ONS’s Perspective on Ambulatory Staffing
Appropriate nurse staffing is only one of the critical factors that contribute to optimal patient outcomes and is as important as the systems, technology, and quality standards in any care setting. The relationship between poor staffing, daily variation in quality, and increased workload to increased care errors, missed care, and patient and nurse dissatisfaction is well described.
Using Photography to Track Progress of Head and Neck Cancers
Building relationships with patients is just one of the many roles of oncology nurses. However, it’s generally not possible to see your patients every day. This isn’t uncommon, but it can pose problems to oncology professionals treating patients with head and neck cancers.
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.
What Oncology Nurses Need to Know About Subcutaneous Rituxan Hycela
In June 2017, the U.S. Food and Drug Administration (FDA) approved Rituxan Hycela, a combination of rituximab and hyaluronidase, for subcutaneous administration in the treatment of follicular lymphoma and diffuse large B-cell lymphoma as well as chronic lymphocytic leukemia (CLL). This agent affords the same clinical benefit as IV rituximab, but in much less time. With this approval comes many questions about which patients are appropriate and administration considerations for subcutaneous rituximab and hyaluronidase.
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.
FDA Approves Lower Dose of Cabazitaxel for Prostate Cancer
On September 14, 2017, the U.S. Food and Drug Administration (FDA) approved a lower dose of cabazitaxel (20 mg/m2 every 3 weeks) in combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer previously treated with a docetaxel-containing treatment regimen. Cabazitaxel (25 mg/m2 every 3 weeks) was approved for this indication in 2010.
Overcome Barriers to Your Clinical Nurse Specialist Practice
As an oncology clinical nurse specialist (CNS), you may find yourself answering over and over the question of, “What is it you do?” In many instances, it is a broader role then most may realize, and you wear several hats. As you explain to other oncology staff what a CNS does, focus on the three spheres of influence.
Manage Pain in Patients With Cancer With These Tools and Resources
One distinct, uniquely personal symptom unifies almost all patients with cancer: pain. It can be as wildly varied and different as each patient it affects. It can be acute, sudden experiences of pain, or the symptoms can be chronic and perpetual. Patients undergoing the treatments associated with cancer often suffer varying degrees of pain through their cancer journeys, which leads to significant physical and psychosocial burdens. This can decrease their quality of life and potentially impact their overall outcomes. A 2015 National Comprehensive Cancer Network report suggested that the evidence suggests a clear link between improved survival outcomes and adequate symptom management.
How Did You Continue to Provide Cancer Care for Patients After a Natural Disaster?
When a severe tornado hit Joplin, MO, on the evening of May 22, 2011, the situation was serious. St. John’s Regional Medical Center in Joplin was hit so hard that it is still unusable. It needed to be evacuated, nearby Freeman hospital became quickly overwhelmed with patients, and the surrounding community prepared for action.
Cancer Care When Disaster Strikes
In the early hours of September 13, 2008, Hurricane Ike—a category 2 hurricane—hit Galveston Island, TX, bringing with it sustained winds of up to 110 miles per hour and storm surges reaching as high as 17 feet. By the next day, more than 200 shelters had opened across Texas to house the estimated 40,000 people who had been forced to evacuate from their homes.
FDA Approves Tisagenlecleucel for B-cell ALL, Tocilizumab for Cytokine Release Syndrome
On August 30, 2017, the U.S. Food and Drug Administration granted regular approval to tisagenlecleucel for the treatment of patients up to age 25 years with B-cell precursor acute lymphoblastic leukemia that is refractory or in second or later relapse.
Natural Disasters Take a Toll on Both Patients and Nurses, at the Cancer Center and at Home
I live in Middle Tennessee, an area that’s part of tornado alley, a pathway across central United States that has a higher incidence of tornadoes. We routinely prepare for the storms, listening for the tornado sirens whether at home or work. Although there have been a number of tornado touchdowns in our region in recent years, fortunately none have directly hit our healthcare facilities.
Are Your Patients Taking Herbs That May Interact With Their Cancer Drugs?
