing chemotherapy or radiotherapy suffer from this debilitating condition. In some cases, patients may not report experiencing fatigue because they think it is a result of their disease or treatment, or they may be afraid that it is a sign that their cancer is progressing. Because oncology nurses are on the frontlines treating patients and interacting with them, they may be more prone to identifying fatigue in their patients, and only by identifying the problem can steps be taken to help remedy it, which can have a significant impact on a patient’s quality of life and survival outcomes. Our article “Discussing Cancer-Related Fatigue and Anemia with Patients,”, reviews fatigue and anemia (which can contribute to or result in fatigue in patients with cancer), including their causes and steps that can be taken to identify and treat these problems.

One of the steps that can be taken to combat fatigue in patients with cancer is exercise, which can also have other benefits in patients with cancer. In our Fitness Forum, Dr Lisa Marie Bernardo discusses how resistance training may improve physical functioning in patients experiencing breast cancer-related lymphedema. Of course, exercise suggestions must always be tailored to the patient. For instance, patients with myeloma should avoid strenuous activities such as running or tennis because of their weakened bones, but may benefit from more low-impact activities, such as walking.

The end of the year is always a time for reflection and appreciation. As an oncology nurse, you have much to be proud of, and we want to take the time to thank you for all that you do to improve the lives of your patients. As we move into 2010, we wish you health, happiness, and continued success in your endeavors, whether great or small.

The majority of patients with cancer, including those who have completed treatments, experience symptoms related to their cancer or to treatments at some point during their cancer journey.

The importance of supportive care

Although 70% of oncologists responding to a survey reported discussing fertility preservation with newly diagnosed patients, only 25% said they provided educational materials or referred patients to fertility specialists. Surveys were mailed to a random sample of 1,979 oncologists and 33% (613) responded. The oncologists were asked about fertility guidelines published by the American Society of Clinical Oncology (ASCO) in 2006, but 38% of the oncologists indicated that they had no knowledge of the ASCO guidelines. 

 It is estimated that 450,000 patients newly diagnosed with cancer may be in need of fertility counseling prior to treatment initiation. Reasons provided by oncologists for not discussing fertility preservation included the opinion that many patients need urgent treatment, the emphasis on other treatment side effects (making fertility preservation a lower priority for discussion), and the cost of fertility preservation, which usually is not covered by health insurance in the United States.

 These survey findings make me wonder if oncologists will now be enlightened and begin to routinely include fertility effects and preservation while they discuss initial treatment plans with newly diagnosed patients. I suspect that some oncologists will be more attentive to this sensitive topic, especially with younger patients, but my hunch is that patients will receive information and support from nurses, or be on their own. 

 One helpful resource available to oncologists, nurses, and patients is Fertile Hope. Founded in October 2001, Fertile Hope is a national, nonprofit organization dedicated to providing reproductive information, support, and hope to patients whose medical treatments present the risk of infertility. Fertile Hope also provides information on financial assistance for fertility preservation, supports fertility preservation research, and provides support to help patients cope with infertility, fertility preservation, assisted reproduction, family planning, genetic counseling, pregnancy, adoption, and other related issues. For more information, visit 

 Source: Quinn G et al. National survey of physicians' practice patterns. Fertility preservation and cancer patients. 

Lots of talk but little action from oncologists.

Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN

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