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BY SUZANNE LINDLEY | MAY 16, 2012
I stepped outside on May 1st and couldn't see any of the horses. As I walked down the fence line, I noticed that the geldings were hanging out in the barn. I didn't think much about it as I scanned the pasture for the mares. Nearing the end of our property I could see that they were standing in the far back corner. Lucy was close to the fence and after a minute or two, I realized that her leg was caught and I could also see a still brown and white form at her feet. I felt a lump form in my throat as I realized that the neighbor's dog must have been chasing her. I assumed she had kicked out at him and connected. I ran back to the garage and grabbed the wire cutters and a shovel; my heart racing. My first task would be to get Lucy's foot loose. I didn't allow myself to think about the poor dog. Home alone, I could only hope that my new mare would remain calm. I called Ronnie and asked him to check on me in a few minutes. I reached Lucy and marveled at how the other mares were standing quietly around her, especially since she had only been a part of the herd for a few short weeks. I worked quickly and calmly to free her leg, cutting wires and pushing back the fence. I patted her shoulder and felt relief that there wasn't a spot on her and was grateful, but surprised, that the other mares kept the dogs back. I was thankful for their help. I reached for the shovel, dreading my next task. I had not allowed myself to look in that direction. Turning, I was greeted by one of the most incredible sights of my life. The lifeless form I expected to see was not that of a dog but instead the most elegant and beautiful filly I have ever laid eyes on. She was no longer laying in a heap, but standing on wobbly legs making her way to Lucy's side. What I would give to have seen the look on my own face!!! A vet checked Lucy as healthy, and slightly overweight, but not pregnant just weeks before. The now eagerly nursing foal proved that doctor wrong...and was quite a shock for me!
The baby nuzzled at her mom who let out a calming whinny. Joyful tears began to stream as I watched Lucy and her little bundle of joy.
Life is........ full of surprises! and mine just happens to be an "Elegant May Surprise!"
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BY LINDSAY RAY | MAY 10, 2012
Yesterday, I came across a video making its way around the Internet. It made me smile (and made me a bit misty eyed). And because these kids, young adults, nurses and parents are better at sharing their message than I ever could be, check out their inspiring video below.
22-year-old leukemia patient Chris Rumble (he's in an orange shirt in the video) decided to use his film talents to make a music video of Kelly Clarkson's "Stronger" featuring his fellow patients, families and staff on the hematology/oncology floor at Seattle Children's Hospital. Rumble is an artist-in-residence- at Seattle Children's as part of LIVESTRONG's Community Impact Project.
What started as a project to cheer people up has now become a viral sensation. And Clarkson even tweeted about it saying, "Oh my goodness y'all have to see this! It's beautiful! I can't wait to visit these kids and nurses!" I agree with Kelly; it's definitely a beautiful video.
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BY JON GARINN | MAY 7, 2012
Although my time at the 37th annual congress of the Oncology Nursing Society was brief, I was able to attend an excellent presentation on PARP inhibitors by Julie Eggert, PhD, RN, of Clemson University in South Carolina and Lori Williams, PhD, RN, of the M.D. Anderson Cancer Center in Houston. I'm no expert on molecular biology, but I'll try to interpret what I heard. Be warned: we're about to enter a microscopic world with a language all its own. Navigating it will require a laser-like focus.
In the beginning...
The story of cancer begins with damage to DNA. Repair the damaged DNA and you stop cancer's growth. It's a simple enough premise. But the devil is in the details.
Hooray for the 1 percent!
DNA (Deoxyribonucleic Acid) is the genetic code in every human cell. And we've got a lot of it: If you were to stretch out the DNA in a single human cell, it would measure nearly 10 feet in length! Considering we have about 100 trillion cells, we've got enough DNA to reach the moon 6,000 times. With so much DNA in our systems, you might think we have a lot that makes us uniquely who we are. But 99 percent of human DNA is exactly alike in everyone. Only 1 percent is unique. Take that, Occupy movement!
