How APRNs Can Manage Immunotherapy-Related Hypothyroidism in Patients With Cancer
Immunotherapy has a unique set of toxicities in comparison to traditional chemotherapy. Endocrine dysfunction, including hypo- or hyperthyroidism, hypophysitis, type-1 diabetes, and primary adrenal insufficiency, may occur. Advanced practice RNs (APRNs) have a role in monitoring and treating patients for endocrine-related toxicities.
FDA Approves Pembrolizumab for Adjuvant Treatment of Melanoma
On February 15, 2019, the U.S. Food and Drug Administration (FDA) approved pembrolizumab for the adjuvant treatment of patients with melanoma with involvement of lymph node(s) following complete resection.
Cultivate Cultural Humility in Yourself and Your Practice
Oncology nurses interact with other staff, patients, and families, each of whom have various cultural and personal preferences. A person’s culture encompasses race, ethnicity, spiritual practices, social habits, and so much more.
Be Alert for Severe, Early-Onset Toxicities From 5-Fluorouracil and Capecitabine
Although 5-fluorouracil (5-FU) and capecitabine (the oral prodrug of 5-FU) are generally well tolerated, patients can experience severe toxicities from either drug that can be life-threatening if not treated quickly. Of the 275,000 patients who receive 5-FU each year, more than 1,300 die from 5-FU toxicity, or approximately 3–4 patients per day.
What Assessment Tools Are Used for Patients With Cancer and Psychiatric Diagnoses?
When patients with cancer also suffer from psychiatric diagnoses, it can present unique challenges to healthcare professionals. Because oncology nurses build relationships with patients while addressing issues, understanding the obstacles to practice is key to providing the best possible care. By having a keen understanding of symptoms, assessment procedures, and necessary response skills, oncology nurses can work together with the mental health team to provide holistic care throughout the cancer journey.
A Matter of Mind: When Patients With Cancer Have Psychiatric Comorbidities
Nearly 20% of Americans experience mental illness in a given year, according to the National Alliance on Mental Illness. With diagnoses such as schizophrenia, bipolar disorder, or major depression, about one in every 25 Americans suffers from a serious mental illness that directly affects major life activities. The prevalence of mental illness in the United States can have a downstream effect on cancer care and patient outcomes, and with these statistics, oncology nurses may encounter patients with cancer who have pre-existing psychiatric disorders. Healthcare providers in fields outside of psychology need to be prepared to address the unique needs and individualized care required to support this patient population during and beyond cancer treatment.
NIH Seeks Research Proposals Through HEAL Initiative Funding
Recognizing the national opioid epidemic in the United States, the National Institutes of Health (NIH) has allocated a to address public health issues like prescription drug abuse and overdose. Through the Helping to End Addiction Long-Term (HEAL) Initiative, the NIH is offering 30 funding opportunities for researchers, awarding $850 million in support.
Which of the Following Drug Is Most Likely to Have a Synergistic Effect When Combined With Radiation Therapy?
Which of the Following Drug Is Most Likely to Have a Synergistic Effect When Combined With Radiation Therapy?
Oncology Drug Reference Sheet: Lutetium Lu 177 Dotatate
Lutetium Lu 177 dototate (Lutathera®) was approved in January 2018 by the U.S. Food and Drug Administration to treat a specific group of neuroendocrine tumors (NETs) in the gastrointestinal tract. NETs are rare, and the tumors produce hormone-like substances in response to signals from the nervous system.
The Role of the APRN in Monitoring Patients Receiving Peptide Receptor Radionuclide Therapy
Neuroendocrine cancers are rare malignancies; however, their incidence is thought to be increasing. Such tumors are characterized by their overexpression of somatostatin receptors, present in up to 80% of cases. However, a novel radiopharmaceutical may give advanced practice RNs (APRNs) a new option to treat certain gastroenteropancreatic neuroendocrine tumors.
Do Cytotoxic Agents Impact Ground Soil or Well Water?
When patients go home after receiving their regimen of powerful cytotoxic agents, oncology nurses routinely encourage them to double flush after using the bathroom to ensure that trace amounts of hazardous medication are eliminated from the environment to prevent other members of the household from being exposed. But what happens with chemotherapy chemicals found in human waste as they enter a patient’s septic system—and eventually the water supply?
The Case of the Gender Gaffe
During the morning shift change, Charlie, an RN, receives a report on Ellis, age 52, who was admitted three days ago for severe abdominal pain and persistent diarrhea after cycle 3 of high-dose ipilumumab and nivolumab.
