On September 22, 2021, the U.S. Food and Drug Administration (FDA) approved ruxolitinib (Jakafi^®) for chronic graft-versus-host disease after failure of one or two lines of systemic therapy in adult and pediatric patients aged 12 years and older.

Jeff is a 60-year-old patient with myeloproliferative disease. After his care team secured a 9/10 match, he received an allogeneic hematopoietic stem cell transplantation with a conditioning regimen of fludarabine and melphalan. Neutrophil engraftment occurred at day 20, and he was discharged to home shortly after engraftment. One month later, he presented to the clinic with abdominal pain and a new diffuse erythematous rash, which his care team initially treated with corticosteroids. However, his abdominal pain persisted, and Jeff was admitted to the hospital a few days later for further workup for suspected acute graft-versus-host disease (GVHD). A computed tomography scan of his abdomen demonstrated worsening enterocolitis because of Yersinia enterocolitica. What would you do?

Because they often face nutrition challenges—such as nausea, taste alterations, difficulty swallowing, and altered gastrointestinal function—that develop during their journey and hinder their nutrition stability, patients with cancer have increased nutrient needs. Oncology dietitians are experts at guiding patients and caregivers through the nutritional process and developing solutions.

Sofia is a 35-year-old patient who identifies as female who was recently diagnosed with breast cancer and is concerned with experiencing chemotherapy-induced alopecia (CIA) as an adverse event from treatment. She comes in for her first infusion of adriamycin plus cyclophosphamide and is using scalp cooling to prevent hair loss. She works as a project manager, which requires her to keep her camera on for her many daily video calls. She is very anxious about losing her hair and asks you if taking minoxidil in addition to the scalp cooling treatment would guarantee she maintains her hair. 

The nonsteroidal anti-inflammatory agent naproxen triggers immune cells in the intestinal lining to fight colorectal cancer in people with Lynch syndrome, researchers reported in Gut.

In 2019, PI3K inhibitors became a new treatment option for postmenopausal women and men with HR-positive, HER2-negative, PIK3CA-mutated, advanced or metastatic breast cancer with the U.S. Food and Drug Administration’s approval of alpelisib in combination with fulvestrant. Although alpelisib remains the only PI3K inhibitor approved today, others are in clinical trials, and the new class of agents has a unique safety profile.

Nearly 60 million people in the United States and almost 200 million around the world have received the COVID-19 coronavirus vaccine as of mid-February 2021, and the numbers will continue to grow as more doses come to market and other manufacturers’ versions receive emergency use authorizations. As more people get vaccinated, some of the expected side effects are being observed in clinical practice and have implications for cancer care. 

On February 12, 2021, the U.S. Food and Drug Administration (FDA) approved trilaciclib (Cosela™) as the first therapy in its class to reduce the frequency of chemotherapy-induced myelosuppression in adults receiving certain types of chemotherapy for extensive-stage small cell lung cancer. Trilaciclib inhibits cyclin-dependent kinase 4/6 (CDK 4/6) enzymes to prevent bone marrow damage.   

Palliative radiation targeted directly to the tumor with stereotactic body radiation therapy eliminated metastatic pain in 33% of patients for six months compared to 16% with standard radiation therapy. Researchers reported the study findings at the American Society for Radiation Oncology annual meeting.

Three years ago, Tony, a 42-year-old man, began FOLFOX chemotherapy treatment for stage III colon cancer and achieved a complete response. Two years later, a biopsy of an intraabdominal lesion uncovered metastatic disease, and he was prescribed the epidermal growth factor inhibitor (EGFRi) cetuximab. Alex, the oncology nurse educating Tony on the side effects of EGFRi therapy, understands that skin toxicities are common with the class of drugs and looks for national guidelines for prevention and management direction.

Painful skin reactions may develop in as many as 95% of patients receiving radiotherapy treatments for cancer. Patients report that it affects their quality of life and that purchasing interventions to soothe their skin increases their out-of-pocket costs. Supporting patients who experience the side effect is critical for their well-being.

