Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.3
Jennifer L. Raybin, PhD, RN, CPNP, Andrew Donson, Nicholas K. Foreman, MRCP, Rajeev Vibhakar, MD, Michael H. Handler, MD, Arthur K. Liu, MD, PhD
Purpose: Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol. Methods: An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard. Results: Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years (M = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI. Conclusion: APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.
{"title":"Maintaining Survival While Improving Quality of Life: An Advanced Practitioner–Led Pilot Feasibility Study to Reduce Radiation Dose in Children With Brain Tumors","authors":"Jennifer L. Raybin, PhD, RN, CPNP, Andrew Donson, Nicholas K. Foreman, MRCP, Rajeev Vibhakar, MD, Michael H. Handler, MD, Arthur K. Liu, MD, PhD","doi":"10.6004/jadpro.2024.15.1.3","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.3","url":null,"abstract":"Purpose: Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol. Methods: An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard. Results: Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years (M = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI. Conclusion: APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"2016 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139879106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is known among clinicians, including advanced practitioners (APs), that non-medical factors will influence health outcomes and contribute to health disparities. Factors such as socioeconomic position, access to health-care and education systems, and living conditions impact whether a patient will be provided similar treatment, care, or resources as others with the same condition. These are referred to as social determinants of health (SDOHs), and negative social factors lead to patients experiencing deleterious outcomes (Pinheiro et al., 2022).
临床医生（包括高级执业医师）都知道，非医疗因素会影响健康结果并造成健康差异。社会经济地位、获得医疗保健和教育系统的机会以及生活条件等因素都会影响患者是否会获得与其他病情相同的患者类似的治疗、护理或资源。这些因素被称为健康的社会决定因素（SDOHs），负面的社会因素会导致患者经历有害的结果（Pinheiro et al.）
{"title":"The Cost of Care: Financial and Social Factors in Cancer Management","authors":"Beth Faiman, PhD, MSN, APRN-BC, AOCN, BMTCN, FAAN, FAPO","doi":"10.6004/jadpro.2024.15.1.1","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.1","url":null,"abstract":"It is known among clinicians, including advanced practitioners (APs), that non-medical factors will influence health outcomes and contribute to health disparities. Factors such as socioeconomic position, access to health-care and education systems, and living conditions impact whether a patient will be provided similar treatment, care, or resources as others with the same condition. These are referred to as social determinants of health (SDOHs), and negative social factors lead to patients experiencing deleterious outcomes (Pinheiro et al., 2022).","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"17 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this review is to assess the efficacy and adverse events associated with intratumoral injection in the treatment of solid tumor malignancies. A literature review was conducted using PubMed, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus databases from 2009 to 2022. A total of 588 articles were retrieved, with five selected based on inclusion and exclusion criteria. Inclusion criteria specified English language publications, in human trials, and use of intratumoral anticancer agents. The findings from this integrative review demonstrate treatment efficacy as measured by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with increased stable disease and partial response in patients as well as a prolonged survival period. Additionally, findings show that this therapy is associated with predominantly mild adverse events.