When Charlie and the certified nursing assistant (CNA) enter Ellis’s room, the patient is sitting up in bed caressing hands with a woman of similar age. Ellis requests help getting into the shower, so Charlie says to the CNA, “Please, help him shower, and I will finish introductions.”
Ellis interrupts Charlie. “I am not a he!”
Use Storytelling to Hear Your Patient’s Voice
Practice reflection is a critical element of self-care for an oncology nurse, and one way to reflect is through storytelling. Whether it’s sharing your own stories or your patients’ stories, writing them down and speaking them aloud to yourself, your family, a small group, or more can be a healing self-care experience.
New Edition of Palliative Care Guidelines Focus on Inclusivity, Responsibility
Palliative care is a necessary inclusion in the care of all people with a serious illness, no matter the diagnosis or setting, and it’s the responsibility all healthcare providers, including specialty providers in oncology.The National Consensus Project (NCP) expanded on these two key tenets in its new release of the fourth edition of the Clinical Practice Guidelines for Quality Palliative Care. ONS is one of 80 organizations endorsing the new guidelines.
Take a Closer Look at Immune Checkpoint Inhibitors
One way that cancer has been able to evade the immune system is through overexpression of immune checkpoint proteins (immune inhibitory pathway), which allow cancer cells to be considered “self” instead of foreign and block T-cell action. Immune checkpoint proteins cytotoxic T-lymphocyte–associated 4 (CTLA-4) and programmed cell death protein (PD-1) are receptors that are expressed on the surface of cytotoxic T cells. Immune checkpoint inhibitors prevent those receptors from binding to their natural ligands, disrupting the immune inhibitory pathway. See Table 1 for a list of approved agents and indications.
Biosimilars and Oral Agents Lead New Approvals in the Cancer Setting
A majority of the U.S. Food and Drug Administration (FDA) approvals for cancer agents in the latter part of 2018 represented second and third approvals for new indications in other disease sites. Many were given expedited approval, but with that comes the potential that the incidence of adverse events may be underrepresented because fewer patients received the agents in a clinical trial setting.
FDA Approves Romiplostim for Pediatric Patients With Immune Thrombocytopenia
On December 14, 2018, the U.S. Food and Drug Administration (FDA) approved romiplostim for pediatric patients one year of age and older with immune thrombocytopenia for at least six months who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
Manage Afatinib’s Adverse Events to Keep Patients on Treatment
Ongoing therapy with afatinib—an oral, irreversible ErbB family blocker—for as long as it is effective and tolerable is considered first-line treatment for metastatic non-small cell lung cancer in patients with EGFR mutations. In their article in the October 2018 issue of the Clinical Journal of Oncology Nursing, Edwards, Adan, Lalla, Lacouture, O’Brien, and Sequist discussed the most common adverse events (AEs) associated with afatinib and their real-life experiences managing them in clinical practice to keep patients on therapy.
Breast MRI Protocol Improves Patient Care
Magnetic resonance imaging (MRI) can help diagnose breast cancer, but it is costly. Leadership at the University of Washington in Bellingham developed a protocol to improve the timeliness of care, moving the time of MRI prior to surgeon evaluation, and found that it led to enhanced patient care, eliminated delays in treatment, avoided unnecessary tests, shifted appropriate care to primary-care providers, and provided all necessary data prior to initial surgical consultation. They presented the findings at the .
Overall Survival From Breast Cancer Differs Based on Tumor Type and Location
Triple-negative breast cancer tumors are thought to be more immunogenic than other breast cancer subtypes, such as luminal A/B or human epidermal growth factor receptor 2-positive (HER2+) tumors. Among all breast cancers, tumors appear more commonly in the upper outer quadrant. However, it is not clear whether expression of immune response genes vary with tumor location among the different subtypes. Researchers assessed gene expression associated with immune response pathways to identify potential treatment targets and presented the findings at the .
How Can Oncology Nurses Support Surgical Patients With Esophageal Cancer?
In 2000, I was diagnosed with stage III esophageal cancer—adenocarcinoma—and was put on a treatment regimen of chemotherapy, radiation therapy, and ultimately surgery to my esophagus. After talking with my doctors and nurses, heartburn was determined to be the cause of cancer. I didn’t realize at the time that survival rates for my disease were extremely low.
Under the Knife: Supporting Patients’ Needs Throughout Surgical Oncology Care
People often use idioms—such as “going under the knife” as a euphemism for surgery—to avoid confronting distressing situations, which is even more pronounced when it comes to life events as serious as cancer. But for many patients with cancer, undergoing a surgical procedure is key to positive outcomes, and they count on the expert clinical care and support of their surgical oncology nurses to see them through it.
