Addressing a clinical problem through evidence-based practice (EBP) involves asking the right questions in the right way, finding the best available evidence, and assessing what practice change may be needed. A core factor in the EBP journey is the development of nurses who possess a spirit of inquiry within a culture that supports a systematic process for asking clinical questions.

The Oncology Center of Excellence of the U.S. Food and Drug Administration (FDA) is informing healthcare providers about new safety information for Varubi^® (rolapitant) injectable emulsion, a substance P/neurokinin (NK-1) receptor antagonist indicated for the prevention of delayed nausea and vomiting associated with cancer chemotherapy in adults.

Taking an intentional drug holiday may improve patients’ response to reintroduction of treatment in drug-resistant melanoma, according to the results of a study published in Cancer Discovery.

Vince was diagnosed with non-muscle invasive, high-grade bladder cancer at age 54 and treated with intravesical Bacille-Calmette Guerin immunotherapy. He stopped smoking and began a consistent walking program. 

On January 12, 2018, the U.S. Food and Drug Administration (FDA) granted approval to afatinib for a broadened indication in first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant epidermal growth factor receptor (EGFR) mutations as detected by an FDA-approved test.

Oncology nursing is rapidly evolving specialty. Nurses need to stay on top of a complex technologic environment, ever-changing science, and rapid assimilation of research into practice. In doing so, they attain and maintain a high level of competency to adequately and safely care for people with cancer.

Each day, more than 175 Americans die from an opioid-related overdose. Misuse of, addiction to, and overdose from opioids cost the United States $78.5 billion a year, “including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.”. Other alarming numbers abound: 21%–29% of patients who are prescribed opioids misuse them, 4%–6% of those transition to heroin, and 80% of people who use heroin first misused prescription opioids.

Medicinal cannabis, a topic that remains largely unstudied in human trials in the United States, is slowly becoming introduced in areas of health care and oncology in states that have legalized it for medical and adult recreational use.

Cancer treatment options continue to multiply as 2017 concludes, with the U.S. Food and Drug Administration (FDA) granting additional new drug approvals and broadening indications for others. Checkpoint inhibitors continue to explode on the scene with accelerated approvals for various indications. Treatment options for hematologic cancers are multiplying. Additionally, the first biosimilar for cancer treatment, bevacizumab-awwb, was approved as a biosimilar to bevacizumab.

On December 19, 2017, the U.S. Food and Drug Administration granted accelerated approval to bosutinib for treatment of patients with newly-diagnosed chronic phase Philadelphia chromosome positive chronic myelogenous leukemia.

On December 19, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to cabozantinib for treatment of patients with advanced renal cell carcinoma (RCC).

Do you consider sleep to be part of your self-care regimen? Does a spinning wheel of thoughts keep you from restful sleep, or do you consciously sacrifice sleep time? If so, you are not alone. The Centers for Disease Control and Prevention (CDC) declared that insufficient sleep is a public health epidemic with an estimated 25% of the United States population suffering from some type of sleep disturbance.

Listening to feedback from patients is still one of the most important ways providers can assess and plan treatments for patients with cancer. However, symptom management is never as simple as screening for pain or asking about fatigue: it involves complex decision making, evidence-based interventions, and the support of the entire care team. It’s a central practice to oncology nursing, and it’s paramount to the successful outcomes of patients with cancer.

A large study published in the Journal of the National Cancer Institute found that patients with nonmetastatic breast, lung, or colorectal cancer who chose to use only alternative medicine had substantially worse survival than patients who received conventional cancer treatment.

Although USP Chapter <800> implementation has been delayed, ONS experts are receiving questions about clarifications and specifics for wearing gowns when handling hazardous drugs (HDs). Questions include topics such as hanging gowns and reusing, length of time gowns can be worn, the need for gowns with oral chemotherapy agents, and materials requirements of gowns. 

Sepsis is a formidable complication of cancer and cancer treatment. Claiming more than 250,000 lives annually, it is a medical emergency. Do you have sepsis algorithms and protocols in place? Do all specialty areas have a way to identify patients with cancer as a highly vulnerable population? Is sepsis-specific education provided to nurses and patients? Starting the conversation and advocating for policy development and change may just save a life.

The elements of an oncology unit are often very similar from location to location—the crescendo of plastic wheels clicking across brightly shined linoleum, beaming fluorescent lights that flicker to life when switched on, mounted fountains of cool hand sanitizer gel. But although oncology units have many similarities, clear differences exist as well.

