What Oncology Nurses Need to Know About Tumor Lysis Syndrome
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.
Oncology Nurses’ Role in Recognizing and Addressing Oncologic Emergencies
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.
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.
How Inhaled Cannabis May Contribute to Pulmonary Toxicity in Patients With Cancer
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.
Longstanding NINR Director Retires After Two Decades of Developing Nursing Science
Patricia Grady, RN, PhD, FAAN, has defined a generation of nurse science and patient-centered research, serving as the National Institute of Nursing Research (NINR) director for more than 23 years. Under her charge, NINR has grown into one of the foremost federal agencies supporting the scope of the nursing research community, driving groundbreaking initiatives and furthering clinical practice.
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.
How APRNs Can Support Patients During Oral Agent Treatment
Oral agents offer many patient benefits, one of which is the freedom to take the medication at home, allowing them to keep their daily routine and gain additional time and independence they would have spent traveling to the clinic for treatment. However, with that freedom comes additional patient responsibilities, and preparation from advanced practice RNs (APRNs) is necessary to ensure patients can self-manage symptoms and adhere to administration regimens. Research shows that patients experience severe symptoms on oral agents that may cause them to miss as many as one-third of the prescribed doses. How can APRNs empower patients to adhere to the treatment plan and ensure safe symptom self-management at home?
The Oncology Nurse Experience in Managing Adverse Events in Patients Receiving Ibrutinib
Ibrutinib is a first-in-class Bruton’s tyrosine kinase inhibitor that is approved by the U.S. Food and Drug Administration to treat chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). The drug’s approval was based on results from the multicenter, open-label, phase III RESONATE trial.
APRNs Must Stay Educated About Medical Cannabis in Cancer Care
As more U.S. states approve the use of medical cannabis, oncology advanced practice RNs (APRNs) may see increasing inquiries from patients who are interested in using it to manage cancer-related symptoms. However, the drug remains illegal under federal law, confounding research efforts for its use in cancer care and limiting the generation of supportive evidence.
Nurses Share New Ways to Prevent and Manage Difficult Side Effects in Cancer Care
Managing toxicities and adverse events (AEs) so that patients can continue to stay on effective treatments is essential to improving outcomes. Catherine Hill, BSN, RN, OCN®, Margaret Blaney, RN, BSN, Ashley Layton, BSN, RN, OCN®, and Kaddie Lopez, BSN, RN, OCN®, PHN, discussed ways to manage and prevent symptoms in cancer care during a session at the 43rd Annual Congress in Washington, DC.
What Does the Research Say About Probiotics and Health?
Probiotics are live microorganisms that can offer health benefits following consumption, by reversing dysbiosis: changes in the composition or function of gut microbes associated with the development of many chronic and degenerative diseases. The majority of probiotics contain nonvirulent, lactic acid-producing bacteria, including Lactobacillus, Streptococcus, Bifidobacterium, Propionibacterium, and Enterococcus, or yeasts such as Saccharomyces boulardii. They are available as dietary supplements or can be obtained from yogurt and other fermented foods. Probiotics have grown in popularity over the past few decades because of perceived benefits such as improved digestion, immune function, and nutrient absorption.
Psychological Distress Affects Caregivers but Not Patient Symptoms in Head and Neck Cancer
Psychological stress in caregivers of patients with head and neck cancer (HNC) may impair the quality of patient care they provide and affect outcomes such as survival. However, patient symptom burden and caregiver tasks and their impact on psychological stress is not well understood.
Better Care Is Needed to Manage Oral Cavity Symptoms of Chronic Graft-Versus-Host Disease
During the State-of-the-Science Lecture at the 43rd Annual Congress in Washington, DC, Jane Fall-Dickinson, PhD, RN, AOCN®, of Georgetown University School of Nursing and Health Studies, discussed chronic graft-versus-host disease (cGVHD), specifically its oral cavity complications. She presented challenges, clinical data, and goals for improving its treatment and management options.
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.
Put Evidence Into Practice to Prevent Infection
Because of immunosuppression from cancer or its treatment, patients are at a higher risk for viral, bacterial, and fungal infections. Patients who develop infections may experience dose delays or reductions that compromise optimal treatment outcomes, resulting in higher mortality rates, longer hospitalizations, and higher cost of care.