The only way we can store so much DNA in our cells is with the help of chromosomes, which act as super-efficient storage units. Before going into "storage," the DNA wraps itself tightly around proteins. These proteins form one of 46 chromosomes in every human cell.
Our cells receive their instructions on what to do from our DNA molecules. For example, our DNA will tell a cell whether it should help us see or make our hearts beat.
The DNA of DNA
To understand how DNA works, you have to know how it's built. Imagine that you have a ladder that is cut in half. It's basically useless, unless you can bond the two sides together. That requires not only a powerful bond, but also a proper alignment.
Visualize DNA as a twisted ladder (scientists call it a "double helix"), with sides (scientists call them "strands") that are made up of sugars and phosphates, and rungs that are made of one of four chemicals: adenine (A), guanine (G), cytosine (C) and thymine (T). The chemical "bases" on one side of the ladder are bonded to the chemical bases on the other side with the help of hydrogen (creating that powerful bond I referred to earlier). But that bond will only work when the chemical bases are combined in certain ways (that proper alignment I spoke about). So, "A" must always bond with "T" and "C" must always bond with "G".
The rungs of our DNA ladder form strings of "letters" that, in turn, form words and sentences--our genetic code or blueprint. Our genes tell our cells to make other molecules (proteins) that enable our cells to perform special functions, such as working with other groups of cells to help us see or make our hearts beat. Although we have about 25,000 genes, only a few contain instructions for helping us see or making our hearts beat.
Handle with care!
DNA is fragile, meaning it's easily susceptible to damage. Consider that we typically experience more than 10,000 spontaneous single strand breaks to our DNA every day. What causes our unstable DNA to become damaged? Most frequently, exposure to environmental agents, such as chemicals or inflammation.
PARP is a protein needed by cells to repair damage, so when that protein is blocked, damage repair is inhibited, resulting in cell death. Some cancer cells are dependent on PARP, particularly those with BRCA or "BRCA-like" gene mutations. Cancers sensitive to PARP inhibition include breast, prostate, squamous cell lung, colorectal, ovarian and melanoma. PARP inhibitors may also be used to prevent repair of damage from chemotherapy or radiation treatments.
Researchers are still learning about how PARP inhibitors work and whether they are more effective alone or in combination with other targeted agents. Results of early trials seem to support the latter. In fact, PARP inhibitors suffered some disappointing trials in breast cancer last year, but research continues, including in ovarian cancer. As is the case with most promising new therapies, scientists are recognizing that they may be effective in specific patients rather than in entire populations.
Because PARP inhibitors are still being studied, none are currently available except through a clinical trial. As is the case with most cancer research, stay tuned.
Your homework assignment
If you've managed to make your way to the end of class, you might consider reading our "Targeting the Triple Threat" feature from our Fall 2009 issue.
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BY LINDSAY RAY | MAY 7, 2012
Today is Melanoma Monday, designated by the American Academy of Dermatology (AAD) to raise awareness about melanoma and other skin cancers while encouraging early detection. Today also kicks off skin cancer awareness month.
Skin cancer is the most common cancer in the United States, with more than a million in nonmelanomas expected to be diagnosed this year and about 76,000 melanoma cases. Melanoma rates are also on the rise in the young adult population. A study published in the April issue of the Mayo Clinic Proceedings found an eight-fold increase in melanoma cases in young women and a four-fold increase in young men when comparing diagnoses in the 1970s to 2000s. The study analyzed data from the Rochester Epidemiology Project to examine first-time diagnoses from 1970-2009. And although diagnoses increased during that time period, overall survival improved. And a recent study in the Journal of Clinical Oncology found that women with early-stage melanoma have a 30 percent survival advantage compared with male patients. (Men are also known to have a higher lifetime risk for melanoma.) The researchers hypothesize that this advantage could be due to biological differences between the sexes but state that there must be further research into this discrepancy.