On November 16, 2017, the U.S. Food and Drug Administration (FDA) approved emicizumab-kxwh (Hemlibra^®, Genentech, Inc.) for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients with hemophilia A (congenital factor VIII deficiency) with factor VIII inhibitors.

Mary, age 60, has been diagnosed with stage IIB ovarian cancer. Because she has a strong family history of various cancers, Mary is tested for Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC).

Her test is positive, and she is told she is at increased risk for developing cancers associated with HNPCC: ovarian, breast, prostate, kidney, endometrial, pancreatic, prostate, and liver.

On November 9, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to brentuximab vedotin (Adetris^®, Seattle Genetics, Inc.) for the treatment of adult patients with primary cutaneous anaplastic large cell lymphoma (pcALCL) or CD30-expressing mycosis fungoides (MF) who have received prior systemic therapy.

As new therapies come to market, patients with multiple myeloma have more treatment options that are improving outcomes and extending overall survival. However, the most effective options involve multidrug combinations and continuous maintenance therapy, which can result in cumulative toxicities and the potential for oncologic emergencies.

On November 6, 2017, the U.S. Food and Drug Administration granted regular approval to vemurafenib (Zelboraf^®) for the treatment of patients with Erdheim-Chester Disease with BRAF V600 mutation.

Building relationships with patients is just one of the many roles of oncology nurses. However, it’s generally not possible to see your patients every day. This isn’t uncommon, but it can pose problems to oncology professionals treating patients with head and neck cancers.

On October 25, 2017, the U.S. Food and Drug Administration (FDA) approved the use of rolapitant (Varubi®) IV in combination with other antiemetic agents for adults experiencing delayed chemotherapy therapy-induced nausea and vomiting (CINV). Rolapitant through oral administration had been approved through the FDA in September 2015. The new IV administration route is expected to offer the same results at a lower cost to patients with CINV. 

In June 2017, the U.S. Food and Drug Administration (FDA) approved Rituxan Hycela, a combination of rituximab and hyaluronidase, for subcutaneous administration in the treatment of follicular lymphoma and diffuse large B-cell lymphoma as well as chronic lymphocytic leukemia (CLL). This agent affords the same clinical benefit as IV rituximab, but in much less time. With this approval comes many questions about which patients are appropriate and administration considerations for subcutaneous rituximab and hyaluronidase.

Despite the findings that more than 90% of cancer pain can be controlled with routine interventions, many patients continue to experience pain throughout their cancer diagnosis and treatment. The average pain score for patients on inpatient oncology units is 5.87 on a 0–10 scale, and 25% of patients spend more than 50% of the time in constant or severe pain.

On September 14, 2017, the U.S. Food and Drug Administration (FDA) approved a lower dose of cabazitaxel (20 mg/m² every 3 weeks) in combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer previously treated with a docetaxel-containing treatment regimen.  Cabazitaxel (25 mg/m² every 3 weeks) was approved for this indication in 2010.

As an oncology clinical nurse specialist (CNS), you may find yourself answering over and over the question of, “What is it you do?” In many instances, it is a broader role then most may realize, and you wear several hats. As you explain to other oncology staff what a CNS does, focus on the three spheres of influence.

One distinct, uniquely personal symptom unifies almost all patients with cancer: pain. It can be as wildly varied and different as each patient it affects. It can be acute, sudden experiences of pain, or the symptoms can be chronic and perpetual. Patients undergoing the treatments associated with cancer often suffer varying degrees of pain through their cancer journeys, which leads to significant physical and psychosocial burdens. This can decrease their quality of life and potentially impact their overall outcomes. A 2015 National Comprehensive Cancer Network report suggested that the evidence suggests a clear link between improved survival outcomes and adequate symptom management.

When a severe tornado hit Joplin, MO, on the evening of May 22, 2011, the situation was serious. St. John’s Regional Medical Center in Joplin was hit so hard that it is still unusable. It needed to be evacuated, nearby Freeman hospital became quickly overwhelmed with patients, and the surrounding community prepared for action.

In the early hours of September 13, 2008, Hurricane Ike—a category 2 hurricane—hit Galveston Island, TX, bringing with it sustained winds of up to 110 miles per hour and storm surges reaching as high as 17 feet. By the next day, more than 200 shelters had opened across Texas to house the estimated 40,000 people who had been forced to evacuate from their homes.

On August 30, 2017, the U.S. Food and Drug Administration granted regular approval to tisagenlecleucel for the treatment of patients up to age 25 years with B-cell precursor acute lymphoblastic leukemia that is refractory or in second or later relapse.

