The Case of the Mysterious Myalgia
Randi is a 57-year-old patient who identifies as female. She was diagnosed with clear cell metastatic renal cell carcinoma (mRCC), and her past medical history includes mild hypertension managed with amlodipine and a two-year history of transient musculoskeletal pain managed with tramadol. She reports a family history of cardiovascular disease and rheumatoid arthritis (RA). Her primary care physician suspects Randi is at the beginning stages of fibromyalgia but has not made a conclusive diagnosis because she hasn’t experienced additional symptoms.
Electroacupuncture and Auricular Acupuncture for Chronic Musculoskeletal Pain in Cancer Survivors
Chronic pain is a common but debilitating late effect for many patients with cancer. When undertreated, patients may experience negative functional, mental, and cancer-related outcomes. Although opioids are often effective for managing cancer pain, they may not be appropriate for some patients and others may struggle to access them because of the opioid crisis. The need for nonpharmacologic pain management options is critical.
The Case of the Virtual Venture
Staff in an oncology infusion unit located in an urban healthcare system watched as patient and caregiver stress increased during the COVID-19 coronavirus pandemic and the November 2020 U.S. presidential elections. During a team meeting, Holly, one of the nurses, brought up a study she read about that used virtual reality (VR) as a distraction for patients undergoing chemotherapy. The staff was interested in implementing a similar program at their institution but wasn’t sure how to start. What would you do?
How to Prevent Opioid Misuse While Effectively Managing Cancer Pain
Opioid misuse is prevalent among the U.S. population—so much so that President Trump declared it a public health emergency in 2017. At the same time, research shows that 20%–50% of patients with cancer and 80% of those with advanced-stage disease report experiencing moderate to severe pain. Balancing the dichotomies is difficult, but oncology nurses and other cancer care providers have a responsibility to provide comprehensive pain management for patients with cancer.
What Does the Evidence Say About Reiki for Cancer?
Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person to promote a sense of well-being. It was founded by the Japanese Buddhist and spiritual teacher Mikao Usui in the early 20th century and brought to the United States in the 1930s, where it has become increasingly popular.
CMS Expands Project to Fight Opioid Abuse
Throughout the country, Americans have seen the effects of opioid abuse. Rising numbers of overdoses have sent shockwaves through communities from Miami to Seattle and everywhere in between. As such, addressing the national opioid epidemic is still a major priority for the Trump administration.
NIH HEAL Initiative Commits $945 Million to Opioid Research
Designated as a national epidemic, opioid addiction and abuse are front and center at the federal level as lawmakers work to support the discovery of new treatments and resources to curb the growing problem. The National Institutes of Health (NIH), with support from the White House, Congress, and the Department of Health and Human Services, awarded $945 million in funding for grants, contracts, and cooperative agreements across 41 states for the Helping to End Addiction Long-Term (HEAL) Initiative. Targeting novel chronic pain interventions, opioid abuse, and the addiction crisis, the HEAL Initiative will funnel funding and resources into efforts that can make an impact immediately and in the future for healthcare providers and their patients.
Pain Management Task Force Issues First Report on Pain Control Best Practices
According to the Centers for Disease Control and Prevention, 50 million Americans experience acute and chronic pain daily. Managing the pain is debilitating and costly, and the impact on the economy is felt through employment issues along with a heightened burden on the healthcare system.
Nurses Have a Pivotal Role as Patient Advocates in the Opioid Crisis
As the current landscape of opioid pain control becomes more complex, oncology nurses remain vital to safe and effective treatment. During a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Tonya Edwards, MSN, MS, RN, FNP-C, of the University of Texas MD Anderson Cancer Center in Houston, and Timothy Tyler, PharmD, FCSHP, FHOPA, of Desert Regional Medical Center’s Comprehensive Cancer Center in Palm Springs, CA, discussed the challenges of opioid pain management as well as actions nurses can take to protect patients.
Smartphone App Helps Patients Manage Cancer Pain
A smartphone app that monitors patients’ self-reported cancer pain and uses artificial intelligence (AI) to differentiate urgent and non-urgent issues and provide real-time recommendations significantly reduced pain and pain-related hospital admissions, researchers reported in an abstract presented at the November 2018 Palliative and Supportive Care in Oncology Symposium in San Diego, CA.
Giroir Reflects on Public Health Programs After First Year at HHS
Washington, DC, and the larger federal government are filled with dedicated professionals who toil quietly, often anonymously, in support of programs, initiatives, and agency work in service of the American public. Such is true for the Department of Health and Human Services’ (HHS) lesser-known leaders like Admiral Brett Giroir, MD, assistant secretary for health, who reflected on his time at HHS as he helped guide the department’s efforts in public health.