Prevent and Treat Venous Thromboembolism in Patients With Cancer
Venous thromboembolism (VTE), namely deep vein thrombosis and pulmonary embolism, is a common and serious complication. VTE is the second-leading cause of death in patients with cancer and has been connected to poorer prognoses. Other consequences include reduced short- and long-term mortality, increased risk for recurrent VTE and bleeding, a threefold increase in hospitalizations, and higher total healthcare costs. Advance practice nurses (APNs) must understand prevention strategies and treatment guidelines for this serious complication.
Motivational Interviewing Nursing Interventions Help Reduce Chemotherapy Symptom Burden
Nursing interventions such as coaching, telephone follow-up, and home care have been reported with inconsistent results. In their article in the January 2018 issue of the Oncology Nursing Forum, Coolbrandt et al. discussed the evaluation of a nursing intervention focused on patient education and self-management to reduce symptom distress in outpatients with cancer.
How Can Cognitive Behavioral Therapy Help Patients With Cancer Manage Insomnia?
Simply put, sleep impacts everything. I consider it to be even more foundational than diet and exercise for some. If patients don’t sleep well, they are more likely to make poor food choices and not exercise. Individuals with insomnia symptoms are at higher risk for a number of physical health problems, including diabetes, obesity, and cardiovascular diseases. Insomnia has been linked to mood and anxiety disorders, higher levels of perceived stress, and impaired cognitive functioning.
Sleep-Wake Disturbances in Patients With Cancer
In bedrooms across the United States, people are crawling into bed, turning down the lights, and lying awake for hours on end. Sleep-wake disturbances and short sleep duration are extremely common, and rates are even higher in patients with cancer. Unfortunately, screening, assessment, and interventions are lacking for patients experiencing sleep-wake disturbances during their cancer journey.
Evidence Shows How Music Therapy Can Affect Patients With Cancer
Music has historically been associated with health and healing in cultures around the world. As a therapeutic intervention in patients with cancer, it is used to address physical and psychological symptoms. The sessions are tailored to meet patients’ individual needs and abilities and can involve listening to, writing, performing, or discussing music and lyrics, guided by a trained therapist. Although music does not affect the disease itself, it produces more immediate effects compared to pharmacologic agents, has a positive impact on mood, and strengthens patients’ ability to cope.
Understanding Medicinal Cannabis in Cancer Care
Medicinal cannabis, a topic that remains largely unstudied in human trials in the United States, is slowly becoming introduced in areas of health care and oncology in states that have legalized it for medical and adult recreational use.
The Case of the Physical Activity Prescription
Raj recently presented to the emergency department for hemoptysis and shortness of breath. Subsequent computed tomography scan and biopsy reveal metastatic small cell lung cancer. He is a 62-year-old former smoker who is 25 pounds overweight and works as an accountant for a large automobile dealership.
Multiple Myeloma Survivors Still Experience Symptoms and Psychological Concerns
Survival from multiple myeloma (MM) has improved, and more attention is required for symptom burden and psychological impact in the long-term management of this disease. Researchers assessed the incidence of self-reported pain, depression, financial and family burden, and impairment of performance status, as well as determined the correlation of total distress with survival. Joshua R. Richter, MD, at the John Theurer Cancer Center in Hackensack, NJ, discussed the findings at the ASH Annual Meeting.
Better Symptom Management Is Needed for Patients With CML
Patients with chronic myeloid leukemia (CML) often experience symptoms and treatment-related adverse events (AEs) that are chronic and may require care from an interdisciplinary team. A study sought to assess symptom burden, palliative care needs, and experiences with healthcare team communication in this patient population. Alexandra K. Zaleta, PhD, at the Research and Training Institute, Cancer Support Community in Philadelphia, PA, discussed the findings at the ASH Annual Meeting.
Supervised Exercise Reduces Fatigue in Patients With Breast Cancer
Exercise—preferably supervised—represents a viable intervention for prevention and treatment of fatigue among patients with breast cancer, a group of Australian, European, and U.S. researchers said. They presented their findings during a poster session on Saturday, December 9, during the San Antonio Breast Cancer Symposium.
