A Primer on Urothelial Cancer
The urinary system, including the bladder, ureters, urethra, and renal pelvis, is lined with urothelial tissue. Urothelial carcinoma is the predominant histologic type of cancer in that system, and 90% of tumors are located in the bladder. With more than 81,400 new cases and nearly 18,000 deaths estimated for 2020, bladder cancer is the fifth most prevalent type of cancer in the United States.
The Case of the HPV-Positive Perk
Warren is a 50-year-old man recently diagnosed with human papillomavirus (HPV)-positive oropharyngeal cancer. He and his wife meet with a radiation oncologist and develop a plan of care. Lisa, the radiation oncology nurse, meets with the couple to provide education and answer questions. Darren tells her that two of his “hard living” uncles died from head and neck cancer and the treatment was horrible. He says, “I’ve only had two sexual partners and never smoked—is this cancer really worth treating?”
NIH Study Links Cigarette Smoking to Higher Stroke Risk in African Americans
The disproportionate adverse health impact from smoking on African Americans is striking. Although oncology nurses are well aware of tobacco’s carcinogenic effects, they also need to understand the implications for comorbid conditions they may see in smokers with cancer. A recent study, through the National Institutes of Health (NIH), confirmed that African Americans have a 2.5 times higher incident of smoking-related strokes than those who never smoke.
Help Patients Understand Genomic Variants of Unknown Significance
Patients approach genetic testing, either for germline (inherited) or somatic (tumor) alterations, hoping it will provide valuable information about their cancer risk, prognosis, or treatment options. Next-generation sequencing makes it possible to test for panels of 40 or more genes simultaneously. By testing more genes, the possibility of finding an actionable, informative result improves, but so does the chance of having a result with one or more variants of unknown clinical significance.
Develop Your Individual Cancer Screening Plan
As oncology nurses, we know that catching cancer early through screening leads to better outcomes and increased survival rates. We ask our survivors and loved ones to prioritize their cancer screenings, reminding them, “I do not want to see you in my clinic chair or hospital bed with cancer, especially not at an advanced level.” Take care of yourself by giving yourself the same lecture.
Family Risk Factors May Indicate Need for Genetics Counseling Referrals
Genetics testing is not just about one family member; the results have implications for an entire family. Results of genetic testing can be confusing, and families often need assistance understanding what it means for them. Genetics counseling before and after testing is very important to help individuals and families understand the results of genetic testing when they are received and over time.
Prevent, Recognize, and Manage Sepsis in Patients With Cancer
Because of weakened immune systems and prolonged treatment courses, patients with cancer have a higher chance of developing sepsis. Once acquired, sepsis puts patients at risk for hospitalization and increased morbidity and mortality. Prevention and prompt management are essential to improve outcomes.
Health Care at Iowa Caucus; FDA Biologic Market; Flavored E-Cigarette Pod Ban
The Iowa Democratic Caucus did not go as smoothly as the political prognosticators expected. Most news outlets are only reporting the level of dysfunction with a voting app that delayed the final numbers significantly, but beneath that is one truth that still rings true: Americans want solutions to their healthcare problems. Health care remained the number one policy issue for 41% of caucus attendees, an astoundingly high rate that beat every other issue handedly.
FDA Finalizes Enforcement Policy on Unauthorized Flavored Cartridge-Based E-Cigarettes
Amid the epidemic levels of youth use of e-cigarettes and the popularity of certain products among children, the U.S. Food and Drug Administration today issued a policy prioritizing enforcement against certain unauthorized flavored e-cigarette products that appeal to kids, including fruit and mint flavors. Under this policy, companies that do not cease manufacture, distribution and sale of unauthorized flavored cartridge-based e-cigarettes (other than tobacco or menthol) within 30 days risk FDA enforcement actions.
Bill to Lower Drug Costs; Surprise Medical Billing; The Fight Against Vaping
The Elijah E. Cummings Lower Drug Costs Now Act of 2019, otherwise known as H.R. 3, is a top priority for House Speaker Nancy Pelosi (D-CA). But she’s facing challenges from progressive Democrats on her left more so than the conservative Senate on her right. Watering down provisions in H.R. 3 too much will lose her the votes she needs to pass the bill in the House, but passing a bill that’s too overarching or progressive will allow Senate Majority Leader Mitch McConnell (R-KY) to refuse to take up the legislation at all.
Trump Vaping Meeting; Drug Pricing Stalemate; DC Sues Juul
The vaping conversation has drawn the attention of everyone on Capitol Hill, and it’s been a contentious debate so far. Tensions were high at the White House during a meeting with smoking cessation advocates after the Trump administration decided to step back from promises to ban flavored vaping products.
