A combination of intensive chemotherapy immunotherapy administration education and shorter training on oncology symptom management can prepare correctional facility nurses to safely care for patients with cancer in the community, according to presenters in an oral abstract session at the 48th Annual ONS Congress^® in April 2023.

The explosion of telehealth transitioned many aspects of cancer care to patients and caregivers as home-based options. However, as with any shift in procedure, disconnecting their own pumps requires additional preparation and processes. Two oncology nurses share how they set up systems to support safe home care for pump disconnection.

Once abandoned because of dose-limiting toxicities, a novel chemotherapy drug is showing even more promise as a modified prodrug. In study results published in Science Advances, researchers demonstrated how turning DRP-104 into a prodrug enables it to kill more tumor cells and activate CD8+ T cells with a “markedly improved tolerability profile.”

Adding carboplatin to standard neoadjuvant chemotherapy for patients with triple-negative breast cancer improves complete response, event-free survival, and overall survival, researchers reported in study findings presented in abstract GS5-01 during the 2022 San Antonio Breast Cancer Symposium. 

Patients who engage in physical activity during or after cancer treatment are less fatigued and return to their usual daily activities faster than those who don’t exercise, researchers reported in JACC: CardioOncology. The benefit is highest among patients who are active during treatment but still pronounced for those who resume physical activity after completing treatment.

Overall survival among patients with non–muscle-invasive bladder cancer who are treated with adjuvant gemcitabine and docetaxel is comparable to overall survival for treatment with bacillus Calmette-Guérin (BCG), researchers reported in the Journal of Urology. The evidence could support a treatment alternative for high-risk patients during the BCG shortage.

High levels of interleukin-6 (IL-6) and C-reactive protein before chemotherapy for breast cancer may predict a patient’s propensity to develop clinical decline and frailty after treatment, according to study findings that researchers reported in the Journal of Clinical Oncology.

Clinicians and researchers know little about the mechanisms for chemotherapy-induced peripheral neuropathy, a side effect of neurotoxic agents that can cause numbness, tingling, and pain in the upper and lower extremities. Until recently, mechanism-based treatment was difficult, but biomarkers are helping nurse scientists identify a potential connection to the hypothalamic-pituitary-adrenal axis.

Biologic agents or chemotherapies can trigger hypersensitivity reactions, which occur when a patient’s immune system identifies an agent as an antigen and initiates a complex reaction involving sensitization of T lymphocytes and macrophages, production of antibodies, and release of histamine. Developing and implementing a hypersensitivity kit containing all necessary medications and associated protocols allows nurses to immediately implement management when reactions occur.

Medication administration is a high-risk process that requires critical thinking, efficient decision-making, attention to detail, and a foundational knowledge of basic pharmacology. The process is not a single task but a cascade of events that include handling, ordering, preparing, dispensing, administering, and monitoring. Although nurses’ involvement varies at each phase, the risk for errors always exists, and consequences can have a lifelong impact on patients, families, and healthcare workers. Nurses can use the following strategies in their responsibility as the last line of defense for safe medication administration.

Cardiac toxicities are associated with many types of cancer therapies, with both length of and time since treatment increasing a patient’s risk for the adverse event. Anthracycline chemotherapies are among the oldest agents still used for a variety of cancer diagnoses, and as cancer survivorship continues to grow, more patients are presenting with late-onset cardiac complications.

Sofia is a 35-year-old patient who identifies as female who was recently diagnosed with breast cancer and is concerned with experiencing chemotherapy-induced alopecia (CIA) as an adverse event from treatment. She comes in for her first infusion of adriamycin plus cyclophosphamide and is using scalp cooling to prevent hair loss. She works as a project manager, which requires her to keep her camera on for her many daily video calls. She is very anxious about losing her hair and asks you if taking minoxidil in addition to the scalp cooling treatment would guarantee she maintains her hair. 

On February 12, 2021, the U.S. Food and Drug Administration (FDA) approved trilaciclib (Cosela™) as the first therapy in its class to reduce the frequency of chemotherapy-induced myelosuppression in adults receiving certain types of chemotherapy for extensive-stage small cell lung cancer. Trilaciclib inhibits cyclin-dependent kinase 4/6 (CDK 4/6) enzymes to prevent bone marrow damage.   

