Depression and depressive symptoms are prevalent in people with cancer, yet interventions for depression are a low priority for most oncology care providers. Barriers to diagnosis and treatment include beliefs by patients and providers that depression is an expected correlate of cancer diagnosis, the reluctance of patients to share psychological concerns, and the reticence of some professionals to assess patients with cancer for depressive symptoms in the midst of busy oncology settings. Intervening to diminish depressive symptoms in people with cancer is important because depression has been associated with poorer quality of life, recovery, and possibly survival. This article reviews and summarizes the evidence for pharmacologic and nonpharmacologic interventions for people with cancer and depression and identifies opportunities for future research and practice change.
Neutropenia can be a significant problem in the oncology setting. Awareness of potential risks, management of neutropenia, and preventive measures guide nurses in providing comprehensive care that can make the difference between life and death.
Overexpression of vascular endothelial growth factor (VEGF) by tumor cells promotes angiogenesis, which correlates with progressive tumor growth and poor outcomes in many types of cancer. Bevacizumab inhibits VEGF to promote regression of tumor vessels by limiting blood supply and tumor growth, enhancing delivery of chemotherapy, and inhibiting formation of new vessels. Combined with chemotherapy, bevacizumab prolongs progression-free and overall survival over chemotherapy alone in patients with metastatic carcinoma of the colon and rectum; unresectable, locally advanced, recurrent or metastatic non-squamous, non-small cell lung cancer (NSCLC); and metastatic HER2-negative breast cancers (mBC). Side effects, including hypertension, proteinuria, bleeding, arterial thrombotic events, and impaired wound healing, can be clinically significant, particularly in patients with risk factors. To optimize patient outcomes, nurses should understand bevacizumab's role in cancer therapy, recognize symptoms of toxicity, and manage its side effects. This article describes the rationale for bevacizumab in the treatment of metastatic colorectal cancer, NSCLC, and mBC and discusses patient selection, treatment duration, and side-effect management to support the role of oncology nurses in caring for, educating, and enhancing treatment adherence among patients with cancer receiving bevacizumab. Two case studies are presented as examples of the complex scenarios nurses may encounter regarding these issues.
Peripheral neuropathy is a condition that can be caused or exacerbated by the administration of certain chemotherapeutic agents. The effects of chemotherapy-induced peripheral neuropathy (CIPN) are dose limiting and might lead to permanent, debilitating disabilities. Oncology nurses should be aware of the impact of CIPN. Nurses should be cognizant of the pathophysiology, pre-existing conditions contributing to an increased risk of CIPN, causative agents, and interventions used in managing CIPN. Awareness that the peripheral nervous system is divided into small fibers, large fibers, and the autonomic nervous system is important in the assessment, detection, and treatment of CIPN. Presenting symptoms are related to the specific fibers that are damaged. Because of the different mechanisms of action, CIPN symptoms vary depending on the chemotherapeutic agents used. This article provides a general overview of CIPN, including pathophysiology, causes, risk factors, assessment, and current treatment. Oncology nurses must be alert for the manifestations of CIPN. Early intervention and patient education can have a positive effect on the quality of life for patients with this disorder.
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