Use the Evidence to Integrate Ethics in Teleoncology Care
Emily manages a rural clinic associated with an academic cancer center. Patients initially have an in-person consultation with their treating oncologists at the main campus but then use telehealth for subsequent visits. To support patients during teleoncology visits, Emily wants to initiate a plan to collaborate with the clinic staff to identify and address the ethical principles for oncology care using telehealth.
Don’t Ask Patients About Their Symptoms—Have Them Tell You
“How are you doing?” We ask this question of our patients repeatedly: at diagnosis, during treatment, throughout survivorship, and at end of life. However, studies show that patients often give inaccurate answers to that direct question.
Studies Show Best Practices to Manage CAR T-Cell Therapies’ irAEs and Improve Outcomes
Rapid advancements in the science of chimeric antigen receptor (CAR) T-cell therapies present unique challenges and opportunities related to patient care. Nurses are at the forefront of those advancements—contributing to practice guidelines, developing center-specific protocols, publishing outcomes and best practices, and researching the patient experience, outcomes, and supportive interventions.
Oncology Clinical Social Workers Add Layers of Support for Patients and Families During CAR T-Cell Therapy
The interprofessional team for chimeric antigen receptor (CAR) T-cell therapy at Smilow Cancer Center at Yale New Haven includes a transplant team, cell collection and processing unit, intensive care unit, pharmacy, telehealth for home evaluations, and social work. On that team, the oncology clinical social worker’s role is chiefly to help patients and families manage the stress associated with therapy. We provide patients and family members with ongoing clinical social work support, including listening, counseling, educating, advocating, and referring them to resources and services.
CAR T-Cell Therapy Programs
Debuting in human clinical trials just a decade ago, chimeric antigen receptor (CAR) T-cell therapy was quickly hailed as a breakthrough cancer treatment for certain hematologic cancers. Today, patients and providers have access to 22 U.S. Food and Drug Administration (FDA)–approved cellular and gene therapy products, and CAR T-cell therapy is available beyond large academic research centers.
Targeting Beta2-Spectrin Could Prevent Biggest Contributor to Increasing HCC Rates
Excessive amounts of a protein called beta2-spectrin may put people at increased risk for nonalcoholic steatohepatitis (NASH), which is the leading cause of hepatocellular carcinoma (HCC), researchers said in a report published in Science Translational Medicine. Developing treatments to lower the protein may help reduce the incidence of both diseases.
Oncology Drug Reference Sheet: Avapritinib
First approved by the U.S. Food and Drug Administration in 2020 for treatment of gastrointestinal stromal tumors (GIST), avapritinib’s (AyvakitTM) approval was extended in 2021 for treatment of advanced systemic mastocytosis (AdvSM). Both approvals are for patients with PDGFR-alpha genetic variants.
Anticipate and Address Anxiety in Survivorship Care
Some people may be overjoyed at the prospect of completing their cancer treatment and returning to normal life, but for many others, fear and anxiety can overshadow feelings of elation. The survivorship phase of a cancer journey can be confusing and uncertain. Comments like, “I don’t know what is next” and “The responsibility for care is now up to me” can alert oncology nurses that patients need additional communication and strategies to transition into healthy survivorship.
Genetic Disorder Reference Sheet: Von Hippel-Lindau Syndrome
An inherited disorder characterized by the formation of benign and malignant tumors and cysts throughout the body, Von Hippel-Lindau syndrome (VHL) occurs with an altered VHL tumor suppressor gene with autosomal dominant transmission. Estimated incidence is 1 in 36,000 people, both males and females equally, and the mean age of onset is 26 years. About 20% of patients with VHL are the first person in their family to have the pathogenic variant (i.e., de novo). The diagnosis is made with germline biomarker testing.
FDA Approves Alpelisib for PIK3CA-Related Overgrowth Spectrum
On April 5, 2022, the U.S. Food and Drug Administration (FDA) granted accelerated approval to alpelisib (Vijoice®) for adult and pediatric patients aged two and older with severe manifestations of PIK3CA-related overgrowth spectrum (PROS) who require systemic therapy.
What Patients and Oncology Nurses Need to Know About Vaccination and Cancer
People with cancer have a particular risk for infection, and vaccines can be a powerful preventive tool. According to the World Health Organization, immunization prevents 2–3 million deaths every year worldwide from diseases, including diphtheria, influenza, and measles. Here’s what patients and nurses need to know about vaccines and guidelines for people with cancer.
E-Cigarettes Are Not an Effective Smoking Cessation Strategy
Smokers who try to quit by switching to e-cigarettes do not have more success than those who use other smoking cessation strategies and in fact may be more likely to relapse, researchers found. They reported their study results in Tobacco Control.
