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.
Plan Ahead to Ensure Consistency in Patient Care and Communication During Drug Shortages
A manufacturing delay leading to a shipping delay caused the October 2019 vincristine shortage, according to a letter Pfizer sent to its customers on October 18; the U.S. Food and Drug Administration first reported the shortage on October 16. It affects both the 1 mg/ml and 2 mg/2 ml single-dose ONCO-TAIN™ glass fliptop vials.
Oncology Drug Reference Sheet: Darolutamide
Based on the results of the phase III ARAMIS trial that demonstrated significant improvement in metastasis-free survival, the U.S. Food and Drug Administration approved darolutamide under priority review on July 30, 2019. Darolutamide is approved for nonmetastatic, castration-resistant prostate cancer in men receiving concurrent gonadotropin-releasing hormone therapy or who have had bilateral orchiectomy.
Should You Wear a Gown to Disconnect Chemo?
The short answer is yes—guidelines from ONS, National Institute of Occupational Safety and Health, Occupational Safety and Health Administration, and U.S. Pharmacopia all call for nurses to always wear appropriate personal protective equipment (PPE) when at risk for exposure, including disconnecting a patient’s chemotherapy. Wearing a gown and other PPE isn’t just good practice—it protects nurses at one of many touchpoints during chemotherapy administration and patient care where healthcare providers are at risk for exposure to hazardous drugs.
Colorectal Cancer Diagnoses Increasing in Patients Younger Than 50
Healthcare providers are seeing increasing numbers of younger patients with colorectal cancer, and they’re being diagnosed with more advanced stages of the disease, researchers reported in study findings published in the journal Cancer.
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.
Cancer Rehabilitation Serves a Critical Role in Patient Care
More and more providers are recognizing that prehabilitation and rehabilitation are key components of successful patient-centered cancer care. Oncology nurses serve as a critical access point to those services and must understand rehabilitation and its indications. To better highlight cancer rehabilitation’s benefits and importance in clinical practice, ONS members Grace Campbell, PhD, MSW, RN, CNL, CRRN, and Beverly Reigle, PhD, RN, shared a conversation about the finer points of cancer rehabilitation specialty practice.
irAEs Linked to Improved Benefit From Pembrolizumab
Patients with advanced melanoma who received adjuvant therapy with pembrolizumab and subsequently developed immune-related adverse events (irAEs) saw a 63% reduced risk of recurrence, compared to 44% for those who did not develop irAEs. The study findings were presented at the 2019 American Society of Clinical Oncology annual meeting.
Patient Education Is Critical to Managing irAEs for Immune Checkpoint Inhibitors
By rebalancing the immune system and re-engaging mechanisms that tumor cells have shut off, immunotherapies such as immune checkpoint inhibitors enable patients’ own bodies to fight their cancers for them. But those same mechanisms can also result in immune-related adverse events (irAEs).
Complexity Is the Cornerstone of BMT Nursing
You’re juggling three patients: one is nauseated and requesting lorazepam now, another’s blood transfusion is finished and the pump’s alarm is loudly chirping down the hall, the third has an order list coming in like rapid fire—and it’s only 8 am. In a blood and marrow transplant (BMT) unit, this sounds like a relatively calm morning.
What the Research Says About Drug Interactions and Medical Cannabis
Despite medical cannabis’s legalization for medical use throughout 31 different jurisdictions in the United States, practicing providers have little research and few guidelines for patient care. To address the gap, in 2018 the National Council of State Boards of Nursing published Nursing Guidelines for Medical Marijuana, which provides general nursing education and guidance—yet doesn’t discuss drug interactions, specifically. To understand how medical cannabis affects concomitant pharmaceuticals, nurses must have a basic knowledge of the endocannabinoid system (ECS).
Patient-Centered Care Through the Oncology Care Model
Better care. Smarter spending. Healthier people. Those are the three hallmark goals of the Oncology Care Model, a value-based payment system developed by the Centers for Medicare and Medicaid Service’s Center for Innovation.
FDA Rolls Out More New Indications for Existing Agents
Pembrolizumab, lenalidomide, and avelumab all received new treatment indications in spring 2019. Here’s what you need to know about dosing, adverse events, and other nursing considerations for these and other drugs that the U.S. Food and Drug Administration (FDA) approved from April–June 2019.
Company Recalls TPN Bags Because of Leak and Infection Risk
Bags used to store and administer total parenteral nutrition (TPN) are being recalled because of leaks near the divider rod and channel when the rod is removed, the Metrix Company of Dubuque, IA, announced on September 9, 2019.
Why Aren’t Nurses Adhering to PPE Requirements?
Oncology nurses are dedicated to providing the best, safest cancer care to their patients—protecting them from medical harm and prolonging life. But when it comes to protecting themselves, nurses sometimes take shortcuts in wearing personal protective equipment (PPE) that guards them against exposure to hazardous drugs.
Handle With Care: How USP <800> Will Affect Nursing Practice
Police officers wear body armor and construction workers wear hard hats. Why? Because these professions carry inherent dangers in the line of duty—and oncology nursing does too. Statistically, healthcare workers face more workplace-related dangers than both law enforcement and construction, yet attention to safety and personal protection isn’t always a central focus. This can be especially true in cancer care, where nurses are required to administer hazardous drugs (HDs) and handle dangerous medications on a daily basis. Although safety recommendations exist, few enforceable standards are protecting nurses handling HDs.
