The Case of the Checkpoint Inhibitor Side Effects
John is a 62-year-old man diagnosed with metastatic non-small cell lung cancer (NSCLC). His tumor tested positive for high PD-L1 expression, and he began pembrolizumab treatment. John presents to the clinic for his third treatment and mentions that during the past week his arms and chest have been itchy and he has noticed a red, bumpy rash on his chest. When assessing John’s skin, you note a maculopapular rash on both of his upper extremities, anterior chest, and upper abdomen. What would you do?
FDA Approves Nivolumab Plus Ipilimumab Combination for Renal Cell Carcinoma
On April 16, 2018, the U.S. Food and Drug Administration (FDA) granted approvals to nivolumab and ipilimumab in combination for the treatment of intermediate or poor risk, previously untreated advanced renal cell carcinoma.
FDA Approves Everolimus for TSC-Associated Partial-Onset Seizures
On April 10, 2018, the U.S. Food and Drug Administration (FDA) approved everolimus tablets for oral suspension for the adjunctive treatment of adult and pediatric patients aged 2-years and older with tuberous sclerosis complex (TSC)-associated partial-onset seizures. Everolimus is also approved for two other manifestations of TSC: TSC-associated subependymal giant cell astrocytoma (SEGA) and TSC-associated renal angiomyolipoma.
FDA Approves Rucaparib for Treatment of Recurrent Ovarian Cancer
On April 6, 2018, the U.S. Food and Drug Administration (FDA) approved rucaparib, a poly ADP-ribose polymerase inhibitor, for the maintenance treatment of recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.
APRNs Bridge the Gap in Survivorship Care
As improved screening, diagnosis, and treatments lead to cancer’s classification as a chronic disease, people with cancer are surviving longer than ever before. However, with lengthened survival comes long-term physical and emotional symptoms and other sequelae that require ongoing surveillance and management. Advanced practice registered nurses (APRNs) are essential to delivering quality survivorship care.
Cancer and Immunotherapy Organizations Release Checkpoint Inhibitor Side Effect Guidelines
New guidelines and consensus recommendations for managing immune-related adverse events (irAEs) from checkpoint inhibitors are available from several key cancer and immunotherapy organizations: a collaboration between the American Society of Clinical Oncology and National Comprehensive Cancer Network, and a separate consensus recommendation from the Society for Immunotherapy of Cancer. ONS contributed to the development of both sets of guidelines.
FDA Grants Accelerated Approval to Blinatumomab for B-Cell Precursor ALL
On March 29, 2018, the U.S. Food and Drug Administration (FDA) granted accelerated approval to blinatumomab (Blincyto®) for the treatment of adult and pediatric patients with B-cell precursor acute lymphoblastic leukemia (ALL) in first or second complete remission with minimal residual disease (MRD) greater than or equal to 0.1%.
Newly Approved Cancer Treatments Indicate Growing Role of Genomics and Oral Therapies
It is becoming more commonplace for nurses to find orders for agents with which they are unfamiliar or quite possibly have never administered. Following is a summary of the latest new U.S. Food and Drug Administration (FDA) approvals or indications to keep you up to date in your practice. Of note, this summary contains the approval of yet another biosimilar in trastuzumab-dkst and rolapitant for chemotherapy-induced nausea and vomiting, which includes a safety alert. Early experiences with rolapitant, a NK-1 inhibitor, indicated a risk of hypersensitivity reactions.
Integrate Evidence With Clinical Expertise and Patient Preferences and Values
Nursing is often referred to as both an art and a science. Evidence-based practitioners must combine understanding the science of health, illness, and disease with the art of adapting care to individual patients and situations, all while thinking critically to improve patient outcomes.
FDA Approves Brentuximab Vedotin for Previously Untreated Stage III, IV Classical Hodgkin Lymphoma
On March 20, 2018, the U.S. Food and Drug Administration (FDA) approved brentuximab vedotin to treat adult patients with previously untreated stage III or IV classical Hodgkin lymphoma in combination with chemotherapy.
The Case of the Pain Paradox: Follow-Up and Clinical Trial
The January 2018 case study introduced Vince, a 55-year-old man receiving chemotherapy and radiation for recurrent bladder cancer. He suffers from chronic back pain because of spinal stenosis and has been on opioid therapy for nearly two years.