Due to the increasing rates of skin cancers among young people, several states have enacted some form of legislation to limit tanning bed usage (a known carcinogen) in this age group. Just last week, Vermont joined California in banning tanning bed usage in those under 18. While other states also have age limitations or require parental permission, these are the only two states to have a ban in place up to 18 years of age.
So how can you be more aware of skin cancer? Or if you have/had skin cancer, how can you share information with family and friends?
• The SPOT Skin Cancer campaign from the AAD offers tools and information for prevention and detection.
• ListentoYourSkin.org, which is sponsored by Leo Pharma, Inc., in association with the AAD, offers information on detection, the precancerous condition actinic keratosis and tools like finding the UV index in your area.
• The David Cornfield Melanoma Fund put together the viral video "Dear 16-year-old Me" to raise awareness and encourage prevention.
• More information skin-cancer specific nonprofits can be found in our toolbox.
• Read recent treatment information from CURE's "Melanoma: Ready for Takeoff" feature published last summer.
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BY KATHY LATOUR | MAY 5, 2012
I rode the shuttle to the early sessions at the Oncology Nursing Society congress this morning, and my conversation with the nurse in the window seat has given me some new perspective on those nurses who are at the bedside of dying cancer patients. We were chatting about which sessions we had attended. Well, actually, I was sort of interviewing her about what she had learned from the meeting, when I saw from her badge that she was a first-time attendee. She said that the poster sessions, where nurse researchers make large posters of their studies, gave her some great ideas that could easily be transferred to her hospital and her job. When I asked what role she served, she said she was a bedside hematology nurse in the stem cell transplant area, and a good portion of her time was spent with very sick patients and their families. Because I know that this area is also one with a high mortality rate, I asked her which of the sessions she had attended and, not unexpectedly, she said she had attended the pre conference workshop on end of life. This overflow workshop explored the issues surrounding that time of transition from this world to the next, and, for those nurses who experience end of life more often in their jobs, it brings with it the need for special skills and the ability to self heal.
I can't imagine how hard it is to keep an open heart to the pain of being present for your patients' deaths and then be expected to walk to the next room where a patient is preparing to go home.
This nurse was struggling with the challenge of creating the relationship needed to spend the last week of a patient's life with them when she wanted to be part of the whole continuum of care. She was looking for ways to spend more time with her dying patients and the family. On that short bus ride, I saw once again how oncology nurses constantly think about ways to be closer to their patients. We parted ways with her talking about how she would share what she had learned with the other nurses in her area when she returned. Wow.
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BY JON GARINN | MAY 4, 2012
What do you get when you fill a hotel ballroom with hundreds of oncology nurses, dozens of admiring supporters, a Dixieland jazz band, an inspirational Hollywood legend, and several grateful patients on hand to pay tribute?
Something indescribable.
To call it a celebration of the oncology nursing profession doesn't quite capture the moment. CURE's sixth annual Extraordinary Healers awards event was certainly that and more. To say it was a show of appreciation for some of nursing's finest is an understatement. To describe it as an opportunity for older generations of nurses to hear from an actress whose groundbreaking role inspired them to consider nursing, and for younger generations who may never have known her work to understand why she is so beloved by nurses, falls short of the moment.
I wish there was a way to convey the emotion of last night's event, but words fail me. It is perhaps ironic that someone who devotes his professional life to words would be inadequate to the task of communicating what it was like to be present at that moment. I've long admired the many fine nurses I've met over the years, but last night's event gave me a new appreciation for them. These selfless, dedicated, compassionate professionals are fiercely determined to bring healing and hope to everyone they encounter throughout the continuum of care, even when facing the most difficult circumstances.
But don't call them heroes. They'll say they're just doing their jobs. If you dare to compare them to angels, they'll quickly change the subject. It's really no surprise that nursing continues to be one of the most trusted professions in America. As the backbone of our healthcare system, nurses deserve our respect, admiration and thanks. In some small way, CURE tried to convey that at last night's event. I wish I could describe what it was like to be there, but words are inadequate to the task.
