What Happens During a Genetics Counseling Session?
When referring patients for genetics counseling and possible testing for hereditary risk, oncology nurses can help relieve their trepidation and anxiety by explaining what to expect during the visit. See the sidebar for key indications for referral.
Proper PPE Procedures for COVID-19
Although many oncology nurses are well versed in donning and doffing (removal) of personal protective equipment (PPE) for administering hazardous drugs, but not infection control. Additionally, nursing colleagues in other specialties may not wear PPE as part of their daily practice. As the COVID-19 novel coronavirus pandemic changes that, oncology nurses should understand PPE use for infection control to promote safety for nurses and patients.
Emotional Coping Strategies for COVID-19
The COVID-19 novel coronavirus pandemic is turning the world, inside and outside of the hospital, upside down. Not only are oncology nurses seeing high demands at work, but changes and restrictions are being instated at home as well.
U.S. Still Has Declining Cancer Death Rates, Latest National Report Says
Overall cancer death rates fell 1.5% on average per year from 2001–2017 in the United States for all cancer sites combined, according to the Annual Report to the Nation on the Status of Cancer from the Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), American Cancer Society, and North American Association of Central Cancer Registries.
Telehealth Visits During COVID-19
With the Centers for Disease Control and Prevention’s recommendations for practicing social distancing to slow the national risk of transmission of COVID-19 novel coronavirus, oncology nurses must take increased precautions with patients with cancer who are at increased risk for contracting or experiencing poorer outcomes from COVID-19. Patients require communication and education in these uncertain times.
COVID-19 Telephone Triage for Patients With Cancer
During the COVID-19 novel coronavirus pandemic, patients might be fearful and uncertain if they should come to their clinic appointments. COVID-19 presents greater risks to older adults and people with comorbid diseases such as cancer and other chronic conditions, and patient concerns will likely increase the volume of phone calls into your clinics and telephone triage lines. Oncology nurses can use the opportunity to assess and educate patients.
COVID-19 Patient Education Talking Points
Nurses and other healthcare providers are navigating a rapidly changing world during the COVID-19 novel coronavirus pandemic, and that includes answering patients’ questions about the disease. Anthony A. Fauci, MD, director of the U.S. National Institute of Allergy and Infectious Diseases, in a Clinical Conversations podcast, suggested a two-pronged approach to talking with patients about COVID-19.
NIDA Calls for Further Cannabis Research in Congress Testimony
Medical cannabis has been approved for use in more than 33 states, many of which have decriminalized its use as well, and a health policy wave has spread across the country through state referendums to ease the burden for legalizing cannabis for health purposes. It’s a different world than it was 30 years ago, and the National Institute on Drug Abuse (NIDA) is frequently called to testify before Congress to address concerns and questions from lawmakers.
BD Issues Class I Recall of Alaris System Infusion Pumps
On February 4, 2020, BD announced a recall of all lots of affected models of its Alaris System pump modules because of multiple system errors, software errors, and use-related errors. On March 6, 2020, the U.S. Food and Drug Administration identified it as a class I recall, its most serious level of recalls, because of the possibility of serious injuries or death.
COVID-19 Fact Sheet and Implications for Patients With Cancer
COVID-19 is a novel coronavirus (a large family of viruses that can cause cold-like illnesses) first identified in Wuhan, China, in December 2019. It is a respiratory illness and can be spread from person to person, possibly through respiratory droplets during close contact. The first case of COVID-19 in the United States was reported on January 21, 2020.
BRAF Mutations Guide Treatment in Metastatic Colorectal Cancer
Molecular profiling has become essential for the treatment of metastatic colorectal cancer (CRC) when surgery cannot be considered and systemic therapy is recommended. CRC has several potential mutations that are diagnostic, prognostic, and predictive. National Comprehensive Cancer Network (NCCN) guidelines recommend that advanced practice providers conduct RAS, BRAF, HER2, and MSI testing as part of a full molecular panel, review the results, and acted on them prior to starting patients on systemic therapy.
