The Case of the Delicate Discussion
Over the past three years, Sharon, age 38, has been intermittently receiving treatment for ovarian cancer. She was initially treated with carboplatin and paclitaxel and remained in remission for 20 months. She responded well to second-line therapy (carboplatin, gemcitabine, and bevacizumab), remaining on bevacizumab maintenance until she experienced a relapse eight months later.
Black Box Warnings Guide Oncologic Emergencies in Acute Care and Outpatient Settings
The transition of chemotherapy and immunotherapy delivery from the acute care and clinic settings to the home setting has created a need for innovative strategies to keep patients safe. Today, with decreased face-to-face interactions, the need for those strategies and tools is even greater in a system reliant on multiple facilities and disciplines to collaborate care in a time when resources are sometimes scarce or minimal, Mary Jo Sarver, ARNP, AOCN®, CRNI, VA-BC, LNC, said in an on-demand session for the inaugural ONS Bridge™ virtual conference.
ONS Guidelines™ Offer Framework for Managing Treatment-Related Hot Flashes
Because of treatment effects on hormones, women with breast cancer and men with prostate cancer have an increased risk of frequent and severe hot flashes after treatment. As many as 80% of patients across both genders experience the symptom, which can have an impact on sleep, mood, energy, and sexual function.
FDA Approves Pralsetinib for Lung Cancer With RET Gene Fusions
On September 4, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pralsetinib (Gavreto™) for adult patients with metastatic, RET fusion-positive non-small cell lung cancer (NSCLC) as detected by an FDA approved test.
FDA Rejects Atezolizumab in Combination With Paclitaxel as Treatment for Breast Cancer
On September 8, 2020, the U.S. Food and Drug Administration (FDA) announced it did not approve atezolizumab (Tecentriq®) in combination with paclitaxel for treatment of breast cancer after a clinical trial studying the use of atezolizumab and paclitaxel in patients with previously untreated inoperable locally advanced or metastatic triple negative breast cancer (mTNBC) showed the drug combination did not work to treat the disease.
FDA Approves Azacitidine Tablets for Acute Myeloid Leukemia
On September 1, 2020, the U.S. Food and Drug Administration (FDA) approved azacitidine tablets for continued treatment of patients with acute myeloid leukemia who achieved first complete remission (CR) or CR with incomplete blood count recovery following intensive induction chemotherapy and who are unable to complete intensive curative therapy.
The Case of the Pancreatic Phenomenon
Ronnie, a 68-year-old patient with stage IV pancreatic ductal adenocarcinoma, recently started palliative FOLFIRINOX chemotherapy, a regimen consisting of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin, every two weeks. During his toxicity evaluation, prior to starting his second cycle, he describes a few concerning symptoms that have been ongoing for several weeks, including unintentional weight loss of 15 kg over the last two months, significant bloating after meals, and frequent flatulence with oily stools that are difficult to flush.
Address Social Determinants by Meeting Patients Where They’re At
A hallmark principle of social work is meeting clients where they’re at. This means taking time to understand where they come from, what might be influencing how they are navigating the healthcare system, and how their cancer diagnosis personally affects them.
Oncology Drug Reference Sheet: Rucaparib
Rucaparib (Rubraca®) has U.S. Food and Drug Administration approval for both maintenance and treatment indications in gynecologic cancers. It originally received accelerated approval in 2016 for the treatment of deleterious, BRCA variant–associated advanced ovarian cancer that has failed two or more chemotherapies. In 2018, it was approved for maintenance therapy of various gynecologic malignancies. Most recently, rucaparib received approval for BRCA-positive metastatic castration-resistant prostate cancer treatment after androgen-directed and chemotherapy.
The Case of the Major Malnutrition Concerns
Max, a 60-year-old patient with head and neck cancer, is receiving chemoradiation. Since his initial consult, he’s experienced a 12% weight loss from baseline, impaired swallowing, pain, anorexia, and dysgeusia. He has financial challenges, limited social support, poor health literacy, and a history of alcohol abuse. He has a feeding tube, but you suspect he is not using it. You reinforce prior education about malnutrition, and although Max refuses to be admitted to the hospital, he promises to do better.
As True Detectives, Genetics Professionals Uncover the Meaning of True or Noninformative Negative Results
Patients who watch crime shows think that DNA testing is as simple as taking a cheek swab and getting the results in two minutes so the case is solved at the end of the 42-minute episode. The reality? DNA can be identified from buccal cells in a cheek swab, but results take several weeks to obtain and are not always a simple negative or positive.
Manage Immune-Related Adverse Events in Patients on Durvalumab
Durvalumab immunotherapy became a new standard of care for patients with stage III unresectable non-small cell lung cancer whose disease did not progress following two cycles of platinum-based chemoradiotherapy after its approval in February 2018, and in March 2020, its indication was expanded for use as first-line treatment in patients with extensive-stage small cell lung cancer as well. Key to keeping patients on immunotherapy treatment and giving them the best chance at long-term survival is effective management of immune-related adverse events.
FDA Grants Accelerated Approval to Belantamab Mafodotin-Blmf for Multiple Myeloma
On August 5, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to belantamab mafodotin-blmf (Blenrep) for adult patients with relapsed or refractory multiple myeloma who received at least four prior therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
Glioblastoma Diagnosis, Treatment, Side Effect Management, and Survivorship Recommendations
Glioblastoma or glioblastoma multiform (GBM) is a primary central nervous system tumor. Approximately 23,890 new brain tumors are diagnosed in the United States each year, with GBM accounting for 38%. GBM can present as a primary diagnosis or evolve from a lower grade brain tumor.