If you're an oncology nurse, consider joining us at next year's event in Washington, DC. If you're a patient, caregiver or survivor, consider nominating your oncology nurse for the Extraordinary Healer award. Regardless of who you are, take time to show appreciation for nurses everywhere. They deserve it.
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BY KATHY LATOUR | MAY 4, 2012
The sixth celebration of the Extraordinary Healer Award For Oncology Nursing was held tonight with a New Orleans style Mardi Gras band, beads, and a festive spirit to match.
The room was full this year as word has grown about this event, which has one goal, to celebrate nurses for the amazing job they do for their patients. The essays we receive from readers point it out over and over as they pay tribute to the men and women who go above and beyond to bring healing to their patients -- whether or not cure is possible.
We publish the winning essay in the summer issue, just as we will this year, but I wish we could somehow let you read all of them. Of course, that would mean publishing all 1,200 we have received in the last six years. We do put a good sampling in a book each year that we hand out, but I wanted to give the nurses a better sense of what patients say about them.
So this year I read the nurses a job description that I created that I think captures the essence of what I have determined would be the job description for the oncology nurse who is a composite of the qualities listed in the essays we read.
Here it is:
Seeking Oncology Nurse: Requirements: A highly skilled nurse who approaches the job with joy – and finds fulfillment spending days and nights amid the pain and despair of cancer patients.
Candidates should be able to demonstrate the ability to be a loving friend while dispensing the most difficult of treatments, and stand with pride as a warrior advocate for his or her patients, many of whom cannot speak for themselves.
He or she must be an accomplished teacher, one filled with compassion and courage – who has the patience of Job and the wisdom of the ages.
In addition to nursing degrees, degrees in psychology and divinity also required – as is background that includes politics and the practice of magic.
Must enjoy long hours, little pay, paperwork and body fluids.
Prior experience as an angel a plus.
Next came our fabulous speaker and honorary mistress of ceremonies, Diahann Carroll.
Actress, singer, and breast cancer survivor, she clearly had inspired more than one nurse in the room to join the nursing profession in her ground breaking role as Julia in 1968. The role was the first ever where an African American woman starred in a network television series and Diahann pointed out that it depicted a Black woman with a professional degree.
And, it turns out that Mary Gullatte, PhD,RN,AOCN,FAAN , the vice president for patient services at Emory University Hospital in Atlanta, who will be inducted on Saturday as the new president of ONS, was one of those inspired by Julia to join the nursing profession. It was our pleasure to bring these two wonderful women together for a photo.
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BY JON GARINN | MAY 2, 2012
I'm preparing to leave Dallas for New Orleans and the 37th annual congress of the Oncology Nursing Society. Since this will be my first time to attend the congress, I'm eager to greet our many oncology nurse readers and receive their feedback. I'm also excited to welcome the finalists in our Extraordinary Healer contest, as well as those who nominated them for this national honor.
I've heard from several readers how difficult it is to identify a single nurse who made a difference in their treatment. It takes a team, they say, and an effective team has few, if any, standout players. While I appreciate the sentiment, I also know there are always star performers. We hope to highlight some of their work tomorrow night at the grand event, hosted by another star performer: Diahnne Carroll.
I'm old enough to remember being inspired by her Emmy-nominated and Golden Globe-winning performance in Julia, a groundbreaking television series, in which she played nurse Julia Baker. She could not have known in 1968 that less than three decades later--after successful turns in movies and on Broadway--she would rely on the comforting care of oncology nurses to deal with a diagnosis of and treatment for breast cancer. Since then, she has become a powerful advocate for early detection and prevention of cancer, encouraging women to get regular mammograms.
I'll have the privilege of meeting Ms. Carroll tomorrow night, as well as the Extraordinary Healers she will honor. I can't wait!
Then, on Friday, I'll attend a presentation on PARP inhibitors, therapies used to treat breast, prostate, lung, colorectal, ovarian and skin cancers. Stay tuned to our blogs for the latest from the annual congress!