FDA Grants Authorization to Eight Smokeless Tobacco Products
Tobacco products are under more scrutiny than ever before. With the rise in youth vaping, the advent of flavored e-cigarettes, and the production of other nicotine delivery systems, the U.S. Food and Drug Administration (FDA) has tightened its review process for new products. The agency is looking to the smoking cessation community, taking insight from the Trump administration, and weighing feedback from other elected officials in the Senate and House of Representatives for ways to protect public health. That said, companies are using technology to create new tobacco-based products, and FDA must find ways to assess harm while balancing free market interests.
Vaping Tax; Expensive Compression Garments; ACA Premiums Fall
The rise in youth vaping has cemented e-cigarettes as a scourge of the tobacco cessation community. The products have been marketed to minors, and Congress is currently reviewing several bills meant to tackle the issue. A House of Representatives panel agreed to levy a new vaping tax on e-cigarette pods, an effort that would raise prices for vaping products in the hopes of making them less appealing and accessible to teens. Even in today’s politicized and divisive environment, bipartisan consensus demonstrates that something must be done at the federal level to combat the increase in underage smoking, particularly with electronic devices.
Updated ONS Position Statement Highlights Health Consequences of Vaping
E-cigarettes, initially introduced as a potential step-down smoking cessation strategy, have become a pervasive part of American culture—especially among users younger than 18 years of age. The rise in vaping rates has become so alarming that the U.S. surgeon general issued a statement declaring youth e-cigarette use a national epidemic. In light of Centers for Disease Control and Prevention reports of increasing vaping-related lung disease and death, ONS released its revised position statement, “Potential Adverse Health Consequences From Use of E-Cigarettes and Vaping,” to highlight the negative effects of vaping, emphasize the lack of regulatory oversight, and better inform oncology nursing practice for patients and their families.
The Case of the Nicotine Nightmare
Jill works as an oncology nurse in a large community hospital. While attending a family gathering, her uncle proudly tells her that he and his 17-year-old son are using e-cigarettes to help them stop smoking traditional cigarettes. He comments that his wife now allows them to “smoke” in the house and car because the vapor is relatively odor free.
Teen E-Cigarette Use Doubles as Federal Agencies Publicly Address Epidemic
The youth vaping epidemic has dominated headlines since the U.S. surgeon general elevated the issue to the nation’s spotlight. In a 2019 survey of junior high and high school students, the National Institute on Drug Addiction (NIDA)—an arm of National Institutes of Health—found that the rate of e-cigarette use had doubled since 2017.
Shalala's Vaping Fight; Pre-Existing Conditions; Trump Nominates Hahn
Vaping has been associated with significant public health effects during the past several months, according to the Centers for Disease Control and Prevention. Congress is making e-cigarette regulation a top priority—especially in the wake of the youth smoking epidemic. Now, several members of Congress have developed their own legislative efforts to address the national issue.
Pediatric Cancer Survivors Have Higher Mortality After Adult Breast Cancer Diagnosis
Women who survived pediatric cancer but developed breast cancer as an adult are more than twice as likely to die prematurely, mostly from comorbid conditions, according to results of a study published in the Journal of Clinical Oncology.
CDC Vaping Illnesses; ONS Capitol Hill Days; CA Calls to End Vaping
Vaping has become a national health issue on Capitol Hill. With more teens than ever using the devices, along with reports connecting lung injury and respiratory illness with vaping, policymakers are eager to understand the problem and act swiftly. Part of the problem includes the high levels of tetrahydrocannabinol and nicotine in vaping products. Congress is working to address the problem through several legislative bills, but few are moving as fast as the public health impact seen in news reports.
Model May Help Predict Lung Cancer Risk in Patients With Nodules
A risk-prediction model that combines patients’ health history with clinical characteristics of their lung nodules may help physicians determine which will develop into cancer, according to the results of a study published in Cancer Prevention Research.
FDA Takes Stronger Oversight Role of Tobacco Products
As the youth smoking epidemic persists and illnesses related to vaping make the headlines, the U.S. Food and Drug Administration (FDA) is searching for solutions to combat the growing impact of new tobacco and nicotine products. After weeks of public outcry, FDA has doubled down on its regulatory stance, issuing several statements—including new warning letters to large tobacco companies—to reinforce its commitment to aggressive oversight and regulation of new tobacco products.