I live in Middle Tennessee, an area that’s part of tornado alley, a pathway across central United States that has a higher incidence of tornadoes. We routinely prepare for the storms, listening for the tornado sirens whether at home or work. Although there have been a number of tornado touchdowns in our region in recent years, fortunately none have directly hit our healthcare facilities.

Many Americans use dietary supplements, including herbal products, in the belief that they are natural and safe. Patients with cancer use them often to enhance the effects or to reduce the adverse reactions of cancer treatments. However, few herbs have been thoroughly studied in humans. Therefore, their interactions with prescription drugs and the clinical relevance, remain undetermined. These interactions could be pharmacokinetic in nature when an herb alters the absorption, metabolism, or excretion of other drugs, or pharmacodynamic in which it affects the mechanism of action of other drugs when consumed together. Following are a few relevant herb-drug interactions encountered in the oncology setting.

 

Kris is a 46-year-old newly diagnosed with stage III cervical cancer. She is an avid runner and vegetarian, and she believes strongly in taking care of herself. “I never thought I would get cancer,” she says. “I thought I did everything I could to avoid this.”

Advanced practice oncology nurses know how complex the care of patients with cancer can be. Every day seems to bring further advancements in the treatment and management of cancer. It can be difficult to keep up with the onslaught of new information, but our patients rely on us to bring them the latest, greatest, and safest treatment options available.

Inquiries received in the ONS clinical inbox often ask about various responsibilities of nurses who hold an ONS chemotherapy provider card and have been deemed competent to administer cancer treatments within their practice setting.

I arrived at work on Tuesday morning to find my charge nurse handing out blue ribbons, beads, and bracelets to staff.

"March is National Colon Cancer Awareness Month,” she said. “Put on the blue, we're promoting awareness and encouraging people to get their screenings!" I stared at some of my coworkers with ribbons tied neatly in their hair.

It’s important to know that I routinely have to field the question, "Are you sure you're old enough to be a nurse?" I had a feeling the ribbon wasn't going to help my credibility. This was also my second day of caring for a patient struggling to cope in a very tough fight against colon cancer. Would she mind? Would it be insensitive?

You may remember Jay, a 62-year-old man with inoperable stage IIIA non-small cell lung cancer (NSCLC), from the case study in the April 2017 issue of ONS Voice. He was symptomatic with a persistent cough, unintentional weight loss, and fatigue.

On July 17, 2017, the U.S. Food and Drug Administration approved neratinib (Nerlynx™, Puma Biotechnology, Inc.) for the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer, to follow adjuvant trastuzumab-based therapy.

On July 7, 2017, the U.S. Food and Drug Administration (FDA) approved L-glutamine oral powder for oral administration to reduce the acute complications of sickle cell disease in adult and pediatric patients five years and older.

Nurses in the intensive care unit (ICU) generally see patients with cancer only when they are extremely sick—not throughout the extensive cancer journey they go through before they get to the ICU. Educating and familiarizing ourselves, as ICU nurses, with a patient’s oncology plan, goals, and history can improve overall care. Learning at which points in the process of cancer treatment certain issues are more likely to arise, such as tumor lysis syndrome during high-dose induction, when a patient is most likely to be neutropenic during a stem cell transplant, and other general facts about oncology, can help improve the care we give. It helps us understand our patients as a whole. The oncology population is a huge part of medical intensive care, and encouraging critical care nurses and oncology nurses to collaborate can help improve the continuity of care and eliminate errors in the ICU.

Five to Ten Percent of patients with cancer will need to visit the intensive care unit (ICU) for a life-threatening condition. In fact, estimates suggest that nearly 30% of patients with esophageal cancer or acute leukemia and those undergoing allogenic stem cell transplantation will need ICU care.

On June 23, 2017, the U.S. Food and Drug Administration (FDA) approved betrixaban (Bevyxxa, Portola) for the prophylaxis of venous thromboembolism (VTE) in adult patients hospitalized for an acute medical illness who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors for VTE.

Oncology clinicians can expect to continue to see new targeted and immunotherapy drugs emerge as clinically approved agents in the fight against cancer. Five cancer-related U.S. Food and Drug Administration (FDA) approvals occurred in the first quarter of 2017; following are their indications for treatment and associated clinical implications. You’ll recognize that some of the agents were already FDA approved for other uses, but as clinical trials continue and new data emerge, clinical use is expanding to other disease sites and indications.