Home Care and Oncology Nurses Partner to Expand Ambulatory Options for Patients With Cancer
Home care is a patient-centered ambulatory care option that improves treatment adherence, symptom management, length of hospital stays, cost of care, psychosocial well-being, and quality of life. It is the future of care delivery, creating a “more accessible, effective, efficient, safe, and economical sustainable system.”
FDA Approves Axicabtagene Ciloleucel for Second-Line Treatment of Large B-Cell Lymphoma
On April 1, 2022, the U.S. Food and Drug Administration (FDA) approved axicabtagene ciloleucel (Yescarta®) for adult patients with large B-cell lymphoma (LBCL) that is refractory to first-line chemoimmunotherapy or relapses within 12 months of first-line chemoimmunotherapy. It is not indicated for the treatment of patients with primary central nervous system lymphoma.
The Evolution of Ambulatory Care
Ambulatory oncology began to gradually evolve in the mid-2000s to include multiple aspects of the care continuum. Then suddenly, a pandemic skyrocketed that growth as institutions Raced to develop their ambulatory infrastructure to meet new and changing needs.
The Oncology Nurse’s Role in Identifying Patients for Cancer Genetics Counseling
During personal and family medical history assessments, many patients report multiple cancer diagnoses in their family or concerns that other family members might be at increased risk for developing cancer. Patients and families might also ask their nurse about risk or parameters for genetic testing. Timely and appropriate referral to genetics professionals for counseling and possible testing for germline risk of malignancy enables individuals at increased risk to follow recommended surveillance and consider surgery and other preventive strategies, ultimately decreasing their risk of cancer-related morbidity and mortality.
What the Evidence Says About Low-Intensity Exercise in Cancer Care
Regular, light-intensity exercise and activity has been shown to reduce the risks of fractures, heart disease, and death. Substantial evidence also indicated benefits for cancer-related outcomes, including fatigue, depression, and quality of life. Additional observational data suggested that sustained physical activity may help reduce cancer recurrence and improve overall survival.
Professional Oncology Navigation Task Force Releases Oncology Navigation Standards of Practice
Today, six oncology-focused professional and patient organizations, including the Oncology Nursing Society (ONS), published standards for use in oncology navigation care. With input from many major navigation-focused disciplines, the standards guide best practices for care providers across cancer settings.
Anxiety and Depression Are Biggest Concerns for Patients With Cancer, Survivors, Caregivers
As many as 49% of patients with cancer are at risk for clinically significant levels of anxiety and 38% are at risk for clinically significant levels of depression, according to data collected through the Cancer Support Community’s (CSC’s) cancer experience registry. Additionally, nearly half of caregivers have anxiety levels that are substantially higher than the national average and one-third face substantially higher fatigue and depression levels. Nationally, the rates for levels of anxiety and depression are 19.1% of U.S. adults aged 18 and older and 8.4% of U.S. adults aged 18 and older, respectively.
Legislators, Professional Organizations Advocate for Safety Protections for Healthcare Workers
Shortly after emergency workplace safety standards were removed and guidance on isolation time following a positive COVID-19 test result was updated, healthcare workers and administrations urged legislators to issue protections for the profession. To ensure their voices were heard, House of Representatives legislators Robert C. “Bobby” Scott (D-VA) and Alma Adams (D-NC) wrote a letter to President Joe Biden and Department of Labor Secretary Marty Walsh to advocate for a reversal.
FDA Approves Lutetium Lu 177 Vipivotide Tetraxetan for Metastatic Castration-Resistant Prostate Cancer
On March 23, 2022, the U.S. Food and Drug Administration (FDA) approved lutetium lu 177 vipivotide tetraxetan (Pluvicto™) for adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor (AR)–pathway inhibition and taxane-based chemotherapy.
American Rescue Plan Funds Will Reduce Burnout, Promote Mental Wellness Among Healthcare Workforce
The United States is investing $103 million to improve healthcare worker retention and respond to the ongoing nursing workforce shortage by reducing burnout and promoting mental health and wellness for healthcare professionals, particularly those in underserved and rural communities, the U.S. Department of Health and Human Services (HHS) said in January 2022.
FDA Informs Healthcare Professionals of Prefilled Saline Flush Syringe Conservation Strategies
On March 21, 2022, the U.S. Food and Drug Administration (FDA) announced that the United States is experiencing interruptions in the supply of prefilled 0.9% sodium chloride (saline) IV lock/flush syringes because of an increase in demand during the COVID-19 pandemic and vendor supply chain challenges, including the permanent discontinuance of certain prefilled saline lock/flush syringes.
FDA Approves Pembrolizumab for Advanced Endometrial Carcinoma
On March 21, 2022, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) as a single agent for patients with microsatellite instability–high (MSI-H) or mismatch repair deficient (dMMR) advanced endometrial carcinoma, as determined by an FDA-approved test, who have disease progression following prior systemic therapy in any setting and who are not candidates for curative surgery or radiation.
