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.

“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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.”

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.

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.

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.

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.

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.

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.

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.

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. 

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.

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.

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.

An optical imaging agent shown to improve diagnostic accuracy, pafolacianine (Cytalux^TM) 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

In clinical trials, 24% of patients achieved an objective response rate with tisotumab vedotin-tftv (Tivdak^TM) 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.

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.

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.

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.

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).

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.

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.

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.

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.

The extra or missing chromosomes—also called aneuploidy—in 90% of cancer cells may be a factor in treatment resistance, a new study shows. Researchers reported the findings in Developmental Cell.

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.

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. 

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.

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.