Many Americans use dietary supplements, including herbal products, in the belief that they are natural and safe. Patients with cancer use them often to enhance the effects or to reduce the adverse reactions of cancer treatments. However, few herbs have been thoroughly studied in humans. Therefore, their interactions with prescription drugs and the clinical relevance, remain undetermined. These interactions could be pharmacokinetic in nature when an herb alters the absorption, metabolism, or excretion of other drugs, or pharmacodynamic in which it affects the mechanism of action of other drugs when consumed together. Following are a few relevant herb-drug interactions encountered in the oncology setting.
The Case of the Anxiety Answer
Kris is a 46-year-old newly diagnosed with stage III cervical cancer. She is an avid runner and vegetarian, and she believes strongly in taking care of herself. “I never thought I would get cancer,” she says. “I thought I did everything I could to avoid this.”
Management of Immunotherapy-Related Endocrinopathies
Advanced practice oncology nurses know how complex the care of patients with cancer can be. Every day seems to bring further advancements in the treatment and management of cancer. It can be difficult to keep up with the onslaught of new information, but our patients rely on us to bring them the latest, greatest, and safest treatment options available.
Who Is Monitoring Your Infusions for Administration Safety?
Inquiries received in the ONS clinical inbox often ask about various responsibilities of nurses who hold an ONS chemotherapy provider card and have been deemed competent to administer cancer treatments within their practice setting.
Walls and a Blue Ribbon
I arrived at work on Tuesday morning to find my charge nurse handing out blue ribbons, beads, and bracelets to staff.
"March is National Colon Cancer Awareness Month,” she said. “Put on the blue, we're promoting awareness and encouraging people to get their screenings!" I stared at some of my coworkers with ribbons tied neatly in their hair.
It’s important to know that I routinely have to field the question, "Are you sure you're old enough to be a nurse?" I had a feeling the ribbon wasn't going to help my credibility. This was also my second day of caring for a patient struggling to cope in a very tough fight against colon cancer. Would she mind? Would it be insensitive?
The Case of the Immunotherapy Inquiry, Part II
You may remember Jay, a 62-year-old man with inoperable stage IIIA non-small cell lung cancer (NSCLC), from the case study in the April 2017 issue of ONS Voice. He was symptomatic with a persistent cough, unintentional weight loss, and fatigue.
FDA Approves Neratinib for Extended Adjuvant Treatment of Early-Stage HER2-Positive Breast Cancer
On July 17, 2017, the U.S. Food and Drug Administration approved neratinib (Nerlynx™, Puma Biotechnology, Inc.) for the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer, to follow adjuvant trastuzumab-based therapy.
Up-Front Palliative Care Consultation Associated With Better Outcomes in Advanced Cancer
Optimal timing for the initiation of specialist palliative care has not been determined. In a study, researchers created a supportive oncology inpatient service that integrates up-front palliative care consultation for certain patients with advanced cancer and compared it to those receiving usual oncologic care with on-demand palliative care consultation. The study’s findings were presented at the ASCO Annual Meeting.
FDA Approves L-Glutamine Powder for the Treatment of Sickle Cell Disease
On July 7, 2017, the U.S. Food and Drug Administration (FDA) approved L-glutamine oral powder for oral administration to reduce the acute complications of sickle cell disease in adult and pediatric patients five years and older.
Oncology Treatments and Trends Continue to Change Rapidly
“This has been a historic year in oncology pharmacology,” Rowena Schwartz, PharmD, BCOP, associate professor at the University of Cincinnati, told the audience during a session at the 42nd Annual Congress in Denver, CO. “There were new drugs, yes, but we’re really learning how to use the drugs that we have.”
Data Aggregate System Seeks Oncology Nurse Ambassadors
During a session at the 42nd Annual Congress in Denver, CO—on what happened to be National Nurses Day—the American Society of Clinical Oncology (ASCO) asked nurses to consider joining an initiative intended to gather, collate, and disseminate massive amounts of data to enhance evidence-based cancer diagnosis and treatment.
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.
Critical Care for Patients With Cancer
Five to Ten Percent of patients with cancer will need to visit the intensive care unit (ICU) for a life-threatening condition. In fact, estimates suggest that nearly 30% of patients with esophageal cancer or acute leukemia and those undergoing allogenic stem cell transplantation will need ICU care.
