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VOL 4, NO 8
CANCER CENTER PROFILE
Breastlink Medical Center A Team-Based Approach to Patient Care
How Comprehensive Is Comprehensive BRACAnalysis? The Story of Kathleen Maxian By Cristi Radford, MS, CGC Sarasota Memorial Health Care System, Sarasota, Florida
ou may or may not have heard the name Kathleen Maxian, but it is likely you have encountered women like her in your practice without knowing it. Kathleen has been featured in several news stories lately, including in the New York Times and on CNN. Her sister, Eileen Kelly, was diagnosed with breast cancer at age 40 and underwent testing for BRCA1 and BRCA2 (BRCA1/2) gene mutations. She was found to be negative. Two years later, Kathleen was diagnosed
with ovarian cancer. Ultimately, Eileen and Kathleen were found to carry a BRCA mutation that is only detected by BART, a test that looks for large genomic rearrangements in BRCA1/2. According to Maxian’s surgeon, “If BART had been done from the beginning, it could have saved Kathleen from getting ovarian cancer.”1 So why wasn’t BART performed on Eileen’s initial genetic test? To understand the science behind Kathleen’s story, the Continued on page 12
SIDE EFFECT MANAGEMENT James Waisman, MD, a breast oncologist with Breastlink, confers with a patient.
reastlink is a network of comprehensive breast centers that specifically focuses on providing treatment and care to women with breast cancer. The Breastlink Medical Group was founded in 1995 by John Link, MD, and now operates 5 breast cancer centers in California (4 in Southern California). Today, Breastlink offers a team-based, patient-centered approach to care, as well as a focus on research into the causes of and the cure for breast cancer. Lori Kells-Rezabek, NP, PhD, of the Manhattan Beach, California, center tells us how Breastlink’s multidisciplinary team works and what is happening in the areas of breast cancer prevention, care, and research.
Continued on page 54
Management of RadiationInduced Skin Reactions Up to Individual Practices By Alice Goodman
lthough cancer patients who undergo radiation therapy frequently have acute and chronic skin reactions, there are no hard and fast guidelines on management of radiationinduced skin reactions or the best prod-
ucts to use. Each center or practice should develop its own clinical guide about how patients should manage skin reactions and which products are recommended for patient use, said Maureen McQuestion, RN, Princess Margaret Continued on page 16
CONFERENCE NEWS: ASTRO
Higher Radiation Doses May Not Help Lung Cancer Patients Live Longer
Metastatic Breast Cancer: Advances in Treatment and Management
By John Schieszer
higher dose of radiation (74 Gy) does not improve overall survival for non–small cell lung cancer (NSCLC) that has spread to the lymph nodes compared with the standard radiation dose (60 Gy), according to a new study presented at the 53rd Annual Meeting of the American Society for Radiation Oncology.
“Most radiation oncologists and lung cancer specialists are surprised by this finding. Although the optimal radiation dose for lung cancer patients has not been tested in a randomized phase 3 trial for over 30 years, most believed that higher doses of radiation cured more patients with lung cancer,” said study investigator Jeffrey Bradley,
Healthcare Literacy Rates ConferenCe news
Oncology Nursing Society Institutes of Learning
Continued on page 26 ©2011 Green Hill Healthcare Communications, LLC
Clinical Trials Awareness, Confusion, and Clarity . . . . . . . . . . 28 Participation of Older Cancer Patients in Clinical Trials . . . . . . . . . 33 your faQs…answered . . . . .
Types of Amyloidosis and Available Treatment Options nutrition with Karen
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Your inspiration, You guide your HER2+ breast cancer patients through their course of treatment with care and support. The HER Connection program can provide some extra help, including:
Text tips and email tailored to HER journey Live outreach call program Live 24/7 support line
Boxed WARNINGS and Additional Important Safety Information s Herceptin administration can result in sub-clinical and clinical cardiac failure. The incidence and severity was highest in patients receiving Herceptin with anthracycline-containing chemotherapy regimens. In a pivotal adjuvant trial, one patient who developed CHF died of cardiomyopathy
s Exposure to Herceptin during pregnancy can result in oligohydramnios, in some cases complicated by pulmonary hypoplasia and neonatal death
s Evaluate cardiac function prior to and during treatment. For adjuvant therapy, also evaluate cardiac function after completion of Herceptin. Discontinue Herceptin for cardiomyopathy
s Detection of HER2 protein overexpression is necessary for selection of patients appropriate for Herceptin therapy
s Exacerbation of chemotherapy-induced neutropenia has also occurred
s Herceptin can result in serious and fatal infusion reactions and pulmonary toxicity. Discontinue Herceptin for anaphylaxis, angioedema, interstitial pneumonitis, or acute respiratory distress syndrome
ÂŠ2011 Genentech USA, Inc.