{"title":"Does Use of Intratumoral Injections in Solid Tumor Malignancies Improve Outcomes and Reduce Adverse Events? An Integrative Review","authors":"Maggie Matyola, APRN, FNP-C, Ashley Martinez, DNP, APRN, FNP-BC, Joyce Dains, DrPH, JD, APRN, FNP-BC, FNAP, FAANP, FAAN","doi":"10.6004/jadpro.2024.15.1.4","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.4","url":null,"abstract":"The purpose of this review is to assess the efficacy and adverse events associated with intratumoral injection in the treatment of solid tumor malignancies. A literature review was conducted using PubMed, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus databases from 2009 to 2022. A total of 588 articles were retrieved, with five selected based on inclusion and exclusion criteria. Inclusion criteria specified English language publications, in human trials, and use of intratumoral anticancer agents. The findings from this integrative review demonstrate treatment efficacy as measured by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with increased stable disease and partial response in patients as well as a prolonged survival period. Additionally, findings show that this therapy is associated with predominantly mild adverse events.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139884231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.6
Anna Poullard, DNP, MSN, APRN-BC, Sheena Charles, MS, FNP-BC
The primary objectives of early phase clinical trials are to determine the safety, tolerability, and recommended doses of an investigational agent for patients with advanced cancer. Although these advances in cancer treatment have resulted in patients living longer, patients often experience psychological side effects that may affect sexual health and intimacy. It is estimated that cancer and its subsequent treatments affect the sexual health and intimacy of 40% to 100% of this patient population. Patients with advanced cancer who have undergone numerous treatments may be impacted negatively, not only physically (such as being disfigured by surgical resection) but also emotionally in relationship aspects with their intimate partners. Health-care providers who treat patients with advanced cancer enrolled in early phase clinical trials tend to focus primarily on treatment, physical side effects, and symptom management. Advanced practice providers (APPs) are accustomed to performing comprehensive physical examinations on patients; however, research indicates that intimacy and sexuality are most often excluded in discussions with patients with advanced cancer. The purpose of the article is to increase awareness of the need to address intimacy and sexuality in this patient population and to encourage APPs to make this a part of their everyday practice.
{"title":"Advanced Practice Providers’ Role in Intimacy in Advanced Cancer Patients","authors":"Anna Poullard, DNP, MSN, APRN-BC, Sheena Charles, MS, FNP-BC","doi":"10.6004/jadpro.2024.15.1.6","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.6","url":null,"abstract":"The primary objectives of early phase clinical trials are to determine the safety, tolerability, and recommended doses of an investigational agent for patients with advanced cancer. Although these advances in cancer treatment have resulted in patients living longer, patients often experience psychological side effects that may affect sexual health and intimacy. It is estimated that cancer and its subsequent treatments affect the sexual health and intimacy of 40% to 100% of this patient population. Patients with advanced cancer who have undergone numerous treatments may be impacted negatively, not only physically (such as being disfigured by surgical resection) but also emotionally in relationship aspects with their intimate partners. Health-care providers who treat patients with advanced cancer enrolled in early phase clinical trials tend to focus primarily on treatment, physical side effects, and symptom management. Advanced practice providers (APPs) are accustomed to performing comprehensive physical examinations on patients; however, research indicates that intimacy and sexuality are most often excluded in discussions with patients with advanced cancer. The purpose of the article is to increase awareness of the need to address intimacy and sexuality in this patient population and to encourage APPs to make this a part of their everyday practice.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"14 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139887693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.5
Jared Thorley, APRN, MSN, FNP, Saneese Stepher, MPAS, PA-C, MPA
Prostate cancer is the second most common cause of cancer-related mortality among men in the United States, with an estimated 34,700 deaths annually. Androgen deprivation therapy (ADT) is the cornerstone of advanced prostate cancer therapy, and injectable luteinizing hormone-releasing hormone (LHRH) agonists have served as the most commonly used ADT for over 30 years. Relugolix, a first-in-class, once-daily, oral gonadotropin-releasing hormone (GnRH) antagonist, was developed to address some of the limitations of available ADT therapies. Herein, we present two hypothetical case reports via an advanced practice provider (APP) perspective that reflect prototypical examples of patients with advanced localized disease not suitable for surgery or newly diagnosed hormone-sensitive metastatic disease treated with relugolix. The cases presented are meant to be instructional and within the scope of the current approved prescribing information for all medications mentioned. Best practices from an APP perspective are shared.
{"title":"Management of Advanced Prostate Cancer With Relugolix: Illustrative Case Scenarios From an Advanced Practice Provider Perspective","authors":"Jared Thorley, APRN, MSN, FNP, Saneese Stepher, MPAS, PA-C, MPA","doi":"10.6004/jadpro.2024.15.1.5","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.5","url":null,"abstract":"Prostate cancer is the second most common cause of cancer-related mortality among men in the United States, with an estimated 34,700 deaths annually. Androgen deprivation therapy (ADT) is the cornerstone of advanced prostate cancer therapy, and injectable luteinizing hormone-releasing hormone (LHRH) agonists have served as the most commonly used ADT for over 30 years. Relugolix, a first-in-class, once-daily, oral gonadotropin-releasing hormone (GnRH) antagonist, was developed to address some of the limitations of available ADT therapies. Herein, we present two hypothetical case reports via an advanced practice provider (APP) perspective that reflect prototypical examples of patients with advanced localized disease not suitable for surgery or newly diagnosed hormone-sensitive metastatic disease treated with relugolix. The cases presented are meant to be instructional and within the scope of the current approved prescribing information for all medications mentioned. Best practices from an APP perspective are shared.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139815201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.2
Tina Harris, DNP, NP-C, AOCNP, Julie Brinzo, DNP, APRN, MBA, FNP-C, Christopher Pell, PhD
Background: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.