Sharon is a 60-year-old woman with metastatic breast cancer that was originally diagnosed in 2005 and treated with a mastectomy, deep inferior epigastric artery perforator flap reconstruction, chemotherapy, post mastectomy radiation, and five years of tamoxifen. Three months ago, her breast cancer recurred, and staging scans demonstrated metastatic disease in the lungs, left axilla, liver, and left iliac bone. A biopsy of the left iliac bone was ER positive, PR negative, and HER2 negative. Sharon began treatment with radiation to the painful left hip and letrozole, with the plan to start palbociclib once radiation was completed. 

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.

Pancreatic cancer is the ninth most common cancer in the United States, accounting for 3% of all cancers but causing 7% of cancer-related deaths, which equates to about 57,500 diagnoses and 47,050 deaths each year. The average person’s risk for pancreatic cancer is about 1 in 64.

Lisa, a 32-year-old tax accountant, completed treatment for stage III triple-negative breast cancer 18 months ago. During a follow-up appointment, Lisa reported worsening headaches and difficulty concentrating at work. A magnetic resonance imaging scan and subsequent biopsy revealed a solitary brain lesion. She completed stereotactic brain radiation two months ago.

From chemotherapy to immunotherapy, many of today’s cancer treatments are associated with skin toxicities. Left unmanaged, they can affect patients’ activities of daily living, self-image, and overall quality of life and may lead to treatment disruptions, delays, or even discontinuation.

Tanya is a 46-year-old woman with leukemia. She recently finished induction therapy, and her oncologist told her she is ready to receive a hematopoietic stem cell transplant. You speak with Tanya about what to expect in the upcoming weeks before her transplant, but she interrupts you: “Nothing tastes good anymore. I am so scared because I thought I completed chemotherapy. The doctor just told me I have to get more before my transplant. Every time I get chemotherapy, I lose my appetite.”

Nutritional status is one aspect of cancer care that may often be overlooked. Patients, particularly those with esophageal, gastric, pancreatic, and non-small cell lung cancers, have increased nutritional requirements because of their high resting energy expenditure. Treatment side effects further hinder a patient’s desire and ability to eat, creating a wider gap between energy intake and energy needs and placing patients with cancer at high risk for malnutrition.

Surgical treatment for breast, gynecologic, prostate, lymphoma, melanoma, or head and neck cancers puts patients at risk for developing secondary lymphedema at any point in the remainder of their life. Studies show that as many as 10%–40% of patients with breast cancer may experience breast cancer–related lymphedema. 

In part thanks to advancements in both cancer treatment and supportive care, the number of cancer survivors is expected to reach 22 million by 2030. Adolescent and young adult (AYA) patients aged 15–39 constitute only 5% of new cancer diagnoses but have an 85% relative five-year survival rate. They represent a significant portion of all current and future cancer survivors and have unique needs, including reaching developmental milestones, coping with disruptions in personal and professional relationships, and encountering potential difficulties in family planning.  

Lymphomas are hematologic malignancies, specifically of the lymphatic system. They are classified into two types: Hodgkin and non-Hodgkin (NHL). NHL is the seventh most common cancer in the United States and Hodgkin seen much less frequently as the 26th, but new treatment options have improved survival rates.

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.

Max, a 60-year-old patient with head and neck cancer, is receiving chemoradiation. Since his initial consult, he’s experienced a 12% weight loss from baseline, impaired swallowing, pain, anorexia, and dysgeusia. He has financial challenges, limited social support, poor health literacy, and a history of alcohol abuse. He has a feeding tube, but you suspect he is not using it. You reinforce prior education about malnutrition, and although Max refuses to be admitted to the hospital, he promises to do better.

Glioblastoma or glioblastoma multiform (GBM) is a primary central nervous system tumor. Approximately 23,890 new brain tumors are diagnosed in the United States each year, with GBM accounting for 38%. GBM can present as a primary diagnosis or evolve from a lower grade brain tumor.

Patients who take five or more medications in the six months before beginning IV chemotherapy for a cancer diagnosis are more likely to be hospitalized after their chemotherapy treatment, according to the findings from a new study published in the Journal of Geriatric Oncology.