FDA Grants Accelerated Approval to Tafasitamab-Cxix for Diffuse Large B-Cell Lymphoma
On July 31, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to tafasitamab-cxix (Monjuvi®), a CD19-directed cytolytic antibody, indicated in combination with lenalidomide for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, including DLBCL arising from low-grade lymphoma, and who are not eligible for autologous stem cell transplant.
FDA Approves Brexucabtagene Autoleucel for Relapsed or Refractory MCL
On July 24, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to brexucabtagene autoleucel (Tecartus™), a CD19-directed genetically modified autologous T cell immunotherapy, for the treatment of adult patients with relapsed or refractory mantle cell lymphoma.
The Case of the HPV-Positive Perk
Warren is a 50-year-old man recently diagnosed with human papillomavirus (HPV)-positive oropharyngeal cancer. He and his wife meet with a radiation oncologist and develop a plan of care. Lisa, the radiation oncology nurse, meets with the couple to provide education and answer questions. Darren tells her that two of his “hard living” uncles died from head and neck cancer and the treatment was horrible. He says, “I’ve only had two sexual partners and never smoked—is this cancer really worth treating?”
What the Evidence Says for Use of Qigong in Patients With Cancer
Qigong is a mind-body practice that originated in China nearly five millennia ago. It integrates movement, meditation, and breath regulation to improve physical and emotional health. The actions are slow, gentle, flowing, repetitious, and weight-bearing and can be adapted or practiced while sitting, standing, or walking. Qigong styles and forms vary widely, depending on the school of thought and philosophy.
The Case of the Thyroid Tradeoff
Tesla is a 24-year-old woman diagnosed with stage IIIA Hodgkin lymphoma. She enrolled in a clinical trial where she received a combination of chemotherapy and immunotherapy with pembrolizumab, an anti-PD-1 antibody. The clinical trial protocol required three doses every three weeks. At baseline, her thyroid function tests were normal. When she presented for her third dose, her labs showed grade 2 hyperthyroidism.
Managing Cancer-Related PTSD Starts With Acknowledgement
Post-traumatic stress disorder (PTSD) is often associated with survivors of military combat or natural disaster, such as refugees or veterans. However, patients with a current or past cancer diagnosis, and their loved ones, are at risk for developing cancer-related PTSD (CR-PTSD).
Care Delivery Models Guide Cancer Practice During COVID-19
Healthcare institutions have used care delivery models to guide practice for years. A care delivery model provides a structured system for work assignments, responsibilities, and authority to provide optimal patient care.
Myeloproliferative Neoplasm Symptoms, Diagnosis, Treatment, and Survivorship Recommendations
Myeloproliferative neoplasms are a group of blood cancers that start with a small mutation in the stem cells of the bone marrow. Although MPNs are quite rare, essential thrombocythemia, polycythemia vera, and myelofibrosis are the most common types. Each represents a mutation of a different source of stem cell.
FDA Approves Oral Combination of Decitabine and Cedazuridine for Myelodysplastic Syndromes
On July 7, 2020, the U.S. Food and Drug Administration (FDA) approved an oral combination of decitabine and cedazuridine (Inqovi®) for adult patients with myelodysplastic syndromes, including the following:
When Function Becomes Malfunction
Malfunctioning medical products can pose safety risks to both patients and nurses and waste valuable time and resources. All medical devices and equipment used in the United States must pass specific manufacturing requirements before they can be approved for sale. But every product, regardless of performance, is subject to malfunction. A challenge for nurses is determining whether an issue is a rare failure or if the product is legitimately problematic.
FDA Approves Avelumab for Urothelial Carcinoma Maintenance Treatment
On June 30, 2020, the U.S. Food and Drug Administration (FDA) approved avelumab (Bavencio®) for maintenance treatment of patients with locally advanced or metastatic urothelial carcinoma (UC) that has not progressed with first-line platinum-containing chemotherapy.
Antibody-Drug Conjugates Join the Best of Two Worlds Into One New Treatment
A new class of drugs, antibody-drug conjugates (ADCs), combines the specificity of targeted therapy with the cytotoxicity of chemotherapy for a powerhouse effect against certain types of cancer variants. Here’s what you need to know about this novel treatment modality.
FDA Approves Pembrolizumab for First-Line Treatment of MSI-H/dMMR Colorectal Cancer
On June 29, 2020, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for first-line treatment of patients with unresectable or metastatic microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) colorectal cancer.
FDA Approves Combination of Pertuzumab, Trastuzumab, and Hyaluronidase-Zzxf for HER2-Positive Breast Cancer
On June 29, 2020, the U.S. Food and Drug Administration (FDA) approved a new fixed-dose combination of pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo™) via subcutaneous injection for use in combination with docetaxel to treat patients with HER2-positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease.
Develop Your Individual Cancer Screening Plan
As oncology nurses, we know that catching cancer early through screening leads to better outcomes and increased survival rates. We ask our survivors and loved ones to prioritize their cancer screenings, reminding them, “I do not want to see you in my clinic chair or hospital bed with cancer, especially not at an advanced level.” Take care of yourself by giving yourself the same lecture.
FDA Approves Pembrolizumab for Treatment of Cutaneous Squamous Cell Carcinoma
On June 24, 2020, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for patients with recurrent or metastatic cutaneous squamous cell carcinoma (cSCC) that is not curable with surgery or radiation.
Cancer Consortium Report Reveals High Mortality Rates in Patients With COVID-19 and Cancer
Patients with cancer who contracted the COVID-19 coronavirus had high rates of 30-day all-cause mortality that was associated with general risk factors and risk factors unique to cancer, according to findings from one of the first data registry reports of patients with the dual diagnoses. The results were published in Lancet.
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.