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What is in a Name—Sedation or Anesthesia
MARCH 2002, VOL 75, NO 3 * Catalan0
What is in a Name-Sedation or Anesthesia
M
any in the perioperative area scoff at the tion and anesthesia (Table 1). The intent statement of involvement of anesthesia care providers standard TX.2 notes that if a practitioner is qualified or perioperative nurses in the develop- to provide moderate sedation, he or she also must be ment or implementation of sedation poli- able to rescue patients who unavoidably or unintencies. Sedation generally is used outside tionally slip into deep sedation. These individuals the OR in such areas as the emergency department, must be competent to manage a compromised airway the gastrointestinal laboratory, the radiology depart- and provide adequate oxygenation and ventilation. ment for interventional procedures, the intensive care Likewise, practitioners providing deep sedation must unit, and various clinics, so why should perioperative be qualified to rescue patients who unavoidably or personnel be concerned? Perioperative personnel and unintentionally slip into general anesthesia. These anesthesia care providers are aware already of the practitioners must be competent to manage an unstarisks and benefits of anesthesia, and they know what ble cardiovascular system, as well as a compromised airway and inadequate oxygenation and ventilation. can happen if an anesthesia emergency occurs. The words qualified and competent are distinThe main controversy among hospital personnel and physicians about the difference between seda- guishing factors for granting clinical privileges to tion and anesthesia revolves around the intent state- administer moderate or deep sedation and may be an ment for standard TX.2 in the Joint Commission on area of review by JCAHO surveyors. Practitioners Accreditation of Healthcare Organizations' who administer moderate or deep sedation should be (JCAHO) sedation standards.' This statement says credentialed or competent and have requisite privithat individuals who administer moderate or deep leges to administer moderate or deep sedation. In sedation and anesthesia must be qualified and have addition, most facilities across the country require the requisite credentials to manage patients at what- practitioners who administer moderate or deep sedation to be trained in basic cardiac ever level of sedation or anesthelife support (BCLS). Some facilisia is achieved. Sedation is to be ties have made it necessary for considered anesthesia, which A B S T R A C T means that everything normally The Joint Commission on practitioners to be trained in done for patients receiving anes- Accreditation of Healthcare Or- BCLS to administer moderate thesia now must be done for ganizations' sedation standards sedation and in advanced cardiac patients receiving sedation. detail the differences between life support (ACLS) or pediatric sedation and anesthesia. These advanced life support (PALS) to WHAT THE STANDARDS SAY standards, however, note that it administer deep sedation. Airway The Joint Commission's new is important that those applying management and an understandsedation and anesthesia standards sedation be trained to rescue ing of medication dosing regimens are in the section on care of the patients who may slip from mod- for sedation are an integral part of patient, specifically TX.2 to erate sedation into deep seda- this process and also should be TX.2.4.1. The overview of seda- tion or from deep sedation into part of the privilege or competention and anesthesia standards con- anesthesia. AORN J 75 (March cy requirements before a practitioner is allowed to administer tains written definitions for seda- 2002) 550-553. KATHLEEN CATALANO,
550 AORN JOURNAL
RN
-
MARCH 2002, VOL 75, NO 3 Catalano
