Nurses Can Provide Safe Spaces for LGBTQ Patients With Cancer
The 2019–2022 ONS Research Agenda mentions LGBTQ patients with cancer among ONS’s research priorities for the very first time. A panel discussion at the 44th Annual ONS Congress focused on this underrepresented patient population, so we are making progress. In the past few years, our field has given a little more attention to LGBTQ patients with cancer, although I suspect that many of the issues are still pervasive.
FDA Approves Selinexor for Relapsed or Refractory Diffuse Large B-Cell Lymphoma
On June 22, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to selinexor (Xpovio®) for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from follicular lymphoma, after at least two lines of systemic therapy.
FDA Grants Accelerated Approval to Tazemetostat for Follicular Lymphoma
On June 18, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to tazemetostat (Tazverik™), an EZH2 inhibitor, for adult patients with relapsed or refractory follicular lymphoma whose tumors are positive for an EZH2 mutation, as detected by an FDA-approved test, who have received at least two prior systemic therapies and have no satisfactory alternative treatment options.
Polypharmacy Before Cancer Is Predictive of Post-Treatment Hospitalization
Patients who take five or more medications in the six months before beginning IV chemotherapy for a cancer diagnosis are more likely to be hospitalized after their chemotherapy treatment, according to the findings from a new study published in the Journal of Geriatric Oncology.
FDA Approves Pembrolizumab for Patients With TMB-H Solid Tumors
On June 16, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab (Keytruda®) for the treatment of adult and pediatric patients with unresectable or metastatic tumor mutational burden-high (TMB-H) [≥ 10 mutations/megabase (mut/Mb)] solid tumors, as determined by an FDA-approved test, that have progressed following prior treatment and have no satisfactory alternative treatment options.
An Oncology Nurse’s Primer on Genomics and Biomarker Terminology
With the massive paradigm shift in cancer therapy to precision medicine, the use of biomarkers and biomarker testing has also rapidly evolved to guide treatment selection. However, the terminology used in genomics is complex and inconsistent, and patient advocacy organizations recommend using a common taxonomy to prevent confusion among patients and providers alike. Nurses spend more time with patients and families than any other member of the healthcare team and can reinforce common language and terminology. As a nurse, here are the terms you need to understand.
Exercise Before ADT Treatment Reduces Rate of Side Effects
Beginning a supervised exercise program before the start of androgen deprivation therapy (ADT) for prostate cancer reduced the incidence of treatment-related side effects, researchers reported in a study published in BJU International.
FDA Extends Indication for Gemtuzumab Ozogamicin for CD33-Positive AML in Pediatric Patients
On June 16, 2020, the U.S. Food and Drug Administration (FDA) extended the indication of gemtuzumab ozogamicin (Mylotarg™) for newly-diagnosed CD33-positive acute myeloid leukemia (AML) to include pediatric patients aged 1 month and older.
FDA Grants Accelerated Approval to Lurbinectedin for Metastatic Small Cell Lung Cancer
On June 15, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to lurbinectedin (Zepzelca™) for adult patients with metastatic small cell lung cancer with disease progression on or after platinum-based chemotherapy.
Pelvic Radiation May Decrease Bone Mineral Density
Women receiving pelvic radiation therapy for gynecologic cancers are at higher risk for significant decreases in bone mineral density (BMD), with 7.8% of women in the study diagnosed with a pelvic fracture, according to findings from a study published in Cancer.
Manage Late Effects From HPV-Positive Oropharyngeal Cancers
The demographic of patients with oropharyngeal cancers is changing. Clinicians are diagnosing fewer older patients with a long history of heavy smoking and alcohol use; instead, a majority of patients are middle-aged Caucasian men who haven’t smoked but have had multiple sexual partners—and have tested positive for human papillomavirus.
Multiple Myeloma Prevention, Screening, Treatment, and Survivorship Recommendations
Multiple myeloma is a plasma cell neoplasm and the second most common hematologic malignancy in the United States, although overall incidence rates are relatively low at approximately 32,000 annually. The overall five-year survival rate is 52%, and most people are diagnosed with the disease in later stages.