To Prevent Hepatoxicity, Monitor Liver Function During Cancer Treatment
Because the liver is the primary site of metabolism for many drugs, baseline function testing and monitoring during cancer treatment are essential. However, the cause of an abnormal liver function test when a patient is receiving chemotherapy or immunotherapy can be difficult to determine.
Oncology Drug Reference Sheet: Venetoclax
Venetoclax (Venclexta®) was approved by the U.S. Food and Drug Administration on May 15, 2019, for the treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) as a single agent or in combination therapy. Previously, it had been approved in late 2018 for use in combination therapy for acute myeloid leukemia (AML) in older adults or those with significant comorbidities.
The Case of the Safety Session
Doug is a 48-year-old triathlete who was recently diagnosed with chronic myeloid leukemia (CML) after a routine blood test showed an increase in white blood cells and a subsequent bone marrow biopsy showed greater than 20% blast cells. The medical oncologist prescribed the oral drug dasatinib. Doug and his wife meet with Staci, RN, to receive oral therapy education. During the teaching, Doug says his wife will have no trouble dispensing the dasatinib because she already prepares all of their meals and nutritional supplements.
Clinical Trial Participants Average 6.5 Years Younger Than Actual Cancer Populations
For the four most common cancer sites (breast, prostate, colorectal, and lung cancer), the median age of patients in clinical trials is an average of 6.5 years younger than the median age of patients diagnosed with that cancer. And the age disparity is worsening, researchers reported in JAMA Oncology.
How Does ONS Support Nurses Who Care for Older Adults With Cancer?
By bringing together gero-oncology experts from the ONS membership, staff, and leadership, the ONS geriatric oncology group is identifying gaps in geriatric oncology nursing research and care and connecting ONS members with available resources targeting this vulnerable population. Adult patients with cancer—aged 65 and older—already make up a majority of patients that oncology nurses see. Despite the population’s prevalence throughout cancer institutions and clinics, many nurses are not acutely familiar with the specialized care required to successfully help them navigate their treatment.
Older Adults With Cancer
The Baby Boomer generation—born between the years 1946 and 1964—currently accounts for more than 76 million Americans, all of whom will be older than 65 in the next decade. With an aging population comes health complications and growing comorbidities. Cancer is often referred to as a disease of the aging, and healthcare providers will need to be equipped to treat the impending wave of older adults with cancer. Oncology nurses are at the frontlines of that care and play a key role in the successful treatment of older patients with cancer using evidence-based interventions and age-specific care.
The Case of the Pregnancy Predicament
A 33-year-old woman presents to the emergency department with fever, weight loss, and dyspnea. She is five months pregnant. A computed tomography (CT) chest scan without contrast shows a large mediastinal mass. Biopsy demonstrates Hodgkin lymphoma (HL), but magnetic resonance imaging (MRI) of her abdomen and pelvis without contrast is negative for lymphadenopathy. Her echocardiogram and pulmonary function testing are normal.
Sex Is an Important Dimension of Cancer Psychosocial Care That We Need to Stop Neglecting
My charge nurse approached me and told me that I am getting an admission from the emergency department who presented with high blood pressure and shortness of breath. She told me that the patient is on concurrent chemoradiation therapy and has a rectal cancer.
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.
High Fitness Linked to Lower Risk and Mortality in Lung and Colorectal Cancers
Adults with the highest cardiorespiratory fitness levels have a reduced risk for lung and colorectal cancer—and a lower risk of death if they do develop the cancers, according to findings from a study published in Cancer.
The Case of the Explicit Exposure
Mr. Larsen presents to the clinic for his first dose of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) for a diagnosis of diffuse large B-cell lymphoma. Elizabeth, his oncology nurse, just started the cyclophosphamide when she is paged to the desk for a call from Mr. Larsen’s oncologist. She quickly removes her face shield and gloves as she hurriedly leaves the room to take the call. After completing the call, she returns to Mr. Larsen’s room to remove her gown.
Which Tumor Marker Can Be Used to Assess Stage, Prognosis, Response to Treatment?
Which tumor marker can be used to assess stage, prognosis, response to treatment in germ cell tumors, lymphoma, melanoma, acute leukemia, and neuroblastoma?
A. Programmed death ligand 1 (PD-L1)
C. Cytokeratin fragment 21-1
D. Lactate dehydrogenase
How to Prepare for a Career in Oncology Nursing
Oncology care is one of the most challenging, yet rewarding, nursing careers that offers opportunities to care for patients in all stages of life. It’s a chance to help guide and support your patients through one of the most difficult times in their lives and be inspired by their determination, hope, and faith.
Collaboration Is Key to CAR T-Cell Therapy Management Across Settings
As of February 2019, only 160 institutions across the United States are certified to administer CAR T-cell therapy, meaning many eligible patients may need to be referred to a treatment center outside of the local ambulatory or community cancer center where they had previously received treatment. The transition from primary oncologist to certified center and back again requires careful coordination to ensure important steps and information aren’t lost.
The Work We Do Now Affects Health Care’s Future
The World Health Organization designated 2020 internationally as the Year of the Nurse and Midwife in honor of Florence Nightingale’s 200th birthday. To celebrate the work that nurses do globally, nursing organizations around the world are creating programs that offer recognition—as well as education, training, and professional development.
FDA Grants Accelerated Approval to Selinexor for Multiple Myeloma
On July 3, 2019, the U.S. Food and Drug Administration (FDA) granted accelerated approval to selinexor (XpvioTM) in combination with dexamethasone for adult patients with relapsed or refractory multiple myeloma (RRMM) who have received at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody.