Conference News: MASCC Conference News continued from cover
Lymphedema in Head and Neck Cancer Although little is known about the prevalence of lymphedema in head and neck cancer (HNC), a series of studies found that three-quarters of patients with HNC have problematic lymphedema, both internally and externally. “Lymphedema is a significant problem affecting a majority of HNC patients. Treatments such as surgery, chemotherapy, radiation, and combined modality therapy can damage lymphatic structures, leading to scar tissue and fibrosis. Lymphedema can be detected noninvasively, and this can inform clinical practice,� stated Sheila Ridner, PhD, RN, FAAN, Vanderbilt University School of Nursing, Nashville, Tennessee.
These studies help characterize the prevalence, patterns, and assessment of lymphedema in HNC. The studies examined prevalence, symptoms, measurement techniques, and symptom assessment tools. Study 1 included 81 patients at least 3 months out from treatment. After a posttreatment interval of a median of 17.7 months, 75.3% had late-effect lymphedema; of these patients, 9.8% had external lymphedema exclusively, 39.4% had internal edema exclusively, and 50.8% had both types. Study 2 included 25 patients with HNC. Swelling (both internal and external) was measured before and after treatment at 6 and 12 weeks using digital photography and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v.4.02. At baseline, digital photography identified external swelling more often than did CTCAE. Internal swelling was identified at baseline in 10 patients, and only 4 had been treated with surgery. Digital photography captured 100% of cases of internal swelling and 92% of cases identified by CTCAE. Study 3 included 100 patients and followed the time course and patterns of internal and external swelling over 36 weeks. Preliminary findings regarding external lymphedema using 3 different tools (Foldi, CTCAE-lymphedema, CTCAE-fibrosis) showed that by 36 weeks post treatment for HNC, >50% had lymphedema. Internal lymphedema, as documented via scoping procedures on the Patterson scale, was present in a few structures in 10% to 20% of patients prior to treatment. At 36 weeks post treatment, about 30% of patients had internal lymphede-
www.TheOncologyNurse.com
ma, and this was observed in more struc- and assessment of lymphedema in HNC. tures than noted prior to treatment. Ridner said that patients should be eduStudy 4 included 30 patients and found cated about lymphedema before, during, that 10 major symptoms were reported by and after treatment. Internal and exter>50% of patients. nal examinations should be conducted Taken together, these studies help to look for lymphedema, and signs and Bendamustine 7/18/13 11:59symptoms AM Page 2 of lymphedema should be evalcharacterizeAsize_071613_TON0210 the prevalence, patterns,
uated at each clinic visit. Patients should be referred to lymphedema treatments when indicated. Reference
Ridner S, Deng J, Murphy BA, et al. Lymphedema in patients with head and neck cancer. Support Care Cancer. 2013;21(suppl 1):S196. Abstract 0558.
Vi ew s eO eri the nc es c olo on om gy line ple Nu a te rse t .co m
Th
Faculty Perspectives
™
A 4-part series The publishers of The Oncology Nurse-APN/PA, The Oncology Pharmacist, and Personalized Medicine in Oncology are proud to present Faculty Perspectives: The History of Bendamustine series.
Faculty Perspectives
Part 1 of a 4-Part Series 2012
DECEMBER
™
A Retrospectiv e
Review of the of Bendamust Characterization a 4-Part Series of ine Part 2
MARCH
CONTRIBU
UME 2013 • VOL
BER 4 • NUM
2
TING FACULT Y
Julie M. Vose , MD, MBA
en Ross, RN, y c MSN, MHA Susanne Liew , OCN Lymphocyti er, PharmD, BCO onic P phoma am a cy of Bend d Non-Hodgkin Lym an ia Leukem Colle
University of Nebraska Medical Cente r
University of Nebra Medical Cente ska r
University of Nebraska Medical Cente r
PMP M O
FACULTY NTRIBUTING
CO
ERSONALIZ ED EDICINE IN ONCOLOGY
������������������ �������������������� ������������������ ����������������� �� ��
Part 3 of a 4Part
APRIL
������� ����������� ����������
2013
�������������� ������������� ������ �����������
Supported
through fundin g by
of University Center Medical
of Nebraska University Center Medical
of Nebraska University Center Medical
n odgkin ic Lymphocy t Lymph oma D ONALIZE
CONTR
Liewer, Susanne BCOP PharmD, Nebraska
Ross, RN, Colleen , OCN MSN, MHA
tyy of B Leukemendamu ia and Non-H
For the complete series including:
Series
• VO LUME 4 • NU MB
ER 3
e, Julie M. Vos MD, MBA
IBUTIN
• Characterization of bendamustine • Registration studies - efficacy • Registration studies - safety • Ongoing clinical investigations please log on to www.TheOncologyNurse.com
• VOLUME 4 • NUMBER 1
Y
OG ERS ONCOLPrecision E IN of Prognostic MEDICIN the Promise Care
ULTY
LD 7KH RIĂ€F
Âť
Âť
plementing d Cancer into Personalize
G FAC
WLRQ RI O SXEOLFD
BAL MARKERS MÂť SORTIU Approaches Âť s eted Technologie
Part 4 of a 4-Part Series Supported
Collee n Ross, MSN, RN, Univer MHA, OCN sity of
Susan ne Pharm Liewer, D, BC Univer OP sity of Ne
Nebra ska al Ce nter
Medic
JUNE 2013 by • VOLUME 4 • NUMBER 4 ing fund
Julie M . Vose, M
braska nter
Medic
through
al Ce
Univer D, MBA sity of Nebra Medic ska al Ce nter
pp Malignancies Utilizing Bendamustine ERSO
MEDICNALIZED INE I N ON CO
pleme nting into Person the Promise alized Cance of Progno stic Precisio r Care Âť n
LOGY Âť
7KH R IĂ€
FLDO S XE
OLFDWLR
g
Q R I
BAL MARKERS SORTIUM Approa Âť ches eted Technol
ogiesÂť
CONTRIBUTING FACULTY Suppor
ted thro
ugh fun
ding by
Colleen Ross, RN, MSN, MHA, OCN
University of Nebraska Medical Center
Julie M. Vose, MD, MBA
Susanne Liewer, PharmD, BCOP
University of Nebraska Medical Center
University of Nebraska Medical Center
ERSONALIZED
MEDICINE IN ONCOLOGY
Âť
plementing the Promise of Prognostic Precision into Personalized Cancer CareÂť
7KH RIĂ€FLDO SXEOLFDWLRQ RI
BAL MARKERS Âť SORTIUM Approaches
ted TechnologiesÂť
Supported through funding by
TON A-SIZE_FP071613
TO VIEW THE COMPLETE SERIES ONLINE PLEASE LOG ON TO:
www.TheOncologyNurse.com August 2013 I VOL 6, NO 7
7