How Nurses Can ‘Curb the Spread’ and Support Themselves
As the United States reopens and social distancing moves into different phases, concerns remain about containing the COVID-19 coronavirus. Anxiety and stress are high as nurses and other healthcare professionals who are caring for COVID-19 positive patients are worried about their own health and the health of their families. A paramount fear is inadvertently spreading the virus to ourselves or our loved ones.
LGBTQ Patients With Cancer
Recognized by the National Academies of Medicine as a population vulnerable to health disparities, people who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) experience specific health disparities, including limited access to health care, increased risk for certain disease types, and an inherent bias in the health system.
FDA Approves Ramucirumab Plus Erlotinib for First-Line Treatment of Metastatic NSCLC
On May 29, 2020, the U.S. Food and Drug Administration (FDA) approved ramucirumab (Cyramza®) in combination with erlotinib for first-line treatment of metastatic non-small cell lung cancer with epidermal growth factor receptor exon 19 deletions or exon 21 mutations.
FDA Approves Nivolumab Plus Ipilimumab and Chemotherapy for First-Line Treatment of Metastatic NSCLC
On May 26, 2020, the U.S. Food and Drug Administration (FDA) approved the combination of nivolumab plus ipilimumab and two cycles of platinum-doublet chemotherapy as first-line treatment for patients with metastatic or recurrent non-small cell lung cancer (NSCLC) with no epidermal growth factor receptor or anaplastic lymphoma kinase genomic tumor aberrations.
FDA Approves Brigatinib for ALK-Positive, Metastatic NSCLC
On May 22, 2020, the U.S. Food and Drug Administration (FDA) approved brigatinib (Alunbrig®) for adult patients with anaplastic lymphoma kinase (ALK)-positive, metastatic non-small cell lung cancer (NSCLC). FDA also approved the Vysis ALK Break Apart FISH Probe Kit as a companion diagnostic for brigatinib.
FDA Approves Olaparib for HRR Gene-Mutated, Metastatic, Castration-Resistant Prostate Cancer
On May 19, 2020, the U.S. Food and Drug Administration (FDA) approved olaparib (Lynparza®) for adult patients with deleterious or suspected deleterious germline or somatic homologous recombination repair (HRR) gene-mutated, metastatic, castration-resistant prostate cancer (mCRPC), who have progressed following prior treatment with enzalutamide or abiraterone.
FDA Approves Atezolizumab for First-Line Treatment of Metastatic NSCLC With High PD-L1 Expression
On May 18, 2020, the U.S. Food and Drug Administration (FDA) approved atezolizumab (Tecentriq®) for first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have high PD-L1 expression (PD-L1 staining ≥ 50% of tumor cells [TC] or PD-L1-stained tumor-infiltrating immune cells [IC] covering ≥ 10% of the tumor area), with no epidermal growth factor receptor or anaplastic lymphoma kinase genomic tumor aberrations.
FDA Approves Ripretinib for Advanced Gastrointestinal Stromal Tumor
On May 15, 2020, the U.S. Food and Drug Administration (FDA) approved ripretinib (Qinlock™) for adult patients with advanced gastrointestinal stromal tumors (GISTs) who received prior treatment with three or more kinase inhibitors, including imatinib.
FDA Grants Accelerated Approval to Rucaparib for BRCA-Mutated, Metastatic, Castration-Resistant Prostate Cancer
On May 15, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to rucaparib (Rubraca®) for patients with deleterious BRCA mutation (germline or somatic)-associated, metastatic, castration-resistant prostate cancer (mCRPC) who had been treated with androgen receptor-directed therapy and taxane-based chemotherapy.
FDA Approves Nivolumab Plus Ipilimumab for First-Line Metastatic Non-Small Cell Lung Cancer
On May 15, 2020, the U.S. Food and Drug Administration (FDA) approved the combination of nivolumab (Opdivo®) and ipilimumab (Yervoy®) as first-line treatment for patients with metastatic non-small cell lung cancer (NSCLC) whose tumors express PD-L1 (≥ 1%), as determined by an FDA-approved test, with no epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) genomic tumor aberrations.
