How Can Oncology Nurses Collaborate With Dietitians to Manage Malnutrition?
Nutrition impact symptoms (NIS) involve any barrier to a patient’s nutritional status. Cancer and its treatments often lead to complex side effects that develop rapidly and change in character and intensity throughout treatment. Barriers to eating and drinking, digesting, and absorbing nutrients lead to negative clinical outcomes for patients with cancer, including malnutrition. Prompt assessment and interventions are key to helping patients avoid treatment holidays and dose reductions while also promoting the best possible quality of life during their cancer journey. In fact, a weight loss of just 5% is an indicator that a patient will likely not receive all of his or her prescribed cancer treatment.
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.
Pneumonitis With Immunotherapy Treatment
Pneumonitis is inflammation of the lung parenchyma; although rare, it can be fatal. Nishino et al. found that the overall incidence of pneumonitis with PD-1 inhibitor monotherapy was 2.7% for all-grade and 0.8% for grade 3 or higher pneumonitis. Naidoo et al. reported an approximate 5% incidence of all-grade pneumonitis, although the incidence of all-grade pneumonitis is higher with combination immunotherapy (up to 10%). The incidence is more common with higher grades in PD-1 inhibitors (versus PD-L1 inhibitors), but it occurs less often with anti-CTLA4 monoclonal antibodies.
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.
Evidence Shows Tai Chi May Be Useful for Insomnia
Nearly 60% of people with cancer experience insomnia; it can persist for years if not appropriately managed. Furthermore, patients with cancer who have insomnia are at increased risk for infections, anxiety, and depression, which can negatively affect quality of life.
Diagnose and Manage Dermatologic Toxicity Secondary to Immunotherapy
Dermatologic toxicity is the most common side effect secondary to immunotherapy. The majority of dermatologic adverse events are mild to moderate rashes on the truck of the body and upper extremities, pruritis, and vitiligo. The most common is maculopapular rash with erythematous macules, papules, and/or plaques that can sometimes be scaly; pruritis is also frequent but often underreported and undertreated and may affect quality of life.
FDA Approves Ruxolitinib for Acute Graft-Versus-Host Disease
On May 24, 2019, the U.S. Food and Drug Administration (FDA) approved ruxolitinib (Jakafi®) for steroid-refractory acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years and older.
Acupuncture for Cancer-Related Fatigue
Fatigue is one of the most prevalent and challenging side effects that people with cancer experience. Commonly known as cancer-related fatigue (CRF), the National Comprehensive Cancer Network defines it as “a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.” CRF affects 50%–90% of patients and can diminish quality of life, lead to functional impairment, and is associated with significant morbidity. Although it improves in many patients the year following treatment, CRF may persist over a much longer period in some.
The Case of the Terrible Toxicities
After completing neoadjuvant chemotherapy for triple-negative invasive breast cancer, Madeline, age 32, had a bilateral mastectomy with reconstructive surgery. Final pathology showed residual disease in the breast and one lymph node, and her oncologist recommended adjuvant therapy with capecitabine (1,500 mg twice a day for 14 days, off for 7 days). Five weeks postoperatively, she started cycle 1. Eight days later, her husband called the cancer clinic reporting that over the past two days, his wife developed profound weakness, unremitting diarrhea despite using diphenoxylate and atropine as directed, and painful, red, swollen hands and feet. Her symptoms represented a drastic change from her usual routine and energy level.
Tachycardia Tied to Higher Mortality in Patients With Cancer
Rates of all-cause mortality in patients with cancer increase in the presence of unexplained sinus tachycardia, the results of a new study show. Researchers presented the findings at the Advancing Cardiovascular Care of the Oncology Patient conference held January 2019 in Washington, DC.
Early Intervention Can Help Preserve Function in Spinal Cord Compression
Spinal cord compression (SCC)—an oncologic emergency—is the initial presentation in roughly 20%–33% of patients with a malignancy, Carol S. Viele RN, MS, OCN®, of the University of California, San Francisco, School of Nursing, said during a session on Saturday, April 13, 2019, at the ONS 44th Annual Congress in Anaheim, CA. Nurses can play a key role in recognizing the condition and getting patients into early treatment that may help preserve their function, she said.