Table 1 sedation or monitor a patient who SEDATION AND ANALGESIA DRINCCIONS' has received sedation. Minimal sedation (ie, anxiolysis) Many hospitals require that Minimal sedation is defined as a medication-induced state during which any physician, dentist, or RN who patients respond normally to verbal commands. Cognitive function and coordiadministers sedation and any nation may be impaired, but ventilatory and cardiovascular functions generally physician, dentist, RN, licensed are unaffected. vocational nurse, or respiratory care practitioner who monitors a Moderate sedation/analgesia (ie, conscious sedation) patient after administration of Moderate sedation/analgesia is defined as a medication-induced depression of sedation pass a sedation test. Most consciousness during which patients respond purposefully to verbal comsedation examinations are given mands, either alone or accompanied by light tactile stimulation. No intervenafter the participant has read and tions are required to maintain the patient's airway, and spontaneous ventilation understood a sedation module per- is adequate. Cardiovascular function usually is maintained. tinent to the type of sedation Deep sedation/analgesia administered at his or her facility. Deep sedation/analgesia is a medication-induced depression of consciousSome facilities require that practi- ness during which patients cannot be aroused easily; however, they do tioners spend time with the anes- respond purposefully to repeated or painful stimulation. Patients' ability to thesia care provider in the OR to independently maintain ventilatory function may be impaired. Patients may learn the necessary skills needed need assistance to maintain an airway, and spontaneous ventilation may be to provide deep sedation. The bot- inadequate. Cardiovascular function usually is maintained. tom line is that these practitioners Anesthesia need to be able to safely rescue Anesthesia consists of general anesthesia and spinal or major regional anespatients who slip from moderate thesia. It does not include local anesthesia. General anesthesia is a medicasedation into deep sedation or tion-induced loss of consciousness during which patients are not orousable, from deep sedation into general even by painful stimulation. Patients' ability to independently maintain ventianesthesia. In addition to the praclatory function often is impaired. Patients often require assistance in maintitioner performing the procedure, taining an airway, and positive pressure ventilation may be required because the standards require a sufficient of depressed spontaneous ventilation or medication-induceddepression of number of qualified personnel to neuromuscular function. Cardiovascular function may be impaired. appropriately access the patient before beginning moderate or NOTE deep sedation and anesthesia, 1 , ComprehensiveAccredifufion Munuul for Hospifuls (Oakbrook Terrace, Ill: provide moderate or deep seda- Joint Commission on Accreditation of Healthcare Organizations, 2001) TX.2tion and anesthesia, TX.2.4.1. perform the procedure, monitor and evaluate the patient, and capnograph also is recommended. It is likely that the recover and discharge the patient from the capnograph would be used only for patients receiving postanesthesia care unit (PACU) or the health care deep sedation. Before surgical and other procedures (eg, interfacility. ventional procedures in radiology, procedures in the MONITORING AND PATIENT EVALUATION gastrointestinal laboratory) aie performed on a Also noted under the intent statement of TX.2 is patient, a history and physical examination must be the need for appropriate equipment (ie, pulse oxime- completed. At least a short history and physical try for continuous measurement of heart rate and examination should be completed for patients underoxygenation, electrocardiogram monitoring for going moderate or deep sedation if this information is patients with significant cardiovascular disease or not on their charts already. Standards TX.2.1 and PE.1.8.1 require a preseanticipated dysrhythrnias, a sphygmomanometer to measure blood pressure at regular intervals). Res- dation assessment for each patient before initiation of piratory frequency and pulmonary ventilation are to moderate or deep sedation. Standards TX.2.1.1 and be monitored continuously as well, so the use of a PE. 1.8.2 pertain to the need to plan each patient's 55 1 AORN JOURNAL
MARCH 2002. VOL 7 5 , NO 3 * Catuluno
Patients need to be reassessed immediately before administration of moderate or deep sedation medication.
