Genetic Disorder Reference Sheet: CDH1 and Hereditary Diffuse Gastric Cancer
Pathogenic variants in the CDH1 gene are associated with hereditary diffuse gastric cancer (HDGC), a poorly differentiated adenocarcinoma that infiltrates into the stomach wall. It causes the stomach wall to thicken without forming a distinct mass, which limits effective screening strategies.
The Case of the Post-Transplant Pulmonary Problem
Benjamin, your 28-year-old patient with acute lymphoblastic leukemia, received a 10/10 matched, unrelated donor for his allogeneic hematopoietic stem cell transplantation. Two months post-transplant, Benjamin developed grade 4 skin and gastrointestinal graft-versus-host disease.
Break Bad News to Patients With This Step-by-Step Guide
When hearing results from blood work or repeat imaging—regardless of whether they are “good” or “bad”—patients want and deserve to be given information truthfully and objectively. Oncology advanced practice providers are often the bearers of bad news, which can be uncomfortable and stressful. But here’s how you can hold those conversations with finesse, empathy, and respect.
Team Training Develops Nurses’ Interprofessional Communication Skills
Oncology nurses must have effective communication and team-based skills to work across disciplines with other members of the care team. In an oncology setting, teamwork promotes safer, more efficient, and higher quality care, as well as a more positive and supportive practice environment. Dana-Farber Cancer Institute (DFCI) has used team training to develop those skills in our staff over the past 15 years.
Train and Retain: From Orientation to Leadership, Here Are the Strategies That Experienced Staff Developers Use
The oncology nursing specialty is in dire need of a solid foundation of eligible staff. As of 2020, more than 51% of the nursing workforce was aged 40 years or older, and the COVID-19 pandemic exacerbated underlying factors such as stress, physical and mental health, and inequities present in the profession for decades.
Mental Health Teams Build Programs That Prioritize Staff Well-Being
Given the inherent nature of caregiving, burnout has been part of the nursing profession since the beginning. As the complexities of the profession increase, so do nurses’ vulnerability. Oncology nurses have multiple physical, emotional, and mental demands, which, if left unaddressed, can lead to burnout, compassion fatigue, and moral distress.
Make Subcutaneous Administration More Comfortable for Your Patients
Much of oncology nursing education focuses on IV administration of systemic therapies because for years, that was the only route. Until 2004, only two cancer therapies were approved for subcutaneous (SC) administration, and just nine others were added through 2012. However, as more familiar IV therapies get SC counterparts, including the more recent approvals of four high-volume monoclonal antibodies (mAbs), infusion nurses are using them more regularly in practice.
Show the World Your Beautiful Mess
Embracing—not judging or hiding—our flaws and vulnerabilities makes us happier and more relatable, a research-supported concept called the beautiful mess effect. What we think are negatives or weaknesses, others see as courageous. Showing vulnerability can lead to stronger relationships, increased self-esteem, and better mental health.
Liver Cancer Diagnoses See Geographic, Racial, Income Disparities
The urban-rural disparity in hepatocellular cancer (HCC) diagnoses is widening, researchers said, particularly in certain racial, income, and age groups. The authors reported their study results in Clinical Gastroenterology and Hepatology.
Oncology Drug Reference Sheet: Amivantamab-Vmjw
After clinical trials demonstrated a 40% overall response rate with 63% of responses lasting six months or more, on May 21, 2021, the U.S. Food and Drug Administration (FDA) approved amivantamab-vmjw (RybrevantTM) for adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion variants, as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy.
Oncology Nurses Share Successes and Challenges Adapting to Telehealth During COVID-19
The COVID-19 coronavirus pandemic has forced healthcare providers to make unprecedented adjustments to patient care, including the pivot to telehealth. At a series of virtual events from October 2020–March 2021, ONS members shared their challenges, successes, and future needs to permanently adopt virtual cancer care visits.
The Case of the Clinical Trials Consultation
Don, age 72, was diagnosed with borderline resectable pancreatic adenocarcinoma more than a year ago. Genetic testing indicated a BRCA2 variant. He completed 12 cycles of FOLFIRINOX followed by a pancreaticoduodenectomy (Whipple procedure). He had no evidence of disease for six months until a liver lesion seen on surveillance imaging tested positive for metastatic pancreatic cancer. His medical oncologist suggests a clinical trial targeting the BRCA2 variant.
