Conflict Engagement Helps Providers Focus on Care
Nurses have an innate drive to improve healthcare delivery. When I was a unit director, I focused on nursing unit turnarounds to improve quality of care. I used mediation as the model for resolving long-time conflicts and provided training to effectively engage and communicate. I started my mediation practice in 2003 to help physicians, nurses, and administrators resolve the complex issues that get in the way of patient care and create stressful work environments.
HHS Solidifies Protections for LGBTQ Patients
In a May 2021 expansion to Section 1557 of the Affordable Care Act and the Title IX civil law, the U.S. Department of Health and Human Services (HHS), through the Office for Civil Rights, increased protections for lesbian, gay, bisexual, transgender, or queer (LGBTQ) people from discrimination. The revisions now prohibit discrimination based on sexual orientation and gender identity.
Big Tobacco Continues to Target Female Smokers, but Oncology Nurses Can Help
More than 16 million people who identify as women and girls in the United States reported smoking in 2021, according to a May 2021 report from the Campaign for Tobacco Free Kids, of which ONS is an active member, who partnered with several leading women’s organizations on the study. Female smokers are also significantly more likely than men to use menthol cigarettes, and e-cigarette use among high school girls rose by 89% from 2017–2020.
Research Between Structural Racism and Health Disparities Calls for Changes in Healthcare Delivery
Structural racism is repeatedly linked to health disparities, but a new agency report outlines plans to address discrimination and improve patient outcomes. In a special 2021 supplement to the journal Ethnicity and Disease, “Structural Racism and Discrimination: Impact on Minority Health and Health Disparities,” the National Institute on Minority Health and Health Disparities published a series of reports exploring the relationships between policies, practices, and health. It also included recommended solutions, including outcomes from interventions in a school district and a local health department and future research directions (e.g., examining ways racism embedded in online systems can contribute to health disparities).
APRNs Are Essential in Survivorship Programs
As the number of cancer survivors continues to grow in the United States, so too does the need for cancer survivorship programs. Oncology advanced practice RNs (APRNs) are essential team members as institutions develop and deliver comprehensive and holistic programs to meet survivors’ needs.
Research Findings Confirm Link Between Communication and Safety
My team’s current project to understand communication in ambulatory oncology settings stems from more than a decade of research (Kamimura et al.), in which we have tried to uncover the factors that facilitate high-quality cancer care for patients and a satisfying practice environment for care teams (Friese).
Career Changes Are Challenging, but Hold On to Hope
In nursing, we talk about progressing from novice to expert. I remember my feelings as a new nurse, of being overwhelmed by the many things that I didn’t know. Over time, I became comfortable in my growing knowledge. I developed skills, learned about diseases and treatments, and adapted to the politics of my particular unit and the people in it.
Nursing Considerations for Prostate Cancer Survivorship Care
Prostate cancer is the most common cancer among those assigned male at birth, with one in eight diagnosed during their lifetime. But with five-year survival rates of 90%, it’s also one of the most successful cancers to treat, making survivorship care even more important.
FDA Grants Accelerated Approval to Infigratinib for Metastatic Cholangiocarcinoma
On May 28, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to infigratinib (Truseltiq™), a kinase inhibitor for patients with previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with a fibroblast growth factor receptor 2 fusion or other rearrangement as detected by an FDA-approved test. FDA also approved the FoundationOne® CDx as a companion diagnostic for infigratinib.
Maximize Your Words’ Healing Power
Effectively treating a cancer diagnosis requires an immense amount of collaboration. Clinicians are equipped with the clinical knowledge to provide the best care possible, and sharing that crucial information with each other and patients is essential for optimal patient outcomes.
FDA Grants Accelerated Approval to Sotorasib for KRAS G12C-Mutated NSCLC
On May 28, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to sotorasib (Lumakras™), a RAS GTPase family inhibitor, for adult patients with KRAS G12Cmutated locally advanced or metastatic non-small cell lung cancer (NSCLC), as determined by an FDA approved test, who have received at least one prior systemic therapy.
FDA Approves Second PSMA-Targeted PET Imaging Drug for Prostate Cancer
On May 27, 2021, the U.S. Food and Drug Administration (FDA) approved piflufolastat F 18 (Pylarify®), a drug for positron-emission tomography (PET) imaging of prostate-specific membrane antigen (PSMA)-positive lesions in patients with prostate cancer.