moderate or deep sedation, so many facilities have added a brief anesthesia portion to the bottom of their short history and physical examination forms. This allows for documentation of the American Society of Anesthesiologists (ASA) score and a place for the anesthesia assessment and plan. PATIENT ASSESSMENT AND INFORMATION SHARING
As with anesthesia, the administration of moderate or deep sedation requires that sedation and anesthesia options and risks be discussed with the patient and his or her family members before administration (ie, TX.2.2). This should be documented by the practitioner in the progress notes or on the surgical or procedure report. In addition, as with anesthesia, patients need to be reassessed (ie, vital signs checked, patient given a quick examination by the sedation provider) immediately before administration of moderate or deep sedation medication or anesthesia (ie, PE. 1.8.3). This must be documented as well. The easiest way to capture this information is to place a small box above the graphic where vital signs will be documented. Next to the box write “patient reassessed immediately before administration of sedation.” After moderate or deep sedation medication has been administered, the patient’s physiological status should be measured and assessed throughout the sedation period to ensure appropriate physiological support for the patient (ie, TX.2.3). A safe practice is to document a patient’s vital signs and pulse oximetry every five minutes during moderate sedation. During deep sedation, it is safe practice to document the capnograph reading every five minutes. The person monitoring the patient has no other responsibilities during this time frame and thus can document these
items adequately on the flow sheet. The patient should be monitored from the time the moderate or deep sedation is initialized through the time he or she has recovered fully from the moderate or deep sedation. The patient’s postoperative status must be assessed on admission to and before discharge from the postsedation recovery area or PACU (ie, TX.2.4, PE. 1.8.3). In most facilities, this is interpreted to mean until the patient has met his or her presedation Aldrete score and is able to be discharged home safely or returned to the inpatient unit. The patient is to be monitored during the postsedation recovery or PACU period (ie, TX.5.4). This monitoring will include airway management, documentation of vital signs, pulse oximetry, and any complications that may arise. Most sedation education programs include airway management and how to assess patients to determine the Aldrete score. One issue to consider may be cross training staff members responsible for monitoring patients recovering from deep sedation with PACU staff members. This ensures the same level of care throughout the organization (ie. L.D. 1.6, M.S. 6.8). The reason for this is that patients receiving deep sedation may unintentionally or unavoidably slip into general anesthesia status. Staff members in the PACU generally are trained in ACLS or PALS. If this is the case, staff members monitoring patients recovering from deep sedation also should be trained in ACLS or PALS to provide the same level of care. Some organizations have PACU nurses or anesthesia care providers take into account the competencies of staff members monitoring patients recovering from deep sedation. Lastly, patients are to be discharged from a postsedation recovery area or the PACU by a qualified licensed independent practitioner (ie, TX.2.4.1). Many organizations use medical staff member-approved discharge criteria when discharging patients from these areas. This is sufficient if use of this criteria is documented clearly in the patient’s medical record. The reason medical staff memberapproved criteria is used by many facilities is to relieve the anesthesia or sedation care provider from physically being present when a patient is discharged. Take care when using discharge criteria approved by medical staff members, however. There have been several reported sentinel events regarding patients being discharged too soon from presedation areas and the PACU because these areas experienced a sudden influx of patients or because of staffing issues. When the patient is discharged
552 AORN JOURNAL
MARCH 2002, VOL 75, NO 3 Cutalano
home, instructions must be provided regarding pain management, medications, diet, activities of daily living, complications of sedation, and where and whom to call in case of complications from the procedure or sedation. POLICY DEVELOPMENT
tion policies and processes when the champions of such policies are anesthesia care providers. They truly are the experts in the field when it comes to management of sedated patients and sedation medication dosage regimens. If your facility has no anesthesia department or the anesthesia department chooses not to be involved in developing policies and processes, take time to review practice parameters for nonanesthesiologists published by the ASA.’ A
Individual facilities must decide how best to achieve compliance with JCAHO standards. It is not a requirement that the anesthesia department be involved in the development and implementation of sedation policies; however, many medical and hospital staff members have far more confidence in seda-
Kathleen Cutalano, RN, JD, is director of administrative projects at the Children 3 Medical Center of Dallas.
NOTES 1. Comprehensive Accreditation Manualfor Hospitals (Oakbrook Terrace, Ill: Joint Commission on Accreditation of Healthcare Organizations, 200 1).
2. “Practice guidelines for sedation and anesthesia by non-anesthesiologists,” American Society of Anesthesiologists, http://www.asahq.org/practice isedationisedation1017.pdf(accessed 16 Jan 2002).
