Guidelines Help APRNs Navigate the Law and the Science for Medical Marijuana
Research and regulations regarding medical marijuana are constantly evolving. Advanced practice RNs (APRNs) caring for patients who may use cannabis need a knowledge base and guidance for practice. During her session on April 29, 2021, for the 46th Annual ONS Congress™, Kathleen Russell, JD, MN, RN, associate director of nursing regulation at the National Council of State Boards of Nursing (NCSBN), reviewed key points from NCSBN’s Guidelines for the Nursing Care of Patients Using Marijuana that are particularly relevant to oncology APRNs.
ONS Members See Beyond Barriers and Understand Benefits of Guidelines
I am a clinician in my heart and soul. I was an ONS charter member and one of the first nurse practitioners (NPs) at Memorial Sloan Kettering Cancer Center in New York, NY, before any NP laws were in place and before colony-stimulating factors. The inability to prevent death secondary to chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) haunted me and led me to conduct several funded studies.
Involve the Entire Cancer Care Team to Effectively Implement Guidelines
Only 19% of strategies to implement clinical practice guidelines are fully effective and the majority (43%) are not effective at all, according to the findings from a clinical review in the European Union. Effective guideline implementation requires teamwork, interprofessional engagement, and selecting the most appropriate tool for the job.
New Guidelines in Cancer Care
Guidelines give oncology nurses an evidence-based, standardized approach to cancer care. But guidelines are most effective used when they’re used as a regular part of practice—a process referred to as implementation.
With several oncology societies releasing new guidelines in 2020 and 2021, including ONS and the American Society of Clinical Oncology (ASCO), the implementation process requires nurse managers and leaders to facilitate staff education, maintain a high quality of care, and answer the all-important question: “Why are we doing this?”
Self-Care Is Essential When Working Remotely
Did you ever imagine that you could do your job remotely? I did not, but that’s what I’m doing right now. Working remotely has become the new normal for certain professional roles, including some in nursing. An estimated 31% of new hires since March 2020 work from home. In February 2020, the Centers for Disease Control and Prevention released social distancing guidelines and recommended the use of telehealth for patient visits. In March 2020, telehealth visits increased 154% compared to March 2019. Working at home has affected both healthcare workers and patients.
Inclusion in National Repository Helps Move ONS Guidelines™ Evidence to Practice
When they launched in 2020, oncology nurses recognized the first five ONS Guidelines™ for cancer treatment-related symptoms and adverse events as the evidence-based standard for patient care. Now, the ECRI Guidelines Trust, a national evaluation organization, has given them that distinction as well, including all of ONS’s current guidelines in its repository.
Manage Cancer Treatment-Related Radiodermatitis With ONS Guidelines™
Painful skin reactions may develop in as many as 95% of patients receiving radiotherapy treatments for cancer. Patients report that it affects their quality of life and that purchasing interventions to soothe their skin increases their out-of-pocket costs. Supporting patients who experience the side effect is critical for their well-being.
CDC Offers Infection Prevention Guidelines for Patients With Cancer During COVID-19
Immunocompromised patients with cancer are three times more likely to die from complications of the COVID-19 coronavirus. New resources from the Centers for Disease Control and Prevention (CDC) provide ideas for preventing infections like COVID-19 in patients with cancer.
Manage Cancer Treatment-Related Constipation With ONS Guidelines™
As many as 43%–58% of patients with cancer experience constipation related to their treatment, and the side effect is both distressing and potentially life threatening if severe enough. Constipation-related emergency department visits increased by 41.5% from 2006–2011, with older adults (aged 85 years or older) making up most of the visits. Estimates suggest that the cost of managing severe cancer-related constipation may range from $500 to more than $2,300 per person per month. Supporting patients who experience the side effect is critical for their well-being.
Protect Patients With Cancer During Flu Season With Recommended Vaccinations
Patients with cancer are at increased risk for complications from the common flu. Plus, ensuring they receive recommended influenza vaccinations will reduce flu-related healthcare demands and decrease stress on the United States’ healthcare system, which is crucial as the nation approaches 10 million COVID-19 coronavirus cases. In response, the Centers for Disease Control and Prevention (CDC) isn’t waiting until National Influenza Vaccination Week, December 6–12, 2020, to promote vaccinations to high-risk populations.
