Oncology Nursing QI Project Shows Normal Saline Is Comparable to Heparin for Pediatric CVCs
Emerging evidence has consistently shown that flushing central venous catheters with normal saline is comparable to heparin flushes in the adult care setting, leading to updated guideline recommendations that include saline as an alternative. But to date, only two studies have evaluated the two options in pediatric patients, the older of which found increased complications when used in children with leukemia or lymphoma. Is normal saline an acceptable alternative in that population?
FDA Warns About Risk of Death and Serious Side Effects With Duvelisib
On June 30, 2022, the U.S. Food and Drug Administration issued a drug safety communication for duvelisib (Copiktra®) after results from a clinical trial showed a possible increased risk of death associated with the agent, which is approved for the treatment of adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL who have received at least two prior therapies. The clinical trial results also associated duvelisib with a higher risk of serious side effects, including infections, diarrhea, lung and intestinal inflammation, skin reactions, and elevated liver enzymes.
Self-Affirmations Build Your Personal and Moral Resiliency
Positive phrases or statements that challenge negative or unhelpful thoughts can motivate you, encourage positive lifestyle changes, and boost your self-esteem. Repeat self-affirmation mantras regularly to fully reap the benefits of this practice and make long-term changes to the way you think and feel.
Healthcare Organizations Advocate for Clinical Trial Diversity in Letter to Congress
Healthcare organizations advocated to improve diversity among clinical trials in a letter sent to U.S. Congress in May encouraging the government to take steps as the reauthorization of the Prescription Drug User Fee Act (PDUFA) approaches. The PDUFA allows the U.S. Food and Drug Administration to review and approve drugs, but the authorization is set to expire in September of 2022.
Support Patients’ Autonomy and Cultural Choices
You are the oncology nurse caring for Maria, who has been diagnosed with non-small cell lung cancer (NSCLC). She says she doesn’t understand how she developed lung cancer because she has always lived a clean lifestyle according to her religious practices. You notice that although Maria is initially conversant with you, she allows her husband to speak for her whenever he is present. When you mention your observation to Maria, she tells you that in her religious culture, medical decisions are deferred to the high elders of the church.
FDA Says It’s Continuing to Evaluate Pulse Oximeters’ Race-Related Accuracy and Limitations
More than a year and a half after a report suggesting a potential racial bias in pulse oximeter technology first surfaced as a letter to the editor in the New England Journal of Medicine (NEJM), on June 21, 2022, the U.S. Food and Drug Administration (FDA) said that it is continuing its investigation into the devices’ accuracy and performance, particularly among people of color.
Oncology Drug Reference Sheet: Loncastuximab Tesirine-Lpyl
Based on LOTIS-2 trial results that reported an overall response rate of nearly 50%, in April 2021 the U.S. Food and Drug Administration granted accelerated approval to loncastuximab tesirine-lpyl (ZynlontaTM) for adults with relapsed or refractory large B-cell lymphoma.
The Case of the Late Head and Neck Lymphedema
Samuel, a 55-year-old patient with a history of T3N1M0 oropharyngeal HPV+ cancer on the base of his tongue, underwent surgery followed by 70 Gy of intensity-modulated radiation over seven weeks with concurrent weekly cisplatin. He responded well and had a positron emission tomography (PET) scan three months post-treatment that showed no cancer. Two months later, Samuel calls the triage line to report swelling on the left side of his neck, the same area where he first noticed a lymph node that led to his initial diagnosis.
Maintain Oral Adherence With ONS Guidelines™
With so many of today’s cancer treatments administered orally, ensuring that patients adhere to their regimen as prescribed is essential to optimal outcomes. According to the World Health Organization, medication adherence is the single most important modifiable factor that affects treatment outcomes.
Pediatric Patients With Cancer Are Vulnerable to Sleep Disturbance
Sleep disturbance has a significant impact on quality of life, including mental and physical health and academic, cognitive, and social functioning. It is one of the most common symptoms reported by pediatric patients with cancer and is significantly related to neurocognitive function for survivors.
FDA Reports Recall of Milk of Magnesia Oral Suspension and Magnesium Hydroxide/Aluminum Hydroxide/Simethicone Oral Suspension
On June 8, 2022, the U.S. Food and Drug Administration (FDA) reported Plastikon Healthcare's voluntarily recall of one lot of Milk of Magnesia 2,400 mg/10 ml oral suspension, one lot of Milk of Magnesia 2,400 mg/30 ml oral suspension, 11 lots of magnesium hydroxide 1,200 mg/aluminum hydroxide 1,200 mg/simethicone 120 mg per 30 ml oral suspension, and two lots of magnesium hydroxide 2,400 mg/aluminum hydroxide 2,400 mg/simethicone 240 mg per 30 ml oral suspension to the consumer level because of microbial contamination.
Independent Advocates Help Patients With Dementia Navigate Cancer Care
Clinicians have an implicit—if not explicit—obligation to advocate for their patients. However, as health care’s complexity increases, independent advocates can help patients navigate systematic challenges throughout the continuum. Independent advocates follow the patient, not the reimbursement constraints, a chief distinction between us and clinical, facility, or agency case managers.
Childhood Cancer Survivors Have Healthy but Riskier Pregnancies
Babies born to adult survivors of childhood cancers are as healthy as those born to adults without a history of cancer, but survivors have a higher risk of severe complications during pregnancy, researchers reported in the Journal of the National Cancer Institute.
