QUESTIONS & ANSWERS
A CANCER PATIENT WHO USES COCAINE
I have a patient with cancer who is actively using cocaine. We will do random urine screens on this patient. How long does cocaine remain in the urine? — Ruth C. Gholz, RN, MS, AOCN, and colleagues at the Cincinnati VA Medical Center
Once cocaine is smoked, inhaled (snorted,) or injected, it can appear as its metabolite, benzoylecgonine, and can be detected in the urine for 2 to 4 days. The actual time is difficult to determine because of the differences among individuals and in how rapidly the drug is metabolized, which depends on weight and other factors. In general, I would expect a cancer patient with significant comorbidities and overall physical deterioration to be on the longer period of detection. — Donald Fleming, MD
COPING WITH CHEMO BRAIN
What is chemo brain, and what can be done for it?
Chemo brain is a series of memory and concentration failures experienced by some patients treated with chemotherapy. Patients with chemo brain are often afraid that it means that their cancer has spread to their brain. Medical treatment with stimulants such as methylphenidate or modafinil are currently being tested. In the meantime, if chemobrain is diagnosed, the patient can do things to make life easier. For example, the patient can have standard places to keep things (such as car or house keys), work more slowly to truly concentrate on the task at hand, and keep a pen and paper at phones and bedside to write notes. But the best thing is to allow others to help out whenever possible to reduce stress and obligation for the patient. — Rosemarie A. Tucci, RN, MSN
ANEMIA IN PATIENTS WITH MDS
Managing anemia in patients with myelodysplastic syndrome (MDS) is complex. When are erythroid growth factors used as primary treatment? — Catherine Rossi, RN III, OCN, York, PA.
Treatment for patients with MDS is multifactorial, involving age, treatment preferences, IPSS scoring, performance status, any antecedent hematologic disorders, and the availability of HLA-matched stem cell donors (Harrison’s Manual of Oncology. 2008;289-303). For those with low-grade MDS and anemia, low or int-1 risk, according to NCCN guidelines, therapy is guided by cytogenetic status (NCCN.org/professionals/physicians_gls/PDF/mds.pdf.). Erythroid growth factors are used as initial treatment when serum epoetin levels are 500 mU/ml or less, the patient is transfusion independent, and there are no 5q deletion or other cytogenetic alterations (Harrison’s Manual of Oncology. 2008;289-303). — Jiajoyce R. Conway, DNP, FNP-BC, NP-C