Novel Therapies: How CAR T Cells and Biosimilars Are Changing Cancer Care
Clinical practice is in a constant state of evolution as new guidelines are released, drugs are approved for new indications, and technology reshapes the way care is delivered. Patients are also arming themselves with a more-advanced-than-ever knowledge and understanding of health care, and providers may be fielding new questions from patients and caregivers about novel treatments such as chimeric antigen receptor (CAR) T-cell therapy and biosimilars.
FDA Updates REMS and Black Box Warnings for Blinatumomab
In May 2019, the U.S. Food and Drug Administration (FDA) added new clarifications to its risk evaluation and mitigation strategy and black box warnings for blinatumomab (Blincyto®). Blinatumomab is a bispecific, CD19-directed CD3 T-cell engager indicated for the treatment of adults and children with (a) B-cell precursor acute lymphoblastic leukemia (ALL) in first or second complete remission with minimal residual disease greater than or equal to 0.1% or (b) relapsed or refractory B-cell precursor ALL.
FDA Approves Lenalidomide for Follicular and Marginal Zone Lymphoma
On May 28, 2019, the U.S. Food and Drug Administration (FDA) approved lenalidomide (Revlimid®) in combination with a rituximab product for previously treated follicular lymphoma and previously treated marginal zone lymphoma.
FDA Cautions That Robotic Devices Are Not Approved for Mastectomy or Other Women’s Cancer Surgeries
Because of limited preliminary evidence that the use of robotic-assisted surgical devices for treatment or prevention of women’s cancers may be associated with diminished long-term survival, the U.S. Food and Drug Administration (FDA) issued a reminder warning to healthcare providers and the public in February 2019 that the technique has not been FDA approved for this purpose.
Commission on Cancer to Revise Standards for Cancer Program Accreditation
The Commission on Cancer (CoC), an organizational consortium of which ONS is a governing member, provides standards for cancer programs to follow to achieve a high level of continuous quality improvement. Last updated in 2016, the standards are currently undergoing analysis and revision, and CoC is seeking public comments until June 3, 2019.
FDA Approves Avelumab Plus Axitinib for Renal Cell Carcinoma
On May 14, 2019, the U.S. Food and Drug Administration (FDA) approved avelumab (Bavencio®) in combination with axitinib for first-line treatment of patients with advanced renal cell carcinoma.
The Case of the Terrible Toxicities
After completing neoadjuvant chemotherapy for triple-negative invasive breast cancer, Madeline, age 32, had a bilateral mastectomy with reconstructive surgery. Final pathology showed residual disease in the breast and one lymph node, and her oncologist recommended adjuvant therapy with capecitabine (1,500 mg twice a day for 14 days, off for 7 days). Five weeks postoperatively, she started cycle 1. Eight days later, her husband called the cancer clinic reporting that over the past two days, his wife developed profound weakness, unremitting diarrhea despite using diphenoxylate and atropine as directed, and painful, red, swollen hands and feet. Her symptoms represented a drastic change from her usual routine and energy level.
Liquid Biopsy Equivalent to Tissue for NSCLC
With faster and equally accurate results, liquid biopsy may be an option for identifying guideline-recommended targeted therapies for non-small cell lung cancer (NSCLC), according to findings presented at the 2019 American Association for Cancer Research Annual Meeting in Atlanta, GA.
FDA Approves Ivosidenib as First-Line Treatment for AML With IDH1 Mutation
On May 2, 2019, the U.S. Food and Drug Administration (FDA) approved ivosidenib (Tibsovo®) for newly-diagnosed acute myeloid leukemia (AML) with a susceptible IDH1 mutation, as detected by an FDA-approved test, in patients who are at least 75 years old or who have comorbidities that preclude the use of intensive induction chemotherapy.
Stay Up to Date on Clinical Treatments for Metastatic CRC
Metastatic colorectal cancer (CRC) remains a significant health problem as the second leading cause of cancer death in the United States and the fourth most frequently diagnosed cancer. Despite improvements in some age groups, its incidence has actually been increasing in patients younger than 50 years. The cause of this trend is currently unknown.
The Value of Oncology Nurse Certification
Oncology care is a complex field in a constant state of paradigm shifts, where new information and research affect clinical practice in countless ways. Amid rapid developments in treatments, technologies, and patient-care modalities, oncology nurses must show they’re up to date with emerging knowledge in their field. Oncology nurse certification is one way nurses can demonstrate their commitment to the art and science of patient-centered oncology care.