FDA Approves Abatacept for Prophylaxis of Acute Graft-Versus-Host Disease
On December 15, 2021, the U.S. Food and Drug Administration (FDA) approved abatacept (Orencia®) for prophylaxis of acute graft-versus-host disease (aGVHD), in combination with a calcineurin inhibitor (CNI) and methotrexate (MTX), in adults and pediatric patients aged 2 and older who are undergoing hematopoietic stem cell transplantation (HSCT) from a matched or one allele-mismatched unrelated donor.
Traits That Make You a Great Nurse Also Lead to Success as a Clinical Trials PI
Clinical trials are led by a principal investigator (PI) with a research team that may include physicians, nurses, social workers, and other healthcare professionals. PIs can represent a variety of disciplines, and nurse scientists often hold that role.
Nursing Considerations for Adolescent and Young Adult Cancer Survivorship Care
Adolescent and young adults (AYAs)—those diagnosed between the ages of 15 and 39—comprise about 5% of all annual cancer diagnoses. The population has unique challenges that must be considered as part of patient-centered survivorship care planning.
Use ClinicalTrials.gov to Find the Right Cancer Research Studies for Your Patients
Among the many online resources for identifying cancer clinical trials, including the National Cancer Institute (NCI), NCI-designated cancer centers or academic cancer centers, and drug and biotechnology companies, ClinicalTrials.gov may be the most comprehensive as a one-stop shop for patients and providers to find publicly and privately supported trials for patients.
FDA Reports Teligent Pharma’s Worldwide Voluntary Recall of Lidocaine HCl Topical Solution 4%
On December 7, 2021, the U.S. Food and Drug Administration (FDA) reported Teligent Pharma’s voluntary recall of two lots of lidocaine HCl topical solution 4% in a 50 ml screw cap glass bottle to the user level. The manufacturer’s testing found that the product is super potent based on an out-of-specification result at the 9-month (lot 16345) and 18-month (lot 15594) stability timepoint.
Patients Cope With Intense Emotions After Clinical Trial Withdrawal
When withdrawing from a clinical trial, patients experience a spectrum of emotions ranging from regret, urgency, frustration—and trust in their healthcare professionals, like oncology nurses, according to the results of a study published in JAMA Network Open.
Nursing Roles in Clinical Trials
Clinical trials provide evidence to support what you do in your work as a nurse every day. They are tools to discover new therapies and identify side effects while considering patient-specific factors like age, comorbidities, race, and sex. They build support for best practices in treatment and patient care.
CMS, HHS Issue Emergency Regulation Requiring COVID-19 Vaccination for Healthcare Workers
In an effort to protect patients and control the COVID-19 coronavirus pandemic, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) have issued an interim final rule requiring all staff at certain Medicare- and Medicaid-certified healthcare facilities to be vaccinated against COVID-19.
FDA Approves Sirolimus Protein-Bound Particles for Malignant Perivascular Epithelioid Cell Tumor
On November 22, 2021, the U.S. Food and Drug Administration (FDA) approved sirolimus protein-bound particles for injectable suspension (Fyarro™) for adult patients with locally advanced unresectable or metastatic malignant perivascular epithelioid cell tumor (PEComa).
Oncology Drug Reference Sheet: Sotorasib
After clinical trials demonstrated an overall response rate of 36% and median response duration of 10 months, the U.S. Food and Drug Administration granted sotorasib (LumakrasTM) accelerated approval on May 28, 2021, for the treatment of adults with KRAS G12C–altered 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.
New NIH Program Aims to Increase Gene Therapies for Rare Diseases
To accelerate the development of gene therapies for the 30 million Americans who have been diagnosed with a rare disease, in October 2021 the National Institutes of Health (NIH), U.S. Food and Drug Administration (FDA), 10 pharmaceutical companies, and five nonprofit organizations announced the creation of the Bespoke Gene Therapy Consortium (BGTC). The consortium is optimizing and streamlining the gene therapy development process to help fill the unmet medical needs of people with rare diseases.
FDA Permits Marketing of E-Cigarette Products, Marking First Authorization of Its Kind
Under the authority given in the Family Smoking Prevention and Tobacco Control Act, in October 2021 the U.S. Food and Drug Administration (FDA) authorized the marketing of three new electronic nicotine delivery system (ENDS) products, “marking the first set of ENDS products ever to be authorized by FDA through the Premarket Tobacco Product Application pathway.” The agency made the announcement it continues its review of thousands of tobacco and e-cigarette products.
Mid-Century Antibiotic May Offer Options After PARP Inhibitor Resistance
Novobiocin, an antibiotic discovered during the 1950s, may be a potential second-line therapy for patients whose tumors have become resistant to poly (ADP-ribose) polymerase (PARP) inhibitors, researchers reported in Nature Cancer. The finding may open up new options for patients with BRCA-variant disease such as breast, ovarian, pancreatic, and prostate cancer.