Manage Cancer Treatment-Related Skin Toxicities With ONS Guidelines™
From chemotherapy to immunotherapy, many of today’s cancer treatments are associated with skin toxicities. Left unmanaged, they can affect patients’ activities of daily living, self-image, and overall quality of life and may lead to treatment disruptions, delays, or even discontinuation.
ACS Cervical Cancer Screening Guidelines Prefer HPV Over Pap Tests
People with a cervix who are aged 25–65 years should receive a human papillomavirus (HPV) test every five years, according to the new American Cancer Society (ACS) guidelines for cervical cancer screening.
Manage Cancer Treatment-Related Lymphedema With ONS Guidelines™
Surgical treatment for breast, gynecologic, prostate, lymphoma, melanoma, or head and neck cancers puts patients at risk for developing secondary lymphedema at any point in the remainder of their life. Studies show that as many as 10%–40% of patients with breast cancer may experience breast cancer–related lymphedema.
ONS Guidelines Give Clinicians Evidence-Based Recommendations for Cancer Treatment-Related Side Effects
Resources that can be used by nurses and other oncology healthcare professionals, patients, and policymakers to improve the care of patients with cancer, were recently launched by the Oncology Nursing Society (ONS) in its first set of five systematically reviewed clinical practice ONS Guidelines™ for managing cancer treatment-related side effects.
FDA Provides COVID-19 Guidelines for Patients With Cancer and Healthcare Providers
As the United States combats the COVID-19 coronavirus pandemic, federal agencies like the U.S. Food and Drug Administration’s (FDA’s) Oncology Center of Excellence (OCE) are reassuring specific populations, such as those in the cancer community, that the agency is still patient-centered in its mission.
CDC Releases Healthcare Professional Preparedness Checklist for COVID-19
Although many federal health agencies are involved in the COVID-19 coronavirus pandemic, central to every discussion has been the Centers for Disease Control and Prevention (CDC). Charged with the safety of the American public’s health, CDC is spearheading the United States’ epidemiologic approach, including how healthcare workers should recognize, test for, report, and respond to the coronavirus.
NINR Acting Director Responds to COVID-19 Pandemic
Tara Schwetz, PhD, acting director of the National Institute of Nursing Research (NINR), issued a statement acknowledging the role of nurses as more essential than ever to patient care during the COVID-19 coronavirus pandemic.
Updated NCCN Cancer Screening Guidelines Inform Practice and Prevention
As an industry standard, the National Comprehensive Cancer Network (NCCN) screening guidelines have served a huge role in cancer prevention and early detection efforts, helping providers identify diagnoses early and give patients their best possible chance at survival. Ensuring screening guidelines are up to date and using the best available evidence is an ongoing process that requires an interprofessional approach.
Research Guides the Transition of PEP Resources to ONS Guidelines
Lymphedema is one of the most common treatment side effects in patients with breast cancer. Estimates suggest that approximately 40% of all breast cancer survivors are at risk to develop lymphedema at some point in their lives. But as far back as 1998 and even before, some healthcare experts were predicting that lymphedema would be eliminated as a side effect from breast cancer treatment. Twenty-one years later, it’s still prevalent among breast cancer survivors, requiring careful management recommendations from oncology nurses to help patients live with this chronic issue.
Evidence Drives the Development of Guidelines for Practice
Evidence-based practice is central to successful patient care—not only in oncology but throughout the entire healthcare community. Currently, the way health care is delivered varies throughout the United States. Not all hospitals or clinics are the same, nor do all institutions operate the same. Many treatments are given to patients without clear evidence of the benefit, and unity and standardization are lacking, which could lead to wide variances in the efficacy and safety of care provided to patients.
Draft ONS Guideline Open for Public Comment
As part of the rigorous process of transitioning ONS Putting Evidence Into Practice recommendations into formal, actionable clinical practice guidelines, the draft guidelines must undergo a public comment period. The first five guidelines to reach that step will be open for public comment in December 2019 and early 2020.
From Evidence to Standard: The Role of Clinical Guidelines in Oncology Care
Leading organizations like ONS develop nationally recommended, evidence-based cancer care guidelines to inform practice, unify and standardize the way patient care is delivered, and ensure successful outcomes. By clarifying gray areas and codifying practice, guidelines enable providers to deliver efficacious, safe oncology care for patients and all care providers.
ONS Trailblazes in Cancer Care With New Position Statements and Guidelines
Just before ONS kicked off its Fourth Annual Capitol Hill Days, the ONS Board of Directors met face-to-face in Washington, DC, on September 20, 2019. On the agenda were several discussion topics that support and advance ONS as a leader and trailblazer in cancer care, including position statements that convey the Society’s viewpoint on key issues and guidelines that will set the standard of care for symptom management.