FDA Approves Rituximab-ABBS as Biosimilar to Rituximab for Non-Hodgkin Lymphoma
On November 28, 2018, the U.S. Food and Drug Administration (FDA) approved rituximab-abbs as the first biosimilar to rituximab for patients with CD20-positive, B-cell non-Hodgkin’s lymphoma (NHL) to be used as a single agent or in combination with chemotherapy.
FDA Approves Gilteritinib for Relapsed, Refractory AML With an FLT3 Mutation
On November 28, 2018, the U.S. Food and Drug Administration (FDA) approved gilteritinib for treatment of adult patients who have relapsed or refractory acute myeloid leukemia (AML) with a FLT3 mutation as detected by an FDA-approved test.
APRN-Led Clinics Enable Comprehensive Survivorship Care
A survivorship clinic allows APRNs to practice autonomously and highlights their strengths and skills, including assessing long-term toxicities, providing expert symptom management, coordinating with other disciplines, and making referrals as appropriate. Long-term toxicities from cancer treatment are disease- and treatment-specific and will be unique to each patient.
Chemotherapy Is Still a Staple in Treatment Plans. Here’s a Fresh Look at a Familiar Treatment Option
Despite all of the new drugs approved in recent years—particularly immunotherapies, oral agents, and biosimilars—that have forced nurses to consider many novel approaches to patient care, the importance of chemotherapy in cancer treatment has remained a constant. In a field where it feels like no two days are the same and new drugs emerge on a rolling basis, chemotherapy continues to be a staple in cancer treatment plans and safety and administration principles remain constant.
FDA Approves Glasdegib for AML in Adults Aged 75 or Older or Who Have Comorbidities
On November 21, 2018, the U.S. Food and Drug Administration (FDA) approved glasdegib in combination with low-dose cytarabine, for newly-diagnosed acute myeloid leukemia (AML) in patients who are 75 years old or older or who have comorbidities that preclude intensive induction chemotherapy.
FDA Approves Brentuximab Vedotin for Previously Untreated sALCL and CD30-Expressing PTCL
On November 16, 2018, the U.S. Food and Drug Administration (FDA) approved brentuximab vedotin in combination with chemotherapy for previously untreated systemic anaplastic large cell lymphoma (sALCL) or other CD30-expressing peripheral T-cell lymphomas (PTCL), including angioimmunoblastic T-cell lymphoma and PTCL not otherwise specified. This is the first FDA approval for previously untreated PTCL including sALCL.
WHO Cautions About Inactivity Pandemic and Disease Risk
No improvement in worldwide exercise levels has been seen since 2001, and, in fact, inactivity has worsened, data in a new report from the World Health Organization (WHO) indicated. The findings were published in Lancet Global Health.
The Case of the Emotional Emergency
Sharon, age 40, was diagnosed with invasive ductal carcinoma. Pathologically, her tumor was grade I, estrogen- and progesterone-receptor positive, and HER2 negative. The mass measured 0.5 cm on ultrasound. Sharon has no family history of cancer and is devastated by the diagnosis. One of her close friends recently died from metastatic breast cancer, and she is certain will have the same fate. She tells Jennifer, an RN in the breast center, that she is going home to “get her affairs in order.”
The Integrative Oncology Nurse: New Role for a New Era in Cancer Care
When patients or loved ones receive a cancer diagnosis, they often experience fear, worry, and a desire to do everything possible to increase the chance of survival. It is also a pivotal time for patients to assess their well-being and lifestyle and make positive changes. For many, complementary therapies become part of their cancer care journey. Internationally, 40% of patients with cancer have reported using complementary therapies to address cancer-related symptoms, improve the effectiveness of conventional treatments, and provide hope.
Recent NSAID Use May Improve Ovarian Cancer Survival
Researchers have found that use of nonsteroidal anti-inflammatory drugs (NSAIDs) after diagnosis appears to improve survival for patients with epithelial ovarian cancer. The study results were published in Lancet Oncology.
Action Plan May Reduce CLABSIs in Hospitalized Patients With Cancer
Despite being preventable, central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and cost the U.S. healthcare system billions of dollars. Infection is a common problem in patients with cancer, particularly those receiving chemotherapy and radiation.