Oncology Drug Reference Sheet: Pafolacianine
An optical imaging agent shown to improve diagnostic accuracy, pafolacianine (CytaluxTM) was approved on November 29, 2021, for use in adult patients with known or suspected ovarian cancer as adjunct therapy in conjunction with planned intraoperative identification of malignant lesions. Pafolacianine is used in combination with a near-infrared (NIR) fluorescence imaging system that requires specialized training provided by the device manufacturer.
FDA Approves Nivolumab and Relatlimab-Rmbw for Unresectable or Metastatic Melanoma
On March 18, 2022, the U.S. Food and Drug Administration (FDA) approved nivolumab and relatlimab-rmbw (Opdualag™) for adult and pediatric patients aged 12 years or older with unresectable or metastatic melanoma. Nivolumab and relatlimab-rmbw is a fixed-dose combination of the LAG-3–blocking antibody relatlimab and the programmed death receptor-1–blocking antibody nivolumab.
FDA Approves Olaparib for Adjuvant Treatment of High-Risk Early Breast Cancer
On March 11, 2022, the U.S. Food and Drug Administration (FDA) approved olaparib (Lynparza®) for adult patients with deleterious or suspected deleterious germline BRCA variant (gBRCAm) human epidermal growth factor receptor 2 (HER2)-negative high-risk early breast cancer who have been treated with neoadjuvant or adjuvant chemotherapy. Patients are selected for therapy based on an FDA-approved companion diagnostic for olaparib.
FDA Approves Ciltacabtagene Autoleucel for Relapsed or Refractory Multiple Myeloma
On February 28, 2022, the U.S. Food and Drug Administration (FDA) approved ciltacabtagene autoleucel (Carvykti™) for adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy, including a proteasome inhibitor (PI), an immunomodulatory agent (IMiD), and an anti-CD38 monoclonal antibody. Ciltacabtagene autoleucel is a B-cell maturation antigen (BCMA)-directed genetically modified autologous chimeric antigen receptor (CAR) T-cell therapy.
FDA Approves Neoadjuvant Nivolumab and Platinum-Doublet Chemotherapy for Early-Stage Non-Small Cell Lung Cancer
On March 4, 2022, the U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) with platinum-doublet chemotherapy for adult patients with resectable non-small cell lung cancer (NSCLC) in the neoadjuvant setting, representing the first FDA approval for neoadjuvant therapy for early-stage NSCLC.
FDA Reports Recall of 0.9% Sodium Chloride for Injection USP 250 ml in Excel Because of Fluid Leakage or Low Fill Volume
On March 3, 2022, the U.S. Food and Drug Administration (FDA) reported B. Braun Medical’s voluntary recall of five lots of 0.9% sodium chloride for injection USP 250 ml in Excel within the United States at the hospital and user levels after receiving reports of fluid leakage or low fill volumes.
Mama at the Bar: Using Analogies to Understand Targeted Therapies
Analogies and visuals are powerful learning tools. If you’re one of the many nurses whose eyes glaze over when approaching genomics, consider connecting the “omics” concepts to interpretative visuals, clinical practice, and everyday life examples to enhance your learning and make the concepts more relevant to you. Here’s an example of how it can be done.
Nursing Considerations for ICI-Related Myocarditis
Before immunotherapies like immune checkpoint inhibitors (ICIs) became a cancer treatment option, myocarditis typically developed in the presence of infections, drug allergies, or autoimmune diseases. Activating the immune system with ICIs can also trigger autoimmune-like adverse events such as myocarditis, and although its incidence in patients with cancer is low, mortality is high.
Prevent Implicit Bias in Patient Care With These Cultural Conversation Starters
Each clinical encounter with a patient brings together three different cultural perspectives: the patient’s, the nurse’s, and health care’s own culture. Patient-centered care acknowledges and responds to the unique needs and preferences of each patient in the context of their culture. As we approach our patients with respect, humility, and curiosity to learn more, we must ask questions to help prevent assumptions, generalizations, and implicit bias from influencing our interactions.
FDA Reports Safety Announcement for Spectrum V8 and Spectrum IQ Infusion Pumps
On February 18, 2022, the U.S. Food and Drug Administration (FDA) reported Baxter International’s urgent safety communication to reinforce safety information regarding upstream occlusion alarms for all Spectrum V8 and Spectrum IQ infusion pumps.
Music Reminds You of the Love You Deserve
Does hearing a certain song suddenly energize you or make the day seem brighter? There’s a reason for that. Music can have a powerful effect on our well-being and is a tool nurses can use to help take care of their mental health.
Immune Checkpoint Inhibitors May Increase Risk of Serious Infection
Nearly a quarter of patients receiving a variety of drugs classified as immune checkpoint inhibitors develop infections during treatment and 15% are considered severe, researcher reported in study findings published in Cancer Medicine.