Oncology Drug Reference Sheet: Talazoparib
Initially approved in 2018, talazoparib (Talzenna®) capsules are indicated for the treatment of adult patients with deleterious or suspected deleterious germline breast cancer susceptibility gene HER2-negative locally advanced or metastatic breast cancer.
Commission on Cancer to Revise Standards for Cancer Program Accreditation
The Commission on Cancer (CoC), an organizational consortium of which ONS is a governing member, provides standards for cancer programs to follow to achieve a high level of continuous quality improvement. Last updated in 2016, the standards are currently undergoing analysis and revision, and CoC is seeking public comments until June 3, 2019.
Updated Scope and Standards Represent Key Foci of Oncology Nursing Practice
To ensure that the Oncology Nursing: Scope and Standards of Practice are consistent with overall nursing standards and to increase the visibility of the oncology nursing standards in the greater nursing and healthcare communities, ONS released an updated version of its reference book in March 2019. The American Nurses Association (ANA) recognizes oncology nursing as a nursing specialty, and the new edition carries ANA’s approval of the oncology nursing scope of practice and acknowledgement of the oncology nursing standards of practice.
Here’s How ONS Is Transitioning Symptom Management Resources Into Guidelines
Using the best evidence to inform care leads to better patient outcomes and can prevent over- or underuse of healthcare resources. Clinical practice guidelines are an important tool for healthcare providers to ensure they are using informed care in their practice. On Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Pamela Ginex, EdD, RN, discussed ONS’s symptom management guidelines and a new initiative to develop and implement guidelines into clinical care.
ONS Tackles Oral Chemotherapy Complexities
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.
Study Finds Guideline Adoption Slow for Antiemetic Prophylaxis in Patients Receiving Carboplatin
In 2017, the National Comprehensive Cancer Network and American Society of Clinical Oncology released new antiemetic guidelines that recommended adding an NK1 receptor antagonist (RA) to standard 5-hydroxytryptamine RA plus dexamethasone upfront for patients receiving carboplatin area under the curve (AUC) ≥ 4. In January 2018, the Centers for Medicare and Medicaid Services instituted a new quality outcome measure, OP-35, which assesses “potentially avoidable” acute care for nausea, vomiting, or eight other common chemotherapy-related toxicities (anemia, dehydration, diarrhea, fever, neutropenia, pain, pneumonia, and sepsis).
New Edition of Palliative Care Guidelines Focus on Inclusivity, Responsibility
Palliative care is a necessary inclusion in the care of all people with a serious illness, no matter the diagnosis or setting, and it’s the responsibility all healthcare providers, including specialty providers in oncology. The National Consensus Project (NCP) expanded on these two key tenets in its new release of the fourth edition of the Clinical Practice Guidelines for Quality Palliative Care. ONS is one of 80 organizations endorsing the new guidelines.
Chapters and Practice-Specific Topics Were on Board Agenda for August
ONS chapters, endorsed recommendations and guidelines, and the role of nurses caring for patients with cancer topped the ONS Board of Directors’ discussion topics during its August 2018 conference call meeting.
Which of the Following Isn’t a Breast Cancer Surveillance Recommendation?
Mrs. Johnson has just been told she's in remission from breast cancer. Which of the following isn't a surveillance recommendation?
A. Routine mammography screening every 12 months for locally recurrent tumors or new primary cancers
B. Screening for cervical and colorectal cancer every six months for two years
C. Gynecologic evaluation every 12 months for women on tamoxifen therapy who have an intact uterus
D. Detailed history and physical examination every three to six months for three years
TNM Gets an Upgrade in Eighth Edition Staging Guidelines
Nearly a century ago, cancer staging was a simple categorization of disease as either local, regional, or distant. Then in the 1940s, a French surgeon developed the concept for a staging system that uses the size of the primary tumor (T), its lymphatic involvement (N), and the presence of metastases (M) to stage a patient’s cancer based on the anatomic extent of the disease at the time of diagnosis.
Updated Core Competencies Reflect Evolution of Nurse Navigator Role
Although care coordination and interdisciplinary collaboration are essential components of every oncology nurse’s role, oncology nurse navigators (ONNs) take that work even farther by helping patients and caregivers navigate a complex healthcare system and access much-needed resources. By ONS’s definition, ONNs are key in meeting patient and caregiver needs while providing evidence-based, cost-effective, and quality cancer care by eliminating barriers to timely care.
