APRNs Can Help Address Global Financial Toxicity
Advancements in oncology, such as new diagnostic tools and novel therapies, have improved overall survival rates but have come at a high cost. In 2011, targeted therapies accounted for 63% of all chemotherapy expenditures. A novel cancer drug routinely costs each patient more than $100,000 per year; annual spending on cancer drugs is globally estimated around $100 billion U.S. dollars and is predicted to rise to $150 billion by 2020.
Here’s an Overview of the Types, Mechanisms, and Side Effects of Currently Approved Immunotherapies
Immunotherapy drugs fall into varying classes, each carrying its own mechanism of action and anticipated side effects. Although some side effects of immunotherapy may appear similar to those of chemotherapy (e.g., diarrhea, fatigue), they actually result from a totally different mechanism—meaning they require a different approach to management. Treating immunotherapy side effects as you would chemotherapy effects would likely result in patient harm.
Manage Diarrhea in Patients Receiving Nerlynx® (Neratinib) Tablets
Nerlynx® (neratinib) tablets, an oral kinase inhibitor, is approved by the U.S. Food and Drug Administration for the extended adjuvant treatment of adult patients with early-stage human epidermal growth factor receptor 2-positive (HER2+) breast cancer, following adjuvant trastuzumab-based therapy.
Evidence for Nephrotoxicity Prevention With Cisplatin Therapy Is Still Limited
Cisplatin chemotherapy is used alone or in combination to treat a variety of cancers, including ovarian, testicular, lung, cervical, bladder, head and neck, and gastric cancers as well as lymphoma, melanoma, and more. Although it offers options for many cancer types, its use may result in nephrotoxicity, a dose-limiting side effect. Use of hydration and diuretics may help reduce its incidence, but no standards or best practices are in place to guide those treatments.
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?
Breast Cancer Chemo and Radiation Linked to Cellular Aging Markers
Women who receive chemotherapy or radiation therapy treatments for breast cancer are more likely to have high levels of DNA damage and reduced activity of an enzyme involved in chromosome healing than those who receive only surgery for breast cancer, according to the results of a study published in NPJ Breast Cancer.
Managing Weight Loss in Patients With Cancer
Patients’ weight and nutrition status will often vary throughout the cancer care continuum. Weight loss might occur before the diagnosis, be one of the presenting cancer symptoms, be related to the tumor itself, or be secondary to side effects of their treatment (e.g., anorexia from chemotherapy or radiation).
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.
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.
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.
Discovery of Peripheral Neuropathy Cause May Lead to Preventive Treatments
Researchers have found that taxane chemotherapies such as paclitaxel impede a protein called Bclw, which leads to the side effect of peripheral neuropathy. The study results were published in Neuron.
The Case of the Physical Activity Prescription
Raj recently presented to the emergency department for hemoptysis and shortness of breath. Subsequent computed tomography scan and biopsy reveal metastatic small cell lung cancer. He is a 62-year-old former smoker who is 25 pounds overweight and works as an accountant for a large automobile dealership.
Infection Linked to Early Mortality in Post-ASCT Multiple Myeloma
Patients with multiple myeloma are at increased risk for early death from infection after high-dose therapy and autologous stem cell transplantation (ASCT), according to the results of a study published in the American Journal of Hematology.
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.
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.
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.
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.
Learn the Nursing Considerations for Cytokine Release Syndrome
Chimeric antigen receptor (CAR) T-cell therapy for relapsed or chemotherapy-resistant acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia, and B-cell lymphomas is becoming more common. The benefit to patients is significant: durable remission and increased comfort are two major advantages. However, severe toxicities are associated with CAR T-cell therapy that must be considered. As with any treatment modality, the best approach to management for an advanced practice oncology nurse is to fully understand those toxicities and be prepared to provide intensive supportive care.
Financial Toxicity and Its Burden on Cancer Care
The cost of health care in the United States has been the source of debate for years. Questions range from the extent of Medicare and a Medicaid coverage, how—or if—the government should regulate drug prices, who deserves coverage, and how Institutions collect payments from insurance companies. But often, one important aspect is missing from the numerous conversations on health care, treatments, and financial reimbursements: the patients.
FDA Approves Rolapitant IV for CINV
On October 25, 2017, the U.S. Food and Drug Administration (FDA) approved the use of rolapitant (Varubi®) IV in combination with other antiemetic agents for adults experiencing delayed chemotherapy therapy-induced nausea and vomiting (CINV). Rolapitant through oral administration had been approved through the FDA in September 2015. The new IV administration route is expected to offer the same results at a lower cost to patients with CINV.
September Is Sepsis Awareness Month
As September winds down, ONS, a partner in the Centers for Disease Control and Prevention’s (CDC’s) and American Nurses Association’s Nursing Infection Control Education Network, is raising awareness of Sepsis Awareness Month by highlighting resources and strategies for oncology nurses who are deeply rooted in preventing and treating sepsis in patients with cancer.
The Case of the Anxiety Answer
Kris is a 46-year-old newly diagnosed with stage III cervical cancer. She is an avid runner and vegetarian, and she believes strongly in taking care of herself. “I never thought I would get cancer,” she says. “I thought I did everything I could to avoid this.”
How Safe and Effective Is Scalp Cooling for Chemotherapy-Induced Alopecia?
Chemotherapy-induced alopecia has been reported by 77% of patients as the most-feared side effect of cancer treatment. In fact, as many as 10% of women say they would consider refusing chemotherapy or choosing a less effective treatment to avoid losing their hair.
Managing VTE in Patients With Cancer
Venous thromboembolism (VTE) is a potentially life-threatening event characterized by clots that form in the veins, and it is the second-leading cause of death for patients diagnosed with cancer. VTE affects up to 10% of the cancer population, making it essential for oncology providers to understand the associated risk factors and preventative measures. In addition, prompt recognition and treatment for VTE becomes crucial to patient care.
Palonosetron HCL Is a Preferred Treatment for Moderately Emetogenic Chemotherapies
Chemotherapy-induced nausea and vomiting (CINV) is an adverse event (AE) associated with cancer therapies that healthcare providers often underestimate. CINV can interfere with treatment compliance and adherence, and patients who experienced CINV in the first cycle of chemotherapy are almost four times more likely to experience it during subsequent treatment cycles.
The Case of the Immunotherapy Inquiry
Jay is a 62-year-old man with newly diagnosed, stage IIIA (T3, N1), unresectable, non-small cell lung cancer (NSCLC) that tested negative for ALK, EGFR, and KRAS mutations. Additionally, PD-L1 (programed death receptor ligand) expression was less than 30%. Jay is symptomatic with a persistent cough, unintentional weight loss, and fatigue.