Updated Scope and Standards Represent Key Foci of Oncology Nursing Practice
To ensure that the Oncology Nursing: Scope and Standards of Practice are consistent with overall nursing standards and to increase the visibility of the oncology nursing standards in the greater nursing and healthcare communities, ONS released an updated version of its reference book in March 2019. The American Nurses Association (ANA) recognizes oncology nursing as a nursing specialty, and the new edition carries ANA’s approval of the oncology nursing scope of practice and acknowledgement of the oncology nursing standards of practice.
How APRNs Can Manage Immunotherapy-Related Hypophysitis in Patients With Cancer
Immunotherapy may place patients at risk for distinctive toxicities that differ from traditional chemotherapy. One example is endocrine dysfunction, including hypophysitis, hypo- or hyperthyroidism, type 1 diabetes, and primary adrenal insufficiency.
Self-Care for the Soles
The twenty-six bones in the foot are always being stepped on. Getting on one’s nerves takes on a whole new meaning when considering that each foot contains an estimated 200,000 nerve endings. With health enthusiasts recommending 10,000 steps per day, which translates to approximately five miles, is it any wonder that the often-abused soles deserve a little self-care?
Oncology Drug Reference Sheet: Cabozantinib
Cabozantinib (Cabometyx®) received an additional U.S. Food and Drug Administration (FDA)-approved indication in January 2019 for use in patients with hepatocellular carcinoma (HCC) who have already been treated with sorafenib. It received prior approval for the treatment of renal cell carcinoma in 2017. The research leading to the approval in the HCC setting showed improved overall survival, progression-free survival, and overall response in the cabozantinib treatment arm.
FDA Approves Pembrolizumab Plus Axitinib for Advanced Renal Cell Carcinoma
On April 19, 2019, the U.S. Food and Drug Administration (FDA) approved pembrolizumab plus axitinib for the first-line treatment of patients with advanced renal cell carcinoma.
Which Ambulatory Infusion Pump Is Best for 5-FU?
Because of its long infusion time over 46–48 hours, 5-fluorouracil (5-FU) is usually administered with an ambulatory infusion pump in the outpatient setting. However, two types of pumps exist. On one side of the spectrum is the elastomeric pump: small, compact, but gets the job done. On the other is the electronic pump: bigger, flashy, with lots of bells and whistles (literally). Here are the advantages and disadvantages of each.
The Case of the Belated BRCA Test
Eighteen months after completing surgical debulking and chemotherapy for stage III high-grade serous ovarian cancer, 56-year-old Lily experienced a rising CA-125 level. At her oncologist’s recommendation, Lily started an aromatase inhibitor, but it did not stop the rising tumor marker. After she began experiencing symptoms of bloating and mild abdominal pain, Lily and her oncologist decided to proceed with second-line chemotherapy. As she left the office, Lily remarked that she did not complete genetic testing when she was originally diagnosed because she does not have any children or a family history of ovarian cancer and she was concerned that her insurance would not cover the testing.
Oncology Urgent Care Clinics Are an Emerging Setting for Cancer Care Delivery
Patients with cancer are living longer, embarking on complex treatment regimens, and experiencing more complications associated with care. As a result, a large volume of patients with cancer require urgent or emergency visits throughout their disease trajectory. Although the need remains constant, what has evolved over time are the chief complaints that bring patients in, the care associated with complications, and new options to lower the burden and cost of care.
Innovations in Surgical Oncology: What Nurses Need to Know
Robotic surgery represents the most significant advancement to date in minimally invasive surgery, Lisa Parks, MS, APRN-CP, ANP-BC, of James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center in Columbus, said during a session on Thursday, April 11, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
What Genetics Means in Hereditary Cancer
Genetic testing and genetics care are playing an increasingly important role in oncology and are continually evolving, Suzanne M. Mahon, DNSc, RN, AOCN®, AGN-BC, of the School of Nursing at Saint Louis University in Missouri, said during a session on Thursday, April 11, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
Nurses Use Evidence-Based Practice to Bust Oncology Myths
Although nurses strive to promote evidence-based interventions, many practices and beliefs persist despite limited research to support them. During a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Nancy Houlihan, MA, AOCN®, of Memorial Sloan Kettering Cancer Center in New York, NY, Lynn Gallagher-Ford, PhD, RN, NE-BC, DPFNAP, FAAN, of Ohio State University, Helene Fuld Health Trust, National Institute for Evidence-Based Practice in Nursing and Healthcare, in Columbus, and Suzanne Dixon, MPH, MS, RD, of No Nutrition Fear in Portland, OR, instructed nurses on how to be myth busters in oncology practice settings.
Research Sheds Light on the Complexities of Shared Decision Making
Making a treatment decision for a cancer diagnosis is a very complex and challenging event for patients. This is particularly evident among men with prostate cancer. Because so many treatment options exist, often without a single best therapeutic or medical outcome, many men with prostate cancer may have challenges when making a treatment decision. Most patients rely on their providers to help them better understand their diagnosis, available treatments, impact, and side effects from treatment, but patients will ultimately seek external information to inform their decision-making process.
