OBJECTIVES:

To illustrate the multiple factors that

can influence the selection of treat-

ments for bladder cancer, and to

instruct the reader in the management

of chemotherapy-related toxicities.

DATA SOURCES:

Actual cases drawn from the authors

clinical experience and scientific

studies.

CONCLUSION:

Patients treated for bladder cancer

often experience toxicities. Some

patients being treated with novel

agents may achieve stable disease.

IMPLICATIONS FOR NURSING

PRACTICE:

Oncology nursesmust be aware of and

able to manage treatment-related tox-

icities with appropriate interventions.

Patients can be effectively instructed

in preventing and managing side

effects, such as constipation, with

the nurses guidance.

Gary Shelton, MSN, ARNP, AOCN:

Oncology CNS, Adult Health NP, New York

University Medical Center, NYU Cancer

Institute, New York, NY.

Address correspondence to Gary Shelton,

MSN, ARNP, AOCN, New York University

Medical Center, 160 East 34th St, 11th Floor,

NYU Cancer Institute, New York, NY 10016;

e-mail: gary.shelton@nyumc.org

2007 Elsevier Inc. All rights reserved.0749-2081/07/2304, Suppl 3-$30.00/0

doi:10.1016/j.soncn.2007.10.009

CASE STUDIES IN THETREATMENT OFBLADDER CANCER

GARY SHELTON

CASE STUDY #1: SELECTING CHEMOTHERAPY FOR

MUSCLE-INVASIVE TUMOR AFTER SURGERY:

GEMCITABINE/CISPLATIN

FM is a 60-year-old woman diagnosed 18 months ago with cT2asuperficial muscle invasive transitional cell carcinoma whounderwent a bladder-sparing cystectomy at that time. On a routinefollow-up computed tomography scan she was found to have recur-rent diseasewith regional lymphnode involvement. FM is asymptom-aticwith regard tohermetastatic disease, has excellent renal function(creatinine 0.8 mg/dL, creatinine clearance of 85 mL/min based ona weight of 72 kg), and currently works full-time. In determining thenext course of action for this patient, the clinician takes into consid-eration her previous treatment, any unresolved treatment-relatedtoxicities, her performance status (Eastern College of Gynecology[ECOG]/Karnofsky Performance Status [KPS]), age, comorbidities,and renal function as identified by creatinine and calculated creati-nine clearance (Table 1).The regimen agreed upon by FM and her treating clinician is the

standard approach for advanced disease as identified earlier, gem-citabine plus cisplatin (GC) (Table 2).

Preventing and Managing Toxicities

It is important for the health care provider (HCP) to understandthe principal toxicities that can occur with GC and to be vigilantin their identification. Early and ongoing patient education is crit-ical to this endeavor. Patients must be prepared to seek the HCPsguidance at the first signs and symptoms of side effects. HCPsshould initiate supportive care measures as soon as warranted, fol-lowing the guidelines of the National Comprehensive Cancer Net-work (NCCN) and institutional or provider preferences.Hydration and urine output are early factors to be observed and

managed, as this regimen is associated with renal toxicity. Patientsare hydrated with normal saline per institutional standards beforecisplatin administration to ensure adequate urine output. Prior to,

Seminars in Oncology Nursing, Vol 23, No 4, Suppl 3 (November), 2007: pp S15-S19 S15