Metastatic colorectal cancer (CRC) remains a significant health problem as the second leading cause of cancer death in the United States and the fourth most frequently diagnosed cancer. Despite improvements in some age groups, its incidence has actually been increasing in patients younger than 50 years. The cause of this trend is currently unknown.   

Oncology care is a complex field in a constant state of paradigm shifts, where new information and research affect clinical practice in countless ways. Amid rapid developments in treatments, technologies, and patient-care modalities, oncology nurses must show they’re up to date with emerging knowledge in their field. Oncology nurse certification is one way nurses can demonstrate their commitment to the art and science of patient-centered oncology care.

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.

Immunotherapy may place patients at risk for distinctive toxicities that differ from traditional chemotherapy. One example is endocrine dysfunction, including hypophysitis, hypo- or hyperthyroidism, type 1 diabetes, and primary adrenal insufficiency. 

The twenty-six bones in the foot are always being stepped on. Getting on one’s nerves takes on a whole new meaning when considering that each foot contains an estimated 200,000 nerve endings. With health enthusiasts recommending 10,000 steps per day, which translates to approximately five miles, is it any wonder that the often-abused soles deserve a little self-care? 

Cabozantinib (Cabometyx^®) received an additional U.S. Food and Drug Administration (FDA)-approved indication in January 2019 for use in patients with hepatocellular carcinoma (HCC) who have already been treated with sorafenib. It received prior approval for the treatment of renal cell carcinoma in 2017. The research leading to the approval in the HCC setting showed improved overall survival, progression-free survival, and overall response in the cabozantinib treatment arm.

On April 19, 2019, the U.S. Food and Drug Administration (FDA) approved pembrolizumab plus axitinib for the first-line treatment of patients with advanced renal cell carcinoma.

Because of its long infusion time over 46–48 hours, 5-fluorouracil (5-FU) is usually administered with an ambulatory infusion pump in the outpatient setting. However, two types of pumps exist. On one side of the spectrum is the elastomeric pump: small, compact, but gets the job done. On the other is the electronic pump: bigger, flashy, with lots of bells and whistles (literally). Here are the advantages and disadvantages of each.

Eighteen months after completing surgical debulking and chemotherapy for stage III high-grade serous ovarian cancer, 56-year-old Lily experienced a rising CA-125 level. At her oncologist’s recommendation, Lily started an aromatase inhibitor, but it did not stop the rising tumor marker. After she began experiencing symptoms of bloating and mild abdominal pain, Lily and her oncologist decided to proceed with second-line chemotherapy. As she left the office, Lily remarked that she did not complete genetic testing when she was originally diagnosed because she does not have any children or a family history of ovarian cancer and she was concerned that her insurance would not cover the testing.

Patients with cancer are living longer, embarking on complex treatment regimens, and experiencing more complications associated with care. As a result, a large volume of patients with cancer require urgent or emergency visits throughout their disease trajectory. Although the need remains constant, what has evolved over time are the chief complaints that bring patients in, the care associated with complications, and new options to lower the burden and cost of care.    

Making a treatment decision for a cancer diagnosis is a very complex and challenging event for patients. This is particularly evident among men with prostate cancer. Because so many treatment options exist, often without a single best therapeutic or medical outcome, many men with prostate cancer may have challenges when making a treatment decision. Most patients rely on their providers to help them better understand their diagnosis, available treatments, impact, and side effects from treatment, but patients will ultimately seek external information to inform their decision-making process.

As the use of oxaliplatin in the treatment of gastrointestinal, gynecologic, and other cancers continues to grow, so too does the incidence of hypersensitivity reactions connected to the drug. Because the development of HSRs may require patients to discontinue oxaliplatin even if it’s effective against their cancer, oncology nurses need to be able to prevent or minimize reactions whenever possible.

“Two heads are better than one” is an idiom so old and often used that it borders on cliché. But as with most colloquial sayings, a kernel of truth is buried underneath. Combining forces to solve problems, overcome obstacles, and coordinate efforts is the key to nearly every successful endeavor, and it’s especially true for patients and providers navigating the cancer journey. 

Which of the Following Late Symptoms of Increased Intracranial Pressure Is Not Included of the Cushing Triad?

A. Hypertension with widening pulse pressure 

B. Bradycardia 

C. Seizure 

D. Abnormal respirations 

In November 2018, the U.S. Food and Drug Administration (FDA) approved glasdegib (Daurismo™) for use in combination with low-dose cytarabine for treatment of patients with newly diagnosed acute myeloid leukemia who are not eligible for intensive chemotherapy. Data from clinical trials indicated that the regimen is safe for older adults and those with significant comorbidities, such as cardiac disease, poor performance status, or elevated serum creatinine.