Oncology Drug Reference Sheet: Trilaciclib
On February 12, 2021, the U.S. Food and Drug Administration approved trilaciclib (CoselaTM), a parenteral inhibitor of cyclin-dependent kinase, to prevent myelosuppression when administered prior to chemotherapy administration. The approval is currently limited to the use of trilaciclib before treatment with platinum- and etoposide-containing regimens and topotecan-containing regimens for treatment of extensive-stage small cell lung cancer.
FDA Grants Accelerated Approval to Amivantamab-Vmjw for Metastatic NSCLC
On May 21, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to amivantamab-vmjw (Rybrevant™), a bispecific antibody directed against epidermal growth factor receptor (EGFR) and MET receptor, for adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion mutations, as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy. FDA also approved the Guardant360® CDx as a companion diagnostic.
What the Evidence Says for Dance/Movement Therapy in Cancer Care
Dance/movement therapy is a complementary modality that may help patients manage cancer and its treatment-associated symptoms. Based on the concept that mind, body, and spirit are interconnected, it combines the communicative elements of dance and movement with other body-focused activities—such as guided imagery, mindfulness, breath awareness, and play—to create an emotionally inviting environment where participants can share feelings and experiences.
FDA Approves Nivolumab for Resected Esophageal or GEJ Cancer
On May 20, 2021, the U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) for patients with completely resected esophageal or gastroesophageal junction (GEJ) cancer with residual pathologic disease who have received neoadjuvant chemoradiotherapy.
The Case of the Weight Loss Wishes
Craig was diagnosed with colorectal cancer after a routine colonoscopy and subsequent colectomy. He meets with Lacey, the oncology nurse, to discuss managing the side effects of his FOLFOX chemotherapy. Lacey notes that Craig’s age is 71, weight is 255 lbs., and body mass index (a body fat ratio based on weight and height) is 38. Craig describes his activity level as “walking to the mailbox and exercising my fingers on the remote control. This cancer treatment will help me knock off some of this extra weight.”
Nursing Considerations for Melanoma Survivorship Care
Breast, prostate, colorectal, and melanoma are the most common primary cancer sites among 58% of survivors. Advancements in immunotherapy and targeted therapies have significantly increased treatment options for a disease that once had very limited treatment options, markedly improving overall five-year survival rates for patients with melanoma. Yet survival rates vary depending on extent of disease (local versus metastatic) and ethnic minority disparities. Although the overall (all stages combined) five-year survival rate for White patients with melanoma is 93%, the rate drops to 87% for Hispanics and to just 23% for those with distant melanoma.
Larotrectinib and Other Tumor-Agnostic Targeted Therapies Are Leading Cancer Care Into the Next Frontier
In 2018, the cancer drug larotrectinib quietly became a milestone along the evolving path to approaching cancer therapy: it was the first agent approved to treat a genetic variant, not a specific type of cancer or disease site. And as oncology treatment science progresses, many predict that it won’t be the last—it’s already been joined by pembrolizumab and entrectinib as tumor-agnostic therapies. The key to curing cancer may be hidden in the disease’s genetic code rather than its location in the body.
Genetic Disorder Reference Sheet: BRCA1 and BRCA2 Hereditary Cancers
BRCA1- or BRCA2-associated hereditary breast and ovarian cancer is the most common form of hereditary breast and ovarian cancer. The prevalence of BRCA1 and BRCA2 pathogenic variants in the general population is estimated at 1 in 400–500 people, although it increases to 1 in 40 for those of Ashkenazi Jewish ancestry, which is linked to three founder pathogenic variants (BRCA1 c.68_69delAG, BRCA1c.5266dupC, and BRCA2 c.5946delT).
FDA Grants Accelerated Approval to Pembrolizumab for HER2-Positive Gastric Cancer
On May 5, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab (Keytruda®) in combination with trastuzumab and fluoropyrimidine- and platinum-containing chemotherapy for first-line treatment of patients with locally advanced unresectable or metastatic HER2-positive gastric or gastroesophageal junction (GEJ) adenocarcinoma.
How to Handle Even the Worst Radiation Therapy Side Effects
Some of the most painful side effects of cancer and its treatment occur with radiation therapy. Although patients may find the effects emotionally devastating, nurses can help take a proactive management approach by preparing patients for what’s ahead. Annette Quinn, RN, MSN, from the University of Pittsburgh Hillman Cancer Center, outlined the most common but distressing side effects and tips for managing them during a session held on April 29, 2021, for the 46th Annual ONS Congress™.
Time in Nature Is Time Well Spent
“Nature alone cures,” Florence Nightingale instructed her fellow nurses in Notes on Nursing—and we’ve continued to follow that principle, creating a healing environment for our patients that involves fresh air and sunlight. That same environment can promote health in nurses as well.
