Oncology Nurse Advisor Forum - July/August 2011
PUBLIC HEALTH INITIATIVES FOR HEAD AND NECK CANCERS
Based on the current literature associating human papillomavirus (HPV) with head and neck cancer, what public health initiatives need to be implemented? — Jeanette Pollard, APRN/PMH-BC
The incidence of head and neck squamous cell carcinoma (HNSCC) associated with human papillomavirus (HPV) has increased and is expected to continue to do so because of the prevalence of HPV infections and commonness of oral-genital sex in the overall population (Clin J Oncol Nurs. 2011;15:165-170). Given that more than 90% of diagnosed head and neck cancers are positive for HPV-16, public health initiatives should focus on primary levels of prevention based on the unique behaviors of HPV-associated cancers such as demographic, behavioral, and clinical characteristics (J Natl Compr Canc Netw. 2011;9:665-673). These cancers tend to be prevalent in middle-aged white men of medium to high socioeconomic status and among those participating in oral sex behaviors. Public health initiatives should target prevention efforts that consider premalignant oropharyngeal conditions, early cancer screenings, and a consistent approach to HPV testing, especially for persons with high risk factors. — Jiajoyce R. Conway, DNP, FNP-BC, AOCNP®, NP-C
FOOD-DRUG INTERACTIONS WITH ORAL TKIs
The drug-drug interactions in various treatments are often a focus point, especially in relation to the oral tyrosine kinase inhibitors (TKIs); however, what is the significance of food-drug interactions especially with oral agents such as nilotinib (Tasigna), sunitinib (Sutent), sorafenib (Nexavar), and erlotinib (Tarceva), to name a few?
Clinical trials have determined that fat absorption is increased with some of the oral TKIs, especially nilotinib, when taken with meals. Spacing medications from meals decreases the possibility of interactions between the medications and fats in foods. On the other hand, taking agents such as capecitabine (Xeloda) with food can reduce the rate and extent of drug absorption by as much as 65% and 35%, respectively, thus impacting drug efficacy. CYP3A4 pathways are common pathways of drug metabolism for many of these agents, and grapefruit, for example, is a common CYP3A4 inhibitor. Thus, consumption of the citrus fruit increases the plasma concentration of many drugs, which in turn increases the probability of drug toxicities. — Jiajoyce R. Conway, DNP, FNP-BC, AOCNP®, NP-C ONA