Massage Therapy Helps Manage Breast Cancer-Related Lymphedema
Lymphedema, the chronic swelling of a limb resulting from fluid accumulation, is a common sequela of surgery or radiation treatment for breast cancer. Nearly 90% of women who develop lymphedema do so within three years of treatment. Survivors commonly report physical and emotional distress, limitations to daily activities in fear of exacerbating lymphedema, and body image issues because of an abnormally enlarged limb.
What Oncology Nurses Need to Know About Pharmacogenomics
A subset of precision medicine, pharmacogenomics, is also growing exponentially, especially in oncology. Currently, 165 drugs or combinations are influenced by pharmacogenetics, and 58 of those are specific to oncology/hematology.
FDA Approves Nivolumab Dosing Update
On March 6, 2018, the U.S. Food and Drug Administration (FDA) approved updated dosing information for nivolumab (Opdivo®). Nivolumab is now the first FDA-approved PD-1 inhibitor that offers a flexible dosing option of every two weeks at 240 mg or every four weeks at 480 mg for most approved indications.
What Is the Role of Interprofessional Teams in a BMT Unit?
The old saying, “it takes a village,” comes to mind. Many team members are needed to help a patient through one of the most critical times of their lives. Blood and marrow transplant (BMT) nurses play a large role, along with BMT physicians. However, we also depend on our BMT pharmacist, BMT dietician, and BMT social worker as part of the interprofessional team. Our patients not only need excellent nursing and medical care, but they also need care from members of the team to support them physically, psychologically, and nutritionally from transplant prep through the transplant itself and into the recovery phase.
Interprofessional Collaborations Improve Cancer Care
When faced with a difficult problem, it’s human nature to seek different perspectives, to work together with others facing similar issues to accomplish a common goal. Compromise, collaboration, and communication are essential to successful teams—whether it’s your daughter’s basketball team, the U.S. government, or any group in between. In oncology, teamwork is no different. Bringing together professionals from different disciplines can yield tremendous results for patients with cancer.
Get an Overview of Radiation Therapy for Cancer
Radiation therapy is a precise cancer treatment that targets tumor cells specifically and spares healthy surrounding tissues. Contrary to pharmacologic treatment methodologies, side effects are predominantly site-specific.
FDA Approves Abemaciclib As Initial Therapy for HR-Positive, HER2-Negative Metastatic Breast Cancer
On February 26, 2018, the U.S. Food and Drug Administration (FDA) approved abemaciclib (Verzenio™) in combination with an aromatase inhibitor as initial endocrine-based therapy for postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 HER2-negative advanced or metastatic breast cancer.
The Case of the Cancer Genetics Referral
Christina is a 29-year-old African American woman with a strong family history of breast and ovarian cancers and a personal history of benign ovarian fibroids. She was referred to your office because of a suspicious lump in her left breast. Because of her family history, Christina is especially worried. You are concerned that Christina could have a hereditary family cancer syndrome, and you know that a comprehensive family history must be obtained.
Prevent and Treat Venous Thromboembolism in Patients With Cancer
Venous thromboembolism (VTE), namely deep vein thrombosis and pulmonary embolism, is a common and serious complication. VTE is the second-leading cause of death in patients with cancer and has been connected to poorer prognoses. Other consequences include reduced short- and long-term mortality, increased risk for recurrent VTE and bleeding, a threefold increase in hospitalizations, and higher total healthcare costs. Advance practice nurses (APNs) must understand prevention strategies and treatment guidelines for this serious complication.
FDA Approves Durvalumab After Chemoradiation for Unresectable Stage III NSCLC
On February 16, 2018, the U.S. Food and Drug Administration (FDA) approved durvalumab (Imfinzi) for patients with unresectable stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.
FDA Approves Apalutamide for Nonmetastatic Castration-Resistant Prostate Cancer
On February 14, 2018, the U.S. Food and Drug Administration (FDA) approved apalutamide (Erleada) for patients with non-metastatic castration-resistant prostate cancer.
Motivational Interviewing Nursing Interventions Help Reduce Chemotherapy Symptom Burden
Nursing interventions such as coaching, telephone follow-up, and home care have been reported with inconsistent results. In their article in the January 2018 issue of the Oncology Nursing Forum, Coolbrandt et al. discussed the evaluation of a nursing intervention focused on patient education and self-management to reduce symptom distress in outpatients with cancer.