Opioid Access; Smoking Age Increase; House Medicare for All
Efforts to curb the national opioid epidemic have taken shape in several ways, including redefined prescription guidelines. However, many insurers are now like the ones commonly prescribed to patients with cancer. For years, ONS has been meeting with congressional offices to advocate that access to prescription opioids for cancer survivors should be exempt from the strict limits assigned to other diagnoses. It’s always been a successful strategy, because related to severe pain management, quality of life, and end-of-life care.
HHS Awards $1 Billion to Fight Opioid Crisis
Recognizing the continuing impact of the national opioid epidemic, the Department of Health and Human Services (HHS) has dedicated $1 billion in funding through a new awards program called the Five-Point Strategy to Combat the Opioid Crisis. The program will empower communities to implement strategies to curb opioid abuse and addiction.
Opioids Have Been a Healthcare Concern Since the 1980s, but Here’s How Nurses Can Help
Although the opioid crisis was formally labeled a public health emergency in late 2017, excess drug abuse beyond prescription directions has been a public health concern for much longer—since the 1980s, in fact. At the November 2018 Center for Advancing Palliative Care Annual Seminar in Orlando, FL, speakers Lynn Hallarman and Mary McPherson presented a session on how the opioid crisis came to be and what our role as nurses is in changing culture and ultimately addressing it.
President Trump Signs Opioids Legislation Into Law
Developed to combat the nation’s opioid crisis, a comprehensive opioid addiction bill has finally made its way to the president’s desk. On October 25, 2018, President Trump signed the opioid package into law. The new law allots more than $8 billion to address addiction, drug trafficking, and recovery issues.
Obamacare Premiums Stabilize; Senate Opioid Package; Medicare for All Questions
Millions of Americans depend on the Affordable Care Act (ACA) marketplace for their health insurance. In the past, costs have been unstable, seeing insurance premiums rise and competition flee. However, new reports estimate that Americans who receive health coverage from ACA will only see moderate increases to their premiums for 2019. During earlier repeal and replace efforts of Obamacare—otherwise known as ACA—the healthcare marketplace was volatile for consumers. Some insurers pulled out of the marketplace, leaving those that remained able to sharply increase premiums.
Evidence Is Building for Acupuncture as an Opioid Alternative for Cancer Pain
Pain is the most common and debilitating side effect that patients with cancer experience. Contributing factors include the disease itself via tumor invasion on surrounding tissue and bone; nerve compression; treatments including chemotherapy, radiotherapy and surgery, especially chemo-induced peripheral neuropathy (CIPN), which can be disabling; and aromatase inhibitors that can cause persistent diffuse joint pain. In addition, pain that “breaks through” continuous pain medicine can be difficult to predict and control.
FDA Commissioner Addresses Chronic Pain and Opioid Use
As the opioid epidemic ravages American lives, every federal agency with an opportunity to review access is stepping up efforts to find appropriate lines between offering proper care and potentially enabling abuse. In a recent statement, U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, acknowledged the challenge of balancing quality care efforts with overprescribing medications and the potential ease of access to opioids.
ONS Member Paice Shares Pain Management Policy Burdens With NCI
For the past two years, opioids have drawn the attention of researchers, members of Congress, the president, and the general public. With stories of drug abuse and heartbreaking tragedy, the problem with opioids in America has been dubbed an epidemic. Federal funding has accompanied the call to combat overdoses and adjust treatment plans to change the way addiction is dealt with from a medical perspective.
House Overwhelmingly Passes Final Opioid Package; Texas v. the United States Could Impact Patients With Preexisting Conditions; Lawmakers Who Forged ACA Look Back
Through tremendous bipartisan support, the House of Representatives passed comprehensive opioid legislation to address the national abuse epidemic in the United States on June 22, 2018. For many healthcare advocates, an opioid legislation package has been a long time coming. The opioid crisis has been in the news since before the 2016 presidential election but was brought to the forefront during that campaign.
HHS Pain Task Force Examines Opioid Epidemic Impact on Patients, Providers
The Department of Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force held its first public meeting from May 30–31, 2018, in Washington, DC. Convened as part of 2016’s Comprehensive Addiction and Recovery Act, the task force has been charged to address the nation’s continued opioid abuse crisis. During the two-day meeting, the 28-member task force deliberated on the goals of an upcoming study, set to be released July 2019, that aims to update best practices and clinical guidelines, while also addressing gaps and inconsistencies in chronic and acute pain management.
Oncology Nurses Have a Responsibility to Identify and Prevent Opioid Abuse in Patients With Cancer
As the opioid abuse epidemic prevails in the United States, patients with cancer can be affected. Yu-Ping Chang, PhD, RN, FGSA, associate dean for research and scholarship in the School of Nursing at the University at Buffalo in New York, and Tonya Edwards, MS, MSN, BSN, FNP-C, a nurse practitioner of supportive care at MD Anderson Cancer Center in Houston, TX, discussed how the opioid epidemic affects patients and how to identify and prevent opioid and substance abuse during a session at the 43rd Annual Congress in Washington, DC.