For Oxaliplatin Hypersensitivity Reactions, Prevention Is the Best Strategy, but Here’s How to Manage Them
As the use of oxaliplatin in the treatment of gastrointestinal, gynecologic, and other cancers continues to grow, so too does the incidence of hypersensitivity reactions connected to the drug. Because the development of HSRs may require patients to discontinue oxaliplatin even if it’s effective against their cancer, oncology nurses need to be able to prevent or minimize reactions whenever possible.
How Shared Decision Making Affects Cancer Care
“Two heads are better than one” is an idiom so old and often used that it borders on cliché. But as with most colloquial sayings, a kernel of truth is buried underneath. Combining forces to solve problems, overcome obstacles, and coordinate efforts is the key to nearly every successful endeavor, and it’s especially true for patients and providers navigating the cancer journey.
Which of the Following Late Symptoms of Increased Intracranial Pressure Is Not Included in the Cushing Triad?
Which of the Following Late Symptoms of Increased Intracranial Pressure Is Not Included of the Cushing Triad?
A. Hypertension with widening pulse pressure
D. Abnormal respirations
Oncology Drug Reference Sheet: Glasdegib
In November 2018, the U.S. Food and Drug Administration (FDA) approved glasdegib (Daurismo™) for use in combination with low-dose cytarabine for treatment of patients with newly diagnosed acute myeloid leukemia who are not eligible for intensive chemotherapy. Data from clinical trials indicated that the regimen is safe for older adults and those with significant comorbidities, such as cardiac disease, poor performance status, or elevated serum creatinine.
Evidence Doesn’t Support Antioxidant Supplementation for Patients With Cancer
Reactive oxygen species (ROS), such as hydroxyl and superoxide radicals, singlet oxygen, and hydrogen peroxide, are byproducts of metabolic processes in the body and play an important role in regulating cell physiology and function. But uncontrolled ROS formation (oxidative stress) can result in DNA, protein, and lipid damage, which has been implicated in several diseases, including cancer. Antioxidants, produced endogenously or in supplemental form, function as ROS scavengers and inhibit oxidative stress. Popular antioxidants include vitamins C and E, selenium, beta carotene, lycopene, resveratrol, flavonoids, anthocyanins, and catechins. They are widely used to prevent cancer and its recurrence.
Which of the Following Leads to the Greatest Percentage of Superior Vena Cava Syndrome Cases?
Which of the Following Leads to the Greatest Percentage of Superior Vena Cava Syndrome Cases?
A. Small cell lung cancer
B. Non-Hodgkin lymphoma
C. Non-small cell lung cancer
D. Kaposi sarcoma
Hospital-Acquired Conditions Reduced by Nearly 1 Million From 2014–2017
According to an Agency for Healthcare Research and Quality (AHRQ) analysis, the number of hospital-acquired conditions (HACs) reported in the United States dropped by 910,000 (13%) from 2014–2017.
How Do You Address Unanticipated Genomic Testing Results?
Genomic testing—identifying variants, like mutations, in tumor cells to inform patient treatment options—occasionally comes with unanticipated results that clinicians have to address with their patients. Clinicians and patients alike are often hopeful that tumor genomic testing will identify a personalized cancer treatment. Indeed, many patients have benefited from being candidates for new targeted therapies identified through genomic testing.
Testing in the Era of Precision Oncology
Every cancer diagnosis is as individualized and unique as the person receiving it. From family history to societal and economic background to a patient’s genetic make-up and composition, cancer affects each person with cancer differently. Initiatives like precision medicine are based in data that suggest that a personalized disease should have its own personalized treatment. As a subset of precision medicine, precision oncology assesses a patient’s unique genetic profile to help align targeted therapies to hit the right cancer subtypes.
Which of the Following Strategies Is an Example of Developing a Provider-Patient Relationship to Negotiate an Oral Adherence Plan?
A provider develops a partnership with a patient and negotiates behaviors to reach an agreement to adhere to oral chemotherapy medication. This is an example of which strategy?
b. Operant conditioning
c. Motivational interviewing
FDA Approves Trifluridine and Tipiracil Tablet for Recurrent Metastatic Gastric or GEJ Adenocarcinoma
On February 22, 2019, the U.S. Food and Drug Administration (FDA) approved trifluridine/tipiracil tablets (Lonsurf)—a fixed combination of trifluridine, a nucleoside metabolic inhibitor, and tipiracil, a thymidine phosphorylase inhibitor—for adult patients with metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma previously treated with at least two prior lines of chemotherapy that included a fluoropyrimidine, a platinum, either a taxane or irinotecan, and if appropriate, HER2/neu-targeted therapy.
