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?

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.

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.

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.

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.

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.

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.

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 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.

Thrombotic events are the second-leading cause of death in patients with cancer after the disease itself. An estimated 4%–20% of patients experience venous thromboembolism at some stage on the cancer journey. 

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.

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.

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.

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.

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.

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 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. 

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. 

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.

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.

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.

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.

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.

Rates of all-cause mortality in patients with cancer increase in the presence of unexplained sinus tachycardia, the results of a new study show. Researchers presented the findings at the Advancing Cardiovascular Care of the Oncology Patient conference held January 2019 in Washington, DC.

Which of the Following Late Symptoms of Increased Intracranial Pressure Is Not Included of the Cushing Triad?

A. Hypertension with widening pulse pressure 

B. Bradycardia 

C. Seizure 

D. Abnormal respirations 

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.

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.

Cancer is largely a disease of an aged population. Estimates suggest that about 60% of all cancers are diagnosed in individuals aged 65 or older, and that number is expected to increase to 70% by 2030. Yet many nurses have little formal geriatric-specific training to care for this population’s unique needs.

As efforts continue to drive down the soaring costs of prescription medications, Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) proposed a bipartisan bill looking to close loopholes used by pharmaceutical companies to drive up profits. The bill would give the Department of Health and Human Services the ability to address companies that misclassify products to pay lower rebates.

In 2000, I was diagnosed with stage III esophageal cancer—adenocarcinoma—and was put on a treatment regimen of chemotherapy, radiation therapy, and ultimately surgery to my esophagus. After talking with my doctors and nurses, heartburn was determined to be the cause of cancer. I didn’t realize at the time that survival rates for my disease were extremely low. 

People often use idioms—such as “going under the knife” as a euphemism for surgery—to avoid confronting distressing situations, which is even more pronounced when it comes to life events as serious as cancer. But for many patients with cancer, undergoing a surgical procedure is key to positive outcomes, and they count on the expert clinical care and support of their surgical oncology nurses to see them through it.

The field of telehealth encompasses many efforts in oncology practice and research. When focusing specifically on telephone triage, we examine patient-initiated requests, such as speaking directly with their nurses on the phone, reporting side effects, or seeking answers to questions about plan of care and treatment. This provides oncology nurses with an opportunity for assessment and intervention. Although many current research efforts focus on proactive phone calls nurses make to their patients, it is also important to understand the impact of incoming calls on patient care and workflow.

Just three to six sessions of a tailored psychotherapy program called CALM, or Managing Cancer and Living Meaningfully, reduced symptoms of depression or prevented the onset of depression in patients with recently diagnosed advanced cancer, according to findings from a study published in the Journal of Clinical Oncology.

As a direct line to the oncology team, the phone conversations between nurses and their patients can help address symptoms, foster valuable patient education, provide useful interventions, encourage side effect reporting, and identify potentially life-threatening situations. Ultimately, successful telephone triage requires a unique skill set for oncology nurses to communicate with their patients and recognize underlying issues.

Tumor lysis syndrome is an oncologic emergency caused by massive tumor cell death with the release of large amounts of potassium, phosphate, and nucleic acids into systemic circulation. Nucleic acids break down to uric acid, leading to hyperuricemia in patients. This, in turn, leads to precipitates in the renal tubules, renal vasoconstriction, decreased renal flow, inflammation, and can potentially cause acute kidney injury. 

Most emergencies can manifest in the blink of an eye. Whether it’s a medical emergency, a car accident, an act of nature, or something else, emergencies are sudden crises that require swift, immediate action. For many patients with cancer, among the most distressing challenges along the treatment journey is the possibility of experiencing an oncologic emergency.

Which of the following nonpharmacologic interventions is currently recommended for practice for cancer-related fatigue?

A. Acupressure

B. Meditation

C. Exercise

D. Tai Chi

Wilson was diagnosed with B-cell lymphoma three days after his 63rd birthday. He underwent chimeric antigen receptor (CAR) T-cell therapy after his disease failed to respond to two lines of systemic chemotherapy.

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.

As medical use of cannabis is increasingly legalized across the United States, oncology nurses need to become more familiar with the implications of patients using it for cancer symptom management. According to Merkle and Tavernier in their article in the August 2018 issue of the Clinical Journal of Oncology Nursing, little research has been conducted in medical cannabis use and the efficacy and toxicity of cancer treatment. Their article reviewed current literature to better understand the effects that cannabis may have on the lungs in patients with cancer.