First-line therapy combining nivolumab with chemotherapy improved median overall survival rates in patients with PD-L1-expressing gastric cancer by 3.3 months in a large international, multicenter trial. The findings were reported during the 2020 European Society for Medical Oncology virtual meeting.

Tanya is a 46-year-old woman with leukemia. She recently finished induction therapy, and her oncologist told her she is ready to receive a hematopoietic stem cell transplant. You speak with Tanya about what to expect in the upcoming weeks before her transplant, but she interrupts you: “Nothing tastes good anymore. I am so scared because I thought I completed chemotherapy. The doctor just told me I have to get more before my transplant. Every time I get chemotherapy, I lose my appetite.”

Durvalumab immunotherapy became a new standard of care for patients with stage III unresectable non-small cell lung cancer whose disease did not progress following two cycles of platinum-based chemoradiotherapy after its approval in February 2018, and in March 2020, its indication was expanded for use as first-line treatment in patients with extensive-stage small cell lung cancer as well. Key to keeping patients on immunotherapy treatment and giving them the best chance at long-term survival is effective management of immune-related adverse events.

Patients who take five or more medications in the six months before beginning IV chemotherapy for a cancer diagnosis are more likely to be hospitalized after their chemotherapy treatment, according to the findings from a new study published in the Journal of Geriatric Oncology.

Antioxidant supplements are associated with increased disease recurrence and statistically nonsignificant increased risk of mortality in patients with breast cancer who were receiving cyclophosphamide, doxorubicin, and paclitaxel, according to findings from a study reported in the Journal of Clinical Oncology.

One aspect that ambulatory oncology nurses must consider in the greater staffing conversation is the time spent on educating patients and caregivers about oral chemotherapy safety in the home setting. Developing an educational framework to guide those conversations not only ensures that all critical information is covered but also that it’s delivered in a standard and efficient process. 

P.G. is a 54-year-old woman who presents to the infusion center to receive her second cycle of chemotherapy for breast cancer. As her oncology nurse, you check the chemotherapy orders and patient history and are concerned to see that her weight has dropped by 10% from baseline, necessitating a change in dosing.

Which of the Following Should Not Be Recommended to Patients Taking Oral Antineoplastic Medication at Home?

A. Handwashing before and after handling the medication is important.

B. Use a urinal or bedpan instead of a toilet to reduce the risk of contamination via body fluids.

C. Keep oral antineoplastic drugs separate from other medications.

D. Do not touch tablets or capsules with bare hands; wear disposable gloves.      

Using chemotherapy with immune checkpoint inhibitors may reactivate tumors’ responses to immunotherapy, researchers concluded in a review article published in the Annals of Oncology.

Dollars spent on cancer drugs increased from $26.8 billion in 2011 to $42.1 billion in 2016, according to the results of a study reported in the Journal of Oncology Practice.

Despite all of the new drugs approved in recent years—particularly immunotherapies, oral agents, and biosimilars—that have forced nurses to consider many novel approaches to patient care, the importance of chemotherapy in cancer treatment has remained a constant. In a field where it feels like no two days are the same and new drugs emerge on a rolling basis, chemotherapy continues to be a staple in cancer treatment plans and safety and administration principles remain constant. 

To ensure that patients and providers are equipped with the latest, most up-to-date knowledge and resources, ONS routinely works with patient advocacy groups, subject matter experts, and other provider organizations to develop and refine critical information for clinical practice. Following safety standards and meeting patient education requirements are critical to successful oral chemotherapy practice.

Which RN is Competent in Chemotherapy Administration?

1. One that took a chemotherapy course online 2 years ago and recently completed their annual education.
2. One that witnessed a chemotherapy competent nurse administer chemotherapy orally and parenterally on five separate occasions
3. One that took a chemotherapy course offered by her hospital and completed an administration checklist with a chemo competent nurse          
4. One who works on a unit that cares for patients receiving chemotherapy

Most patients and practitioners associate chemotherapy with cancer treatments, yet the drugs are also used to treat a number of autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, antineutrophil cytoplasmic antibody–associated vasculitis, and systemic lupus erythematosus. 