Oncology Drug Reference Sheet: Ribociclib
Ribociclib is a CDK 4/6 inhibitor first approved by the U.S. Food and Drug Administration in early 2017 for postmenopausal women with HR-positive, HER2-negative advanced or metastatic breast cancer in combination with an aromatase inhibitor as initial endocrine therapy, based on the MONALEESA trial results.
How APRNs Can Manage Immunotherapy-Related Hypothyroidism in Patients With Cancer
Immunotherapy has a unique set of toxicities in comparison to traditional chemotherapy. Endocrine dysfunction, including hypo- or hyperthyroidism, hypophysitis, type-1 diabetes, and primary adrenal insufficiency, may occur. Advanced practice RNs (APRNs) have a role in monitoring and treating patients for endocrine-related toxicities.
FDA Approves Pembrolizumab for Adjuvant Treatment of Melanoma
On February 15, 2019, the U.S. Food and Drug Administration (FDA) approved pembrolizumab for the adjuvant treatment of patients with melanoma with involvement of lymph node(s) following complete resection.
Cultivate Cultural Humility in Yourself and Your Practice
Oncology nurses interact with other staff, patients, and families, each of whom have various cultural and personal preferences. A person’s culture encompasses race, ethnicity, spiritual practices, social habits, and so much more.
Be Alert for Severe, Early-Onset Toxicities From 5-Fluorouracil and Capecitabine
Although 5-fluorouracil (5-FU) and capecitabine (the oral prodrug of 5-FU) are generally well tolerated, patients can experience severe toxicities from either drug that can be life-threatening if not treated quickly. Of the 275,000 patients who receive 5-FU each year, more than 1,300 die from 5-FU toxicity, or approximately 3–4 patients per day.
What Assessment Tools Are Used for Patients With Cancer and Psychiatric Diagnoses?
When patients with cancer also suffer from psychiatric diagnoses, it can present unique challenges to healthcare professionals. Because oncology nurses build relationships with patients while addressing issues, understanding the obstacles to practice is key to providing the best possible care. By having a keen understanding of symptoms, assessment procedures, and necessary response skills, oncology nurses can work together with the mental health team to provide holistic care throughout the cancer journey.
A Matter of Mind: When Patients With Cancer Have Psychiatric Comorbidities
Nearly 20% of Americans experience mental illness in a given year, according to the National Alliance on Mental Illness. With diagnoses such as schizophrenia, bipolar disorder, or major depression, about one in every 25 Americans suffers from a serious mental illness that directly affects major life activities. The prevalence of mental illness in the United States can have a downstream effect on cancer care and patient outcomes, and with these statistics, oncology nurses may encounter patients with cancer who have pre-existing psychiatric disorders. Healthcare providers in fields outside of psychology need to be prepared to address the unique needs and individualized care required to support this patient population during and beyond cancer treatment.
NIH Seeks Research Proposals Through HEAL Initiative Funding
Recognizing the national opioid epidemic in the United States, the National Institutes of Health (NIH) has allocated a to address public health issues like prescription drug abuse and overdose. Through the Helping to End Addiction Long-Term (HEAL) Initiative, the NIH is offering 30 funding opportunities for researchers, awarding $850 million in support.
Which of the Following Drug Is Most Likely to Have a Synergistic Effect When Combined With Radiation Therapy?
Which of the Following Drug Is Most Likely to Have a Synergistic Effect When Combined With Radiation Therapy?
Oncology Drug Reference Sheet: Lutetium Lu 177 Dotatate
Lutetium Lu 177 dototate (Lutathera®) was approved in January 2018 by the U.S. Food and Drug Administration to treat a specific group of neuroendocrine tumors (NETs) in the gastrointestinal tract. NETs are rare, and the tumors produce hormone-like substances in response to signals from the nervous system.
The Role of the APRN in Monitoring Patients Receiving Peptide Receptor Radionuclide Therapy
Neuroendocrine cancers are rare malignancies; however, their incidence is thought to be increasing. Such tumors are characterized by their overexpression of somatostatin receptors, present in up to 80% of cases. However, a novel radiopharmaceutical may give advanced practice RNs (APRNs) a new option to treat certain gastroenteropancreatic neuroendocrine tumors.
Do Cytotoxic Agents Impact Ground Soil or Well Water?
When patients go home after receiving their regimen of powerful cytotoxic agents, oncology nurses routinely encourage them to double flush after using the bathroom to ensure that trace amounts of hazardous medication are eliminated from the environment to prevent other members of the household from being exposed. But what happens with chemotherapy chemicals found in human waste as they enter a patient’s septic system—and eventually the water supply?