Diet Choices and Supplement Use May Affect MPN Symptom Burden
Patients with myeloproliferative neoplasms (MPN) have increased inflammatory cytokines that contribute to symptom burden and nutritional deficiencies. Some studies have indicated that diets and supplements have demonstrated antioxidant and anti-inflammatory pharmacologic properties, such as decreased inflammatory markers and reactive oxygen species. Researchers conducted a study to examine nutritional and supplemental needs in this patient population. Robyn M. Scherber, MD, at Oregon Health and Science University in Portland, discussed the findings at the ASH Annual Meeting.
Involve the Palliative Care Team Early to Minimize Symptom Impact
Patients with cancer experience many feelings: they’re frightened and they’re hopeful, but mostly they’re in a new world. Symptoms associated with cancer and its treatment are taxing on patients’ physical, emotional, and spiritual well-being. In some cases, cancer-related symptoms and side effects are so debilitating that providers struggle to manage them just to get patients to a point where they can continue their treatment. Oncology nurses can lead the interprofessional care team to work together to proactively manage symptoms to ensure patients can endure treatment and come out as themselves on the other side. Proper symptom management doesn’t just promote quality of life but the best possible chance for patient survival.
The Crucial Role of Symptom Management in Cancer Care
Listening to feedback from patients is still one of the most important ways providers can assess and plan treatments for patients with cancer. However, symptom management is never as simple as screening for pain or asking about fatigue: it involves complex decision making, evidence-based interventions, and the support of the entire care team. It’s a central practice to oncology nursing, and it’s paramount to the successful outcomes of patients with cancer.
Get Resources to Educate and Monitor Patients for Sepsis
Sepsis is a formidable complication of cancer and cancer treatment. Claiming more than 250,000 lives annually, it is a medical emergency. Do you have sepsis algorithms and protocols in place? Do all specialty areas have a way to identify patients with cancer as a highly vulnerable population? Is sepsis-specific education provided to nurses and patients? Starting the conversation and advocating for policy development and change may just save a life.
Lancet Oncology Commission Releases Cancer Research Priorities
The future of oncology care hinges on the implementation of new sciences, the collaboration of researchers, and timeliness with which healthcare professionals can integrate change into practice, according to a new report released by Lancet Oncology.
HHS Announces Opioid Crisis Prevention Program
Prescription drug abuse and overdose has reached epic proportions in the United States. In 2016, President Obama signed the Comprehensive Addiction and Recovery Act into law to reclassify drug abuse as a disease and not a crime. Additionally, millions of dollars of federal aid were set aside to help combat the scourge. In September 2017, the Department of Health and Human Services (HHS) released a statement committing the department to the cause.
Learn the Nursing Considerations for Cytokine Release Syndrome
Chimeric antigen receptor (CAR) T-cell therapy for relapsed or chemotherapy-resistant acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia, and B-cell lymphomas is becoming more common. The benefit to patients is significant: durable remission and increased comfort are two major advantages. However, severe toxicities are associated with CAR T-cell therapy that must be considered. As with any treatment modality, the best approach to management for an advanced practice oncology nurse is to fully understand those toxicities and be prepared to provide intensive supportive care.
FDA Approves Rolapitant IV for CINV
On October 25, 2017, the U.S. Food and Drug Administration (FDA) approved the use of rolapitant (Varubi®) IV in combination with other antiemetic agents for adults experiencing delayed chemotherapy therapy-induced nausea and vomiting (CINV). Rolapitant through oral administration had been approved through the FDA in September 2015. The new IV administration route is expected to offer the same results at a lower cost to patients with CINV.
Meditation Has Many Benefits for Patients With Cancer
Meditation is a healing practice that involves focusing attention, regulating breathing, and developing a nonjudgmental awareness of one’s thoughts and feelings. It aims to improve emotional regulation and overall well-being. Data from the 2012 National Health Interview Survey indicate that 18 million adults and 927,000 children practice meditation. Meditation encompasses repeating words with phonetic significance as in mantram meditation; paying attention or continually returning to the present moment as in mindfulness meditation; or practicing specific movements as in tai chi and qigong.
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.
Exercise's Role in Cancer Care
Until the 1980s, the value of exercise was unrecognized in the oncology setting. It was widely believed that patients with cancer undergoing cytotoxic treatments needed to rest and avoid exercise. But a 1989 study conducted by Winningham and Mac Vicar, both oncology nurses at the Ohio State University, dispelled this notion. The trial involved 45 women receiving adjuvant chemotherapy for operable breast cancer and showed that a 10-week interval-based, aerobic exercise was not only safe but also significantly improved body composition, aerobic capacity, and patient-reported nausea.
