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Oncology Nurse Advisor Forum

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ONCOLOGY NURSE ADVISOR FORUM QUESTIONS & ANSWERS Our Consultants INGREDIENTS TO LOOK FOR IN A SUNSCREEN Ann J. Brady, RN, BSN, What are the two most important ingredients to look for in sunscreen? — symptom management care Debbie Meckler, RN, BSN coordinator at the Cancer Center, Huntington Hospital, Pasadena, California. The goal of sunscreen is to provide broad spectrum protection against UVA and UVB rays. A good chemical sunscreen includes ingredients that protect against Jia R. Conway, DNP, FNP-BC, both. Avobenzome and benzophenones (oxybenzone, dioxybenzone, sulisoben- NP-C, oncology nurse zone) are ingredients that protect against UVA rays. Aminobenzoic acid (PABA), practitioner at Cancer Care Associates of York in York, benzophenones, menthyl anthranilate (also known as meradimate), padimate, and Pennsylvania. phenylbenzimidazole are ingredients that protect against UVB rays. Unlike chemical sunscreen ingredients, which absorb the sun’s rays, titanium dioxide and zinc oxide Donald R. Fleming, MD, are physical sunscreens that actually reflect the UVA and UVB rays of the sun. hematologist/oncologist, Cancer Care Center, Davis Mexoryl SX, also known as ecamsule, is the newest sunscreen ingredient approved Memorial Hospital, Elkins, by the FDA. It provides broad-spectrum protection against both UVA and UVB West Virginia. rays. Mexoryl SX is only used in high-end sunscreens, such as La Roche Posay Anthelios XL SPF 50 Cream and Lancôme UV Expert 20. Karen MacDonald, RN, BSN, Helioplex is a name brand sunscreen stabilizer. It makes sunscreen ingredients CPON, pediatric oncology more photostable so they do not break down when exposed to the sun. nurse, William Beaumont Hospital, Royal Oak, Michigan. Retinyl palmitate (vitamin A) and oxybenzone are sunscreen ingredients that are concerning to some parents. Although many experts claim these ingredients are safe, Kerstin L. McSteen, BSN, MSN, their safety is a common sunscreen controversy, and some parents choose to avoid ACHPN, CNS-BC, clinical nurse them and look for sunscreens with different ingredients. specialist, palliative care consult service, Abbott Northwestern SPF stands for sun protection factor. It is mainly a measure of UVB protection and Hospital, Allina Health System, ranges from 1 to 45 or higher. The number is determined experimentally indoors by Minneapolis, Minnesota. exposing human subjects to a light spectrum meant to mimic noontime sun. Some K. Lynne Quinn, RN, MSN, subjects wear sunscreen and others do not. The amount of light that induces redness CRNP, AOCNP, director of in sunscreen-protected skin, divided by the amount of light that induces redness in radiation oncology, Bryn Mawr unprotected skin is the SPF. A sunscreen with an SPF of 15 filters 92% of the Hospital and Bryn Mawr Health Center, Bryn Mawr, Pennsylvania. UVB. A sunscreen with an SPF of 15 will delay the onset of sunburn in a person who would otherwise burn in 10 minutes to burn in 150 minutes. The SPF 15 sunscreen allows a person to stay out in the sun 15 times longer. There is currently Barbara B. Rogers, CRNP, MN, AOCN, ANP-BC, Fox no uniform measure of UVA absorption. There are broad-spectrum sunscreens that Chase Cancer Center, Philadelphia, protect against UVA and UVB radiation although it is important to remember that Pennsylvania the SPF does not predict UVA protection. If the patient has sensitive skin, recommend a sunscreen that is PABA-free, Lisa A. Thompson, PharmD, fragrance free, and hypoallergenic. A physical sunscreen, with either zinc oxide or BCOP, assistant professor of titanium dioxide, might also be an appropriate choice, instead of a sunscreen with clinical pharmacy, University of Colorado School of Pharmacy, chemical ingredients. Aurora. Other good suncreens include Neutrogena Ultra Sheer Dry-Touch Sunblock SPF with helioplex, Neutrogena UVA/UVB SPF 45, Blue Lizard Australian sunscreen, Rosemarie A. Tucci, RN, MSN, AOCN, manager for oncology research & data services, Lankenau Hospital, DO YOU HAVE A QUESTION FOR OUR CONSULTANTS? Wynnewood, Pennsylvania Send it to [email protected]. 16 ONCOLOGY NURSE ADVISOR • JANUARY/FEBRUARY 2013 • www.OncologyNurseAdvisor.com ONCOLOGY NURSE ADVISOR FORUM Solbar sunscreen, and Coppertone Sport Sunblock Gel SPF 30. fiber is recommended so that sugar is processed more slowly without —Sandra Cuellar, PharmD, BCOP overproducing insulin.3 —Maria Deutsch, MS, PharmD REFERENCES DIETARY INFORMATION FOR PATIENTS 1. DeCensi A, Gennari A. Insulin breast cancer connection: confirmatory UNDERGOING CHEMOTHERAPY data set the stage for better care. J Clin Oncol. 