AMA Medicare Expansion; Vaping Respiratory Disease; Nursing Shortage
With the 2020 election cycle kicking into high gear, upcoming presidential debates will continue to highlight health care as a major domestic issue. Downstream contests for House and Senate seats are also in play, and health care will serve a huge role in those campaigns, too. Candidates are offering a slew of different options like a new single-payer system, Medicare expansion, Medicare for All, Medicare for All with an additional buy-in program, and many other iterations.
Hyperthyroidism Treatment Linked to Increased Cancer Death Risk
Radioactive iodine treatment for hyperthyroidism is associated with long-term risk of death from solid cancers, particularly breast cancer, according to the results of a study published in JAMA Internal Medicine.
House Committee Examines Juul’s Role in the Youth Smoking Epidemic
For nearly two decades, smoking rates among all ages were on the decline. Restrictions on marketing, sales, and distribution made it difficult for underage smokers to get their hands on traditional cigarettes, and adults were seeing the benefits of smoking cessation campaigns and education.
FDA Recalls Textured Breast Implants Because of Lymphoma Risk
On July 24, 2019, the U.S Food and Drug Administration (FDA) requested that Allergan recall its BIOCELL textured breast implants and tissue expanders because of the associated increased risk of breast implant-associated anaplastic large cell lymphoma; Allergan agreed and is removing the products from the global market.
Tobacco 21 Gets Federal Boost
In February 2019, the U.S. Surgeon General declared the rise of youth vaping was the latest epidemic facing the American public. Reversing a two-decades-long trend of declining smoking rates among underage smokers, e-cigarette use and vaping have become commonplace among children younger than 18.
America’s Old Tobacco Business Reignites as a New Industry
America’s love affair with tobacco has a long and sordid history. As automated machines ushered in a new age of modernization in the early 20th century, cigarettes were readily available as never before. Although some in the temperance movement believed tobacco products were the gateway to alcohol and drug abuse, by the 1930s and 1940s, physicians were touting cigarettes as almost a healing treatment that calmed the nerves and desensitized the body with positive effects.
PCHETA in the Senate; Armed Forces Tobacco Use; Drug Pricing Executive Order
An ONS priority bill, the Palliative Care and Hospice Education and Training Act (PCHETA) emphasizes how providers are educated and trained in palliative care, enabling them to provide a higher level of care to their patients. PCHETA legislation—and its reception on Capitol Hill—has evolved from being misinterpreted as training providers to hasten death to a true understanding that palliative care is patient-centered care, and it provides patients and their family members with further treatment options, symptom management resources, and quality of life. In a display of bipartisanship, Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV) reintroduced PCHETA legislation to the Senate floor for consideration.
Eliminating Private Insurance; Raising the Smoking Age; HPV Vaccine Recommendation
Candidates in the first Democratic presidential debate spent some time addressing issues related to healthcare access. In point-blank questions, they were asked what they might do in support of Medicare for All, especially whether they’d be in favor of eliminating private insurance companies. Many were supportive of the overarching legislation, some were wary of eliminating insurance companies outright, and others flat out opposed it.
Obesity-Related Cancer Incidence Increases in Young Adults
A new study showed that incidence rates are increasing for 6 of the 12 obesity-related cancers in U.S. young adults and that, over time, the increases are occurring in progressively younger ages and successively younger generations. The findings were published in Lancet Public Health.
Which of the Following Actions Would Not Decrease Risk for Asbestos-Related Cancers?
A.Use building materials made with asbestos to decrease chances of fire in your home.
B. Test your air for asbestos levels.
C. Maintain proper protective gear while working in environments with potential for asbestos exposure.
D. Check with an asbestos expert to assess your home if it was built before 1975.
Risk Assessment Tool Predicts Survival in Older Patients Undergoing HCT
Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (alloHCT), and traditional transplant-specific prognostic indices such as the hematopoietic cell transplant comorbidity index (HCT-CI) may not adequately predict survival. Researchers found that routine pretransplant assessments by interdisciplinary clinical providers, including advanced practice providers and nursing staff, may uncover additional geriatric deficits. Richard J. Lin, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York, NY, discussed the findings at the ASH Annual Meeting on December 1, 2018.
The Overlooked Link Between Alcohol and Breast Cancer
At a recent college alumni dinner, a friend and wine expert pulled me aside and asked, “Is it true that wine increases the risk of breast cancer?” She knew I worked in the cancer division at the Centers for Disease Control and Prevention (CDC), so it was a reasonable question. I’ve been at wine tastings she’s hosted, and I needed to be straight.
“Yes,” I said, “the evidence is clear: drinking alcohol of any kind increases breast cancer risk.”
U.S. Pediatric Cancer Incidence Varies by Geography
A new study demonstrated that pediatric cancer rates vary by U.S. state and geographic region, with the highest rates in the Northeast, specifically New Hampshire; Washington, DC; and New Jersey. The study findings were published in Morbidity and Mortality Weekly Report.