A. Adoptive transfer 

B. Antibody-dependent cellular cytotoxicity 

C. Pathogen associated molecular patterns 

D. Phagocytosis 

Reactive oxygen species (ROS), such as hydroxyl and superoxide radicals, singlet oxygen, and hydrogen peroxide, are byproducts of metabolic processes in the body and play an important role in regulating cell physiology and function. But uncontrolled ROS formation (oxidative stress) can result in DNA, protein, and lipid damage, which has been implicated in several diseases, including cancer. Antioxidants, produced endogenously or in supplemental form, function as ROS scavengers and inhibit oxidative stress. Popular antioxidants include vitamins C and E, selenium, beta carotene, lycopene, resveratrol, flavonoids, anthocyanins, and catechins. They are widely used to prevent cancer and its recurrence.

Which of the Following Leads to the Greatest Percentage of Superior Vena Cava Syndrome Cases?           

A. Small cell lung cancer

B. Non-Hodgkin lymphoma

C. Non-small cell lung cancer 

D. Kaposi sarcoma                

According to an Agency for Healthcare Research and Quality (AHRQ) analysis, the number of hospital-acquired conditions (HACs) reported in the United States dropped by 910,000 (13%) from 2014–2017. 

Genomic testing—identifying variants, like mutations, in tumor cells to inform patient treatment options—occasionally comes with unanticipated results that clinicians have to address with their patients. Clinicians and patients alike are often hopeful that tumor genomic testing will identify a personalized cancer treatment. Indeed, many patients have benefited from being candidates for new targeted therapies identified through genomic testing. 

Every cancer diagnosis is as individualized and unique as the person receiving it. From family history to societal and economic background to a patient’s genetic make-up and composition, cancer affects each person with cancer differently. Initiatives like precision medicine are based in data that suggest that a personalized disease should have its own personalized treatment. As a subset of precision medicine, precision oncology assesses a patient’s unique genetic profile to help align targeted therapies to hit the right cancer subtypes. 

A provider develops a partnership with a patient and negotiates behaviors to reach an agreement to adhere to oral chemotherapy medication. This is an example of which strategy?

a. Reinforcement

b. Operant conditioning

c. Motivational interviewing

d. Partnership   

On February 22, 2019, the U.S. Food and Drug Administration (FDA) approved trifluridine/tipiracil tablets (Lonsurf)—a fixed combination of trifluridine, a nucleoside metabolic inhibitor, and tipiracil, a thymidine phosphorylase inhibitor—for adult patients with metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma previously treated with at least two prior lines of chemotherapy that included a fluoropyrimidine, a platinum, either a taxane or irinotecan, and if appropriate, HER2/neu-targeted therapy.

Ribociclib is a CDK 4/6 inhibitor first approved by the U.S. Food and Drug Administration in early 2017 for postmenopausal women with HR-positive, HER2-negative advanced or metastatic breast cancer in combination with an aromatase inhibitor as initial endocrine therapy, based on the MONALEESA trial results. 

Immunotherapy has a unique set of toxicities in comparison to traditional chemotherapy. Endocrine dysfunction, including hypo- or hyperthyroidism, hypophysitis, type-1 diabetes, and primary adrenal insufficiency, may occur. Advanced practice RNs (APRNs) have a role in monitoring and treating patients for endocrine-related toxicities.

On February 15, 2019, the U.S. Food and Drug Administration (FDA) approved pembrolizumab for the adjuvant treatment of patients with melanoma with involvement of lymph node(s) following complete resection. 

Oncology nurses interact with other staff, patients, and families, each of whom have various cultural and personal preferences. A person’s culture encompasses race, ethnicity, spiritual practices, social habits, and so much more. 

A. Diagnostic liquid biopsies

B. Hematologic staging criteria

C. Anatomic prognostic factors

D. Nonanatomic prognostic factors

Although 5-fluorouracil (5-FU) and capecitabine (the oral prodrug of 5-FU) are generally well tolerated, patients can experience severe toxicities from either drug that can be life-threatening if not treated quickly. Of the 275,000 patients who receive 5-FU each year, more than 1,300 die from 5-FU toxicity, or approximately 3–4 patients per day.

When patients with cancer also suffer from psychiatric diagnoses, it can present unique challenges to healthcare professionals. Because oncology nurses build relationships with patients while addressing issues, understanding the obstacles to practice is key to providing the best possible care. By having a keen understanding of symptoms, assessment procedures, and necessary response skills, oncology nurses can work together with the mental health team to provide holistic care throughout the cancer journey. 