Oncology Drug Reference Sheet: Tisotumab Vedotin-Tftv
In clinical trials, 24% of patients achieved an objective response rate with tisotumab vedotin-tftv (TivdakTM) that lasted a median of 8.3 months, leading to the agent’s U.S. Food and Drug Administration September 2021 approval for use in adults with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy.
Master the Essentials of Effective Communication
Communication is central to an oncology nurse’s role—with patients and families, within the unit, and across interprofessional teams. The Joint Commission identified poor communication as a causative factor in 80% of medical errors, particularly during caregiving handoffs. Effective communication skills are both a science and an art, but oncology professionals can use a variety of tools and techniques to enhance their practice.
COVID-19’s Impact on Our Nursing Leaders
Rewind. I adjust the strap on my mask and pinch it tightly around my nose and move it just under my lower eyelashes to prevent my goggles from fogging. These days, I am grateful for the face cover as it hides the pallor from six months in and the dark circles from long hours and anxious sleep. I wait at the valet circle for my team. Another SOS text out to them this morning. All hands on deck.
Geriatric Assessments Reduce Side Effect Incidence in Older Adults With Cancer
Regularly conducting geriatric assessments in older patients and using the information to guide their care reduces their risk of side effects by nearly 30%, researchers reported in study findings published in Lancet.
Evidence Defines Nursing Implications for Combination Cancer Treatment Side Effects
Immune checkpoint inhibitors (ICIs) enhance immune response against foreign antigens, such as cancer, by manipulating checkpoints that have stopped the body from fighting them. In doing so, they also increase risk of the immune system attacking healthy cells and producing inflammatory side effects, resulting in immune-related adverse events (irAEs).
Combination CDK4/6 and Fulvestrant Has Survival Benefits in Late-Stage Breast Cancer
Combining a CDK4/6 inhibitor and fulvestrant improves overall survival consistently among patients with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer, according to a U.S. Food and Drug Administration (FDA) analysis. The agency reported the findings in Lancet Oncology.
The Pharmacist’s Role in Combination Cancer Treatments
Since the first checkpoint inhibitor was approved in 2011, we have made tremendous leaps in immunotherapy in a short span of 10 years. Now we see immunotherapy combined with a variety of options, including chemotherapy or other oral and IV targeted therapy.
What the Evidence Says About Traditional Chinese Medicine Herbal Formula Xiao Yao San for Depression and Anxiety
An estimated 16% of patients with cancer experience depressive spectrum disorders in oncologic, hematologic, and palliative care settings, seriously affecting their quality of life. Although conventional antidepressants can be effective in many situations, they are associated with adverse effects, such as fatigue, drowsiness, sleep difficulties, nausea, weight gain, nervousness, dry mouth, blurred vision and sexual dysfunction.
Oncology Drug Reference Sheet: Ivosidenib
Adding to its earlier approvals for use in adults with acute myeloid leukemia (AML), on August 25, 2021, the U.S. Food and Drug Administration (FDA) approved ivosidenib (Tibsovo®) for adults with previously treated, locally advanced or metastatic cholangiocarcinoma. Cholangiocarcinoma, or cancer of the bile ducts, is a rare cancer, and ivosidenib is the only currently approved agent for patients with an IDH1 variant.
Genetic Disorder Reference Sheet: CDH1 and Hereditary Diffuse Gastric Cancer
Pathogenic variants in the CDH1 gene are associated with hereditary diffuse gastric cancer (HDGC), a poorly differentiated adenocarcinoma that infiltrates into the stomach wall. It causes the stomach wall to thicken without forming a distinct mass, which limits effective screening strategies.
The Case of the Post-Transplant Pulmonary Problem
Benjamin, your 28-year-old patient with acute lymphoblastic leukemia, received a 10/10 matched, unrelated donor for his allogeneic hematopoietic stem cell transplantation. Two months post-transplant, Benjamin developed grade 4 skin and gastrointestinal graft-versus-host disease.
Break Bad News to Patients With This Step-by-Step Guide
When hearing results from blood work or repeat imaging—regardless of whether they are “good” or “bad”—patients want and deserve to be given information truthfully and objectively. Oncology advanced practice providers are often the bearers of bad news, which can be uncomfortable and stressful. But here’s how you can hold those conversations with finesse, empathy, and respect.
Team Training Develops Nurses’ Interprofessional Communication Skills
Oncology nurses must have effective communication and team-based skills to work across disciplines with other members of the care team. In an oncology setting, teamwork promotes safer, more efficient, and higher quality care, as well as a more positive and supportive practice environment. Dana-Farber Cancer Institute (DFCI) has used team training to develop those skills in our staff over the past 15 years.