FDA Approves Abiraterone Acetate With Prednisone for High-Risk Metastatic CSPC
On February 7, 2018, the U.S. Food and Drug Administration (FDA) approved abiraterone acetate tablets in combination with prednisone for metastatic high-risk castration-sensitive prostate cancer (CSPC).
How Can Cognitive Behavioral Therapy Help Patients With Cancer Manage Insomnia?
Simply put, sleep impacts everything. I consider it to be even more foundational than diet and exercise for some. If patients don’t sleep well, they are more likely to make poor food choices and not exercise. Individuals with insomnia symptoms are at higher risk for a number of physical health problems, including diabetes, obesity, and cardiovascular diseases. Insomnia has been linked to mood and anxiety disorders, higher levels of perceived stress, and impaired cognitive functioning.
Sleep-Wake Disturbances in Patients With Cancer
In bedrooms across the United States, people are crawling into bed, turning down the lights, and lying awake for hours on end. Sleep-wake disturbances and short sleep duration are extremely common, and rates are even higher in patients with cancer. Unfortunately, screening, assessment, and interventions are lacking for patients experiencing sleep-wake disturbances during their cancer journey.
Immunotherapy Without Immune Cells May Be on the Horizon
Researchers have generated immunotherapy in the laboratory using nonimmune cells. If the findings can be translated into treatment, it may reduce some of the immune-related adverse events that patients experience with today’s cancer immunotherapy treatments. The study was reported in Nature Chemical Biology.
A Spirit of Inquiry Leads to Evidence-Based Answers to Practice Questions
Addressing a clinical problem through evidence-based practice (EBP) involves asking the right questions in the right way, finding the best available evidence, and assessing what practice change may be needed. A core factor in the EBP journey is the development of nurses who possess a spirit of inquiry within a culture that supports a systematic process for asking clinical questions.
Safety Information on Varubi (Rolapitant) Injectable Emulsion
The Oncology Center of Excellence of the U.S. Food and Drug Administration (FDA) is informing healthcare providers about new safety information for Varubi® (rolapitant) injectable emulsion, a substance P/neurokinin (NK-1) receptor antagonist indicated for the prevention of delayed nausea and vomiting associated with cancer chemotherapy in adults.
FDA Broadens Afatinib Indication to Previously Untreated, Metastatic NSCLC
On January 12, 2018, the U.S. Food and Drug Administration (FDA) granted approval to afatinib for a broadened indication in first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant epidermal growth factor receptor (EGFR) mutations as detected by an FDA-approved test.
What Competencies Are Required for Oncology Nurse Generalists?
Oncology nursing is rapidly evolving specialty. Nurses need to stay on top of a complex technologic environment, ever-changing science, and rapid assimilation of research into practice. In doing so, they attain and maintain a high level of competency to adequately and safely care for people with cancer.
Despite Regulations, Patients With Cancer Pain Still Need Safe Access to Opioids
Each day, more than 175 Americans die from an opioid-related overdose. Misuse of, addiction to, and overdose from opioids cost the United States $78.5 billion a year, “including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.”. Other alarming numbers abound: 21%–29% of patients who are prescribed opioids misuse them, 4%–6% of those transition to heroin, and 80% of people who use heroin first misused prescription opioids.
Understanding Medical Cannabis in Cancer Care
Medicinal cannabis, a topic that remains largely unstudied in human trials in the United States, is slowly becoming introduced in areas of health care and oncology in states that have legalized it for medical and adult recreational use.
FDA Approves First Biosimilar for Cancer Treatment, Among Other New Immunotherapy Dosing and Indications
Cancer treatment options continue to multiply as 2017 concludes, with the U.S. Food and Drug Administration (FDA) granting additional new drug approvals and broadening indications for others. Checkpoint inhibitors continue to explode on the scene with accelerated approvals for various indications. Treatment options for hematologic cancers are multiplying. Additionally, the first biosimilar for cancer treatment, bevacizumab-awwb, was approved as a biosimilar to bevacizumab.
FDA Grants Accelerated Approval to Bosutinib for Treatment of Newly-Diagnosed PH+ CML
On December 19, 2017, the U.S. Food and Drug Administration granted accelerated approval to bosutinib for treatment of patients with newly-diagnosed chronic phase Philadelphia chromosome positive chronic myelogenous leukemia.