FDA Reports Illumina Cybersecurity Vulnerability May Present Risks for Patient Results and Customer Networks
On June 2, 2022, the U.S. Food and Drug Administration (FDA) reported a cybersecurity vulnerability that affects software in the Illumina NextSeq 550Dx, MiSeqDx, NextSeq 500, NextSeq 550, MiSeq, iSeq, and MiniSeq next generation sequencing instruments. The devices are used in diagnostic (Dx), research-use only (RUO), or dual boot (either Dx or RUO) modes.
Connect With Your Patients on a Human Level as Well as a Healthcare Level
As a healthcare provider, I had been warned about getting too close to my patients. They told me that it was unprofessional, it would cloud my judgment, it would lead to emotional burnout, and various other reasons. For my first year as a nurse, I took that advice to heart and kept my emotional distance while still doing my best to provide care to the whole patient. Then one night I met Jeff, and everything changed.
FDA Withdraws Approval of Umbralisib Because of Safety Concerns
Because of safety concerns, the U.S. Food and Drug Administration (FDA) withdrew its approval of umbralisib (Ukoniq®) on June 1, 2022. Umbralisib had been approved to treat marginal zone lymphoma (MZL) and follicular lymphoma (FL).
FDA Approves Tisagenlecleucel for Relapsed or Refractory Follicular Lymphoma
On May 27, 2022, the U.S. Food and Drug Administration (FDA) granted accelerated approval to tisagenlecleucel (Kymriah®) for adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.
FDA Approves Nivolumab in Combination With Chemotherapy and in Combination With Ipilimumab for First-Line Esophageal Squamous Cell Carcinoma Indications
On May 27, 2022, the U.S. Food and Drug Administration (FDA) approved nivolumab (Opdivo®) in combination with fluoropyrimidine- and platinum-based chemotherapy and nivolumab in combination with ipilimumab (Yervoy®) for the first-line treatment of patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC).
Rest, Unwind, and Reflect so You Can Lead by Example
Many nurses, even those in leadership, believe in the misconception that well-being is an indulgence or luxury they cannot afford, but this simply isn’t the case: it’s an investment that can improve your effectiveness, especially as a leader.
FDA Approves Ivosidenib in Combination With Azacitidine for Newly Diagnosed Acute Myeloid Leukemia
On May 25, 2022, the U.S. Food and Drug Administration (FDA) approved ivosidenib (Tibsovo®) in combination with azacitidine for patients with newly diagnosed acute myeloid leukemia (AML) with a susceptible IDH1 variant as detected by an FDA-approved test in adults aged 75 years or older or those who have comorbidities that preclude use of intensive induction chemotherapy.
Mrs. Jones Gave Me the ‘Ah-Ha’ Moment That Guided My Entire Nursing Career
After years of hard work, Mrs. Jones and her husband had what seemed to be an idyllic life traveling and enjoying their life together. As a newly minted nurse on the medical/surgical unit, I got to know them over the months I cared for her during repeated admissions for melanoma. At each admission, they would be side by side, inseparable and so in love. I was just a new bride, and I wondered if my marriage would be as magical as theirs.
Oncology Drug Reference Sheet: Belumosudil
Chronic graft-versus-host disease (GVHD) is a severe adverse reaction after allogeneic hematopoietic cell transplantation that decreases quality of life and is a major cause of death. In July 2021, the U.S. Food and Drug Administration approved belumosudil (RezurockTM) as a third-line treatment option for chronic GVHD.
Use the Evidence to Integrate Ethics in Teleoncology Care
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.
Don’t Ask Patients About Their Symptoms—Have Them Tell You
“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.
Studies Show Best Practices to Manage CAR T-Cell Therapies’ irAEs and Improve Outcomes
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.
Oncology Clinical Social Workers Add Layers of Support for Patients and Families During CAR T-Cell Therapy
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.
CAR T-Cell Therapy Programs
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.
Targeting Beta2-Spectrin Could Prevent Biggest Contributor to Increasing HCC Rates
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.
Oncology Drug Reference Sheet: Avapritinib
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.
Anticipate and Address Anxiety in Survivorship Care
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.
Genetic Disorder Reference Sheet: Von Hippel-Lindau Syndrome
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.
FDA Approves Alpelisib for PIK3CA-Related Overgrowth Spectrum
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.
What Patients and Oncology Nurses Need to Know About Vaccination and Cancer
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.
E-Cigarettes Are Not an Effective Smoking Cessation Strategy
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 and Oncology Nurses Partner to Expand Ambulatory Options for Patients With Cancer
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.”
FDA Approves Axicabtagene Ciloleucel for Second-Line Treatment of Large B-Cell Lymphoma
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.
The Evolution of Ambulatory Care
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.
The Oncology Nurse’s Role in Identifying Patients for Cancer Genetics Counseling
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.
What the Evidence Says About Low-Intensity Exercise in Cancer Care
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.
Professional Oncology Navigation Task Force Releases Oncology Navigation Standards of Practice
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.
Anxiety and Depression Are Biggest Concerns for Patients With Cancer, Survivors, Caregivers
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.
Legislators, Professional Organizations Advocate for Safety Protections for Healthcare Workers
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.
FDA Approves Lutetium Lu 177 Vipivotide Tetraxetan for Metastatic Castration-Resistant Prostate Cancer
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.
American Rescue Plan Funds Will Reduce Burnout, Promote Mental Wellness Among Healthcare Workforce
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.
FDA Informs Healthcare Professionals of Prefilled Saline Flush Syringe Conservation Strategies
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.
FDA Approves Pembrolizumab for Advanced Endometrial Carcinoma
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.
Oncology Drug Reference Sheet: Pafolacianine
An optical imaging agent shown to improve diagnostic accuracy, pafolacianine (CytaluxTM) 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.
FDA Approves Nivolumab and Relatlimab-Rmbw for Unresectable or Metastatic Melanoma
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.