背景：对多学科团队进行经济毒性（FT）风险、筛查和护理协调方面的教育，是解决新诊断的 III 期或 IV 期癌症患者护理差距的一种方法。目标：本质量改进项目（QIP）的目标是为多学科团队提供一项教育计划，为实现以下目标提供启示：（1）提高未进行基线筛查的财务毒性筛查率；（2）在出现财务毒性的患者中增加资源护理协调转介；以及（3）在为期 8 周的项目中评估财务毒性与所选人口统计学识别指标之间的关系。方法：采用 "计划-实施-研究-行动"（Plan-Do-Study-Act，PDSA）模式来学习和引导 QIP 期间的变革，重点关注财务毒性综合评分（COST）和新诊断的 III 期或 IV 期妇科癌症参与者的资源护理协调。结果：在 42 名（80.75%）同意参加 QIP 的参与者中，61.90% 的 COST 评分低于 23 分，100%（26 名）的参与者接受了资源护理协调转介。平均有 6.50 名患者进入诊所接受治疗，其中 50%（3.25 人）报告有家庭病史。按此比例计算，在 50 周的一年中，有 162.50 名患者经历了 FT，但未接受资源护理协调。然而，由于部分患者未同意参与 QIP，在 50 周的一年中，FT（是）患者的平均人数可能在 199.50 到 225.00 之间，从而导致可能有 62.50 名 FT 患者（或 225.00 患者中的 28%）未接受转介。在这一质量改进项目中，年龄是影响固定电话转诊成本得分的主要因素。在这一质量改进项目中，许多变量都是不可观测的，可能会影响固定电话成本得分。然而，单独建模显示，年龄本身就能解释所观察到的 FT COST 分数变化的约 15%。对更多变量的控制可能会使模型更加完善，但从数据分析来看，年龄作为 FT COST 分数变化的驱动因素似乎不太可能消失。结论制定一项以结构化 QIP-PDSA 计划为重点的多学科教育计划，可以作为规范 FT 筛查和护理协调计划的一个范例。QIP 团队成功地将 PDSA 模型路线图筛查计划纳入其中，识别出了出现 FT 的参与者，并及时将 100% 的参与者转介到资源护理协调机构。
{"title":"A Financial Toxicity Screening and Care Coordination Quality Improvement Program in a Gynecology Oncology Urban Practice","authors":"Tina Harris, DNP, NP-C, AOCNP, Julie Brinzo, DNP, APRN, MBA, FNP-C, Christopher Pell, PhD","doi":"10.6004/jadpro.2024.15.1.2","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.2","url":null,"abstract":"Background: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"1091 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139831268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.6004/jadpro.2024.15.1.5
Jared Thorley, APRN, MSN, FNP, Saneese Stepher, MPAS, PA-C, MPA
Prostate cancer is the second most common cause of cancer-related mortality among men in the United States, with an estimated 34,700 deaths annually. Androgen deprivation therapy (ADT) is the cornerstone of advanced prostate cancer therapy, and injectable luteinizing hormone-releasing hormone (LHRH) agonists have served as the most commonly used ADT for over 30 years. Relugolix, a first-in-class, once-daily, oral gonadotropin-releasing hormone (GnRH) antagonist, was developed to address some of the limitations of available ADT therapies. Herein, we present two hypothetical case reports via an advanced practice provider (APP) perspective that reflect prototypical examples of patients with advanced localized disease not suitable for surgery or newly diagnosed hormone-sensitive metastatic disease treated with relugolix. The cases presented are meant to be instructional and within the scope of the current approved prescribing information for all medications mentioned. Best practices from an APP perspective are shared.
