Monica R. McLemore

Epidemiological and Genetic Factors Associated With Ovarian Cancer

The purpose of this article was to provide a comprehensive review of the epidemiological and genetic factors associated with ovarian cancer. A more complete understanding of the determinants of ovarian cancer may lead to the development of better screening and detection methods for this disease. The first section of this article reviews current literature on screening and early detection of ovarian cancer. The second section reviews the epidemiology of ovarian cancer, specifically highlighting the risk factors associated with the development of this disease. The article concludes with a discussion of how oncology nurses can apply this information to improve patient care.

Introducing the MUC16 Gene: Implications for Prevention and Early Detection in Epithelial Ovarian Cancer

More than 24,000 women in the United States are diagnosed with ovarian cancer every year, and half of these women die from their disease. Stage 1 ovarian cancer is curable in 95% of cases; however, due to inadequate screening tools and lack of symptoms in early disease, ovarian cancer is generally at Stage 3 or 4 when finally diagnosed. CA125 is a tumor antigen used to monitor the progression and regression of epithelial ovarian cancer. When its levels are elevated postsurgery (hysterectomy/salpingo-oophorectomy with or without peritoneal washings and lymph node biopsy) and postchemotherapy, it is suggestive of recurrent disease. Due to its similarly elevated levels in some nonmalignant conditions, however, it is not specific enough to be used for population screening. The CA125 molecule is considered a very large glycoprotein because of its molecular weight, and it has three domains: the carboxy terminal domain, the extracellular domain, and the amino terminal domain. MUC16 is the gene that encodes the peptide moiety of the CA125 molecule. MUC16 domains provide novel opportunities to develop newassays and refine current tools to improve the sensitivity and specificity of CA125 for population-based screening guidelines.

Gardasil®: Introducing the New Human Papillomavirus Vaccine

In 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine for prevention of cervical cancer based on the molecular biology of the disease. Gardasil (quadrivalent human papillomavirus [HPV] [types 6, 11, 16, and 18] recombinant vaccine, Merck & Co., Inc., Whitehouse Station, NJ) combats the common types of HPV responsible for cervical cancer precursor lesions. This article provides a simple overview of the (a) epidemiology of HPV, (b) HPV vaccine, (c) dosing and administration, and (d) nursing implications about this possibly life-saving vaccine.

A Comparison of the Cyclic Variation in Serum Levels of CA125 Across the Menstrual Cycle Using Two Commercial Assays

Background: Clinicians use CA125, a tumor-associated antigen, primarily to monitor epithelial ovarian cancer. However, CA125 lacks the sensitivity and specificity necessary for population-based screening in healthy women. The purpose of this study was to determine if serum concentrations of CA125 differed across the three phases of the menstrual cycle in healthy, premenopausal women using two commercially available assays. Methods: Healthy, Caucasian women between the ages of 18 and 39 were enrolled using strict criteria to exclude factors known to contribute to CA125 fluctuations. Menstrual cycle regularity was determined using calendars maintained by participants for 3 months. After cycle regularity was established, blood was drawn at three time points for CA125 determination using two commercial assays (i.e., Siemens and Panomics). Results: Regardless of the assay used, CA125 values were highest during menses. The CA125 values decreased 0.2 U/ml per day from menses to the end of the same cycle, which resulted in a net decrease of 5.8 U/ml across the cycle. Conclusions: The two commercial assays for CA125 determination demonstrated good concordance in terms of reference ranges regardless of epitope differences. While CA125 levels changed over the course of the menstrual cycle, these changes may not be clinically significant in healthy women. This study is the first to control for factors known to contribute to CA125 elevations; to quantify a decrease in CA125 levels across the menstrual cycle; and to confirm concordance in the relative decreases in serum CA125 levels across the menstrual cycle between two frequently used commercial assays.

CJON Reporter: The Role of the Data Safety Monitoring Board: Why Was the Avastin® Phase III Clinical Trial Stopped?

In early February 2006, Genentech Inc. issued a joint press release with Roche Holding Corporation explaining that their phase III early-stage colon cancer trial of Avastin (bevacizumab, Genentech Inc., South San Francisco, CA) would be stopped after the deaths of four patients. This announcement was the result of preliminary review of the data by the Data Safety Monitoring Board (DSMB) that was formed to monitor the study. What is the DSMB? What criteria does it use to determine whether a study should be stopped early? The purpose of this article is to (a) explain the role of the DSMB, (b) give an overview of the Avastin Adjuvant (AVANT) study, and (c) provide information and resources about clinical trials for practicing RNs in oncology.

