Cancer genomics influences all oncology nursing roles. Walking through the cancer care continuum shows how genomics—and oncology nursing—are involved at every level.

In May 2020, the U.S. Food and Drug Administration gave accelerated approval for selpercatinib (Retevmo^®) to treat RET-altered non-small cell lung cancer or thyroid cancer based on overall response rate and duration of response. Selpercatinib fights cancer by impeding RET protein activity. The determining clinical trial results demonstrated that it reduced tumor size in more than 50% of patients and was associated with fewer adverse reactions than other drugs that block the RET protein.

Healthy older adults who take daily low-dose aspirin have increased risk of being diagnosed with advanced cancers and dying from cancer, according to findings from a new study published in the Journal of the National Cancer Institute.

Lisa, a 32-year-old tax accountant, completed treatment for stage III triple-negative breast cancer 18 months ago. During a follow-up appointment, Lisa reported worsening headaches and difficulty concentrating at work. A magnetic resonance imaging scan and subsequent biopsy revealed a solitary brain lesion. She completed stereotactic brain radiation two months ago.

On November 13, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to pembrolizumab in combination with chemotherapy for the treatment of patients with locally recurrent unresectable or metastatic triple negative breast cancer (TNBC) whose tumors express PD-L1 (combined positive score [CPS] ≥ 10) as determined by an FDA-approved test. FDA also approved the PD-L1 IHC 22C3 pharmDx as a companion diagnostic for selecting patients with TNBC for pembrolizumab.

From chemotherapy to immunotherapy, many of today’s cancer treatments are associated with skin toxicities. Left unmanaged, they can affect patients’ activities of daily living, self-image, and overall quality of life and may lead to treatment disruptions, delays, or even discontinuation.

Tanya is a 46-year-old woman with leukemia. She recently finished induction therapy, and her oncologist told her she is ready to receive a hematopoietic stem cell transplant. You speak with Tanya about what to expect in the upcoming weeks before her transplant, but she interrupts you: “Nothing tastes good anymore. I am so scared because I thought I completed chemotherapy. The doctor just told me I have to get more before my transplant. Every time I get chemotherapy, I lose my appetite.”

Lung cancer is the leading cause of cancer death in the United States, accounting for about one quarter of cancer deaths, and more than a quarter of million lung cancer diagnoses are projected in the United States for 2020. Lung cancer has various types, pathologies, and histologies, each with its own prognosis and treatment plan. Non-small cell lung cancer consists of about 80%–85% of lung cancer diagnoses.

Technology is synonymous with modern-day health care, and the experiences of 2020 have shown that telehealth allows clinicians to provide care along every inch of the cancer continuum. Although we’ve seen it used most recently to provide continuity of care from the safety of patients’ homes, one of telehealth's bigger purposes is overcoming geographic and practical disparities to enable more patients to access quality cancer care.

Each year more than 50,000 stem cell transplantations are completed worldwide. The stimulation, harvesting, and therapeutic use of patient and donor cells has evolved as a treatment for diverse cancer diagnoses, and specially trained nurses are at the heart of the clinical trials and care delivery to propel cell transplant therapy across practice settings.

Approximately 700 members responded to ONS’s 2020 genomics survey, which gauged oncology nurses’ current genomic knowledge, applications in practice, and the specific questions they have about genetics and genomics. Here are the answers to the most frequently asked questions based on the survey responses.

Cervical cancer rates have dropped more than 90% among women who received the human papillomavirus (HPV) vaccine, according to the results of a Swedish study published in the New England Journal of Medicine. Global health leaders are calling it a milestone study. 

In June 2020, the U.S. Food and Drug Administration granted accelerated approval to lurbinectedin (Zepzelca^TM) for adults with metastatic small cell lung cancer (SCLC) whose disease has progressed on or after platinum-based chemotherapy. The approval adds a second choice for patients who experience treatment-resistant SCLC progression, who previously had only topotecan as an option.

Nutritional status is one aspect of cancer care that may often be overlooked. Patients, particularly those with esophageal, gastric, pancreatic, and non-small cell lung cancers, have increased nutritional requirements because of their high resting energy expenditure. Treatment side effects further hinder a patient’s desire and ability to eat, creating a wider gap between energy intake and energy needs and placing patients with cancer at high risk for malnutrition.

In the United States, breast cancer is the most commonly diagnosed cancer in women. One in eight women will develop invasive disease in their lifetime with approximately 270,00 new cases diagnosed in the United States in 2019. Caucasian women have the highest incidence rate, whereas African American women are most likely to die from the disease. The five-year survival rate is 91%, with an estimated 3.8 million breast cancer survivors living in the United States.

Surgical treatment for breast, gynecologic, prostate, lymphoma, melanoma, or head and neck cancers puts patients at risk for developing secondary lymphedema at any point in the remainder of their life. Studies show that as many as 10%–40% of patients with breast cancer may experience breast cancer–related lymphedema. 

Included in the treatment plan for approximately 50% of all patients with cancer, radiotherapy (RT) is a significant component of cancer care. RT is a technology-driven oncology modality, which means it has continually evolved since being introduced in cancer care in the early 20th century.

Lymphomas are hematologic malignancies, specifically of the lymphatic system. They are classified into two types: Hodgkin and non-Hodgkin (NHL). NHL is the seventh most common cancer in the United States and Hodgkin seen much less frequently as the 26th, but new treatment options have improved survival rates.

Zanubrutinib (Brukinsa^TM) received U.S. Food and Drug Administration accelerated approval on November 14, 2019, for the treatment of adult patients with mantle cell lymphoma who have received at least one prior therapy.

The urinary system, including the bladder, ureters, urethra, and renal pelvis, is lined with urothelial tissue. Urothelial carcinoma is the predominant histologic type of cancer in that system, and 90% of tumors are located in the bladder. With more than 81,400 new cases and nearly 18,000 deaths estimated for 2020, bladder cancer is the fifth most prevalent type of cancer in the United States.

While working in a palliative care clinic, I developed a connection with one of my patients through an unexpected medium: word search puzzles. She was doing one the first time I entered her exam room, so I introduced myself and asked if it was a difficult one.  

The Human Genome Project determined the DNA sequence (order of base pairs) of the entire human genome. Humans are 99.9% identical at the level of base pair ordering, but the 0.1% difference contributes to disease risk. Upon completion of the human genetic blueprint, research turned to identifying and cataloguing genomic variation as well as determining the clinical relevance of variants.

Common classes of non-cancer medications that affect a patient’s microbiome are associated with increased or decreased survival with immune checkpoint inhibitor drugs, researchers reported in study findings published in BMC Cancer.

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.

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.

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.

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.   

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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?”

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.

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.

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).

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 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.

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:

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.

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.

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.

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.