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The Case of the CIA-Combatting Combination

Clinical practice

The Case of the CIA-Combatting Combination

Career Changes Are Challenging, but Hold On to Hope

nursing professional development

Career Changes Are Challenging, but Hold On to Hope

Mentors Changed My Career at Every Stage, From New Grad to Leader

nursing professional development

Mentors Changed My Career at Every Stage, From New Grad to Leader

The COVID-19 Pandemic Fast-Tracked Our Growth as Nurses

The COVID-19 Pandemic Fast-Tracked Our Growth as Nurses

When Everything Still Isn't Enough

Advance care planning

When Everything Still Isn't Enough

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The Case of the Mysterious Myalgia

Randi is a 57-year-old patient who identifies as female. She was diagnosed with clear cell metastatic renal cell carcinoma (mRCC), and her past medical history includes mild hypertension managed with amlodipine and a two-year history of transient musculoskeletal pain managed with tramadol. She reports a family history of cardiovascular disease and rheumatoid arthritis (RA). Her primary care physician suspects Randi is at the beginning stages of fibromyalgia but has not made a conclusive diagnosis because she hasn’t experienced additional symptoms.

Clinical practice

The Case of the Weight Loss Wishes

Craig was diagnosed with colorectal cancer after a routine colonoscopy and subsequent colectomy. He meets with Lacey, the oncology nurse, to discuss managing the side effects of his FOLFOX chemotherapy. Lacey notes that Craig’s age is 71, weight is 255 lbs., and body mass index (a body fat ratio based on weight and height) is 38. Craig describes his activity level as “walking to the mailbox and exercising my fingers on the remote control. This cancer treatment will help me knock off some of this extra weight.”

Patient Support

The Case of the Transgender Considerations for Cancer Screening

Sally, a nurse practitioner in a cancer survivorship clinic, is preparing to discuss screening and surveillance guidelines with Jonah, a 32-year-old survivor of Hodgkin lymphoma. Sally reviews Jonah’s patient history form and notes that Jonah uses he and him pronouns. His gender identity is male and sex assigned at birth was female. Jonah’s surgical history includes gender-affirming surgery on chest tissue (also known as top surgery), and his current medications include supplemental testosterone. Jonah also specifies that he is transmasculine—an umbrella term used to indicate that Jonah feels a connection with masculinity.

Nurse self-care

Don’t Get Trapped in the Pitfalls of Perfectionism

Having high expectations can motivate you to achieve your very best. In the extreme, however, aiming for perfection can be dangerous to your mental health. In a 2015 TED Talk, self-proclaimed perfectionist Petra Kolber passionately revealed that despite being at the top in her field in the fitness industry, she felt her best was never good enough and she lived a joyless life.

Survivorship care plans

The Case of the Sensitive Staging System

Marianne, an oncology nurse navigator, is preparing a cancer treatment summary and survivorship care plan for Sylvia, who finished breast cancer treatment six weeks ago. Sylvia was treated with neoadjuvant therapy followed by mastectomy, reconstruction, and radiation. Her tumor was characterized as multifocal invasive ductal carcinoma, grade 2, estrogen and progesterone positive, and HER2/neu negative. Sylvia has no family history of breast cancer. Marianne notices that the oncologist recorded Sylvia’s cancer as a stage IB. Marianne wonders if the stage was determined before or after chemotherapy and surgery.

February 15, 2021

Patient Support

How to Manage Survivor Guilt During a Pandemic

Pandemics have a tremendous impact on societies and individuals alike. From incidence rates to death tolls, financial hardship to job loss, and anxiety to isolation, we’ve all been affected in one way or another—although some much more than others.

February 11, 2021

Clinical practice

The Case of the Targeted Therapy Toxicities

Three years ago, Tony, a 42-year-old man, began FOLFOX chemotherapy treatment for stage III colon cancer and achieved a complete response. Two years later, a biopsy of an intraabdominal lesion uncovered metastatic disease, and he was prescribed the epidermal growth factor inhibitor (EGFRi) cetuximab. Alex, the oncology nurse educating Tony on the side effects of EGFRi therapy, understands that skin toxicities are common with the class of drugs and looks for national guidelines for prevention and management direction.

January 19, 2021

Interprofessional issues

How to Accept Criticism With Class

Quick: what’s your first reaction when you hear the word criticism? Do you brace yourself for feelings of failure and put up a defensive wall? It’s hard to respond otherwise, but try to look at it differently. Criticism can be positive if we accept it with class and let it help us gain knowledge about ourselves.

January 14, 2021

Clinical practice

The Case of the Virtual Venture

Staff in an oncology infusion unit located in an urban healthcare system watched as patient and caregiver stress increased during the COVID-19 coronavirus pandemic and the November 2020 U.S. presidential elections. During a team meeting, Holly, one of the nurses, brought up a study she read about that used virtual reality (VR) as a distraction for patients undergoing chemotherapy. The staff was interested in implementing a similar program at their institution but wasn’t sure how to start. What would you do?