2011;29(1):7-10. Is there an evidence-based booklet on cancer and diet available 2. Chowdhury TA. Diabetes and cancer. QJM. 2010;103(12):905-915. for patients undergoing chemotherapy? Is there any evidence 3. Sugar and cancer: is there a connection? Caring4cancer Web site. that sugar causes cancer? —Karen Klarkowski, RN, OCN https://www.caring4cancer.com/go/cancer/nutrition/questions/sugar- and-cancer-is-there-a-connection.htm. Accessed January 22, 2013. Most patients going through chemotherapy experience side effects such as nausea, vomiting, and changes in smell and taste. Food choices that appeal to them are usually limited, but it is necessary DRUG ALLOCATION DURING A SHORTAGE that they eat the proper food to boost their immune system to help What criteria are used at facilities to determine which fight off their cancer. Foods that are mild tasting and easy to eat patients receive drugs during an extreme drug shortage are the most favorable. Here are a few examples. when only a limited supply is available within the facil- Citrus fruits are a good source of vitamin C and antioxidants, ity? How is this issue communicated to patients, if at all? and help to alleviate the metallic taste that can occur after chemo- —Susan Shaw, BSN, RN, OCN, CBCN therapy. If the patient develops canker sores in his or her mouth due to chemotherapy treatment, a banana would be a better choice. A good source of information on this subject is the American Society Fresh turkey and chicken are good sources of protein, which can of Health System Pharmacists (ASHP) guidelines.1 When a drug help to maintain a patient’s strength during chemotherapy treat- shortage has been identified, operational and therapeutic assessments ments. Whole grains, such as brown rice, whole wheat bread, and need to occur. The operational assessment validates the details of buckwheat, provide the body with B vitamins, selenium, vitamin the shortage, determines the stock on hand, determines availability E, and healthy carbohydrates for energy. Yogurt is soft on the palate from predetermined alternative sources, estimates the impact on the and is beneficial for those patients who developed canker sores in health system, and determines the availability of alternative drug their mouths due to chemotherapy treatment. Yogurt is also a good products. The therapeutic assessment identifies the primary patients source of protein, calcium, B vitamins, and potassium. affected and determines therapeutic alternatives.1 Many websites offer diet information for patients with cancer. In terms of allocating any drug on hand to patients, the intent of A few Web sites with dietary information for patients with cancer therapy should be considered.1 In cases where the intent of therapy is are LiveStrong (www.livestrong.com/article/117861-foods-during- curative and no therapeutic equivalent alternative exists, the remain- chemo/), The Scott Hamilton CARES Initiative (www.chemocare. ing drug should be considered for those patients. When a shortage com/eatingwell/), and the American Cancer Society (www.cancer. occurs, determine which patients are currently taking the drug and the org/acs/groups/cid/documents/webcontent/002903-pdf.pdf). therapeutic intent. Communicating this information to the oncologist The connection between cancer and insulin is growing but is not is imperative, and the physician communicates this to the patient. In yet conclusive. As we know, there are many reasons to limit excess addition, oncologists should avoid starting any new patients on the sugar in our diets. Here’s another reason. Recent studies have drug in shortage. —Sandra Cuellar, PharmD, BCOP n shown that excess sugar consumption increases insulin secretion, and hyperinsulinemia has been shown to have a direct tumor-promoting REFERENCE effect.1 Hyperinsulinemia also increases insulin-like growth factor 1. ASHP Expert Panel on Drug Product Shortages, Fox ER, Birt A, James KB, (IGF) which is correlated with an increased risk of breast cancer.2 et al. ASHP guidelines on managing drug product shortages in hospitals Moderation is key here. A balanced diet with protein, fat, and and health systems. Am J Health Syst Pharm. 2009;66(15):1399-1406. When a shortage occurs, determine which patients are currently on the drug and the therapeutic intent. Communicating this information to the oncologist is imperative, and the physician communicates this to the patient. 18 ONCOLOGY NURSE ADVISOR • JANUARY/FEBRUARY 2013 • www.OncologyNurseAdvisor.com .
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