Emerging strategies in the management of cancer.

PURPOSE/OBJECTIVES: To review advances in understanding the biology of cancer that will lead to new prognostic indicators and approaches for treating cancer and its metastases and to explore the implications of these developments for oncology nurses.

DATA SOURCES

Published papers, abstracts, research result, package inserts, books, and personal experience.

DATA SYNTHESIS

Understanding is evolving that cancer is a genetic disease that occurs when a single cell and its progeny are remarkably changed by a series of genetic mutations. A new paradigm for managing cancer is emerging that is based on new prognostic indicators, intracellular and intercellular communication, and biologic control. Potential new therapeutic strategies include gene-directed therapy, control of cellular proliferation, exploitation of cell death, inhibition of metastasis, and reversal of multidrug resistance. Many of these therapies are only beginning to enter phase I/II clinical trials.

CONCLUSIONS

With continued progress, doctors will be able to identify patients with the highest likelihood of experiencing recurrent or progressive disease and formulate therapeutic strategies specific for their disease and even for their individual genetic makeup.

IMPLICATIONS FOR NURSING PRACTICE

To remain abreast of these new and increasingly sophisticated treatments, oncology nurses must be knowledgeable about cell and cancer biology, human genetics, the immune system, a how advances in these fields are forming the foundation for new therapies. Nurses with creativity and drive will continue to lead the way in developing management strategies for patients receiving these new therapies.