FDA Approves Betrixaban for Extended Duration Prophylaxis of Venous Thromboembolism
On June 23, 2017, the U.S. Food and Drug Administration (FDA) approved betrixaban (Bevyxxa, Portola) for the prophylaxis of venous thromboembolism (VTE) in adult patients hospitalized for an acute medical illness who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors for VTE.
Recent FDA Approvals Continue to Focus on Targeted and Immunotherapy
Oncology clinicians can expect to continue to see new targeted and immunotherapy drugs emerge as clinically approved agents in the fight against cancer. Five cancer-related U.S. Food and Drug Administration (FDA) approvals occurred in the first quarter of 2017; following are their indications for treatment and associated clinical implications. You’ll recognize that some of the agents were already FDA approved for other uses, but as clinical trials continue and new data emerge, clinical use is expanding to other disease sites and indications.
An Overview of Colorectal and Pancreatic Cancers
Colorectal cancer (CRC) represents 8% of all new cancer cases and 8.4% of all cancer deaths, with a five-year survival rate of 64.9% (between 2007–2013). Pancreatic cancer represents 3.2% of all new cancer cases and 7.2% of all cancer deaths, with a five-year survival rate of just 8.2% (between 2007–2013). ONS member Christine Guarnieri, MSN, RN-BC, OCN®, of Huntington Hospital in New York, discussed both of these cancers at the Oncology Nurse Advisor Navigation Summit.
How ONS and Oncology Nursing Are Helping to Define Big Data and Cancer Care
For oncology nurses, physicians, and care professionals, the importance of implementing tools to collect and analyze big data cannot be understated. Through collaboration and multidisciplinary tactics, data can help drive improvements in the way patients are treated.
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.
FDA Approves ALA Optical Imaging Agent for Gliomas
On June 6, 2017, the U.S. Food and Drug Administration (FDA) approved aminolevulinic acid hydrochloride, known as ALA HCl (Gleolan, NX Development Corp.) as an optical imaging agent indicated in patients with gliomas (suspected World Health Organization Grades III or IV on preoperative imaging) as an adjunct for the visualization of malignant tissue during surgery.
The Role of Acupuncture in Treating Hot Flashes in Breast Cancer Survivors
Hot flashes, also known as hot flushes, are marked by periods of sudden, intense feelings of warmth that begin at the chest and radiate to the neck and face, along with flushing, sweating, and heart palpitations, lasting several seconds to minutes. Compared to healthy postmenopausal women, breast cancer patients and survivors are prone to experiencing more severe and longer-lasting hot flashes. A bothersome symptom, hot flashes can occur anytime during a 24-hour period, but those occurring at night are most troubling because they interfere with sleep. Sleep deprivation negatively impacts daytime functioning as well as pain, fatigue, depression, and anxiety levels, diminishing quality of life significantly.
CDC Warns Healthcare Workers of Emerging, Multidrug-Resistant Fungus
Candida auris is a multi-drug resistant yeast that is known to cause invasive infection and death. It first emerged in June 2016 and continues to present itself as a serious global threat. According to the Centers for Disease Control and Prevention (CDC), throughout 2017, healthcare facilities in multiple countries report serious illnesses caused by C.auris in hospitalized patients.
What Special Considerations Are Needed When Setting up IV Chemotherapy?
No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. Of the utmost importance is that the administration setup ensures chemotherapy is given safely and allows for prompt nursing intervention in the event of an adverse reaction or infiltration.
When Ineffective Pain Control Means Chemical Coping
Central to our role as oncology nurses is provision of symptom relief balanced with a manageable side-effect profile. Although opioids are extremely effective at cancer pain management, they also bind to the brain’s limbic system and can produce reward responses. This can result in dependence and drug-seeking behaviors.
FDA Grants Approval to Pembrolizumab for Locally Advanced or Metastatic Urothelial Carcinoma
On May 18, 2017, the U.S. Food and Drug Administration (FDA) granted regular approval to pembrolizumab (Keytruda®, Merck and Co., Inc.) for patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.