6391928 Onc Nurse Jrnl Ad AUG M01 indd 1-2
s The most common adverse reactions associated with Herceptin use were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, dyspnea, rash, neutropenia, anemia, and myalgia
So. San Francisco, CA
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Adjuvant indications Herceptin is indicated for adjuvant treatment of HER2-overexpressing node-positive or nodenegative (ER/PR-negative or with one high-risk feature*) breast cancer:
s As part of a treatment regimen containing doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel s With docetaxel and carboplatin s As a single agent following multi-modality anthracycline-based therapy *High-risk is defined as ER/PR positive with one of the following features: tumor size >2 cm, age <35 years, or tumor grade 2 or 3.
Please see brief summary of full Prescribing Information, including Boxed WARNINGS and additional important safety information, on the following pages.
8/3/11 3:02 PM
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HERCEPTINÂŽ (trastuzumab) Brief Summary For full Prescribing Information, see package insert. WARNING: CARDIOMYOPATHY, INFUSION REACTIONS, EMBRYO-FETAL TOXICITY, and PULMONARY TOXICITY Cardiomyopathy Herceptin administration can result in sub clinical and clinical cardiac failure. The incidence and severity was highest in patients receiving Herceptin with anthracycline containing chemotherapy regimens. Evaluate left ventricular function in all patients prior to and during treatment with Herceptin. Discontinue Herceptin treatment in patients receiving adjuvant therapy and withhold Herceptin in patients with metastatic disease for clinically significant decrease in left ventricular function. [see Warnings and Precautions and Dosage and Administration] Infusion Reactions; Pulmonary Toxicity Herceptin administration can result in serious and fatal infusion reactions and pulmonary toxicity. Symptoms usually occur during or within 24 hours of Herceptin administration. Interrupt Herceptin infusion for dyspnea or clinically significant hypotension. Monitor patients until symptoms completely resolve. Discontinue Herceptin for anaphylaxis, angioedema, interstitial pneumonitis, or acute respiratory distress syndrome. [see Warnings and Precautions] Embryo-Fetal Toxicity Exposure to Herceptin during pregnancy can result in oligohydramnios and oligohydramnios sequence manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death. [see Warnings and Precautions, Use in Specific Populations] INDICATIONS AND USAGE Adjuvant Breast Cancer Herceptin is indicated for adjuvant treatment of HER2 overexpressing node positive or node negative (ER/PR negative or with one high risk feature [see Clinical Studies= BREAST CANCER s AS PART OF A TREATMENT REGIMEN consisting of doxorubicin, cyclophosphamide, and either PACLITAXEL OR DOCETAXEL s WITH DOCETAXEL AND CARBOPLATIN s AS A SINGLE AGENT FOLLOWING MULTI MODALITY ANTHRACYCLINE based therapy. Metastatic Breast Cancer Herceptin is INDICATED s )N COMBINATION WITH PACLITAXEL FOR lRST LINE TREATMENT OF (%2 OVEREXPRESSING METASTATIC BREAST CANCER s !S A SINGLE AGENT FOR TREATMENT OF (%2 OVEREXPRESSING breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease. Metastatic Gastric Cancer Herceptin is indicated, in combination WITH CISPLATIN AND CAPECITABINE OR mUOROURACIL FOR THE treatment of patients with HER2 overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma, who have not received prior treatment for metastatic disease. CONTRAINDICATIONS None. WARNINGS AND PRECAUTIONS Cardiomyopathy Herceptin can cause left ventricular cardiac dysfunction, arrhythmias, hypertension, disabling cardiac failure, cardiomyopathy, and cardiac death [see Boxed Warning: Cardiomyopathy]. Herceptin can also cause asymptomatic decline in left ventricular ejection fraction (LVEF). There is a 4âˆ’6 fold increase in the incidence of symptomatic myocardial dysfunction among patients receiving Herceptin as a single agent or in combination therapy compared with those not receiving Herceptin. The highest absolute incidence occurs when Herceptin is administered with an anthracycline. Withhold Herceptin for â‰Ľ 16% absolute decrease in LVEF from PRE TREATMENT VALUES OR AN ,6%&