{"title":"Management of Advanced Prostate Cancer With Relugolix: Illustrative Case Scenarios From an Advanced Practice Provider Perspective","authors":"Jared Thorley, APRN, MSN, FNP, Saneese Stepher, MPAS, PA-C, MPA","doi":"10.6004/jadpro.2024.15.1.5","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.5","url":null,"abstract":"Prostate cancer is the second most common cause of cancer-related mortality among men in the United States, with an estimated 34,700 deaths annually. Androgen deprivation therapy (ADT) is the cornerstone of advanced prostate cancer therapy, and injectable luteinizing hormone-releasing hormone (LHRH) agonists have served as the most commonly used ADT for over 30 years. Relugolix, a first-in-class, once-daily, oral gonadotropin-releasing hormone (GnRH) antagonist, was developed to address some of the limitations of available ADT therapies. Herein, we present two hypothetical case reports via an advanced practice provider (APP) perspective that reflect prototypical examples of patients with advanced localized disease not suitable for surgery or newly diagnosed hormone-sensitive metastatic disease treated with relugolix. The cases presented are meant to be instructional and within the scope of the current approved prescribing information for all medications mentioned. Best practices from an APP perspective are shared.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"42 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.6004/jadpro.2023.14.7.12
Archana Ajmera, MSN, ANP-BC, AOCNP, Leigh Boehmer, PharmD, BCOP, Christa Marie Braun-Inglis, DNP, APRN, FNP-BC, AOCNP, Brianna Hoffner, MSN, ANP-BC, AOCNP, FAPO, Maria Matta, MPH, Rana R. McKay, MD
Oncology advanced practitioners (APs) work in collaboration with physicians to provide high-quality, specialized oncology care. Data are lacking on individual AP function within different practice settings, specifically around the prescribing of anticancer therapies. Our primary aim was to conduct a prospective, national, web-based survey to understand AP roles in prescribing anticancer therapies and the related privileging process(es) in both academic and community oncology practice settings. A 38-question survey was developed based on a review of published oncology AP data sets, expert input, and cognitive interviews with key AP informants. Survey domains included basic respondent demographics, practice setting information, and prescribing and privileging practices. The survey was distributed by the Association of Community Cancer Centers (ACCC) and the Advanced Practitioner Society for Hematology and Oncology (APSHO) in late 2022. 180 individuals responded, and 135 oncology APs completed the survey. The majority of respondents practice in states that allow prescriptive privileging for anticancer therapies. Only half of those that have prescriptive privileging have an established privileging and competency process at their practice setting. Among the nurse practitioners and physician assistants practicing in primarily independent roles, only about half can prescribe both standard-of-care and investigational therapies. This national survey provides valuable insights into the prescribing practices of oncology APs. The findings highlight the need to further develop standardized privileging and competency strategies within the AP community. By addressing these gaps, APs can play a crucial role in addressing workforce shortages in oncology and optimizing patient outcomes.