American Cancer Society Releases Statistics The American Cancer Society (ACS) has released two annual publications on cancer statistics according to a Jan 22, 2002, news release from ACS. Cancer Facts & Figures 2002 includes estimates of the number of new cancer cases and cancer deaths likely to occur in the United States this year. It also features a section on early detection of colorectal cancer. Cancer Prevention & Early Detection Facts and Figures 2002 presents data on lifestyle factors, such as tobacco use, nutrition, physical activity, sun exposure, and use of cancer screening. According to the release, Cancer Facts & Figures 2002 states that approximately 1,284,900 new cases of cancer are expected to occur in the United States this year. This publication also includes the following statistics. Lung cancer, which will claim an estimated 154,900 lives this year, remains the leading cause of cancer death in the United States. The death rate for all cancers is approximately 33% higher for African Americans than for Caucasians. Between 1992 and 1998, however, the incidence of cancer and the mortality rate among African American men decreased more than for any other racial or ethnic group. The five-year survival rate for all cancers is 62%, up 2% from last year’s report.
About one-third of the 550,500 cancer deaths expected to occur in 2002 are related to lifestyle factors that individuals can control, including diet, physical inactivity, obesity, smoking, and tanning, according to the release. The following information is found in Cancer Prevention & Early Detection Facts and Figures 2002. Despite widespread awareness of the dangers of cigarette smoking and tobacco use, 170,000 people likely will die from tobacco-related causes this year. The percentage of high school students who smoke varied widely by state, with the highest percentage, more than 40%, occurring in Kentucky, North Dakota, South Dakota, Ohio, and West Virginia. Tanning and sunburning will cause the majority of the 53,600 cases of skin cancer likely to be diagnosed in 2002. Between the years 1960 and 2000, the percentage of adults classified as obese increased from 12.8% to 20%. Both publications are available on the ACS web site, http:llwww.cancer.org. Cancer Facts and Figures Now Available (news release, Atlanta: American Cancer Sociek Jan 22, 2002), http:/hww.cancer.org (accessed 23 Jan 2002).
553 AORN JOURNAL
What is in a Name-Sedation or Anesthesia
M
any in the perioperative area scoff at the tion and anesthesia (Table 1). The intent statement of involvement of anesthesia care providers standard TX.2 notes that if a practitioner is qualified or perioperative nurses in the develop- to provide moderate sedation, he or she also must be ment or implementation of sedation poli- able to rescue patients who unavoidably or unintencies. Sedation generally is used outside tionally slip into deep sedation. These individuals the OR in such areas as the emergency department, must be competent to manage a compromised airway the gastrointestinal laboratory, the radiology depart- and provide adequate oxygenation and ventilation. ment for interventional procedures, the intensive care Likewise, practitioners providing deep sedation must unit, and various clinics, so why should perioperative be qualified to rescue patients who unavoidably or personnel be concerned? Perioperative personnel and unintentionally slip into general anesthesia. These anesthesia care providers are aware already of the practitioners must be competent to manage an unstarisks and benefits of anesthesia, and they know what ble cardiovascular system, as well as a compromised airway and inadequate oxygenation and ventilation. can happen if an anesthesia emergency occurs. The words qualified and competent are distinThe main controversy among hospital personnel and physicians about the difference between seda- guishing factors for granting clinical privileges to tion and anesthesia revolves around the intent state- administer moderate or deep sedation and may be an ment for standard TX.2 in the Joint Commission on area of review by JCAHO surveyors. Practitioners Accreditation of Healthcare Organizations' who administer moderate or deep sedation should be (JCAHO) sedation standards.' This statement says credentialed or competent and have requisite privithat individuals who administer moderate or deep leges to administer moderate or deep sedation. In sedation and anesthesia must be qualified and have addition, most facilities across the country require the requisite credentials to manage patients at what- practitioners who administer moderate or deep sedation to be trained in basic cardiac ever level of sedation or anesthelife support (BCLS). Some facilisia is achieved. Sedation is to be ties have made it necessary for considered anesthesia, which A B S T R A C T means that everything normally The Joint Commission on practitioners to be trained in done for patients receiving anes- Accreditation of Healthcare Or- BCLS to administer moderate thesia now must be done for ganizations' sedation standards sedation and in advanced cardiac patients receiving sedation. detail the differences between life support (ACLS) or pediatric sedation and anesthesia. These advanced life support (PALS) to WHAT THE STANDARDS SAY standards, however, note that it administer deep sedation. Airway The Joint Commission's new is important that those applying management and an understandsedation and anesthesia standards sedation be trained to rescue ing of medication dosing regimens are in the section on care of the patients who may slip from mod- for sedation are an integral part of patient, specifically TX.2 to erate sedation into deep seda- this process and also should be TX.2.4.1. The overview of seda- tion or from deep sedation into part of the privilege or competention and anesthesia standards con- anesthesia. AORN J 75 (March cy requirements before a practitioner is allowed to administer tains written definitions for seda- 2002) 550-553. KATHLEEN CATALANO,