Study Finds Association Between Increased BMI and Lower Breast Cancer Risk in Young Women
Young women with high body fat have a decreased chance of developing breast cancer before menopause, according to a new study published in JAMA Oncology. The finding may help researchers better understand the role obesity plays in breast cancer risk.
Researchers Clarify Connection Between Night Shift Work Duration and the Risk of Colorectal Cancer
Evidence already supports a connection between night shift work and an increased risk of colorectal cancer (CRC), but the mechanism has been difficult to pinpoint. In a study presented at the 2018 American Society of Clinical Oncology Annual Meeting, researchers evaluated the insulin receptor substrate (IRS) 1 and 2 proteins and presented the role they play in the connection of night shift work and CRC.
Study Gives a Better Understanding of ARID1A Mutations in Colorectal Cancer
A component of the SWI/SNF chromatin remodeling complex, AT-rich interactive domain 1A (ARID1A), regulates gene expression. Data on the characteristics and associated clinicopathologic features of ARID1A in colorectal cancer (CRC) are limited, even though its mutations are reported in a variety of other cancers. In study findings presented at the 2018 American Society of Clinical Oncology Annual Meeting, researchers explained an increased understanding of the ARID1A mutation in CRC.
Childhood Obesity May Be a Factor in Increasing Cancer Rates in Young Adults
Although overall cancer rates are on the decline, 9 of the 20 most common cancers in the United States are increasing more frequently in young adults aged 20–44. And those same 9 cancers are among the 13 cancers that have clear ties to obesity. In a new study published in Obesity, a researcher makes the case for a connection between the two.
Cancer Prevention and Awareness Starts With Oncology Nurses
April is designated as National Cancer Control Month in the United States. It’s a federally endorsed observation, annually encouraged by a proclamation from the president. April is dedicated to raising awareness for cancer prevention and treatment throughout the country. Approved through a joint resolution by Congress in 1938, the yearly presidential announcement serves as a reminder to all Americans that awareness of the factors that cause or prevent cancer are crucial to the public health.
Which Is a Breast Cancer Risk Factor?
Test your oncology knowledge with ONS. Which of the following is a risk factor for developing breast cancer?
- Women who are gravida 3 para 2
- Mild to moderate alcohol use
- Absence of the BRCA1 or BRCA2 mutation
- Going through menopause prior to age 55
CDC Promotes World Cancer Day 2018
On February 4, 2018, The Center for Disease Control and Prevention’s (CDC’s) annual World Cancer Day will aim to raise cancer awareness and support in a unified, global effort. The CDC’s efforts focus on cancer research and prevention, as well as improving services to patients with cancer, understanding and sharing common sentiments related to cancer, and mobilizing the global community against the disease.
National Academies Explain the Public Health Consequences of E-Cigarettes
The National Academies of Sciences, Engineering, and Medicine recently released its latest report on the consequences of smoking, specifically related to electronic cigarettes. The report discusses the new effects of e-cigarettes as a public health hazard. According to the report, the effects of long-term e-cigarette use are still unknown, especially related to morbidity and mortality.
Most Americans Are Unaware of Key Cancer Risk Factors
According to results from the first National Cancer Opinion Survey of 4,016 U.S. adults, the majority of Americans are unaware of several major risk factors for cancer, particularly obesity, which is the second-largest preventable cause of cancer in the United States, after smoking.
ASCO Links Alcohol to Increased Risk for Several Cancers
In a November 2017 special statement, the American Society of Clinical Oncology (ASCO) cited evidence that alcohol consumption directly increases the risk for oropharyngeal and larynx cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer. Although heavy drinking increases risk the most, ASCO noted that even modest consumption puts people at higher risk for these and other cancers. The World Health Organization’s International Agency for Research on Cancer has classified alcohol as a group I carcinogen because it causes cancer in humans.
Height and Weight May Be Linked to Aggressive Prostate Cancer
Taller men and those with a higher body mass index (BMI) may be at increased risk for high-grade prostate cancer and disease-related mortality, according to the results of a study published in BMC Medicine.
Why Breast Cancer Awareness Is Important All Year
As Breast Cancer Awareness Month begins this week, we’ll start seeing pink awareness efforts everywhere. Pink products will line the shelves at stores, awareness and fundraising ads will showcase celebrities wearing pink ribbons, and high school, collegiate, and even professional athletes will adorn their uniforms with pink, some even articulating a specific person or family member affected by breast cancer for whom they’re dedicating their athletic efforts.