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.

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.  

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.

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.

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? 

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.

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.

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.  

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.

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.  

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.   

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.

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.

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.

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.

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.

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.

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.

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.