Nurses Say That Oncology Inpatient Medical Cannabis Use Improves Symptom Management and Quality of Stay
An overwhelming majority of nurses say that terminally ill patients with cancer in California who use medical cannabis under Ryan’s Law in an inpatient setting have better symptom management and satisfaction with the quality of their stay, according to survey findings reported during the 48th Annual ONS Congress® in April 2023.
Nurse-Created Apps Help Pediatric Patients Find Their Voice and Navigate Their Cancer Journey
A nurse’s perspective in the creation of health technology tools to deliver quality patient care is important for the digital era we provide care in. Advancements can be as complex as artificial intelligence in big institutions or as simple as a mobile app for personal smartphones. I’ve been working with other healthcare providers to develop the latter to improve care for pediatric patients with cancer.
Machine-Learning Algorithm Uses Cancer Symptom Severity to Predict Patient Outcomes
Unsupervised machine learning can assign older adult patients to low, moderate, or high prediagnosis symptom severity categories, allowing healthcare providers to identify patients at risk for hospitalization or death even before initiating treatment, researchers reported in JAMA Network Open.
Cancer Center Cultivates Novel Herbal Oncology Program
Nearly 60% of patients with cancer turn to herbal supplements for symptom relief, but patient-physician communication about that use remains inadequate. Unsupervised herbal use can lead to adverse events and herb-drug interactions for patients during active treatment. Many physicians and providers also lack sufficient knowledge about herbal supplements to help patients make informed decisions.
When Delirium Is Recognized and Addressed Early, Patient Outcomes Improve
An “acute state of confusion resulting from organic brain dysfunction,” delirium is a medical emergency that can be highly distressing to both patients and caregivers. Approximately 2.6 million older adults experience delirium each year.
Nurse-Led Online Intervention Improves Symptoms, Control, and QOL in Ovarian Cancer
An eight-week online symptom self-management program, which can be facilitated by a nurse, significantly improves symptom burden, sense of control, and quality of life among patients with ovarian cancer. Researchers reported the evidence in the Journal of Clinical Oncology.
New SIO-ASCO Guideline Identifies Integrative Care Recommendations for Cancer-Related Pain
Cancer-related pain, whether from the disease or its treatments, is a distressing symptom that persists through survivorship. Pain diminishes patients’ quality of life and negatively affects their cancer-related outcomes.
Precision Oncology Models Guide Tailored Nursing Interventions for Ovarian Cancer Symptom Clusters
Using the National Institutes of Health Symptom Science Model and Nursing Science Precision Health Model helps oncology nurses to recognize symptoms more promptly in patients with ovarian cancer and provide precision interventions that address racial disparities and foster equity in symptom-focused, patient-centered care, Mahoney and Pierce reported in the October 2022 issue of the Clinical Journal of Oncology Nursing.
The Intersection of Pelvic Health and Oncology Optimizes Sexual Symptom Management
Both a patient’s cancer and their subsequent treatment plan can affect their bodies, including pelvic health and sexual functioning. A pelvic health physical therapist can help combat—or even prevent—those issues as a member of the interprofessional cancer care team.
Nurses Use Innovation to Perform Symptom and Pain Assessments
Symptom and pain assessment tools can measure multiple aspects of a patient’s pain experience in both ambulatory and acute care settings. My interest in symptom assessment began with to my work as an oncology nurse practitioner, when I witnessed how symptom management can make a positive difference in patients’ lives and ability to tolerate cancer treatment.
The Clinical Pharmacist’s Role in Symptom Assessments
Healthcare professionals involved in direct patient care, such as nurses, pharmacists, advanced practice providers, and physicians, learn methods of symptom assessment during education and training, but each profession uses a slightly different lens. The ability to consider polypharmacy and drug-drug interactions in patient assessment is one of the most important skills a clinical pharmacist uses in daily practice. Clinical pharmacists caring for patients with cancer must identify drug-related side effects, monitor and manage patients during chronic drug therapy, and educate patients and members of the interprofessional team, all in the context of the intricacies of antineoplastic therapy and adherence assessment.