FDA Grants Accelerated Approval to Loncastuximab Tesirine-Lpyl for Large B-Cell Lymphoma
On April 23, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to loncastuximab tesirine-lpyl (Zynlonta™), a CD19-directed antibody and alkylating agent conjugate, for adult patients with relapsed or refractory large B-cell lymphoma, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, DLBCL arising from low grade lymphoma, and high-grade B-cell lymphoma, after two or more lines of systemic therapy.
FDA Grants Accelerated Approval to Dostarlimab-Gxly for dMMR Endometrial Cancer
On April 22, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to dostarlimab-gxly (Jemperli), an anti-PD-1 antibody, for adult patients with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer, as determined by an FDA-approved test, that has progressed on or following treatment with a prior platinum-containing regimen.
HER2 Status Has Implications for Breast Cancer Treatment and Nursing Care
Breast cancer is classified by several factors, including the presence of human epidermal growth factor receptor 2 (HER2), a type of growth-promoting protein found on the surface of cells. All breast cells have HER2 receptors, but some breast cancers have more HER2 receptors than normal, which may promote tumor growth. About 60% of breast cancers have some level of HER2 expression, and approximately one in five patients has high levels of the HER2 protein, which is considered HER2-positive.
Research Shows That Better Cancer Care Requires Listening—to Both Patients and Clinicians
Oncology nursing research has a powerful impact on quality care and positive patient outcomes, but the science must be grounded in clinical context because researchers’ ultimate goal is to disseminate their findings to clinicians to facilitate practice change, ONS’s 2021 Distinguished Researcher Christopher Friese, PhD, RN, AOCN®, FAAN, of the University of Michigan and Rogel Cancer Center, said during his session for the 46th Annual ONS Congress™ on April 22, 2021.
FDA Announces Several New Recalls of BD Alaris Pump Module Model 8100 Because of Key and Bezel Problems
On April 16, 2021, the U.S. Food and Drug Administration (FDA) reported Care Fusion 303, Inc.’s, recall of the BD Alaris Pump Module 8100 because the device may experience stuck or unresponsive keys during operation. FDA identified it as a class I recall, the most serious type of recall, where use of the devices may cause serious injuries or death.
The Case of the Transgender Considerations for Cancer Screening
Sally, a nurse practitioner in a cancer survivorship clinic, is preparing to discuss screening and surveillance guidelines with Jonah, a 32-year-old survivor of Hodgkin lymphoma. Sally reviews Jonah’s patient history form and notes that Jonah uses he and him pronouns. His gender identity is male and sex assigned at birth was female. Jonah’s surgical history includes gender-affirming surgery on chest tissue (also known as top surgery), and his current medications include supplemental testosterone. Jonah also specifies that he is transmasculine—an umbrella term used to indicate that Jonah feels a connection with masculinity.
FDA Approves Nivolumab in Combination With Chemotherapy for Metastatic Gastric Cancer and Esophageal Adenocarcinoma
On April 16, 2021, the U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) in combination with fluoropyrimidine- and platinum-containing chemotherapy for advanced or metastatic gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma.
FDA Grants Accelerated Approval to Sacituzumab Govitecan for Advanced Urothelial Cancer
On April 13, 2021, the U.S. Food and Drug Administration (FDA) granted accelerated approval to sacituzumab govitecan (Trodelvy®) for patients with locally advanced or metastatic urothelial cancer who previously received a platinum-containing chemotherapy and either a programmed death receptor-1 or a programmed death-ligand 1 inhibitor.
Nursing Management of Adverse Events From Enfortumab Vedotin Therapy for Urothelial Cancer
Once patients stop responding to platinum-based chemotherapy for locally advanced or metastatic urothelial cancer, their treatment options had been somewhat limited: PD-1/PD-L1 inhibitors were effective in only 13%–29% of patients and taxanes in only 11%–13%. When the antibody drug conjugate enfortumab vedotin was approved in late 2019, it offered new hope for patients and providers, with clinical trials reporting a 44% objective response rate.
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.
The Case of the Targeted Therapy Toxicity
Tyrone is a 74-year-old man with a history of acute myeloid leukemia (AML), type 2 diabetes, and hypertension who was admitted to the hospital after lab results revealed 40% circulating blasts in his peripheral blood that was concerning for relapsed disease. He was diagnosed with AML three years ago and achieved remission after treatment with a hypomethylating agent.
Nursing Considerations for Head and Neck Cancer Survivorship Care
Despite accounting for only 3% of all cancer survivors, patients with head and neck cancers often require significant support and survivorship care. And oncology nurses can expect survivorship to grow with recent improvements in prognosis and treatment options, such as with reductions in human papillomavirus-related oropharyngeal cancers, which tend to affect young people and offer improved long-term survival rates.