Beginning a supervised exercise program before the start of androgen deprivation therapy (ADT) for prostate cancer reduced the incidence of treatment-related side effects, researchers reported in a study published in BJU International.

Women receiving pelvic radiation therapy for gynecologic cancers are at higher risk for significant decreases in bone mineral density (BMD), with 7.8% of women in the study diagnosed with a pelvic fracture, according to findings from a study published in Cancer.

Proton beam radiation therapy is safer and equally effective as traditional radiation for adults with advanced cancers, researchers reported in study findings in JAMA Oncology.

Doug is a 70-year-old man receiving treatment at the cancer center for metastatic renal cell carcinoma. He was initially treated with sunitinib, a tyrosine kinase inhibitor (TKI). He has been experiencing significant upper back pain and is having trouble with fine motor skills in his fingers. The oncologist, suspecting spinal cord compression (SCC), ordered a computed tomography scan, which confirmed metastatic lesions in the spine leading to instability and mild SCC. The oncologist refers Doug for surgery and advises him that a new medication, cabozantinib, will be ordered for after his surgery. The oncologist asks you, the oncology nurse, to instruct Doug on surgical preparations and educate him on cabozantinib.

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.

A new type of remodeled CAR T-cell treatment is just as effective as the original therapy but may result in fewer neurologic side effects, researchers reported in Nature Medicine.

Janice is 32 years old and was recently diagnosed with triple-negative breast cancer. She is receiving neoadjuvant chemotherapy with doxorubicin and cyclophosphamide, followed by weekly paclitaxel. Janice is a nationally recognized performer (vocal and piano) and is distraught over the possibility of losing her hair or developing chemotherapy-induced peripheral neuropathy and mouth sores. She asks the nurse what can be done to prevent those unwanted side effects.  

Children with acute lymphoblastic leukemia (ALL) at risk for cancer recurrence in the brain don’t need prophylactic radiation therapy, researchers reported in the Journal of Clinical Oncology. 

Vaping pens and other electronic smoking devices were branded as step-down strategies to help the 60 million Americans who are unable to quit traditional cigarettes. The U.S. Food and Drug Administration even supported the idea initially, but research eventually showed that vaping products contain the same or higher levels of nicotine as other tobacco products and are equally as addictive.

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.

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.

The rise in youth vaping has cemented e-cigarettes as a scourge of the tobacco cessation community. The products have been marketed to minors, and Congress is currently reviewing several bills meant to tackle the issue. A House of Representatives panel agreed to levy a new vaping tax on e-cigarette pods, an effort that would raise prices for vaping products in the hopes of making them less appealing and accessible to teens. Even in today’s politicized and divisive environment, bipartisan consensus demonstrates that something must be done at the federal level to combat the increase in underage smoking, particularly with electronic devices.

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. 

Patients with hematologic cancers have a 19% increased risk for blood clots or bleeding events even 10 years after diagnosis, according to the results of a study published in the Journal of Thrombosis and Haemostasis.

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.

As the use of oxaliplatin in the treatment of gastrointestinal, gynecologic, and other cancers continues to grow, so too does the incidence of hypersensitivity reactions connected to the drug. Because the development of HSRs may require patients to discontinue oxaliplatin even if it’s effective against their cancer, oncology nurses need to be able to prevent or minimize reactions whenever possible.

Cervical cancer is the fourth most common cancer in women and the seventh most common overall. Cancer-related fatigue (CRF) has an estimated prevalence of 50%–90% in all patients and has been reported to affect 17%–33% of women with gynecologic cancers for as long as three to eight years after diagnosis. Many national guidelines from organizations such as the American College of Sports Medicine, American Cancer Society, National Institute for Health and Care Excellence, and ONS all recommend exercise to improve fatigue in patients with cancer. But no research has synthesized the evidence for exercise as an intervention for fatigue specifically in patients with gynecologic cancers. 

Although 5-fluorouracil (5-FU) and capecitabine (the oral prodrug of 5-FU) are generally well tolerated, patients can experience severe toxicities from either drug that can be life-threatening if not treated quickly. Of the 275,000 patients who receive 5-FU each year, more than 1,300 die from 5-FU toxicity, or approximately 3–4 patients per day.