How DNA Sequencing Technologies Are Used in Cancer Care, Now and in the Future
Genomic testing identifies germline or inherited DNA changes that increase a person’s cancer risk, and it also can identify or profile the somatic or acquired changes in a tumor that guide selection of appropriate targeted therapies. The latter type of genomic testing is an analysis of DNA sequence information.
The Case of the CDK4/6 Inhibitors Checklist
Three years ago, Sarah, age 54, completed standard chemotherapy and radiation treatment for stage II, ER- and PR-positive, HER2-negative invasive breast cancer. A recent computed tomography scan, ordered to evaluate persistent hip pain, revealed bone lesions, and a biopsy and positron-emission tomography scan confirmed bone-only metastatic breast cancer. A CDK4/6 inhibitor, ribociclib, was added to the letrozole she was already taking.
Immune-Related Adverse Events With PD-1 Inhibitors in Head and Neck Cancer
Clinical trial results show that PD-1 inhibitors offer improved survival and a better safety profile compared to standard, single-agent chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck. However, because of their mechanism of action as immunotherapy, patients receiving the agents may experience immune-related adverse events (irAEs).
Ovarian Cancer: Prevention, Screening, Treatment, and Survivorship Recommendations
Even though its incidence is less common, ovarian cancer is the fifth leading cause of death from cancer in women, according to the American Cancer Society. It also estimated more than 22,000 new cases of ovarian cancer in 2019, with a five-year survival of 47% for all stages.
Updated NCCN Cancer Screening Guidelines Inform Practice and Prevention
As an industry standard, the National Comprehensive Cancer Network (NCCN) screening guidelines have served a huge role in cancer prevention and early detection efforts, helping providers identify diagnoses early and give patients their best possible chance at survival. Ensuring screening guidelines are up to date and using the best available evidence is an ongoing process that requires an interprofessional approach.
Nurses Can Protect Patients From Neurotoxicity During Lumbar Puncture Procedures
When cleaning patients’ skin in preparation for lumbar puncture procedures, oncology nurses must consider side effects from use of various germicide solutions. Chlorhexidine gluconate (CHG) solution has been considered the broad-spectrum germicide effective against most nosocomial yeasts and gram-positive and -negative bacteria. It’s available as 2% or 5% CHG in 70% isopropyl alcohol and is used as an antiseptic for skin preparation and central venous catheter dressings.
Oncology Drug Reference Sheet: Entrectinib
Entrectinib was approved by the U.S. Food and Drug Administration in August 2019 as the third tumor-agnostic cancer drug, meaning it targets a specific mutation of the cancer, not the organ of origin. The other two currently approved tumor-agnostic drugs are larotrectinib and pembrolizumab.
Prioritize Your Time Amid Today’s Attention Seekers
In a world where we are bombarded with too many attention seekers (e.g., activities, people, internet), we need to prioritize which stimuli are worth our immediate attention. Nurses are inundated with busy, fast-paced, and evolving roles, and 90% report that they do not have enough time to properly care for patients. The pressure to do so much in a limited amount of time increases stress levels and burnout and decreases our capacity for self-care. Prioritizing and devoting allotted time to our attention seekers may improve stress management, work-life balance, and overall self-care.
Breast Cancer Is More Fatal in Men Than Women
Men have higher death rates than women across all stages of breast cancer, study findings reported in JAMA Oncology show. In the study, five-year overall survival after a breast cancer diagnosis was 77.6% for men and 86.4% for women.
Germline and Somatic Mutations: What Is the Difference?
Cancer occurs from mutations, or harmful changes from an alteration in a gene’s DNA sequence. Most mutations involve changes in the order of the base pairs, including substitutions, deletions, additions, or shifts. Mutations can be divided into broad categories based on the tissue where they occur.
What the Research Cautions About Kratom’s Opioid-Like Abuse Potential
Kratom is a Southeast Asian tropical tree, the leaves of which have been chewed, smoked, or made as tea for their stimulant and euphoric effects. They have also been employed in traditional medicine to reduce pain and fever, to relieve diarrhea, for wound healing, and as a substitute for opium. Recently, kratom supplements have become popular in the United States for alleviating pain, improving mood, lowering anxiety, and alternative opioid withdrawal treatment.