Defining Individual Biosignatures Through Precision Health Symptom Science Helps Nurses Deliver Even Better Care
Understanding the underlying mechanisms of cancerrelated symptoms enables oncology nurses to provide the best patient-centered care. Biosignatures are indicators of life, and in disease, they contribute to the determination of clinical profiles. Identifying specific biologic markers associated with similar patient characteristics and symptoms may help us create tailored interventions for improved symptom management.
FDA Reports Recall of Custom Convenience Kits Because of Prefilled Syringe Plunger Defect
On November 9, 2021, the U.S. Food and Drug Administration (FDA) reported Aligned Medical Solutions’ recall of its custom convenience kits because of the potential for the plunger of the Cardinal Health monoject flush prefilled syringe (0.9% sodium chloride) to draw back after the air has been expelled and reintroduce air back into the syringe. FDA identified the recall as a class I recall, the most serious type of recall.
APRNs Can Lead by Example When Integrating Palliative Care in Practice
Early and regular integration of palliative care (PC) improves patient and caregiver outcomes in symptom management, quality of life, psychosocial health, communication, shared decision-making, overall satisfaction—and even survival. Health systems also benefit through reduced emergency department visits, hospitalizations, and intensive care stays; increased completion of advanced directives; and improved quality of end-of-life care. Both the Centers for Medicare and Medicaid Services’ (CMS’s) Oncology Care Model and many oncology organizations, including ONS, support the approach for patients with cancer.
Genetic Disorder Reference Sheet: Familial Adenomatous Polyposis
Individuals with 10–100+ polyps may have a germline pathogenic variant in the APC gene, placing them at higher risk for developing colorectal, gastrointestinal, and other cancers. The condition is known as familial adenosis polyposis (FAP), and loss of function in the APC gene is the first step in the adenoma-to-carcinoma sequence. Some people have an attenuated form (aFAP), with delayed polyp growth and fewer polyps (see sidebar). As many as 20% are de novo, meaning that they are the first in their family to have an identified pathogenic variant.
Clinical Full-Body Skin Examination Identifies Twice the Number of Cancers
A dermatologist-performed total-body skin examination (TBSE) identifies more than two times the number of skin cancers than patients or other providers discovered, researchers reported in the International Journal of Women’s Dermatology. The cancers may otherwise have gone undiagnosed, leading to later-stage disease and poorer outcomes.
Bringing Biosignatures to the Bedside
With the growth of genomics and targeted therapy, nurse scientists are gaining deeper understanding the vast facets of patients’ symptom experience, and biosignatures could be the key to unlocking the next frontier in symptom science research.
Many Popular Online Cancer Articles Contain Misleading Information, NCI Says
With a plethora of information available online, patients with cancer and their families have access to plenty of resources to learn more about their diagnosis and treatment options. However, one-third of the online articles about cancer circulating on social media contain incorrect information, according to findings from a 2021 study published in the Journal of the National Cancer Institute.
Find Solace in Silence
A balanced life allows us to function at our best. Our bodies do that naturally through homeostasis, a familiar term from nursing school, by self-regulating physiological processes to ensure equilibrium and optimal functioning. But our brains sometimes need help to self-regulate, and one way to do that is to practice silence. After a day of noise and action, silence and solitude can calm and restore you.
Oncology Drug Reference Sheet: Belantamab Mafodotin-Blmf
A first-of-its-kind antibody-drug conjugate for multiple myeloma, belantamab mafodotin-blmf (Blenrep) received accelerated approval from the U.S. Food and Drug Administration (FDA) in August 2020. The approval was based on clinical trial findings that demonstrated a 31% overall response rate that lasted at least six months in 73% of responders.
The Case of the Missing Oral Mucositis
Bob is a 68-year-old patient with early-stage cancer of the glottic larynx (right true vocal cord). He is receiving a hypofractionated three-dimensional conformal therapy without concurrent chemotherapy, 225 cGy each day for five days a week to a total dose of 6,075 cGy. He is now in his fourth week of treatment at 4,000 cGy and experiencing side effects. His voice is a high-pitched whisper and talking requires a lot of effort. He reports pain when swallowing his favorite foods like nachos and has lost 2 kg since his last weight check four days ago. Bob also reports some dizziness with position changes, and his pulse and blood pressure screenings show that he’s mildly orthostatic.