Symptom assessment gives oncology nurses a consistent matrix to directly evaluate the significance that symptoms have on patients’ distress, quality of life, and survival. Both symptoms and their impact can evolve throughout a patient’s cancer course, making high-quality and detail-oriented assessments an essential tool for successful treatment and management.
Don’t Ask Patients About Their Symptoms—Have Them Tell You
“How are you doing?” We ask this question of our patients repeatedly: at diagnosis, during treatment, throughout survivorship, and at end of life. However, studies show that patients often give inaccurate answers to that direct question.
ONS Launches New Learning Extension Activities for Popular Cancer Basics Course
The Oncology Nursing Society’s (ONS’s) new Learning Extension Activities Plan (LEAP), an opportunity for student nurse learners to further develop their knowledge of some of the topics covered in ONS’s Cancer Basics course, was created to help faculty members teach oncology to nursing students.
Real-World Usage Reports Show That ONS Guidelines™ Empower Nurses to Provide Best Patient Care
Among their many benefits in practice, ONS Guidelines™ arm oncology nurses with the evidence to advocate for their patients’ care, according to findings from a fall 2021 focus group ONS conducted with nurses practicing at all levels of direct care.
Exercise the Evidence: How I Moved From an Idea to Program Development
As a clinical nurse specialist (CNS) with a cardiovascular background, I have seen the evidence-based benefits of exercise in a variety of settings. However, several years ago, when I was working as a CNS on an acute inpatient oncology unit, I noticed that exercise was not regularly included in care plans. As I learned from staff, this was done out of concern that patients needed to rest to save their energy.
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.
Genetic Counselors Help Patients and Providers Understand Biomarker Testing Goals and Results
Genetic counselors have a unique ability to explain complex genetic information to patients, providers, and our healthcare colleagues and to empower patients to take an active role in their healthcare decisions. We review biosignature data points and help explain the difference between variants that were acquired (somatic) versus those that may have a germline component, or possibly inherited from a parent. By working with oncology teams, genetic counselors provide guidance on potential next steps to evaluate variation occurrences and how providers, patients, and their families can use the information to guide their care.
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.
New Multiple Myeloma Treatments Present New Challenges in Side Effect Management
New strategies are emerging to manage the complex side effects and adverse events from multiple myeloma (MM) therapies, Lorraine Mack, APN/MSN CNL, OCN®, AOCNS®, and Dodi Georges, MSN, CWON, OCN®, both from Northwestern Medicine, said during a session held September 14, 2021, at the ONS BridgeTM virtual conference. They shared best practices for nursing interventions for patients undergoing new treatment options.
Diagnose and Treat Hypercalcemia of Malignancy
Hypercalcemia of malignancy (HCM) is a common paraneoplastic syndrome associated with poor prognosis that affects approximately 20%–30% of patients with cancer. It’s most often seen in patients with breast, lung, renal, or ovarian cancers; squamous cell carcinoma of the head and neck; multiple myeloma; and certain lymphomas.
An APRN’s Clinical Guide to Medical Marijuana
More and more patients with cancer are asking their healthcare providers whether medical marijuana can help them manage symptoms and side effects. Advanced practice RNs (APRNs) must be prepared to educate patients and assess their eligibility for therapeutic cannabis.
Nursing Management of Adverse Events From Enfortumab Vedotin Therapy for Urothelial Cancer
Once patients stop responding to platinum-based chemotherapy for locally advanced or metastatic urothelial cancer, their treatment options had been somewhat limited: PD-1/PD-L1 inhibitors were effective in only 13%–29% of patients and taxanes in only 11%–13%. When the antibody drug conjugate enfortumab vedotin was approved in late 2019, it offered new hope for patients and providers, with clinical trials reporting a 44% objective response rate.
What the Evidence Says About Music Therapy for Cancer-Related Fatigue
Cancer-related fatigue is a serious, debilitating symptom that affects nearly 90% of patients following treatment, with the majority reporting the adverse event at moderate to severe levels. It can prolong hospital stays and limit patients’ ability to complete their treatments and resume daily activities, ultimately affecting quality of life and survival. Despite high prevalence rates, cancer-related fatigue was reported as “inadequately addressed” in findings from a large multisite study.