AHRQ Shutters National Guideline Clearinghouse Because of Budget Cuts
As of July 16, 2018, the Agency for Healthcare Research and Quality (AHRQ) through the U.S. Department of Health and Human Services ceased maintenance on guideline.gov, the website that housed the National Guideline Clearinghouse. The website had been a resource for healthcare providers for more than 20 years.
Which Is Not an ONS Recommendation When Accessing an Implanted Port?
Which of the following is not an ONS recommendation for practice when accessing an implanted port?
A. Sterile gloves must be worn during the procedure.
B. Palpate the outline of the port body prior to accessing.
C. Aspirate to confirm blood return after accessing.
D. Use only a noncoring needle.
Cancer and Immunotherapy Organizations Release Checkpoint Inhibitor Side Effect Guidelines
New guidelines and consensus recommendations for managing immune-related adverse events (irAEs) from checkpoint inhibitors are available from several key cancer and immunotherapy organizations: a collaboration between the American Society of Clinical Oncology and National Comprehensive Cancer Network, and a separate consensus recommendation from the Society for Immunotherapy of Cancer. ONS contributed to the development of both sets of guidelines.
National Roundtable Will Work to Increase HPV Vaccination
The American Cancer Society has partnered with the Centers for Disease Control and Prevention (CDC) to promote public awareness and adoption for the human papilloma virus (HPV) vaccine. The joint initiative, dubbed the National HPV Vaccination Roundtable, brings together public, private, and voluntary experts to raise awareness of the benefits of the vaccine in an effort to decrease incidence and mortality rates associated with HPV cancers.
What Competencies Are Required for Oncology Nurse Generalists?
Oncology nursing is rapidly evolving specialty. Nurses need to stay on top of a complex technologic environment, ever-changing science, and rapid assimilation of research into practice. In doing so, they attain and maintain a high level of competency to adequately and safely care for people with cancer.
What Are ONS’s Recommendations for Gowns When Handling Hazardous Drugs?
Although USP Chapter <800> implementation has been delayed, ONS experts are receiving questions about clarifications and specifics for wearing gowns when handling hazardous drugs (HDs). Questions include topics such as hanging gowns and reusing, length of time gowns can be worn, the need for gowns with oral chemotherapy agents, and materials requirements of gowns.
Should a Provider Be on Site During Chemotherapy Administration?
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.
What Precautions and Recommendations Are Necessary for Patients Receiving Oral Chemotherapy in the Home?
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.
Evidence-Based Standards Guide the Use and Maintenance of Venous Implanted Ports
Implanted ports are an important lifeline for patients receiving antineoplastic treatments; however, despite vast nursing research on the maintenance and utilization of venous implanted ports, still so much remains to be learned. Many of the practices surrounding implanted ports remain controversial.
Joint Commission Offers Telehealth Revisions to Hospital, Ambulatory Accreditation Standards
As healthcare institutions are looking to adopt new technologies to better assist patients, telehealth is becoming a prominent resource for many practitioners. By providing the ability to call or video conference with healthcare providers, institutions can offer patients the care they need from the comfort of their own homes.
Interpreting Guidelines Correctly Helps Workplaces Remain Compliant
Guidelines are established as tools to enhance patient care; however, translating guidelines can be difficult. Diana Scott, RN, MHA, CPHQ, senior director of accreditation services at Vizient, and Carma Herring, RN, MS, OCN®, from the John Stoddard Cancer Center, discussed mandates from the Joint Commission and Centers for Medicare and Medicaid Services (CMS), as well as tips for using guidelines and being compliant during a session at the 42nd Annual Congress in Denver, CO.
Revised USPSTF Draft Guidelines Recommend Individual Prostate Cancer Screening Decisions
The U.S. Preventive Services Task Force (USPSTF) has issued new draft revisions for prostate cancer screening guidelines. In the draft, the USPSTF has changed its previous stance on prostate-specific antigen (PSA) screening tests for men aged 55–69. The drafted guidelines now recommend PSA screening tests for men aged 55–69 based on individual assessment. The USPSTF has upgraded its recommendation from D to C, encouraging physicians to discuss with their patients whether PSA testing is right for them. The USPSTF still recommends against PSA screening tests in patients aged 70 or older.