FDA Approves Avapritinib for Gastrointestinal Stromal Tumors With a Rare Mutation
On January 9, 2020, the U.S. Food and Drug Administration (FDA) approved avapritinib (AyvakitTM) for adults with unresectable or metastatic gastrointestinal stromal tumor harboring a platelet-derived growth factor receptor alpha exon 18 mutation, including D842V mutations.
FDA Approves Pembrolizumab for BCG-Unresponsive, High-Risk Non-Muscle Invasive Bladder Cancer
On January 8, 2020, the U.S. Food and Drug Administration (FDA) approved pembrolizumab for the treatment of patients with Bacillus Calmette-Guerin unresponsive, high-risk, non-muscle invasive bladder cancer with carcinoma in situ with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy.
Does Cryotherapy Prevent Extremity Toxicities From Taxane Chemotherapy?
As many as 50% of patients receiving taxane chemotherapy have reported experiencing peripheral neuropathy (PN) or nail changes during treatment. Both are potentially dose-limiting adverse events: nail changes can lead to infections; PN affects patients’ ability to perform activities of daily living and results in sensory impairments such as loss of balance, muscle weakness, and numbness that can increase patients’ risk for falls.
CAR T-Cell Therapy Offers Rapid QOL Improvements in Younger Patients
Children and young adults with relapsed or refractory B-cell acute lymphoblastic leukemia reported rapid improvements in quality of life (QOL) after treatment with tisagenlecleucel, a CAR T-cell therapy, according to the results of a study published in Lancet Oncology.
New Patient Education Formats Help Nurses Connect Patients to Individualized Resources
“An investment in knowledge pays the best interest,” Benjamin Franklin wrote. for oncology nurses and their patients, this couldn’t be more apt. Patient education is critical throughout the cancer journey, and nurses are essential to individualizing that education.
Commission on Cancer Revises Its Standards. Here Are the Takeaways for Oncology Nurses.
Oncology nurses are critical to meeting three components of the newly revised Commission on Cancer (CoC) standards released in fall 2019: certification, survivorship, and barriers to care.
FDA Approves Fam-Trastuzumab Deruxtecan-Nxki for Unresectable or Metastatic HER2-Positive Breast Cancer
On December 20, 2019, the Food and Drug Administration granted accelerated approval to fam-trastuzumab deruxtecan-nxki (Enhertu®) for patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.
Multigene Testing Is Cost Effective for All Women With Breast Cancer
According to findings from a new analysis published in JAMA Oncology, multigene testing should be expanded to all women with breast cancer and not just those with certain family histories or clinical factors.
FDA Grants Accelerated Approval to Enfortumab Vedotin-ejfv for Metastatic Urothelial Cancer
On December 18, 2019, the U.S. Food and Drug Administration granted accelerated approval to enfortumab vedotin-ejfv (PadcevTM) for adult patients with locally advanced or metastatic urothelial cancer who have previously received a programmed death receptor-1 (PD-1) or programmed death-ligand 1 inhibitor, and a platinum-containing chemotherapy in the neoadjuvant/adjuvant, locally advanced or metastatic setting.
Combining Tamoxifen and Blue Light Can Better Target CAR T Cells
Bioengineers may have found a way to use tamoxifen activated with blue light to control precisely which tissues and body areas CAR T cells attack, reducing toxicities in other parts of the body. They reported their work in ACS Synthetic Biology.
Newer Therapies at Last Offer Systemic Options for Metastatic HCC
Already the third leading cause of cancer deaths worldwide, hepatocellular carcinoma (HCC) is a continually growing burden as the incidence of obesity, type II diabetes, and hypertension also increase, which may lead to cirrhosis and nonalcoholic fatty liver disease. Its incidence is highest in Asia and Africa, where the prevalence of hepatitis B and hepatitis C may result in chronic liver disease and subsequently HCC.
Evidence-Based Program Reduced C. Difficile Incidence in Patients With Cancer
Clostridium difficile infection is a dangerous and sometimes deadly adverse event in immunocompromised patients with cancer. Although transmission risk is high in the hospital setting, even with isolation precautions, oncology providers can use a variety of prevention techniques to reduce the chance for infection in their patients.