FDA Approves Sacituzumab Govitecan for Triple-Negative Breast Cancer
On April 7, 2021, the U.S. Food and Drug Administration (FDA) granted regular approval to sacituzumab govitecan (Trodelvy®) for patients with unresectable locally advanced or metastatic triple-negative breast cancer who received two or more prior systemic therapies, at least one of which for metastatic disease.
FDA Approves New Cetuximab Dosing Regimen for Colorectal Cancer and Squamous Cell Carcinoma
On April 6, 2021, the U.S. Food and Drug Administration (FDA) approved a new dosage regimen for cetuximab (Erbitux®) of 500 mg/m2 via IV infusion for 120 minutes every two weeks for patients with KRAS wild-type, epidermal growth factor receptor-expressing colorectal cancer or squamous cell carcinoma of the head and neck.
FDA Issues Safety Communication for ADM Products Used in Implant-Based Breast Reconstruction
On March 31, 2021, the U.S. Food and Drug Administration (FDA) issued a safety communication informing patients, caregivers, and healthcare providers that certain acellular dermal matrix (ADM) products used in implant-based breast reconstruction may have a higher chance for complications or problems.
FDA Approves Isatuximab-Irfc for Multiple Myeloma
On March 31, 2021, the U.S. Food and Drug Administration (FDA) approved isatuximab-irfc (Sarclisa®) in combination with carfilzomib and dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received one to three prior lines of therapy.
FDA Approves Idecabtagene Vicleucel as the First Cell-Based Gene Therapy for Adult Patients With Multiple Myeloma
On March 27, 2021, the U.S. Food and Drug Administration (FDA) approved idecabtagene vicleucel (Abecma), for the treatment of adult patients with relapsed or refractory multiple myeloma after four or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody. This is the first FDA-approved cell-based gene therapy for multiple myeloma.
Zydus Pharmaceuticals Inc. Issues Voluntary Nationwide Recall of Acyclovir Sodium Injection
On March 25, 2021, the U.S. Food and Drug Administration shared Zydus Pharmaceuticals Inc.’s notice of its voluntary recall of four lots of acyclovir sodium injection 50 mg/ml, supplied in 10 ml and 20 ml vials, after receiving reports of crystallization in the product.
The Case of the Cord Blood Match
Zhang is a 67-year-old man who had no history of medical concerns until he was hospitalized for pneumonia. A complete blood count taken during his workup for pneumonia showed pancytopenia, and a biopsy confirmed a diagnosis of acute myeloid leukemia. After multiple rounds of induction therapy, Zhang's bone marrow biopsy showed minimal residual disease and he entered remission. His oncologist recommends an allogeneic hematopoietic stem cell transplant as soon as possible because of the disease's aggressive nature, but he has no match in the registry.
Infection Prevention for Oncology Nurses
Regardless of care setting, oncology nurses must be vigilant about creating a safe environment for and educating patients about the importance of infection prevention. Patients with cancer are at increased risk for viral, bacterial, and fungal infections, but the extent depends on cancer type and treatment.
Genetic Disorder Reference Sheet: CHEK2 Gene Pathogenic Variants
The CHEK2 (checkpoint kinase 2) tumor suppressor gene provides cells with instructions for making a protein known as CHK2, which becomes active when the cell’s DNA is damaged or strands of it break. CHEK2 halts cell division and enables either cell repair or destruction. Without a properly functioning CHEK2 gene, cells lose a key restraint on their growth which may lead to uncontrolled cells and possibly malignancy. CHEK2*1100delC is the most common pathogenic variant and most prevalent in European populations.
FDA Approves Pembrolizumab for Esophageal or GEJ Carcinoma
On March 22, 2021, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for use in combination with platinum- and fluoropyrimidine-based chemotherapy for patients with metastatic or locally advanced esophageal or gastroesophageal junction (GEJ) (tumors with an epicenter 1–5 cm above the gastroesophageal junction) carcinoma who are not candidates for surgical resection or definitive chemoradiation.
FDA Advises Healthcare Professionals Not to Use BD’s ChloraPrep™ 3 ml Applicators
On March 19, 2021, the U.S. Food and Drug Administration (FDA) issued an advisory to healthcare professionals not to use ChloraPrep 3 ml applicators manufactured by BD (Becton, Dickinson and Company) because of the risk of microbial contamination. The product was distributed globally and is labeled with “CareFusion, El Paso, TX.”