FDA Grants Regular Approval to Cabometyx for First-Line Treatment of Advanced Renal Cell Carcinoma
On December 19, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to cabozantinib for treatment of patients with advanced renal cell carcinoma (RCC).
Sweet Dreams Discourage Inflammation
Do you consider sleep to be part of your self-care regimen? Does a spinning wheel of thoughts keep you from restful sleep, or do you consciously sacrifice sleep time? If so, you are not alone. The Centers for Disease Control and Prevention (CDC) declared that insufficient sleep is a public health epidemic with an estimated 25% of the United States population suffering from some type of sleep disturbance.
The Crucial Role of Symptom Management in Cancer Care
Listening to feedback from patients is still one of the most important ways providers can assess and plan treatments for patients with cancer. However, symptom management is never as simple as screening for pain or asking about fatigue: it involves complex decision making, evidence-based interventions, and the support of the entire care team. It’s a central practice to oncology nursing, and it’s paramount to the successful outcomes of patients with cancer.
Using Alternative Medicine Instead of Conventional Cancer Treatments Increases Risk of Death
A large study published in the Journal of the National Cancer Institute found that patients with nonmetastatic breast, lung, or colorectal cancer who chose to use only alternative medicine had substantially worse survival than patients who received conventional cancer treatment.
What Are ONS’s Recommendations for Gowns When Handling Hazardous Drugs?
Although USP Chapter <800> implementation has been delayed, ONS experts are receiving questions about clarifications and specifics for wearing gowns when handling hazardous drugs (HDs). Questions include topics such as hanging gowns and reusing, length of time gowns can be worn, the need for gowns with oral chemotherapy agents, and materials requirements of gowns.
Get Resources to Educate and Monitor Patients for Sepsis
Sepsis is a formidable complication of cancer and cancer treatment. Claiming more than 250,000 lives annually, it is a medical emergency. Do you have sepsis algorithms and protocols in place? Do all specialty areas have a way to identify patients with cancer as a highly vulnerable population? Is sepsis-specific education provided to nurses and patients? Starting the conversation and advocating for policy development and change may just save a life.
What’s the Procedure for Delivering Chemotherapy to an Inpatient Unit?
The elements of an oncology unit are often very similar from location to location—the crescendo of plastic wheels clicking across brightly shined linoleum, beaming fluorescent lights that flicker to life when switched on, mounted fountains of cool hand sanitizer gel. But although oncology units have many similarities, clear differences exist as well.
FDA Approves Emicizumab-Kxwh for Bleeding in Patients With Hemophilia A With Factor VIII Inhibitors
On November 16, 2017, the U.S. Food and Drug Administration (FDA) approved emicizumab-kxwh (Hemlibra®, Genentech, Inc.) for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients with hemophilia A (congenital factor VIII deficiency) with factor VIII inhibitors.
The Case of the Slow-to-Manifest Side Effects
Mary, age 60, has been diagnosed with stage IIB ovarian cancer. Because she has a strong family history of various cancers, Mary is tested for Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC).
Her test is positive, and she is told she is at increased risk for developing cancers associated with HNPCC: ovarian, breast, prostate, kidney, endometrial, pancreatic, prostate, and liver.
FDA Approves Brentuximab Vedotin for Primary Cutaneous Anaplastic Large Cell Lymphoma, CD30-Expressing Mycosis Fungoides
On November 9, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to brentuximab vedotin (Adetris®, Seattle Genetics, Inc.) for the treatment of adult patients with primary cutaneous anaplastic large cell lymphoma (pcALCL) or CD30-expressing mycosis fungoides (MF) who have received prior systemic therapy.
Manage Oncologic Emergencies With Multiple Myeloma
As new therapies come to market, patients with multiple myeloma have more treatment options that are improving outcomes and extending overall survival. However, the most effective options involve multidrug combinations and continuous maintenance therapy, which can result in cumulative toxicities and the potential for oncologic emergencies.
FDA Approves Vemurafenib for Erdheim-Chester Disease
On November 6, 2017, the U.S. Food and Drug Administration granted regular approval to vemurafenib (Zelboraf®) for the treatment of patients with Erdheim-Chester Disease with BRAF V600 mutation.
Using Photography to Track Progress of Head and Neck Cancers
Building relationships with patients is just one of the many roles of oncology nurses. However, it’s generally not possible to see your patients every day. This isn’t uncommon, but it can pose problems to oncology professionals treating patients with head and neck cancers.