B. Braun Recalls Certain Lots of Blood Administration Sets
Because of the potential for leakage at the joint between the blood filters and tubing, B. Braun issued a voluntary recall of 22 lots of its y-type blood administration sets in November 2019. The recalled sets are used to deliver blood from a container to a patient's vascular system through an IV catheter inserted into a vein or central venous catheter.
Evidence Drives the Development of Guidelines for Practice
Evidence-based practice is central to successful patient care—not only in oncology but throughout the entire healthcare community. Currently, the way health care is delivered varies throughout the United States. Not all hospitals or clinics are the same, nor do all institutions operate the same. Many treatments are given to patients without clear evidence of the benefit, and unity and standardization are lacking, which could lead to wide variances in the efficacy and safety of care provided to patients.
Draft ONS Guideline Open for Public Comment
As part of the rigorous process of transitioning ONS Putting Evidence Into Practice recommendations into formal, actionable clinical practice guidelines, the draft guidelines must undergo a public comment period. The first five guidelines to reach that step will be open for public comment in December 2019 and early 2020.
From Evidence to Standard: The Role of Clinical Guidelines in Oncology Care
Leading organizations like ONS develop nationally recommended, evidence-based cancer care guidelines to inform practice, unify and standardize the way patient care is delivered, and ensure successful outcomes. By clarifying gray areas and codifying practice, guidelines enable providers to deliver efficacious, safe oncology care for patients and all care providers.
Oncology Drug Reference Sheet: Blinatumomab
Blinatumomab received accelerated approval from the U.S. Food and Drug Administration (FDA) in 2014 for the treatment of B-cell precursor acute lymphoblastic leukemia. The drug’s unique administration procedures have prompted nurses to evaluate their practice for safety.
Cope With Moral Distress by Focusing on the Possibilities
Ethical dilemmas arise more often than we realize: consider the patient you have been taking care of for three days telling you he wants no further treatment, but later goes along with family members when they push for more treatment. Moral distress occurs when nurses believe they know the correct action to take but are prevented from doing so. It may lead to a decrease in the quality of patient care and can be a causative factor when nurses leave their current job and sometimes even the profession.
Do Antibiotics Affect Response to Immune Checkpoint Inhibitors?
Receiving antibiotics in the 30 days prior to starting immune checkpoint inhibitor treatment was associated with significantly reduced median overall survival, according to findings from a study published in JAMA Oncology. However, antibiotic use during treatment had no effect on survival.
The Case of the Efficacy Explanation
Jenni is an oncology nurse practitioner in an outpatient medical oncology clinic. She is meeting with 70-year-old Don after his first cycle of cabozantinib for treatment of metastatic medullary thyroid carcinoma when he asks why the oncologist put him on a pill instead of using IV chemotherapy. “Is it because I don’t have long to live?” Don wonders.
The Vital Role of Oncology Nursing in Ambulatory Care
Thanks to significant scientific and technologic advancements in the past 15 years, the majority of cancer care—an estimated 80% or higher—is being delivered in the outpatient setting.For patients, ambulatory oncology care offers comfort, flexibility, and a sense of normalcy during their difficult cancer journey while maintaining the highest-level treatment and care for optimal outcomes. Oncology nurses are key to successful outpatient care, serving as caregivers, educators, advocates, and patient champions from diagnosis through treatment and into survivorship.
Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents
As a side effect of cancer or its treatment, anemia is associated with reduced quality of life, thanks to symptoms such as palpitations, fatigue, dyspnea, and dizziness. Etiology is often multifactorial with contributing factors such as suppression of hematopoiesis from malignancy or cancer treatments, bleeding, nutritional deficiencies, renal insufficiency, or hemolysis.
New Liquid Biopsy Approach Is Accurate in Detecting Early Cancer
A test that looks at circulating DNA rather than specific mutations is accurate in detecting 72% of early cancer cases and correctly identifying the tissue of origin in 75% of cases, researchers reported in study findings published in Nature.