Oncology Nursing Foundation Refocuses Commitment to All Oncology Nurses
Support for oncology nursing is critical to the advancement of the profession and the future of care for patients with cancer. The Oncology Nursing Foundation—formerly known as the Oncology Nursing Society (ONS) Foundation—is a nonprofit, tax-exempt, charitable organization dedicated solely to supporting oncology nurses both nationally and internationally. Today, the Foundation announced its name change to wholly encapsulate the organization’s longstanding focus and goals. Through continuing education scholarships, research grants, and career development funding, the Oncology Nursing Foundation supports oncology nurses in their pursuits to provide safer and more effective cancer care for their patients.
FDA Grants Accelerated Approval to Pembrolizumab for Hepatocellular Carcinoma
On November 9, 2018, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab (Keytruda) for patients with hepatocellular carcinoma who have been previously treated with sorafenib.
An Oncology Nursing Overview of Biosimilars
Since the first biosimilar agent was approved by the U.S. Food and Drug Administration (FDA) in 2015, patients and providers have had concerns about the implications for their care and practice, respectively. Because 6 of the 12 biosimilar drugs currently approved in the United States have indications for oncology practice, oncology nurses have a responsibility to understand the drugs’ safety and efficacy for the patients in their care.
This Week, Recognize and Thank Your Oncology Nurse Practitioner Colleagues
Nurse practitioners (NPs) play an undeniably valuable role in producing quality outcomes in cancer patients. For National NP Week from November 11–17, 2018, pause with ONS to recognize, thank, and support the oncology NPs who relentlessly pursue excellence, striving for the best for their patients from diagnosis through survivorship.
How Oncology Nurses Provide Quality Care Through Telephone Triage
As a direct line to the oncology team, the phone conversations between nurses and their patients can help address symptoms, foster valuable patient education, provide useful interventions, encourage side effect reporting, and identify potentially life-threatening situations. Ultimately, successful telephone triage requires a unique skill set for oncology nurses to communicate with their patients and recognize underlying issues.
FDA Approves Pembrolizumab in Combination With Chemotherapy for First-Line Treatment of Metastatic Squamous NSCLC
On October 30, 2018, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda) in combination with carboplatin and either paclitaxel or nab-paclitaxel as first-line treatment of metastatic squamous non-small cell lung cancer (NSCLC).
Oral Adherence With Nerlynx® (Neratinib) Tablets: Patient Case
AS is a 58-year-old woman who was diagnosed at age 55 with a right infiltrating ductal carcinoma of the breast, identified as grade III, ER and PR positive, and HER2 positive. She had bilateral mastectomy, and tumor size was noted to be 2.8 cm. She had a positive sentinel lymph node. She was staged at IIB (pT2, pN1, M0). Her left breast was noted to have usual ductal epithelial hyperplasia and a 1.2 cm fibroadenoma. AS’s genetic testing revealed a BRCA1 mutation (BRCA1 c.3748G>T [p.Glu1250*]), which may confer an increased risk for breast cancer in the range of 46%–87%, and 39%–63% risk for ovarian cancer by age 70. As her patient history shows, she has some risk factors for nonadherence, including no support at home and some financial issues. Throughout her care, the team worked to communicate and prepare AS to help ensure adherence as much as possible.
Oral Adherence With Nerlynx® (Neratinib) Tablets: Introduction
The cancer treatment landscape has shifted with the emergence of new, targeted therapies. Development and use of oral oncolytics, targeted cancer therapies that can be taken by patients orally in their own homes, has increased in recent years. This increase is due in part to research in extra- and intracellular signaling pathways. By interfering with or blocking these signals, targeted drugs have become standard agents in cancer therapy. Oral oncolytics currently account for about 25% of the oncology pipeline of drugs in clinical development, and experts project that oral oncoloytic use will continue to rise.
Institution Meets Magnet Designation by Incorporating ONS Standards in Care Delivery
To meet or maintain Magnet designation, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program expects organizations to incorporate specialty standards and guidelines into the care delivery system.
Neuroendocrine Prostate Cancer Subtype Is Aggressive and More Common Than Expected
Nearly 20% of men with metastatic, castration-resistant prostate cancer had tumors that developed into the treatment-emergent small-cell neuroendocrine (t-SCNC) subtype, which is associated with shorter survival than other subtypes, according to findings from a study published in the Journal of Clinical Oncology.
FDA Approves Talazoparib for gBRCAm HER2-Negative Locally Advanced or Metastatic Breast Cancer
On October 16, 2018, the U.S. Food and Drug Administration (FDA) approved talazoparib, a poly (ADP-ribose) polymerase inhibitor, for patients with deleterious or suspected deleterious germline BRCA-mutated, HER2‑negative locally advanced or metastatic breast cancer. Patients must be selected for therapy based on an FDA-approved companion diagnostic for talazoparib.