Nurses Must Help Patients Use Cannabis Safely
Regardless of their own feelings or biases about cannabis, nurses must recognize that their patients are using it and help them to access the drug safely, Eloise Theisen, MSN, RN, AGPCNP-BC, of the Radicle Health Clinician Network in Walnut Creek, CA, said during a session on Saturday, April 13, 2019, at the ONS 44th Annual Congress in Anaheim, CA. Many patients with cancer are using cannabis and are looking to their healthcare providers for information on how they can use it to reduce their symptoms, she said.
Here’s How ONS Is Transitioning Symptom Management Resources Into Guidelines
Using the best evidence to inform care leads to better patient outcomes and can prevent over- or underuse of healthcare resources. Clinical practice guidelines are an important tool for healthcare providers to ensure they are using informed care in their practice. On Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Pamela Ginex, EdD, RN, discussed ONS’s symptom management guidelines and a new initiative to develop and implement guidelines into clinical care.
Nurses Need to Recognize the Unique Needs of Older Adults With Cancer
The number of U.S. adults aged 65 and over is rapidly increasing: by 2030, they’re estimated to represent about 70% of cancer diagnoses. During a session on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, speakers discussed how the complexities of cancer care can affect the expanding population of older adults with cancer.
Which of the Following Late Symptoms of Increased Intracranial Pressure Is Not Included in the Cushing Triad?
Which of the Following Late Symptoms of Increased Intracranial Pressure Is Not Included of the Cushing Triad?
A. Hypertension with widening pulse pressure
D. Abnormal respirations
Smartphone App Helps Patients Manage Cancer Pain
A smartphone app that monitors patients’ self-reported cancer pain and uses artificial intelligence (AI) to differentiate urgent and non-urgent issues and provide real-time recommendations significantly reduced pain and pain-related hospital admissions, researchers reported in an abstract presented at the November 2018 Palliative and Supportive Care in Oncology Symposium in San Diego, CA.
Opioids Have Been a Healthcare Concern Since the 1980s, but Here’s How Nurses Can Help
Although the opioid crisis was formally labeled a public health emergency in late 2017, excess drug abuse beyond prescription directions has been a public health concern for much longer—since the 1980s, in fact. At the November 2018 Center for Advancing Palliative Care Annual Seminar in Orlando, FL, speakers Lynn Hallarman and Mary McPherson presented a session on how the opioid crisis came to be and what our role as nurses is in changing culture and ultimately addressing it.
What You Need to Know About Caring for Geriatric Patients With Cancer
Cancer is largely a disease of an aged population. Estimates suggest that about 60% of all cancers are diagnosed in individuals aged 65 or older, and that number is expected to increase to 70% by 2030. Yet many nurses have little formal geriatric-specific training to care for this population’s unique needs.
Bipartisan Drug Pricing Bill; Freshman Democrats; Medical Cannabis Concerns
As efforts continue to drive down the soaring costs of prescription medications, Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) proposed a bipartisan bill looking to close loopholes used by pharmaceutical companies to drive up profits. The bill would give the Department of Health and Human Services the ability to address companies that misclassify products to pay lower rebates.
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.
Mobile Health Technology Provides Symptom Management Information for Pediatric BMT Recipients
Improved monitoring of pediatric patients undergoing blood and marrow transplant (BMT) may result in better precision symptom management strategies. Mobile health and wearable technologies may aid in such efforts by providing data on complex symptom patterns, trajectories, and interactions. Researchers conducted a pilot study and found that integrating mobile health technology into care was feasible, although they had concerns about compliance. Nirmish Shah, MD, of Duke University School of Medicine in Raleigh, NC, discussed the findings at the ASH Annual Meeting on December 3, 2018.
