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Rita Wickham

Publications and source records attributed to Rita Wickham.

6 recordsLinked to original sources
PubMed2007

The continuum of care: a paradigm for the management of metastatic colorectal cancer.

New agents for the treatment of metastatic colorectal cancer have extended median overall survival to more than 20 months, an increase that has changed the view of advanced colorectal cancer from an acute to a chronic condition. This article proposes a shift in treatment strategy from the concept of successive "lines" of therapy, in which chemotherapy is continued until disease progression, to that of a continuum of care, in which the use of chemotherapy is tailored to the clinical setting and includes switching chemotherapy prior to disease progression, maintenance therapy, drug "holidays," and surgical resection of metastases in selected patients. In this approach, the distinction between lines of therapy is no longer absolute. This represents a paradigm shift in the management of metastatic colorectal cancer to that of a continuum of care approach that includes individualized planning, in which patients are given the opportunity to benefit from exposure to all active agents and modalities while minimizing unnecessary treatment and toxicity, with the ultimate goal of improving survival as well as quality of life.

Antineoplastic Agents↗
PubMed2006

Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk.

PURPOSE/OBJECTIVES: To review the literature regarding the incidence, current practice, guideline recommendations, nursing management, and knowledge gaps relevant to vesicant extravasation. DATA SOURCES: Published research articles, books, case reports, and national guidelines. DATA SYNTHESIS: Vesicant extravasation is a relatively rare but significant complication of chemotherapy administration. Extravasation may have a range of consequences that can cause serious physical and quality-of-life effects. Knowledge of risk factors and preventive measures can reduce patient risk. Data-based and empirical management strategies such as immediate local measures (agent withdrawal, comfort measures, and medical interventions) may minimize risk for extravasation, as well as lead to timely recognition and management and decreased morbidity should extravasation occur. CONCLUSIONS: Vesicant extravasation and sequelae constitute a complex patient problem that clinicians should strive to prevent or to minimize injury should it occur. To this end, clinicians must demonstrate awareness of risks and use specialized knowledge while administering vesicant agents. IMPLICATIONS FOR NURSING: Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.

Antineoplastic Agents↗
PubMed2006

Vesicant extravasation part II: Evidence-based management and continuing controversies.

PURPOSE/OBJECTIVES: To review the literature, synthesize current recommendations, and discuss remaining controversies regarding vesicant extravasation management. DATA SOURCES: Published evidence-based reports, clinical articles, and anecdotal case reports about antineoplastic and nonantineoplastic vesicant agent management. DATA SYNTHESIS: Prevention of vesicant extravasation sequelae requires knowledge about vesicant extravasation manifestations and differentiation of vesicant extravasation from other local IV site reactions. When evidence is weak or missing, logical application of data-based or empirical management strategies is critical. Actions may include timely administration of subcutaneous or topical antidotes, comfort measures, and surgical interventions to minimize the extent of tissue damage and morbidity should extravasation occur. CONCLUSIONS: Vesicant extravasation and sequelae constitute a complex patient problem. Clinicians should strive to prevent extravasation or seek to minimize injury should it occur. To this end, clinicians must demonstrate awareness of its risks and use specialized knowledge when administering vesicant agents. IMPLICATIONS FOR NURSING: Nurses who administer vesicant agents should understand the nursing and collaborative actions that should be taken to minimize patient morbidity, pain, and disability.

Antineoplastic Agents↗