Rules of Tumor Cell Development and Their Application to Biomarkers for Ovarian Cancer

PURPOSE/OBJECTIVES To apply the Hanahan and Weinberg conceptual framework for tumor development to the specific biomarkers observed or expressed in ovarian cancer. DATA SOURCES Data-based publications, topical reviews, and book chapters. DATA SYNTHESIS Articles specific to ovarian cancer were reviewed to examine whether the six rules from the Hanahan and Weinberg conceptual framework were applicable to biomarkers of ovarian cancer. This approach allows for the application of a general framework for the development of solid tumors to the development of ovarian cancer. CONCLUSIONS The six rules for tumor cell development outlined in the Hanahan and Weinberg conceptual framework are applicable to biomarkers expressed or observed in patients with ovarian cancer. IMPLICATIONS FOR NURSING Oncology nurses can enhance their clinical teaching by integrating this information into their practice. Nurses who conduct research on ovarian cancer can use this framework to guide the selection of biomarker(s) for these studies. Finally, nurse educators can use this framework when teaching students key concepts in the care of patients with cancer.

Recruitment and retention strategies for expert nurses in abortion care provision

OBJECTIVE(S) The purpose of this thematic analysis is to describe recruitment, retention and career development strategies for expert nurses in abortion care provision. STUDY DESIGN Thematic analysis influenced by grounded theory methods were used to analyze interviews, which examined cognitive, emotional, and behavioral processes associated with how nurses make decisions about participation in abortion care provision. The purposive sample consisted of 16 nurses, who were interviewed between November 2012 and August 2013, who work (or have worked) with women seeking abortions in abortion clinics, emergency departments, labor and delivery units and post anesthesia care units. RESULTS Several themes emerged from the broad categories that contribute to successful nurse recruitment, retention, and career development in abortion care provision. All areas were significantly influenced by engagement in leadership activities and professional society membership. The most notable theme specific to recruitment was exposure to abortion through education as a student, or through an employer. Retention is most influenced by flexibility in practice, including: advocating for patients, translating ones skill set, believing that nursing is shared work, and juggling multiple roles. Lastly, providing on the job training opportunities for knowledge and skill advancement best enables career development. CONCLUSION(S) Clear mechanisms exist to develop expert nurses in abortion care provision. IMPLICATIONS The findings from our study should encourage employers to provide exposure opportunities, develop activities to recruit and retain nurses, and to support career development in abortion care provision. Additionally, future workforce development efforts should include and engage nursing education institutions and employers to design structured support for this trajectory.

Multiple Unintended Pregnancies in U.S. Women: A Systematic Review

BACKGROUND Each year, nearly one-half of all pregnancies in the United States are unintended. Risk factors of unintended pregnancy have been studied without attention to whether the pregnancy was the womans first unintended pregnancy or whether she had had more than one. Little is known about the prevalence, incidence, and risk factors for multiple unintended pregnancies. The purpose of this paper is to present a systematic review of the extant literature on the risk factors for multiple unintended pregnancies in women in the United States, and whether these factors are specific to multiple unintended pregnancies. METHODS PubMed, PsychInfo, CINAHL, Web of Science, and JSTOR databases were searched for empirical research studies performed after 1979, in the United States, with a primary outcome of multiple unintended pregnancies. Articles that did not establish the intendedness of the studied pregnancies were excluded. RESULTS Seven studies were identified. For multiple unintended pregnancies, incidence rates ranged from 7.4 to 30.9 per 100 person-years and prevalence rates ranged from 17% to 31.6%. Greater age; identifying as Black or Hispanic; nonvoluntary first intercourse, particularly at a young age; sex trade involvement; and previous abortion were found to be associated with multiple unintended pregnancies. Use of intrauterine devices or combined oral contraceptives were found to decrease the risk of multiple unintended pregnancies. CONCLUSIONS This review suggests a small number of modifiable factors that may be used to better predict and manage multiple unintended pregnancies.

Illness Narratives of African Americans Living With Coronary Heart Disease A Critical Interactionist Analysis

How African American men and women respond to and manage living with coronary heart disease (CHD) is not well understood despite the well-documented disproportionate burden of CHD and its complications among African Americans in the United States. Through a critical interactionist perspective, we explore illness experiences of African Americans living with CHD and describe a broad range of micro-, meso-, and macro-contextual factors that influence their illness experiences. For participants in this study, CHD has become a “Black disease” wherein certain bodies have become historically and racially marked; a conceptualization maintained and passed on by African Americans themselves. Such findings highlight that CHD is more than a “lifestyle disease” where high-risk behaviors and lack of healthy choices are ultimate culprits. Rather, CHD is perceived by African Americans who have it as yet another product of ongoing racial and socio-structural dynamics through which their health burdens are created, sustained, and reproduced.

Expanding Access to Sexual and Reproductive Health Services Through Nursing Education

Abstract Thoughtful, unbiased, evidence‐based content in nursing education is crucial for the development of confident and competent nurses who provide care in every setting. The purpose of this article is twofold: to provide evidence to show that comprehensive sexual and reproductive health care by nurses is informed by educational exposure to content and to provide recommendations for change at the individual, institutional, and structural levels to improve and expand sexual and reproductive health services.