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BY KATHY LATOUR | MAY 2, 2012
New Orleans is hosting the Oncology Nursing Society Congress this year, which means the angel energy is at an all time high here as thousands of nurses arrive from across the United States. On Thursday evening CURE presents one nurse with the Extraordinary Healer award, an annual honor we bestow on one of three finalists from hundreds of nurses nominated by our readers.
And it does take people with something special to become oncology nurses. They could have chosen nursing careers that required much less in the way of emotional commitment than working with cancer patients, and yet they are fiercely committed to their patients whether as inpatient nurses or outpatient chemo nurses or nurse practitioners or oncology nurse specialists.
At one time I spoke to small groups of oncology nurses on a regular basis, and I used to begin by passing out small pads of paper and asking them to write down why they had chosen oncology nursing. I would give them about 5 minutes and then tell them to stop writing. Without taking up what they had written, I would tell them that I knew what they had written – I knew why they had become oncology nurses.
"You became oncology nurses because you really like the hours, right?" I would say, and they would laugh and shake their heads at the absurdity. "Oh," I said, "That's right, it's because you like the pay," and again they would elbow each other in unspoken agreement that money was never enough and it had nothing to do with it. "No," I would say in response to them, "then it has to be that you really like body fluids."
This would set them laughing. "No, that's not it."
And then I would get serious and tell them what I did know they had written.
They were "called" in one of any number of ways to oncology nursing. A family member had died of cancer, prompting a vow that they would be there for patients in their lives – or they had chosen oncology after nursing school when one patient had touched them during that part of training when they didn't know what area they wanted. And my favorite – always when I spoke there would be in any group of 20 nurses at least two who had vowed they would NEVER do oncology. They hated it. They would do anything else, but not oncology. And then for some reason they ended up in oncology.
I heard stories about returning from maternity leave and oncology was the only opening and they agreed to it, "only until something else came up" and that was 25 years ago.
Or, they wanted a transfer from an existing job because of one reason or another and the only opening was in oncology and they took it until something else opened up and now knew they were meant to be there. That's why I say the angel energy is high this week. These men and women are the chosen nurses to be there for us at the worst time of our lives, when we are frightened, sick, angry, confused and, did I say terrified. They may have chosen oncology or it may have chosen them, but it's where they belong and they know it. And so do we.
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BY ELIZABETH WHITTINGTON | MAY 2, 2012
Bayer, the maker of an experimental drug for colorectal cancer and GIST, has opened an expanded access program for colorectal cancer patients who have progressed on other therapies.
Patients are encouraged to talk to their doctor about whether they are eligible for the program.
Details can be found at: Regorafenib in Subjects With Metastatic Colorectal Cancer (CRC) Who Have Progressed After Standard Therapy: CONSIGN
Regorafenib is a targeted agent that has shown slight progression-free survival benefit in patients who have progressed on several lines of therapy. Results from the CORRECT trial, which was first presented at the ASCO Gastrointestinal Symposium earlier this year, showed that the drug improved survival by a median of 1.4 months, from 5 months with placebo to 6.4 months--a 29 percent increase in overall survival. The drug controlled the disease in nearly half of patients, delaying or reducing tumor growth in 44.8 percent of patients as opposed to 15.3 percent in the placebo arm.
The phase 3B expanded access program was designed to provide patients with metastatic colorectal cancer the drug if they have no other therapy options. The program will be until the drug is approved, which is not guaranteed. Researchers will be collecting safety data during the study. Common side effects reported included hand-foot rash, fatigue and diarrhea.
Patients will take the oral drug once a day in four-week cycles (daily for three weeks, then one week off before starting therapy again.)
More information on expanded access and other programs to access investigational therapies can be found in "Ethics of Access." You can also find more information on the FDA.gov website.
Bayer has opened 55 sites around the world, including at least 10 sites in the U.S. For more information on access to regorafenib, email Bayer at clinical-trials-contact@bayerhealthcare.com.
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