550 AORN JOURNAL
RN
-
MARCH 2002, VOL 75, NO 3 Catalano
Table 1 sedation or monitor a patient who SEDATION AND ANALGESIA DRINCCIONS' has received sedation. Minimal sedation (ie, anxiolysis) Many hospitals require that Minimal sedation is defined as a medication-induced state during which any physician, dentist, or RN who patients respond normally to verbal commands. Cognitive function and coordiadministers sedation and any nation may be impaired, but ventilatory and cardiovascular functions generally physician, dentist, RN, licensed are unaffected. vocational nurse, or respiratory care practitioner who monitors a Moderate sedation/analgesia (ie, conscious sedation) patient after administration of Moderate sedation/analgesia is defined as a medication-induced depression of sedation pass a sedation test. Most consciousness during which patients respond purposefully to verbal comsedation examinations are given mands, either alone or accompanied by light tactile stimulation. No intervenafter the participant has read and tions are required to maintain the patient's airway, and spontaneous ventilation understood a sedation module per- is adequate. Cardiovascular function usually is maintained. tinent to the type of sedation Deep sedation/analgesia administered at his or her facility. Deep sedation/analgesia is a medication-induced depression of consciousSome facilities require that practi- ness during which patients cannot be aroused easily; however, they do tioners spend time with the anes- respond purposefully to repeated or painful stimulation. Patients' ability to thesia care provider in the OR to independently maintain ventilatory function may be impaired. Patients may learn the necessary skills needed need assistance to maintain an airway, and spontaneous ventilation may be to provide deep sedation. The bot- inadequate. Cardiovascular function usually is maintained. tom line is that these practitioners Anesthesia need to be able to safely rescue Anesthesia consists of general anesthesia and spinal or major regional anespatients who slip from moderate thesia. It does not include local anesthesia. General anesthesia is a medicasedation into deep sedation or tion-induced loss of consciousness during which patients are not orousable, from deep sedation into general even by painful stimulation. Patients' ability to independently maintain ventianesthesia. In addition to the praclatory function often is impaired. Patients often require assistance in maintitioner performing the procedure, taining an airway, and positive pressure ventilation may be required because the standards require a sufficient of depressed spontaneous ventilation or medication-induceddepression of number of qualified personnel to neuromuscular function. Cardiovascular function may be impaired. appropriately access the patient before beginning moderate or NOTE deep sedation and anesthesia, 1 , ComprehensiveAccredifufion Munuul for Hospifuls (Oakbrook Terrace, Ill: provide moderate or deep seda- Joint Commission on Accreditation of Healthcare Organizations, 2001) TX.2tion and anesthesia, TX.2.4.1. perform the procedure, monitor and evaluate the patient, and capnograph also is recommended. It is likely that the recover and discharge the patient from the capnograph would be used only for patients receiving postanesthesia care unit (PACU) or the health care deep sedation. Before surgical and other procedures (eg, interfacility. ventional procedures in radiology, procedures in the MONITORING AND PATIENT EVALUATION gastrointestinal laboratory) aie performed on a Also noted under the intent statement of TX.2 is patient, a history and physical examination must be the need for appropriate equipment (ie, pulse oxime- completed. At least a short history and physical try for continuous measurement of heart rate and examination should be completed for patients underoxygenation, electrocardiogram monitoring for going moderate or deep sedation if this information is patients with significant cardiovascular disease or not on their charts already. Standards TX.2.1 and PE.1.8.1 require a preseanticipated dysrhythrnias, a sphygmomanometer to measure blood pressure at regular intervals). Res- dation assessment for each patient before initiation of piratory frequency and pulmonary ventilation are to moderate or deep sedation. Standards TX.2.1.1 and be monitored continuously as well, so the use of a PE. 1.8.2 pertain to the need to plan each patient's 55 1 AORN JOURNAL
MARCH 2002. VOL 7 5 , NO 3 * Catuluno
Patients need to be reassessed immediately before administration of moderate or deep sedation medication.
