Chemotherapy in the elderly: supportive measures for chemotherapy-induced myelotoxicity

Private Rooms, Semi-Open Areas, or Open Areas for Chemotherapy Care: Perspectives of Cancer Patients, Families, and Nursing Staff

OBJECTIVE

This research aims to better understand the needs and preferences of cancer outpatients, their families, and nursing staff with regard to private rooms, semi-open areas, or open areas for ambulatory cancer care.

BACKGROUND

Environments for cancer chemotherapy care are outpatient settings, and recommendations based on findings regarding inpatient settings may not be appropriate. Users of chemotherapy treatment environments include cancer patients, their families, and nursing staff.

METHOD

A questionnaire survey was conducted in an academic cancer center in Louisiana. The participants included 171 cancer patients, 145 family members, and 16 nursing staff members. Both quantitative and qualitative methods were used to analyze the data. Participants' environmental preferences were compared using analysis of variance. Reasons for preferences were analyzed through key word and content analysis.

RESULTS

Semi-open areas were preferred by the staff, whereas the three types of treatment environments were equally popular among both patients and families (preferred by 29%/28%/27% of the participants). Female patients and patients receiving longer periods of treatment per occurrence were more likely to prefer private rooms ( p < .05). Three common reasons for preferences were needs for privacy, social interaction, and patient-nurse access. Additional reasons for patient and family preferences included needs for sleep, openness, and access to nature. A shared environment of chemotherapy care was suggested to be appropriate for four to seven patients to occupy.

CONCLUSION

Multiple types of treatment environments should be provided in chemotherapy care to incorporate varied user needs. Privacy, social interaction, patient-nurse access, and access to nature should be considered during the design of environments for cancer chemotherapy.

The opposite effects of doxorubicin on bone marrow stem cells versus breast cancer stem cells depend on glucosylceramide synthase

Myelosuppression and drug resistance are common adverse effects in cancer patients with chemotherapy, and those severely limit the therapeutic efficacy and lead treatment failure. It is unclear by which cellular mechanism anticancer drugs suppress bone marrow, while drug-resistant tumors survive. We report that due to the difference of glucosylceramide synthase (GCS), catalyzing ceramide glycosylation, doxorubicin (Dox) eliminates bone marrow stem cells (BMSCs) and expands breast cancer stem cells (BCSCs). It was found that Dox decreased the numbers of BMSCs (ABCG2(+)) and the sphere formation in a dose-dependent fashion in isolated bone marrow cells. In tumor-bearing mice, Dox treatments (5mg/kg, 6 days) decreased the numbers of BMSCs and white blood cells; conversely, those treatments increased the numbers of BCSCs (CD24(-)/CD44(+)/ESA(+)) more than threefold in the same mice. Furthermore, therapeutic-dose of Dox (1mg/kg/week, 42 days) decreased the numbers of BMSCs while it increased BCSCs in vivo. Breast cancer cells, rather than bone marrow cells, highly expressed GCS, which was induced by Dox and correlated with BCSC pluripotency. These results indicate that Dox may have opposite effects, suppressing BMSCs versus expanding BCSCs, and GCS is one determinant of the differentiated responsiveness of bone marrow and cancer cells.

Chemotherapy in conjoint aging-tumor systems: some simple models for addressing coupled aging-cancer dynamics

Background

In this paper we consider two approaches to examining the complex dynamics of conjoint aging-cancer cellular systems undergoing chemotherapeutic intervention. In particular, we focus on the effect of cells growing conjointly in a culture plate as a precursor to considering the larger multi-dimensional models of such systems. Tumor cell growth is considered from both the logistic and the Gompertzian case, while normal cell growth of fibroblasts (WI-38 human diploid fibroblasts) is considered as logistic only.

Results

We demonstrate, in a simple approach, how the interdependency of different cell types in a tumor, together with specifications of for treatment, can lead to different evolutionary patterns for normal and tumor cells during a course of therapy.

Conclusions

These results have significance for understanding appropriate pharmacotherapy for elderly patients who are also undergoing chemotherapy.

Family Caring Strategies in Neutropenia

Aggressive chemotherapy protocols result in neutropenia in approximately half of all patients receiving chemotherapy. Thus, neutropenia continues to be a significant and potentially life-threatening side effect of treatment, even with use of colony-stimulating factors. Families of patients with neutropenia often provide the primary healing environment because most chemotherapy protocols are managed on an outpatient basis. To learn about the family's experience of managing chemotherapy-induced neutropenia (CIN), a grounded-theory methodology was used to analyze data from seven families. The central theme revealed by these families was "turbulent waiting with intensified connections." This meant that when families had a sense of greater vulnerability in response to the waiting after diagnosis of CIN, they connected intensely with each other and healthcare providers. Families reported that connections with nurses became more significant when neutropenia interrupted chemotherapy. Families also developed family caring strategies to manage this period of waiting for the chemotherapy to resume. These strategies included family inquiry, family vigilance, and family balancing. Nurses need to be aware of approaches to support the family's ability to manage CIN. Interventions and approaches constructed from the perspective of a family-professional partnership will enhance the family cancer experience as well as ongoing family growth and function.