December 17, 2020

Clinical practice

The Case of the Chronic Cancer Condition

Lisa, a 32-year-old tax accountant, completed treatment for stage III triple-negative breast cancer 18 months ago. During a follow-up appointment, Lisa reported worsening headaches and difficulty concentrating at work. A magnetic resonance imaging scan and subsequent biopsy revealed a solitary brain lesion. She completed stereotactic brain radiation two months ago.

November 16, 2020

Nurse self-care

How Will You Define Your New Normal?

The phrase “a new normal” is used in the oncology setting to describe the changes a person faces as a result of cancer and its treatments. Physical and emotional scars plus activity limitations are examples of adjustments cancer survivors make as they define what will be their new normal. But in today’s media, the new normal is being used to label the changes the world’s population is facing as a result of the COVID-19 coronavirus pandemic.

September 24, 2020

Clinical practice

The Case of the Delicate Discussion

Over the past three years, Sharon, age 38, has been intermittently receiving treatment for ovarian cancer. She was initially treated with carboplatin and paclitaxel and remained in remission for 20 months. She responded well to second-line therapy (carboplatin, gemcitabine, and bevacizumab), remaining on bevacizumab maintenance until she experienced a relapse eight months later.

September 15, 2020

Nurse self-care

If You’re Trying to Be Productive, Stop Multitasking

When it comes to the human brain, the ability to effectively multitask is a myth. Although computers can run two or more programs simultaneously, our brains must task-switch, and in the transfer of attention, time and productivity are lost. Monotasking, or single tasking, is now considered a way to increase productivity and actually maximize time.

Clinical practice

The Case of the HPV-Positive Perk

Warren is a 50-year-old man recently diagnosed with human papillomavirus (HPV)-positive oropharyngeal cancer. He and his wife meet with a radiation oncologist and develop a plan of care. Lisa, the radiation oncology nurse, meets with the couple to provide education and answer questions. Darren tells her that two of his “hard living” uncles died from head and neck cancer and the treatment was horrible. He says, “I’ve only had two sexual partners and never smoked—is this cancer really worth treating?”

Nurse self-care

How to Practice Self-Care During Times of Uncertainty

Uncertainty prevails in times of crisis. Patients with cancer are all too familiar with the initial uncertainty surrounding a cancer diagnosis, treatments, and adjusting to a new normal. Oncology nurses are seeing parallels with the COVID-19 coronavirus pandemic as people worldwide face the unknowns of a health threat and the economic aftermath of the outbreak. Medical caregivers are confronting it head on as they work together to protect and tend to the physical and psychosocial needs of others.

Treatment side effects

The Case of the Medication Modification

Doug is a 70-year-old man receiving treatment at the cancer center for metastatic renal cell carcinoma. He was initially treated with sunitinib, a tyrosine kinase inhibitor (TKI). He has been experiencing significant upper back pain and is having trouble with fine motor skills in his fingers. The oncologist, suspecting spinal cord compression (SCC), ordered a computed tomography scan, which confirmed metastatic lesions in the spine leading to instability and mild SCC. The oncologist refers Doug for surgery and advises him that a new medication, cabozantinib, will be ordered for after his surgery. The oncologist asks you, the oncology nurse, to instruct Doug on surgical preparations and educate him on cabozantinib.

Cancer treatments

The Case of the Cryotherapy Consequences

Janice is 32 years old and was recently diagnosed with triple-negative breast cancer. She is receiving neoadjuvant chemotherapy with doxorubicin and cyclophosphamide, followed by weekly paclitaxel. Janice is a nationally recognized performer (vocal and piano) and is distraught over the possibility of losing her hair or developing chemotherapy-induced peripheral neuropathy and mouth sores. She asks the nurse what can be done to prevent those unwanted side effects.

Nurse self-care

Clear the Clutter With This Chinese Discipline

Physical and mental clutter can negatively affect your mood, productivity, and overall health. Think about how you feel when looking for a misplaced report on a disorderly desk covered with papers stacked atop magazines next to a conglomerate of used cups and scattered pens. Or observe your thoughts as they randomly shift from subject to object and back again. Being in a state of perceived chaos can stimulate feelings of anxiety and biologically increase cortisol levels.

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.

February 18, 2020

The Case Supporting the Seasons of Survivorship

Jamie is completing her last cycle of carboplatin and paclitaxel for stage I ovarian cancer. The oncology infusion nurse notices that Jamie appears withdrawn and nervous, so he takes time to ask her how she is feeling about completing treatment. Jamie responds, “I feel as frightened about finishing treatment as I did when I was diagnosed with cancer.” She also shares that she doesn’t want to ring the cancer center’s bell to ceremoniously signify the end of her treatment because she doesn’t want to “jinx it.”

December 17, 2019

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.

November 19, 2019

Nurse self-care

Harness Stress for Focus and Productivity

Stress is generally associated with negative mental and physical consequences. But can it actually be a healthy, even sought-after phenomenon at times?

October 29, 2019

Cancer risk factors

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.

October 15, 2019

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.

August 20, 2019

Clinical practice

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.

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To discuss the information in this article with other oncology nurses, visit the ONS Communities.

To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org.

Deborah Christensen MSN, APRN, AOCNS®

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