Nurse Scientists Guide the Evidence in Symptom Science, and Inaugural Colloquium Recognizes That Impact on a National Level
Oncology nurses hold a unique position in improving symptom management and health outcomes in people with cancer, and their contributions to the body of symptom science are critical. In support of that work, ONS embarked on a landmark partnership with the National Institute of Nursing Research and National Cancer Institute's Center for Cancer Research to present the inaugural Colloquium on Symptom Science Advances in Oncology Nursing on February 4–5, 2021.
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?
Manage Cancer Treatment-Related Constipation With ONS Guidelines™
As many as 43%–58% of patients with cancer experience constipation related to their treatment, and the side effect is both distressing and potentially life threatening if severe enough. Constipation-related emergency department visits increased by 41.5% from 2006–2011, with older adults (aged 85 years or older) making up most of the visits. Estimates suggest that the cost of managing severe cancer-related constipation may range from $500 to more than $2,300 per person per month. Supporting patients who experience the side effect is critical for their well-being.
Patients With Gynecologic Cancers Have Significant Fatigue After Surgery
Forty-eight percent of women with gynecologic cancers report experiencing clinically significant fatigue after surgery that may continue six months (44%) and one (39%) year later, researchers reported in study findings published in Cancer.
ONS Center for Innovation Launches New Tool to Help Improve Patient Outcomes
Cancer treatment often causes symptoms that result in treatment delays and unplanned care, which adversely affects patient outcomes, healthcare costs, and patient satisfaction. To decrease those possibilities, the ONS Center for Innovation launched ONS On-Call™, an oncology-specific decision support tool to guide standardized, evidence-based symptom assessment and leverage ONS’s proprietary evidence-based resources for patient-reported symptoms. Designed by nurses, the cloud-hosted tool ensures best practices in the clinic and institution by providing nurses with guided, comprehensive, and evidence-based assessments that illuminate the causative factors of patients’ symptoms and experience.
Opioids Can Be Used Safely for Cancer-Related Pain
During the current opioid epidemic, a safe, balanced approach to pain management is imperative. In an ONS Bridge presentation, Jeannine M. Brant, PhD, APRN, AOCN®, FAAN, discussed the use of opioids in patients with cancer.
ONS Guidelines™ Offer Framework for Managing Treatment-Related Hot Flashes
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.
Oncology Symptom Science Research Needs to Focus on New Therapies
Immunotherapy, emerging therapies, precision health, and biosignatures are the next frontier for oncology symptom science research, specifically patient-reported outcomes and immune-related adverse events, researchers reported during a presentation on September 8, 2020, at the inaugural ONS Bridge™ virtual conference.
The Case of the Pancreatic Phenomenon
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.
What the Evidence Says About Qigong in Patients With Cancer
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.
Managing Cancer-Related PTSD Starts With Acknowledgement
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).
Myeloproliferative Neoplasm Symptoms, Diagnosis, Treatment, and Survivorship Recommendations
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.
Cardio-Oncology Program Monitors Heart Toxicities Throughout Survivorship
Cancer is second only to heart disease as the leading cause of death in the United States. But heart conditions overlap with cancer in more ways than mortality. Chemotherapy, immunotherapy, radiation, and the myriad medication combinations used in cancer can lead to various complications, including cardiotoxic side effects. Because of the prevalence of heart disease, many patients with cancer also present with pre-existing cardiac comorbidities.
Does Cryotherapy Prevent Extremity Toxicities From Taxane Chemotherapy?
As many as 50% of patients receiving taxane chemotherapy have reported experiencing peripheral neuropathy (PN) or nail changes during treatment. Both are potentially dose-limiting adverse events: nail changes can lead to infections; PN affects patients’ ability to perform activities of daily living and results in sensory impairments such as loss of balance, muscle weakness, and numbness that can increase patients’ risk for falls.
