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Fitch M.I.,Sunnybrook Odette Cancer Center
Current Opinion in Oncology | Year: 2011

Purpose of Review: Interest in screening for distress in cancer patients has escalated in recent years. Despite widespread acknowledgement that screening ought to occur in daily practice, relatively few examples of successful programs exist. Recent Findings: Evidence about the need for identifying psychosocial distress is clear and there are suitable tools available to perform the screening. However, understanding about the complexities of implementing a practically sound and relevant program is still unfolding. Concerted and consistent efforts are required to achieve success in screening for distress and realize relevant outcomes. Summary: This article outlines a review of recent literature on screening for distress and the role of oncology nursing. Significant developments in the field of screening for distress in cancer are highlighted and on-going controversies are described. Suggestions for future research and clinical practice are presented. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Fitch M.I.,Sunnybrook Odette Cancer Center
Canadian oncology nursing journal = Revue canadienne de nursing oncologique | Year: 2012

Many patients with advanced cancer have numerous medical complications and multiple sites involving metastases that cause distressing symptoms. Radiotherapy is often used for the palliative treatment of these patients, especially those with bone metastases. There is a lack of information about the types of supportive care needs these patients experience, the services that are available for them, and whether people want help with their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, spiritual, psychological, and practical) of patients with advanced cancer who attended the Palliative Radiation Therapy Rapid Response Clinic (PRTRRC) at a comprehensive, ambulatory cancer centre. A second purpose was to determine if patients wanted assistance in meeting those needs. A total of 69 patients participated in this study by completing a self-report questionnaire. The data provided a clear indication that a range of supportive care needs remained unmet for this patient group. Lack of energy, pain, and concerns about the worries of those close to them were the most frequently reported needs. Additionally, patients expressed a range of difficulty managing needs and many of these patients desired help to manage the identified needs. However, despite this reality, significant numbers of patients indicated they did not wish to have assistance with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing supportive care to these patients. Source

Fitch M.I.,Sunnybrook Odette Cancer Center
Canadian oncology nursing journal = Revue canadienne de nursing oncologique | Year: 2012

The practice of routine screening for distress in cancer populations has been gaining worldwide support over the past several years with the conceptualization of distress as the sixth vital sign. Across Canada, experience with screening for distress is growing, as cancer facilities implement screening programs. Early learning from these efforts has emphasized the need for a programmatic approach and the importance of oncology nurses in screening and providing the initial response to distress. To date, little has been written from the nursing perspective about the oncology nursing role in a program screening for distress and responding to the identified patient concerns. This article describes the current thinking about distress; explores how screening for and responding to distress is integral to oncology nursing practice; and shares the early learning and experiences of cancer nurses in implementing screening for distress initiatives. Source

Villarreal-garza C.,Instituto Nacional Of Cancerologia | Cortes J.,Autonomous University of Barcelona | Andre F.,Institut Universitaire de France | Verma S.,Sunnybrook Odette Cancer Center
Annals of Oncology | Year: 2012

Background: There is an unmet therapeutic need in endocrine-resistant, hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (BC). Preclinical studies support the hypothesis that the mammalian target of rapamycin (mTOR) inhibition could potentially overcome resistance to endocrine therapy. Materials and methods: A literature review regarding BC and mTOR inhibitors was undertaken. The reference lists from retrieved manuscripts were reviewed to identify further studies. Results: Phase II studies have reported that the combination of mTOR inhibitors with endocrine therapy shows efficacy in patients with advanced disease that progressed after treatment with aromatase inhibitors. The recent findings of the phase III BOLERO-2 confirmed that everolimus in combination with exemestane significantly improved progression-free survival and response rate, with a manageable safety profile. Conclusions: The addition of everolimus to exemestane for women with HR-positive metastatic BC is now considered a new therapeutic strategy. However, a word of caution should be added regarding toxic effects, which might limit practical use and compliance. It is essential that clinicians are educated about key recommendations for toxicity management and specific guideline dose modifications. Additional research efforts with the addition of these compounds in the early-stage setting is greatly needed to improve the survival of patients with HR-positive BC. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Verma S.,Sunnybrook Odette Cancer Center | Ewer M.S.,University of Texas M. D. Anderson Cancer Center
Annals of Oncology | Year: 2011

The cardiotoxicity of anthracyclines, trastuzumab and other agents is of special importance to adjuvant breast cancer patients whose life expectancy is restored to normal but who may be left with cardiac abnormalities that can present years later. We systematically reviewed the design of current trials (including adjuvant studies) on the clinicaltrials.gov Web site. Surprisingly few specify primary or secondary cardiac end points. Although cardiac ultrasound (echocardiography) and multiple uptake gated acquisition scintigraphy remain the most frequent techniques for estimating left ventricular ejection fraction, there is no consistency in the degree of reduction from baseline or absolute value taken as indicating cardiotoxicity. The details given do not suggest that diastolic function (which may give earlier warning of problems) is a focus of interest. There is growing interest in troponin as a marker of myocyte death and brain natriuretic peptide as a marker of myocardial stress and possible heart failure (though their clinical usefulness has still to be adequately defined). The duration of follow-up in many adjuvant studies may not be sufficient to determine the risk of late cardiac events. The findings indicate a need to study and standardize cardiac toxicity assessments inoncology trials. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

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