Research Shows That Telephone Triage Is a Vital Part of Patient Experience
The field of telehealth encompasses many efforts in oncology practice and research. When focusing specifically on telephone triage, we examine patient-initiated requests, such as speaking directly with their nurses on the phone, reporting side effects, or seeking answers to questions about plan of care and treatment. This provides oncology nurses with an opportunity for assessment and intervention. Although many current research efforts focus on proactive phone calls nurses make to their patients, it is also important to understand the impact of incoming calls on patient care and workflow.
Nutritional Support Reduces Weight Loss for Patients With Head and Neck Cancer
As many as 50% of patients with head and neck cancer experience pretreatment weight loss. In addition, treatment frequently involves chemotherapy and radiation, which can also result in weight loss, as well as mucositis and dysphagia, which can affect patients’ ability to eat. This could lead to treatment delays that may impact treatment efficacy.
Tailored Psychotherapy Combats Depression in Advanced Cancer
Just three to six sessions of a tailored psychotherapy program called CALM, or Managing Cancer and Living Meaningfully, reduced symptoms of depression or prevented the onset of depression in patients with recently diagnosed advanced cancer, according to findings from a study published in the Journal of Clinical Oncology.
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.
An APP-Led Infusion Center Can Reduce Hospital Use for Patients With Cancer
Emergency department visits by patients with cancer can be unnecessary, costly, and potentially dangerous. Most symptom management concerns can be safely and quickly handled in the outpatient setting, but provider access can be a barrier.
What Oncology Nurses Need to Know About Tumor Lysis Syndrome
Tumor lysis syndrome is an oncologic emergency caused by massive tumor cell death with the release of large amounts of potassium, phosphate, and nucleic acids into systemic circulation. Nucleic acids break down to uric acid, leading to hyperuricemia in patients. This, in turn, leads to precipitates in the renal tubules, renal vasoconstriction, decreased renal flow, inflammation, and can potentially cause acute kidney injury.
Oncology Nurses’ Role in Recognizing and Addressing Oncologic Emergencies
Most emergencies can manifest in the blink of an eye. Whether it’s a medical emergency, a car accident, an act of nature, or something else, emergencies are sudden crises that require swift, immediate action. For many patients with cancer, among the most distressing challenges along the treatment journey is the possibility of experiencing an oncologic emergency.
Evidence Is Building for Acupuncture as an Opioid Alternative for Cancer Pain
Pain is the most common and debilitating side effect that patients with cancer experience. Contributing factors include the disease itself via tumor invasion on surrounding tissue and bone; nerve compression; treatments including chemotherapy, radiotherapy and surgery, especially chemo-induced peripheral neuropathy (CIPN), which can be disabling; and aromatase inhibitors that can cause persistent diffuse joint pain. In addition, pain that “breaks through” continuous pain medicine can be difficult to predict and control.
How Inhaled Cannabis May Contribute to Pulmonary Toxicity in Patients With Cancer
As medical use of cannabis is increasingly legalized across the United States, oncology nurses need to become more familiar with the implications of patients using it for cancer symptom management. According to Merkle and Tavernier in their article in the August 2018 issue of the Clinical Journal of Oncology Nursing, little research has been conducted in medical cannabis use and the efficacy and toxicity of cancer treatment. Their article reviewed current literature to better understand the effects that cannabis may have on the lungs in patients with cancer.
Longstanding NINR Director Retires After Two Decades of Developing Nursing Science
Patricia Grady, RN, PhD, FAAN, has defined a generation of nurse science and patient-centered research, serving as the National Institute of Nursing Research (NINR) director for more than 23 years. Under her charge, NINR has grown into one of the foremost federal agencies supporting the scope of the nursing research community, driving groundbreaking initiatives and furthering clinical practice.
ONS Member Paice Shares Pain Management Policy Burdens With NCI
For the past two years, opioids have drawn the attention of researchers, members of Congress, the president, and the general public. With stories of drug abuse and heartbreaking tragedy, the problem with opioids in America has been dubbed an epidemic. Federal funding has accompanied the call to combat overdoses and adjust treatment plans to change the way addiction is dealt with from a medical perspective.