Dermascopic Clues Help Identify Seborrheic Keratosis-Like Melanoma
Melanomas that resemble seborrheic keratosis (SK) can be challenging to diagnose correctly. SKs are often removed without being evaluated dermascopically or sent for pathologic analysis, risking the possibility of missing a diagnosis of SK-like melanoma. A new study published in JAMA Dermatology outlined the key dermascopic clues that clinicians can use to identify SK-like melanomas to prevent treatment delays and achieve the best patient outcomes.
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.
FDA Grants Accelerated Approval to Avelumab for Urothelial Carcinoma
On May 9, 2017, the U.S. Food and Drug Administration (FDA) granted accelerated approval to avelumab for patients with locally advanced or metastatic urothelial carcinoma whose disease progressed during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant platinum-containing chemotherapy.
Nursing Considerations for Adverse Events From CAR T-Cell Therapy
Chimeric antigen receptor (CAR) T-cell therapy offers options for pediatric patients with relapsed or refractory acute lymphoblastic leukemia, but it comes with a unique set of side effects that can range from mild to severe. As the primary patient providers, oncology nurses are often the first to identify signs and symptoms of adverse events and acute changes in patients’ status. Understanding what to watch for can improve outcomes and help nurses deliver safe, effective care.
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.
Educational Initiative Increases Nurse Understanding of Infusion-Related Reactions and Interventions
Denise Portz, MSN, RN, AOCNS®, ACNS-BC, a clinical nurse specialist at the Froedtert Hospital in Wisconsin, presented the findings during a poster session at the ONS 42nd Annual Congress in Denver, CO. The poster was titled “Providing Oncology Infusion Nurses Evidence-Based Guidelines and Interventions to Manage Infusion Reactions and Anaphylaxis.”
Use Pharmacologic and Nonpharmacologic Options to Treat Anxiety and Depression in Patients With Cancer
Jane Rosenthal, MD, FAPM, from New York University Langone Medical Center, discussed treatment and management options patients suffering from these disorders during a session at the 42nd Annual Congress in Denver, CO.
Are All Patients Treated Equally?
It’s 2017, and one would think that all patients are treated equally. Nursing has certainly been educated to treat all patients with the same levels of respect and dignity and to provide excellent medical care regardless of age, race, ethnicity, or religious beliefs. In the theory of nursing, I think we all strive and believe that patients should be treated equally. However, at least for the reality of nursing that I work in, that doesn’t always feel true.
Interpreting Guidelines Correctly Helps Workplaces Remain Compliant
Guidelines are established as tools to enhance patient care; however, translating guidelines can be difficult. Diana Scott, RN, MHA, CPHQ, senior director of accreditation services at Vizient, and Carma Herring, RN, MS, OCN®, from the John Stoddard Cancer Center, discussed mandates from the Joint Commission and Centers for Medicare and Medicaid Services (CMS), as well as tips for using guidelines and being compliant during a session at the 42nd Annual Congress in Denver, CO.
Studies Show Ways to Attain CMS Benchmark Measures for Cancer Care
Currently, the Centers for Medicare and Medicaid Services (CMS) mandates 33 oncology-specific benchmark measures related to end-of-life care and hospice, unplanned hospital admissions (UHAs), pain, falls, medication, central venous catheter (CVC) line, pressure ulcers, tobacco cessation, catheter-associated urinary tract infections, sepsis, and function. Advanced practice nurses can play a role in achieving benchmarks and developing innovative strategies to accomplish these goals.
Tips for Managing Chronic Pain in High-Risk Patient Populations
Pain management is often necessary for patients with cancer and other high-risk conditions. Despite guidelines and treatment algorithms, caring for this patient population can be challenging. Oscar DeLeon, MD, of the Roswell Park Cancer Institute, Kathleen Broglio, DNP, ANP-BC, ACHPN, CPE, FPCN, from Dartmouth Hitchcock Medical Center, and Jennifer Grimmer, DNP, FNP-BC, of the Roswell Park Cancer Institute, discussed strategies and best practice for pain management during a session at the 42nd Annual Congress in Denver, CO.