ONS Supports Medicare Coverage of Lymphedema Compression Supplies
On August 25, 2017, ONS submitted comments to the House Ways and Means Health Subcommittee in response to its Medicare Red Tape Relief Project. The initiative, sponsored by subcommittee chairman Pat Tiberi (R-OH), asked providers for input on ways to improve health care for seniors and reduce Medicare regulations and mandates.
How Safe and Effective Is Scalp Cooling for Chemotherapy-Induced Alopecia?
Chemotherapy-induced alopecia has been reported by 77% of patients as the most-feared side effect of cancer treatment. In fact, as many as 10% of women say they would consider refusing chemotherapy or choosing a less effective treatment to avoid losing their hair.
How Can Oncology and ICU Nurses Work Together to Treat Critically Ill Patients With Cancer?
Nurses in the intensive care unit (ICU) generally see patients with cancer only when they are extremely sick—not throughout the extensive cancer journey they go through before they get to the ICU. Educating and familiarizing ourselves, as ICU nurses, with a patient’s oncology plan, goals, and history can improve overall care. Learning at which points in the process of cancer treatment certain issues are more likely to arise, such as tumor lysis syndrome during high-dose induction, when a patient is most likely to be neutropenic during a stem cell transplant, and other general facts about oncology, can help improve the care we give. It helps us understand our patients as a whole. The oncology population is a huge part of medical intensive care, and encouraging critical care nurses and oncology nurses to collaborate can help improve the continuity of care and eliminate errors in the ICU.
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.
The Challenge of Caring for Multiple Patients With Cancer
As more new treatments enter practice—like immunotherapy, targeted therapy, and combination therapies—oncology nurses are required to be experts in every treatment they administer. They need to constantly walk a tightrope, balancing multiple medications for one patient then quickly moving to the next patient on a completely different treatment protocol.
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.
Research Gives Insight on Cognitive Function in Patients With Cancer
Poor cognitive function can cause distress, impact quality of life, and contribute to treatment non-adherence, Catherine Bender, PhD, RN, FAAN, from the University of Pittsburgh, explained during the Distinguished Nurse Researcher session at the 42nd Annual Congress in Denver, CO. She is the 2017 recipient of the Distinguished Nurse Research Award, which recognizes the contributions of a member who has conducted or promoted research that has enhanced the science and practice of oncology nursing.
Advisory Board Provides Input on Interventions to Help Older Adults Manage CINV
Chemotherapy-induced nausea and vomiting (CINV) can lead to serious adverse events (AEs) for older adults that could result in hospitalizations. Older adults may be overwhelmed with the amount of information involved with diagnosis and treatment, may not believe their actions will have an impact on symptoms, and tend to adopt a “wait and see” approach to managing AEs. Educational initiatives that tailor symptom management to older adults are necessary to engage and prepare these patients to self-mange CINV at home.
Navigating Medical Marijuana Laws and Use in Treatment
Medical marijuana laws still vary across the United States, and barriers persist for patients and providers, including fear of addiction and side effects as well as safety, financial, and legal concerns. Carey Clark, PhD, RN, AHN-BC, of the University of Maine at Augusta, Jacquelyn Bainbridge, PharmD, FCCP, from the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Lisa Kennedy Sheldon, PhD, APRN-BC, AOCNP®, FAAN, chief clinical officer at the Oncology Nursing Society, discussed the latest in medical marijuana laws and usage during a session at the 42nd Annual Congress in Denver, CO.
Using Patient-Reported Outcomes Improves Symptoms in Adults With Acute Leukemia
Ashley Bryant, PhD, RN, OCN®, assistant professor at the University of North Carolina at Chapel Hill School of Nursing, was the recipient of the 2017 Victoria Mock New Investigator Award and gave a lecture at the 42nd Annual Congress in Denver, CO, on her work on patient-reported symptoms and quality of life.
Study Finds Guideline Training and Reinforcement of CINV Knowledge Is Important
Chemotherapy-induced nausea and vomiting (CINV) is a side effect reported by 40%–80% of patients receiving cancer treatment. However, CINV can be prevented in 70%–80% of those cases with appropriate antiemetic prophylaxis. Few studies have evaluated approaches to improve provider adherence to antiemetic guidelines, and those who do adhere often have limited demonstrated success.