FDA Grants Accelerated Approval to Pomalidomide for Kaposi Sarcoma
On May 14, 2020, the U.S. Food and Drug Administration (FDA) expanded the indication of pomalidomide (Pomalyst®) to include treating adult patients with AIDS-related Kaposi sarcoma after failure of highly active antiretroviral therapy and Kaposi sarcoma in adult patients who are HIV negative.
COVID-19 Talking Points for Patients With Cancer, Caregivers, and Family Members
To keep our communities safe and the most vulnerable people healthy, everyone needs to stay at home as much as possible. But patients with cancer and survivors must take extra steps to help maintain their health and safety. These patient education talking points can help people with cancer, as well as their family members and caregivers, stay well while staying at home.
How to Prevent Opioid Misuse While Effectively Managing Cancer Pain
Opioid misuse is prevalent among the U.S. population—so much so that President Trump declared it a public health emergency in 2017. At the same time, research shows that 20%–50% of patients with cancer and 80% of those with advanced-stage disease report experiencing moderate to severe pain. Balancing the dichotomies is difficult, but oncology nurses and other cancer care providers have a responsibility to provide comprehensive pain management for patients with cancer.
Harnessing the Abscopal Effect May Change Cancer Care
The abscopal effect is a unique phenomenon in cancer treatment that occurs when radiation shrinks untreated tumors found elsewhere in the body in addition to the targeted tumor. The effect has a long history, dating back to the 1950s, but it doesn’t commonly occur in practice and the mechanisms are not fully understood. Research has shown that combining immunotherapy with radiation increases the rate at which the abscopal effect occurs. Understanding how it appears in practice could potentially lead to new cancer treatments and a novel approach to combining immunotherapies with radiation.
Immunotherapies have revolutionized the approach to cancer treatment by leveraging patients’ own immune systems to fight the disease. But the novel therapies have also brought an evolution in traditional treatment regimens through their combination with chemotherapy, radiation, targeted therapy, or even other immunotherapy drugs.
Drug Combo May Be Effective for BRCA-Mutated Pancreatic Cancer
More than 65% of patients with germline BRCA/PALB2-mutated pancreatic ductal adenocarcinoma responded to treatment with combination cisplatin and gemcitabine, according to results of a study reported in the Journal of Clinical Oncology. Two- and three-year survival rates reached 31% and 18%, respectively.
What Happens During a Genetics Counseling Session?
When referring patients for genetics counseling and possible testing for hereditary risk, oncology nurses can help relieve their trepidation and anxiety by explaining what to expect during the visit. See the sidebar for key indications for referral.
Proper PPE Procedures for COVID-19
Although many oncology nurses are well versed in donning and doffing (removal) of personal protective equipment (PPE) for administering hazardous drugs, but not infection control. Additionally, nursing colleagues in other specialties may not wear PPE as part of their daily practice. As the COVID-19 novel coronavirus pandemic changes that, oncology nurses should understand PPE use for infection control to promote safety for nurses and patients.
Emotional Coping Strategies for COVID-19
The COVID-19 novel coronavirus pandemic is turning the world, inside and outside of the hospital, upside down. Not only are oncology nurses seeing high demands at work, but changes and restrictions are being instated at home as well.
U.S. Still Has Declining Cancer Death Rates, Latest National Report Says
Overall cancer death rates fell 1.5% on average per year from 2001–2017 in the United States for all cancer sites combined, according to the Annual Report to the Nation on the Status of Cancer from the Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), American Cancer Society, and North American Association of Central Cancer Registries.
Telehealth Visits During COVID-19
With the Centers for Disease Control and Prevention’s recommendations for practicing social distancing to slow the national risk of transmission of COVID-19 novel coronavirus, oncology nurses must take increased precautions with patients with cancer who are at increased risk for contracting or experiencing poorer outcomes from COVID-19. Patients require communication and education in these uncertain times.