How APRNs Can Support Patients During Oral Agent Treatment
Oral agents offer many patient benefits, one of which is the freedom to take the medication at home, allowing them to keep their daily routine and gain additional time and independence they would have spent traveling to the clinic for treatment. However, with that freedom comes additional patient responsibilities, and preparation from advanced practice RNs (APRNs) is necessary to ensure patients can self-manage symptoms and adhere to administration regimens. Research shows that patients experience severe symptoms on oral agents that may cause them to miss as many as one-third of the prescribed doses. How can APRNs empower patients to adhere to the treatment plan and ensure safe symptom self-management at home?
The Oncology Nurse Experience in Managing Adverse Events in Patients Receiving Ibrutinib
Ibrutinib is a first-in-class Bruton’s tyrosine kinase inhibitor that is approved by the U.S. Food and Drug Administration to treat chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). The drug’s approval was based on results from the multicenter, open-label, phase III RESONATE trial.
APRNs Must Stay Educated About Medical Cannabis in Cancer Care
As more U.S. states approve the use of medical cannabis, oncology advanced practice RNs (APRNs) may see increasing inquiries from patients who are interested in using it to manage cancer-related symptoms. However, the drug remains illegal under federal law, confounding research efforts for its use in cancer care and limiting the generation of supportive evidence.
Nurses Share New Ways to Prevent and Manage Difficult Side Effects in Cancer Care
Managing toxicities and adverse events (AEs) so that patients can continue to stay on effective treatments is essential to improving outcomes. Catherine Hill, BSN, RN, OCN®, Margaret Blaney, RN, BSN, Ashley Layton, BSN, RN, OCN®, and Kaddie Lopez, BSN, RN, OCN®, PHN, discussed ways to manage and prevent symptoms in cancer care during a session at the 43rd Annual Congress in Washington, DC.
What Does the Research Say About Probiotics and Health?
Probiotics are live microorganisms that can offer health benefits following consumption, by reversing dysbiosis: changes in the composition or function of gut microbes associated with the development of many chronic and degenerative diseases. The majority of probiotics contain nonvirulent, lactic acid-producing bacteria, including Lactobacillus, Streptococcus, Bifidobacterium, Propionibacterium, and Enterococcus, or yeasts such as Saccharomyces boulardii. They are available as dietary supplements or can be obtained from yogurt and other fermented foods. Probiotics have grown in popularity over the past few decades because of perceived benefits such as improved digestion, immune function, and nutrient absorption.
Psychological Distress Affects Caregivers but Not Patient Symptoms in Head and Neck Cancer
Psychological stress in caregivers of patients with head and neck cancer (HNC) may impair the quality of patient care they provide and affect outcomes such as survival. However, patient symptom burden and caregiver tasks and their impact on psychological stress is not well understood.
Better Care Is Needed to Manage Oral Cavity Symptoms of Chronic Graft-Versus-Host Disease
During the State-of-the-Science Lecture at the 43rd Annual Congress in Washington, DC, Jane Fall-Dickinson, PhD, RN, AOCN®, of Georgetown University School of Nursing and Health Studies, discussed chronic graft-versus-host disease (cGVHD), specifically its oral cavity complications. She presented challenges, clinical data, and goals for improving its treatment and management options.
Opioids Are Not Always the Answer
As the opioid crisis continues in the United States, helping patients find effective and safer ways to manage their pain becomes increasingly important. During a session at the 43rd Annual Congress in Washington, DC, Jeannine Brant, PhD, APRN, AOCN®, FAAN, of Billings Clinic in Montana, instructed nurses on ways to treat cancer-related pain and discomforts other than (or in addition to) narcotic pain medicines.
Put Evidence Into Practice to Prevent Infection
Because of immunosuppression from cancer or its treatment, patients are at a higher risk for viral, bacterial, and fungal infections. Patients who develop infections may experience dose delays or reductions that compromise optimal treatment outcomes, resulting in higher mortality rates, longer hospitalizations, and higher cost of care.
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.
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.
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.