Opioids Are Not Always the Answer
As the opioid crisis continues in the United States, helping patients find effective and safer ways to manage their pain becomes increasingly important. During a session at the 43rd Annual Congress in Washington, DC, Jeannine Brant, PhD, APRN, AOCN®, FAAN, of Billings Clinic in Montana, instructed nurses on ways to treat cancer-related pain and discomforts other than (or in addition to) narcotic pain medicines.
NIH Completes In-Depth Genomic Analysis; Senate Panel Unveils Draft Opioid Bill; Teenagers Struggle to Quit Vaping
Researchers for the PanCancer Atlas, a genomic data set reference tool, recently completed an analysis of molecular and clinical information from more than 10,000 different tumors spanning more than 33 cancer types. The PanCancer Atlas is the result of nearly a decade’s worth of work associated with the Cancer Genome Atlas—a multi-institutional program driven by the National Human Genome Research Institute and the National Cancer Institute (NCI). The results of the analysis were published as a set of 27 papers.
Medicare Cracks Down on Opioid Prescriptions, Abuse; Health Care Tops Poll of American Worries; Leading Chemotherapy Researcher, Physician Dies at 92
An estimated 14.4 million Medicare recipients were prescribed some form of opioid treatment in 2016, paid for by their Medicare benefits. In an attempt to help curb the national opioid epidemic, officials from the Center for Medicare and Medicaid Services (CMS) announced that Medicare would no longer pay for long-term, high-dose prescription pain medication. Unsurprisingly, the plan received flak from patient and provider advocacy groups alike. Opponents to the CMS announcement decried the efforts, citing barriers to crucial medications needed for patients in chronic or severe pain—including those with cancer.
The Case of the Pain Paradox: Follow-Up and Clinical Trial
The January 2018 case study introduced Vince, a 55-year-old man receiving chemotherapy and radiation for recurrent bladder cancer. He suffers from chronic back pain because of spinal stenosis and has been on opioid therapy for nearly two years.
NIH Funds Precision Research for Childhood Cancer; Will Congress Lift Medicaid Ban for Opioid Epidemic?; FDA-Approved Breast Cancer Test May Impact Oncology Nurses
Cancer treatments aren’t one-size-fits-all, and they differ greatly depending on age. As the leading cause of disease-related death for children, pediatric cancers pose a critical threat to this population. According to the National Institutes of Health (NIH), one reason pediatric cancer mortality rates persist is because there’s “limited knowledge” related to the biological mechanisms affecting childhood cancers. NIH-funded studies are breaking ground and uncovering new information about the genomics of pediatric cancers.
Bipartisan Bill Unveiled to Fight Opioid Epidemic; FDA Renews Commitment to Curb Tobacco Use; Walker Embraces Obamacare for Wisconsin Residents
In 2016, former President Obama signed the Comprehensive Addiction and Recover Act (CARA) into law. Since then, some aspects of drug addiction have been decriminalized and refocused as medical issues, helping to remove some of the stigma associated with addiction. Although CARA is a start when tackling addiction issues, several senators—both Republican and Democrat—want to take it a step farther in the national fight against opioid abuse.
Remembering Margo McCaffery’s Contributions to Pain Management
Former ONS member Margo McCaffery, RN, MS, FAAN, was a leader and pioneer in pain management for nursing. Through her work, she helped to identify and treat patients with acute and chronic pain in a number of healthcare settings. McCaffery’s 1968 definition of pain was simple—“It’s whatever the experiencing person says it is, existing whenever and wherever the person says it does.” Her words have become a touchstone for clinicians addressing and treating patients in pain.
Despite Regulations, Patients With Cancer Pain Still Need Safe Access to Opioids
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.
White House Commission Reports on Drug Addiction and Opioid Epidemic
In the past few years, drug abuse and opioid addiction levels have grown to epidemic proportions. In 2016, Congress passed the Comprehensive Addiction and Recovery Act (CARA) to decriminalize drug use and reclassify addiction as a disease. After President Obama signed CARA into law, the bill allocated hundreds of millions of dollars to combat the epidemic, alongside funding for Americans in need of addiction treatment and support.
Assess and Manage Cancer-Related Pain
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.
The Case of the Comfort Care Concerns
Phil is a 63-year-old man who is admitted to the inpatient oncology unit for severe pain resulting from metastatic small cell lung cancer. His wife and two daughters are at his bedside. Earlier in the day, the medical oncologist discussed additional treatment options or hospice care. Phil decided on comfort care with the hope of getting his pain managed and going home on hospice.
Manage Pain in Patients With Cancer With These Tools and Resources
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.