moderate or deep sedation, so many facilities have added a brief anesthesia portion to the bottom of their short history and physical examination forms. This allows for documentation of the American Society of Anesthesiologists (ASA) score and a place for the anesthesia assessment and plan. PATIENT ASSESSMENT AND INFORMATION SHARING
As with anesthesia, the administration of moderate or deep sedation requires that sedation and anesthesia options and risks be discussed with the patient and his or her family members before administration (ie, TX.2.2). This should be documented by the practitioner in the progress notes or on the surgical or procedure report. In addition, as with anesthesia, patients need to be reassessed (ie, vital signs checked, patient given a quick examination by the sedation provider) immediately before administration of moderate or deep sedation medication or anesthesia (ie, PE. 1.8.3). This must be documented as well. The easiest way to capture this information is to place a small box above the graphic where vital signs will be documented. Next to the box write “patient reassessed immediately before administration of sedation.” After moderate or deep sedation medication has been administered, the patient’s physiological status should be measured and assessed throughout the sedation period to ensure appropriate physiological support for the patient (ie, TX.2.3). A safe practice is to document a patient’s vital signs and pulse oximetry every five minutes during moderate sedation. During deep sedation, it is safe practice to document the capnograph reading every five minutes. The person monitoring the patient has no other responsibilities during this time frame and thus can document these
items adequately on the flow sheet. The patient should be monitored from the time the moderate or deep sedation is initialized through the time he or she has recovered fully from the moderate or deep sedation. The patient’s postoperative status must be assessed on admission to and before discharge from the postsedation recovery area or PACU (ie, TX.2.4, PE. 1.8.3). In most facilities, this is interpreted to mean until the patient has met his or her presedation Aldrete score and is able to be discharged home safely or returned to the inpatient unit. The patient is to be monitored during the postsedation recovery or PACU period (ie, TX.5.4). This monitoring will include airway management, documentation of vital signs, pulse oximetry, and any complications that may arise. Most sedation education programs include airway management and how to assess patients to determine the Aldrete score. One issue to consider may be cross training staff members responsible for monitoring patients recovering from deep sedation with PACU staff members. This ensures the same level of care throughout the organization (ie. L.D. 1.6, M.S. 6.8). The reason for this is that patients receiving deep sedation may unintentionally or unavoidably slip into general anesthesia status. Staff members in the PACU generally are trained in ACLS or PALS. If this is the case, staff members monitoring patients recovering from deep sedation also should be trained in ACLS or PALS to provide the same level of care. Some organizations have PACU nurses or anesthesia care providers take into account the competencies of staff members monitoring patients recovering from deep sedation. Lastly, patients are to be discharged from a postsedation recovery area or the PACU by a qualified licensed independent practitioner (ie, TX.2.4.1). Many organizations use medical staff member-approved discharge criteria when discharging patients from these areas. This is sufficient if use of this criteria is documented clearly in the patient’s medical record. The reason medical staff memberapproved criteria is used by many facilities is to relieve the anesthesia or sedation care provider from physically being present when a patient is discharged. Take care when using discharge criteria approved by medical staff members, however. There have been several reported sentinel events regarding patients being discharged too soon from presedation areas and the PACU because these areas experienced a sudden influx of patients or because of staffing issues. When the patient is discharged