NIDA Calls for Further Cannabis Research in Congress Testimony
Medical cannabis has been approved for use in more than 33 states, many of which have decriminalized its use as well, and a health policy wave has spread across the country through state referendums to ease the burden for legalizing cannabis for health purposes. It’s a different world than it was 30 years ago, and the National Institute on Drug Abuse (NIDA) is frequently called to testify before Congress to address concerns and questions from lawmakers.
BD Issues Class I Recall of Alaris System Infusion Pumps
On February 4, 2020, BD announced a recall of all lots of affected models of its Alaris System pump modules because of multiple system errors, software errors, and use-related errors. On March 6, 2020, the U.S. Food and Drug Administration identified it as a class I recall, its most serious level of recalls, because of the possibility of serious injuries or death.
COVID-19 Fact Sheet and Implications for Patients With Cancer
COVID-19 is a novel coronavirus (a large family of viruses that can cause cold-like illnesses) first identified in Wuhan, China, in December 2019. It is a respiratory illness and can be spread from person to person, possibly through respiratory droplets during close contact. The first case of COVID-19 in the United States was reported on January 21, 2020.
The Case of the Candy-Coated (Mis)Conception
P.G. is a 54-year-old woman who presents to the infusion center to receive her second cycle of chemotherapy for breast cancer. As her oncology nurse, you check the chemotherapy orders and patient history and are concerned to see that her weight has dropped by 10% from baseline, necessitating a change in dosing.
BRAF Mutations Guide Treatment in Metastatic Colorectal Cancer
Molecular profiling has become essential for the treatment of metastatic colorectal cancer (CRC) when surgery cannot be considered and systemic therapy is recommended. CRC has several potential mutations that are diagnostic, prognostic, and predictive. National Comprehensive Cancer Network (NCCN) guidelines recommend that advanced practice providers conduct RAS, BRAF, HER2, and MSI testing as part of a full molecular panel, review the results, and acted on them prior to starting patients on systemic therapy.
How DNA Sequencing Technologies Are Used in Cancer Care, Now and in the Future
Genomic testing identifies germline or inherited DNA changes that increase a person’s cancer risk, and it also can identify or profile the somatic or acquired changes in a tumor that guide selection of appropriate targeted therapies. The latter type of genomic testing is an analysis of DNA sequence information.
The Case of the CDK4/6 Inhibitors Checklist
Three years ago, Sarah, age 54, completed standard chemotherapy and radiation treatment for stage II, ER- and PR-positive, HER2-negative invasive breast cancer. A recent computed tomography scan, ordered to evaluate persistent hip pain, revealed bone lesions, and a biopsy and positron-emission tomography scan confirmed bone-only metastatic breast cancer. A CDK4/6 inhibitor, ribociclib, was added to the letrozole she was already taking.
Immune-Related Adverse Events With PD-1 Inhibitors in Head and Neck Cancer
Clinical trial results show that PD-1 inhibitors offer improved survival and a better safety profile compared to standard, single-agent chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck. However, because of their mechanism of action as immunotherapy, patients receiving the agents may experience immune-related adverse events (irAEs).
Ovarian Cancer: Prevention, Screening, Treatment, and Survivorship Recommendations
Even though its incidence is less common, ovarian cancer is the fifth leading cause of death from cancer in women, according to the American Cancer Society. It also estimated more than 22,000 new cases of ovarian cancer in 2019, with a five-year survival of 47% for all stages.
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.
Nurses Can Protect Patients From Neurotoxicity During Lumbar Puncture Procedures
When cleaning patients’ skin in preparation for lumbar puncture procedures, oncology nurses must consider side effects from use of various germicide solutions. Chlorhexidine gluconate (CHG) solution has been considered the broad-spectrum germicide effective against most nosocomial yeasts and gram-positive and -negative bacteria. It’s available as 2% or 5% CHG in 70% isopropyl alcohol and is used as an antiseptic for skin preparation and central venous catheter dressings.
Oncology Drug Reference Sheet: Entrectinib
Entrectinib was approved by the U.S. Food and Drug Administration in August 2019 as the third tumor-agnostic cancer drug, meaning it targets a specific mutation of the cancer, not the organ of origin. The other two currently approved tumor-agnostic drugs are larotrectinib and pembrolizumab.