Nearly 20% of Americans experience mental illness in a given year, according to the National Alliance on Mental Illness. With diagnoses such as schizophrenia, bipolar disorder, or major depression, about one in every 25 Americans suffers from a serious mental illness that directly affects major life activities. The prevalence of mental illness in the United States can have a downstream effect on cancer care and patient outcomes, and with these statistics, oncology nurses may encounter patients with cancer who have pre-existing psychiatric disorders. Healthcare providers in fields outside of psychology need to be prepared to address the unique needs and individualized care required to support this patient population during and beyond cancer treatment. 

Recognizing the national opioid epidemic in the United States, the National Institutes of Health (NIH) has allocated a new funding stream for new research to address public health issues like prescription drug abuse and overdose. Through the Helping to End Addiction Long-Term (HEAL) Initiative, the NIH is offering 30 funding opportunities for researchers, awarding $850 million in support.

Which of the Following Drug Is Most Likely to Have a Synergistic Effect When Combined With Radiation Therapy?

A. Amifostine 

B. Pentoxifylline 

C. Palifermin 

D. Ipilimumab

Lutetium Lu 177 dototate (Lutathera^®) was approved in January 2018 by the U.S. Food and Drug Administration to treat a specific group of neuroendocrine tumors (NETs) in the gastrointestinal tract. NETs are rare, and the tumors produce hormone-like substances in response to signals from the nervous system.

Neuroendocrine cancers are rare malignancies; however, their incidence is thought to be increasing. Such tumors are characterized by their overexpression of somatostatin receptors, present in up to 80% of cases. However, a novel radiopharmaceutical may give advanced practice RNs (APRNs) a new option to treat certain gastroenteropancreatic neuroendocrine tumors.

When patients go home after receiving their regimen of powerful cytotoxic agents, oncology nurses routinely encourage them to double flush after using the bathroom to ensure that trace amounts of hazardous medication are eliminated from the environment to prevent other members of the household from being exposed. But what happens with chemotherapy chemicals found in human waste as they enter a patient’s septic system—and eventually the water supply?

On January 14, 2019, the U.S. Food and Drug Administration (FDA) approved cabozantinib for patients with hepatocellular carcinoma who have been previously treated with sorafenib.

During the morning shift change, Charlie, an RN, receives a report on Ellis, age 52, who was admitted three days ago for severe abdominal pain and persistent diarrhea after cycle 3 of high-dose ipilumumab and nivolumab.

When Charlie and the certified nursing assistant (CNA) enter Ellis’s room, the patient is sitting up in bed caressing hands with a woman of similar age. Ellis requests help getting into the shower, so Charlie says to the CNA, “Please, help him shower, and I will finish introductions.” 

Ellis interrupts Charlie. “I am not a he!” 

Which of the Following Represents the Rate of Radioactive Decay Equal to One Disintegration per Second? 

A. Gray

B. Becquerel  

C. Curie

Practice reflection is a critical element of self-care for an oncology nurse, and one way to reflect is through storytelling. Whether it’s sharing your own stories or your patients’ stories, writing them down and speaking them aloud to yourself, your family, a small group, or more can be a healing self-care experience.

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.

One way that cancer has been able to evade the immune system is through overexpression of immune checkpoint proteins (immune inhibitory pathway), which allow cancer cells to be considered “self” instead of foreign and block T-cell action. Immune checkpoint proteins cytotoxic T-lymphocyte–associated 4 (CTLA-4) and programmed cell death protein (PD-1) are receptors that are expressed on the surface of cytotoxic T cells. Immune checkpoint inhibitors prevent those receptors from binding to their natural ligands, disrupting the immune inhibitory pathway. See Table 1 for a list of approved agents and indications.  

A majority of the U.S. Food and Drug Administration (FDA) approvals for cancer agents in the latter part of 2018 represented second and third approvals for new indications in other disease sites. Many were given expedited approval, but with that comes the potential that the incidence of adverse events may be underrepresented because fewer patients received the agents in a clinical trial setting. 

On December 14, 2018, the U.S. Food and Drug Administration (FDA) approved romiplostim for pediatric patients one year of age and older with immune thrombocytopenia for at least six months who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.

Ongoing therapy with afatinib—an oral, irreversible ErbB family blocker—for as long as it is effective and tolerable is considered first-line treatment for metastatic non-small cell lung cancer in patients with EGFR mutations. In their article in the October 2018 issue of the Clinical Journal of Oncology Nursing, Edwards, Adan, Lalla, Lacouture, O’Brien, and Sequist discussed the most common adverse events (AEs) associated with afatinib and their real-life experiences managing them in clinical practice to keep patients on therapy.