552 AORN JOURNAL
MARCH 2002, VOL 75, NO 3 Cutalano
home, instructions must be provided regarding pain management, medications, diet, activities of daily living, complications of sedation, and where and whom to call in case of complications from the procedure or sedation. POLICY DEVELOPMENT
tion policies and processes when the champions of such policies are anesthesia care providers. They truly are the experts in the field when it comes to management of sedated patients and sedation medication dosage regimens. If your facility has no anesthesia department or the anesthesia department chooses not to be involved in developing policies and processes, take time to review practice parameters for nonanesthesiologists published by the ASA.’ A
Individual facilities must decide how best to achieve compliance with JCAHO standards. It is not a requirement that the anesthesia department be involved in the development and implementation of sedation policies; however, many medical and hospital staff members have far more confidence in seda-
Kathleen Cutalano, RN, JD, is director of administrative projects at the Children 3 Medical Center of Dallas.
NOTES 1. Comprehensive Accreditation Manualfor Hospitals (Oakbrook Terrace, Ill: Joint Commission on Accreditation of Healthcare Organizations, 200 1).
2. “Practice guidelines for sedation and anesthesia by non-anesthesiologists,” American Society of Anesthesiologists, http://www.asahq.org/practice isedationisedation1017.pdf(accessed 16 Jan 2002).
American Cancer Society Releases Statistics The American Cancer Society (ACS) has released two annual publications on cancer statistics according to a Jan 22, 2002, news release from ACS. Cancer Facts & Figures 2002 includes estimates of the number of new cancer cases and cancer deaths likely to occur in the United States this year. It also features a section on early detection of colorectal cancer. Cancer Prevention & Early Detection Facts and Figures 2002 presents data on lifestyle factors, such as tobacco use, nutrition, physical activity, sun exposure, and use of cancer screening. According to the release, Cancer Facts & Figures 2002 states that approximately 1,284,900 new cases of cancer are expected to occur in the United States this year. This publication also includes the following statistics. Lung cancer, which will claim an estimated 154,900 lives this year, remains the leading cause of cancer death in the United States. The death rate for all cancers is approximately 33% higher for African Americans than for Caucasians. Between 1992 and 1998, however, the incidence of cancer and the mortality rate among African American men decreased more than for any other racial or ethnic group. The five-year survival rate for all cancers is 62%, up 2% from last year’s report.
About one-third of the 550,500 cancer deaths expected to occur in 2002 are related to lifestyle factors that individuals can control, including diet, physical inactivity, obesity, smoking, and tanning, according to the release. The following information is found in Cancer Prevention & Early Detection Facts and Figures 2002. Despite widespread awareness of the dangers of cigarette smoking and tobacco use, 170,000 people likely will die from tobacco-related causes this year. The percentage of high school students who smoke varied widely by state, with the highest percentage, more than 40%, occurring in Kentucky, North Dakota, South Dakota, Ohio, and West Virginia. Tanning and sunburning will cause the majority of the 53,600 cases of skin cancer likely to be diagnosed in 2002. Between the years 1960 and 2000, the percentage of adults classified as obese increased from 12.8% to 20%. Both publications are available on the ACS web site, http:llwww.cancer.org. Cancer Facts and Figures Now Available (news release, Atlanta: American Cancer Sociek Jan 22, 2002), http:/hww.cancer.org (accessed 23 Jan 2002).
553 AORN JOURNAL