ONS Shares Views on Advance Care Planning, Patient Access to Opioids in Comment Letter to CMS
ONS joined the Patient Quality of Life Coalition (PQLC) in signing a final comment letter to the Centers for Medicare and Medicaid Services (CMS) administrator, Seema Verma, on the agency’s proposed 2018 updates to the Quality Payment Program, CMS-5522-P. PQLC, which represents patients, health professionals, and healthcare systems, advocates for palliative care for patients and families facing serious illness.
Trump Declares Opioid Crisis a National Emergency; Recent Poll Shows Health Care, Government Most Important to Americans; FDA Launches Campaign to Fight Youth E-Cigarette Use
Experts currently estimate that opioid addiction kills nearly 100 Americans every day, and the scale of the problem is continuing to grow. In response, President Trump to unofficially declared the opioid crisis a national emergency during a public statement from his golf resort in Bedminster, NJ, on August 10, 2017.
Managing Pain in Patients With Substance Use Disorder
In their article in the April 2017 issue of the Clinical Journal of Oncology Nursing, Compton and Chang provided a guide for nurses caring for patients with substance use disorder (SUD), including overview, diagnosis, and treatment of SUD as well as its implications for pain management and cancer treatment considerations when a patient with SUD is diagnosed with cancer.
When Ineffective Pain Control Means Chemical Coping
Central to our role as oncology nurses is provision of symptom relief balanced with a manageable side-effect profile. Although opioids are extremely effective at cancer pain management, they also bind to the brain’s limbic system and can produce reward responses. This can result in dependence and drug-seeking behaviors.
HHS Announces Opioid Crisis Prevention Program
Prescription drug abuse has reached epic proportions in the United States. Efforts have been made to help combat this growing issue. In 2016, President Obama signed into law the Comprehensive Addiction and Recovery Act (CARA) to reclassify drug abuse as a disease instead of a crime.
The Case of the Omitted Opioid
Rocky is a 56-year-old man with stage III oropharyngeal cancer. He is undergoing concurrent chemotherapy and radiation. Rocky is a long-haul truck driver, has had sporadic medical care in the past, has no primary care provider, and usually visits the emergency department in whatever town he is in when he gets sick. He was diagnosed during one of those visits after an episode of hematemesis.
Tips for Managing Chronic Pain in High-Risk Patient Populations
Pain management is often necessary for patients with cancer and other high-risk conditions. Despite guidelines and treatment algorithms, caring for this patient population can be challenging. Oscar DeLeon, MD, of the Roswell Park Cancer Institute, Kathleen Broglio, DNP, ANP-BC, ACHPN, CPE, FPCN, from Dartmouth Hitchcock Medical Center, and Jennifer Grimmer, DNP, FNP-BC, of the Roswell Park Cancer Institute, discussed strategies and best practice for pain management during a session at the 42nd Annual Congress in Denver, CO.
GOP to Potentially Revisit Healthcare Legislation; New State Funding Will Combat Opioid Epidemic; FDA Reaches Reauthorization Fee Deal for New Drugs, Devices
As the first 100 days of the Trump administration ends, the White House is still pressing Congress to revisit healthcare legislation—one of Trump’s main campaign promises.
PA Legislation Aims to Expand Role of Nurse Practitioners; Bipartisan Support Needed to Tackle the Nation’s Opioid Epidemic; New Poll Reveals Bipartisan Interest in Single-Payer Health Care
New legislation proposing to allow nurse practitioners the ability to practice to the full extent of their licensure is making its way through the Pennsylvania House and Senate. The bill was introduced to help ease the burden on healthcare professionals by loosening restrictions on the supervision over nurse practitioners.
Executive Order to Fight Opioid Epidemic; Trump Administration Proposes Cuts to Spending in 2017 and 2018; White House Supports April as Cancer Control Month
President Trump is a preparing a new executive order that would outline recommendations for the nation’s fight against opioid addiction. According to report released in STAT, the executive order would form a commission of four top Trump aides, including Attorney General Jeffery Sessions, Health and Human Services Secretary Tom Price, Veterans Affairs Secretary David Shulkin, and Defense Secretary James Mattis. The commission would be led by New Jersey Governor Chris Christie and would be fleshed out with another five other yet-to-be-named officials from the state government level, law enforcement, and other areas potentially impacted by the national crisis.
Concern Over ACA Repeal, Bipartisan Support Against Opioid Epidemic, ACA Replacement May Mean Unwanted Limitations
In a series of articles published by the Washington Post, patients living with cancer are speaking out against the potential harm that could impact cancer care with repeal of the Affordable Care Act (ACA). Told through each patient’s own experience with the ACA, the stories paint a vivid picture for lawmakers on Capitol Hill. By putting a face to those affected by repealing the ACA, this series may give representatives pause before they consider getting rid of the healthcare bill.