FDA Amends EUAs With Booster Doses for COVID-19 Vaccines
On October 20, 2021, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) for the Moderna and Janssen (Johnson and Johnson) COVID-19 vaccines to allow for the use of a single booster dose for certain populations.
The Case of the End-of-Life Evaluation
Ron, your 73-year-old patient, decides to transition to hospice care after receiving lung cancer treatment for three years. His partner finds Ron’s decision to move to hospice difficult to accept and encourages him to look for a clinical trial or try alternative treatments. You suggest that the couple speaks with a hospital chaplain, and Ron agrees. His surprised partner says, “Why do you want to talk with a chaplain? We’ve never been religious!”
Genetic Disorder Reference Sheet: ATM Pathogenic Variants
An estimated 1%–2% of adults have one pathogenic ataxia telangiectasia mutated (ATM) gene variant (heterozygous) and are considered carriers. People who are homozygous (two altered copies) have ataxia-telangiectasia (A-T), a hereditary condition that often appears in childhood and is characterized by progressive neurologic problems that lead to difficulty walking and an increased risk for developing various malignancies. Children with A-T may begin staggering and appear unsteady (ataxia) shortly after learning to walk.
FDA Approves Atezolizumab as Adjuvant Treatment for Non-Small Cell Lung Cancer
On October 15, 2021, the U.S. Food and Drug Administration (FDA) approved atezolizumab (Tecentriq®) for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage II–IIIA non-small cell lung cancer (NSCLC) with PD-L1 expression on ≥ 1% of tumor cells as determined by an FDA-approved test.
NIH Provides $185 Million to Advance Understanding of Human Genome Functions
To drive the advancement of our understanding of the human genome, the National Institute of Health (NIH) is providing $185 million in funding over the next five years, the agency announced in September 2021.
Interprofessional Collaboration Helps Improve Cancer Care
Much of the care we provide is complex and requires the contributions of many knowledgeable and experienced professionals. To satisfy the National Academy of Medicine recommendations of providing safe, timely, effective, efficient, equitable, and patient-centered care, healthcare professionals must function as highly collaborative teams.
FDA Reports Worldwide Recall of Lidocaine HCl Topical Solution 4% Because of Super Potency
On October 13, 2021, the U.S. Food and Drug Administration (FDA) reported Teligent Pharma’s voluntary recall of five lots of lidocaine HCl topical solution 4% in a 50 ml screw cap glass bottle to the user level because the firm’s testing found it to be super potent based on an out-of-specification result obtained at the 18-month stability timepoint.
Legislators Call for Improvement in Palliative Care and Hospice Workforce
Legislators across the United States are recognizing what ONS has advocated for more than a decade: the need for improved access to and better understanding of palliative and hospice care. In September 2021, Senator Tammy Baldwin (D-WI) and Representative Yvette D. Clarke (D-NY) voiced their support for palliative care through a letter to the U.S. Congress.
FDA Approves Pembrolizumab Combination for First-Line Treatment of Cervical Cancer
On October 13, 2021, the U.S. Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) in combination with chemotherapy, with or without bevacizumab, for patients with persistent, recurrent, or metastatic cervical cancer whose tumors express PD-L1 (CPS ≥ 1), as determined by an FDA-approved test.
FDA Approves Abemaciclib With Endocrine Therapy for Early Breast Cancer
On October 12, 2021, the U.S. Food and Drug Administration (FDA) approved abemaciclib (Verzenio®) with endocrine therapy (tamoxifen or an aromatase inhibitor) for adjuvant treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-positive, early breast cancer at high risk for recurrence and a Ki-67 score ≥ 20%, as determined by an FDA-approved test. This is the first CDK4/6 inhibitor approved for adjuvant treatment of breast cancer.
HER2 Therapies May Be Effective in a Variety of Solid Tumors
Researchers have found that 2%–3% of all solid tumors overexpress or amplify HER2 protein that may be a target for drugs such as pertuzumab and trastuzumab, particularly in KRAS-variant disease. They presented their findings during the 2021 American Society of Clinical Oncology annual meeting.
Evidence-Based Practice Gives Oncology Nurses Knowledge and Standards for Clinical Care
We have an approximately 14- to 17-year gap between the inception of research discovery and the implementation of findings into clinical practice. As a profession, nurses have a shared responsibility to address the challenge of identifying and overcoming barriers to evidence-based practice (EBP) implementation to provide the best possible clinical care for patients. My primary area of focus as a researcher is on using EBP to improve patient, staff, and organizational outcomes through the Science and Practice Aligned Within Nursing (SPAWN) model, a framework for applying EBP to clinical nursing care.