On May 15, 2018, the U.S. Food and Drug Administration approved epoetin alfa-epbx (Retacrit™) as a biosimilar to epoetin alfa (Epogen/Procrit) for the treatment of anemia due to chronic kidney disease.

What is the preferred method to administer vincristine into a peripheral IV site when treating a patient with lymphoma or leukemia? 

A. Direct IV push by syringe 

B. By syringe through free-flowing IV fluids (side-arm technique) 

C. Gravity drip using an IV minibag 

D. By minibag using an IV pump 

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.

Which of the following is gene that may play a role in tumor resistance to chemotherapy?

A. NRAS

B. APC

C. p53

D. VHL

Which of the following is NOT an ASCO/ONS Chemotherapy Administration Safety Standard?

A. Chemotherapy orders include sequencing of agents, when applicable.  

B. A licensed independent practitioner is on-site and readily available to staff where chemotherapy is administered.

C. Two chemotherapy-competent RNs must be in the infusion area at all times when chemotherapy is infusing.  

D. If chemotherapy is administered in a non-healthcare setting, a second identifier such as a driver’s license, is used to verify the patient’s identity.  

For sub-Saharan African (SSA) countries, cancer incidence is on the rise. The increase in cancer rates can be attributed to several factors, including economic and social development and infectious disease rates. In that part of the world, many healthcare professionals don’t have access to up-to-date information regarding safe chemotherapy handling and administration. The American Cancer Society (ACS) and Clinton Health Access Initiative (CHAI) developed the ChemoSafe program to share critical information and resource acquisition focused on safe chemotherapy administration and cancer treatments with healthcare providers in SSA. ONS provided specific nursing content to support the ChemoSafe initiative, including educational materials and courses.

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.

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.

Oral cancer treatments are effective and practical and can provide a level of flexibility for patients, allowing them to seamlessly continue their treatments without the burden of infusion visits. With many patients receiving oral chemotherapy, oncology nurses must recognize complications that can arise regarding procedure and documentation in practice.  

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 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.

In clinics and oncology floors across the country, IV pumps are infusing, chemotherapy is administered through IV push, and nurses are moving swiftly from one patient to the next. Administering chemotherapy is a complex, in-depth procedure that requires training, education, and a level of experience beyond that of the standard healthcare professional. However, even the best oncology nurses need the support of their team members and the administration to provide the safest possible care environments for their patients.

Researchers have discovered a protein that may lead to a new way to prevent resistance and improve outcomes for patients whose cancers have a BRCA2 mutation. The findings were reported in Molecular Cell.

So far, 2017 has seen an incredible amount of U.S. Food and Drug Administration approvals for new agents and indications. Biotherapy and targeted agents represent many of the newly approved treatment options—a great deal of which are offered in oral form, increasing the opportunity for patients to receive treatment at home.

Between administering antineoplastic agents, monitoring patient vitals, and preparing patients for treatment, oncology nurses are required to balance their attention between many intricate tasks. Chief among the division of duties is that oncology nurses closely monitor their patients for hypersensitivity reactions (HSRs) to prescribed agents.

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.

On August 3, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to a liposome-encapsulated combination of daunorubicin and cytarabine (Vyxeos™, Jazz Pharmaceuticals, Inc.) for the treatment of adults with newly-diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), two types of AML having a poor prognosis.

High-dose chemotherapy with hematopoietic stem cell support is a well-established treatment for many hematologic malignancies. This treatment can be a difficult journey for patients and families. Historically, patients have been treated in a traditional hospital setting in anticipation of severe side effects, including mucositis, febrile neutropenia, thrombocytopenia, and pulmonary, renal, and hepatic complications. Patients can remain profoundly immunosuppressed for months while recovering from transplant. However, better supportive care in recent years has allowed many centers to move all or a portion of their transplant care into an outpatient setting.

Inquiries received in the ONS clinical inbox often ask about various responsibilities of nurses who hold an ONS chemotherapy provider card and have been deemed competent to administer cancer treatments within their practice setting.