Experts Recommend Tailored Exercise for All Cancer Treatment Plans
Systemic use of exercise prescriptions not only lowers the risk of certain cancers but also helps to improve side effects and survival from cancer and should therefore be incorporated into cancer treatment plans, experts from the American College of Sports Medicine and 17 partner organizations said in articles published in Medicine and Science in Sports and Exercise and CA: A Cancer Journal for Clinicians.
Draft ONS Guideline Open for Public Comment
As part of the rigorous process of transitioning ONS Putting Evidence Into Practice recommendations into formal, actionable clinical practice guidelines, the draft guidelines must undergo a public comment period. The first five guidelines to reach that step will be open for public comment in December 2019 and early 2020.
How Can Oncology Nurses Collaborate With Dietitians to Manage Malnutrition?
Nutrition impact symptoms (NIS) involve any barrier to a patient’s nutritional status. Cancer and its treatments often lead to complex side effects that develop rapidly and change in character and intensity throughout treatment. Barriers to eating and drinking, digesting, and absorbing nutrients lead to negative clinical outcomes for patients with cancer, including malnutrition. Prompt assessment and interventions are key to helping patients avoid treatment holidays and dose reductions while also promoting the best possible quality of life during their cancer journey. In fact, a weight loss of just 5% is an indicator that a patient will likely not receive all of his or her prescribed cancer treatment.
Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents
As a side effect of cancer or its treatment, anemia is associated with reduced quality of life, thanks to symptoms such as palpitations, fatigue, dyspnea, and dizziness. Etiology is often multifactorial with contributing factors such as suppression of hematopoiesis from malignancy or cancer treatments, bleeding, nutritional deficiencies, renal insufficiency, or hemolysis.
Pneumonitis With Immunotherapy Treatment
Pneumonitis is inflammation of the lung parenchyma; although rare, it can be fatal. Nishino et al. found that the overall incidence of pneumonitis with PD-1 inhibitor monotherapy was 2.7% for all-grade and 0.8% for grade 3 or higher pneumonitis. Naidoo et al. reported an approximate 5% incidence of all-grade pneumonitis, although the incidence of all-grade pneumonitis is higher with combination immunotherapy (up to 10%). The incidence is more common with higher grades in PD-1 inhibitors (versus PD-L1 inhibitors), but it occurs less often with anti-CTLA4 monoclonal antibodies.
To Prevent Hepatotoxicity, Monitor Liver Function During Cancer Treatment
Because the liver is the primary site of metabolism for many drugs, baseline function testing and monitoring during cancer treatment are essential. However, the cause of an abnormal liver function test when a patient is receiving chemotherapy or immunotherapy can be difficult to determine.
Evidence Shows Tai Chi May Be Useful for Insomnia
Nearly 60% of people with cancer experience insomnia; it can persist for years if not appropriately managed. Furthermore, patients with cancer who have insomnia are at increased risk for infections, anxiety, and depression, which can negatively affect quality of life.
Diagnose and Manage Dermatologic Toxicity Secondary to Immunotherapy
Dermatologic toxicity is the most common side effect secondary to immunotherapy. The majority of dermatologic adverse events are mild to moderate rashes on the truck of the body and upper extremities, pruritis, and vitiligo. The most common is maculopapular rash with erythematous macules, papules, and/or plaques that can sometimes be scaly; pruritis is also frequent but often underreported and undertreated and may affect quality of life.
FDA Approves Ruxolitinib for Acute Graft-Versus-Host Disease
On May 24, 2019, the U.S. Food and Drug Administration (FDA) approved ruxolitinib (Jakafi®) for steroid-refractory acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years and older.
Acupuncture for Cancer-Related Fatigue
Fatigue is one of the most prevalent and challenging side effects that people with cancer experience. Commonly known as cancer-related fatigue (CRF), the National Comprehensive Cancer Network defines it as “a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.” CRF affects 50%–90% of patients and can diminish quality of life, lead to functional impairment, and is associated with significant morbidity. Although it improves in many patients the year following treatment, CRF may persist over a much longer period in some.
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.