肿瘤进修医师（APs）与医生合作，提供高质量的专业肿瘤治疗。目前尚缺乏有关个体执业医师在不同执业环境中职能的数据，特别是围绕抗癌疗法处方的数据。我们的主要目的是开展一项前瞻性的全国性网络调查，以了解抗癌治疗师在开具抗癌治疗处方方面的作用，以及在学术和社区肿瘤学实践环境中的相关特权流程。根据对已发表的肿瘤学 AP 数据集的回顾、专家意见以及对主要 AP 信息提供者的认知访谈，制定了一份包含 38 个问题的调查问卷。调查领域包括受访者的基本人口统计学特征、实践环境信息以及处方和特权实践。调查由社区癌症中心协会 (ACCC) 和血液学与肿瘤学高级执业医师协会 (APSHO) 于 2022 年底发布。180 人作出了回应，135 名肿瘤科执业医师完成了调查。大多数受访者在允许抗癌疗法处方权的州执业。在允许处方特权的受访者中，只有一半的人在其执业机构建立了特权和能力流程。在以独立执业为主的执业护士和执业助理医师中，只有约一半的人可以同时开具标准疗法和研究疗法的处方。这项全国性调查为了解肿瘤科助理医师的处方实践提供了宝贵的资料。调查结果表明，有必要在全科医生群体中进一步制定标准化的特权和能力战略。通过弥补这些差距，全科医生可以在解决肿瘤学人才短缺和优化患者治疗效果方面发挥重要作用。
{"title":"Understanding Advanced Practitioner Prescriptive Privileges for Anticancer Therapies: A National Survey","authors":"Archana Ajmera, MSN, ANP-BC, AOCNP, Leigh Boehmer, PharmD, BCOP, Christa Marie Braun-Inglis, DNP, APRN, FNP-BC, AOCNP, Brianna Hoffner, MSN, ANP-BC, AOCNP, FAPO, Maria Matta, MPH, Rana R. McKay, MD","doi":"10.6004/jadpro.2023.14.7.12","DOIUrl":"https://doi.org/10.6004/jadpro.2023.14.7.12","url":null,"abstract":"Oncology advanced practitioners (APs) work in collaboration with physicians to provide high-quality, specialized oncology care. Data are lacking on individual AP function within different practice settings, specifically around the prescribing of anticancer therapies. Our primary aim was to conduct a prospective, national, web-based survey to understand AP roles in prescribing anticancer therapies and the related privileging process(es) in both academic and community oncology practice settings. A 38-question survey was developed based on a review of published oncology AP data sets, expert input, and cognitive interviews with key AP informants. Survey domains included basic respondent demographics, practice setting information, and prescribing and privileging practices. The survey was distributed by the Association of Community Cancer Centers (ACCC) and the Advanced Practitioner Society for Hematology and Oncology (APSHO) in late 2022. 180 individuals responded, and 135 oncology APs completed the survey. The majority of respondents practice in states that allow prescriptive privileging for anticancer therapies. Only half of those that have prescriptive privileging have an established privileging and competency process at their practice setting. Among the nurse practitioners and physician assistants practicing in primarily independent roles, only about half can prescribe both standard-of-care and investigational therapies. This national survey provides valuable insights into the prescribing practices of oncology APs. The findings highlight the need to further develop standardized privileging and competency strategies within the AP community. By addressing these gaps, APs can play a crucial role in addressing workforce shortages in oncology and optimizing patient outcomes.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Cytomegalovirus (CMV) is a major cause of morbidity and mortality in stem cell transplant (SCT) patients. Cytomegalovirus hyperimmunoglobulin (CMV-HIG) therapy has been described in the solid organ transplant setting. However, no review has focused on preemptive use of intravenous CMV immunoglobulins in the SCT setting. This review aims to consolidate findings regarding the preemptive use of CMV-HIG for CMV viremia in SCT patients. Methods: PubMed and Scopus were searched using specific search criteria for publications from 2011 to 2021. Search terms were: cytomegalovirus, CMV, immunoglobulins, immunoglobulin, IVIG, CMVIG, hematopoietic stem cell transplantation, and stem cell. Included studies discussed stem cell transplantation, immunoglobulins, and cytomegalovirus. 366 articles were identified from the search. Five articles met the inclusion and exclusion criteria. Results: Preemptive CMV-HIG resulted in an overall response in 65% to 100% of patients with a clearance time of 14 to 21 days. Early use of CMV-HIG may shorten clearance time. No treatment-related mortality or serious adverse events were associated. Conclusion: CMV-HIG is an effective treatment option in SCT patients that is as safe as antivirals alone. Preemptive CMV-HIG with antivirals may provide the added advantage of reduced time to viremia clearance without adding renal injury. Larger, prospective studies are needed to evaluate CMV-HIG’s impact on time to viremia clearance and the effectiveness of preemptive CMV-HIG use with antivirals.
{"title":"Role of Preemptive Cytomegalovirus Hyperimmunoglobulin in Cytomegalovirus Viremia Following Stem Cell Transplant: An Integrative Review","authors":"Jaci Whittaker, MSN, APRN, FNP-BC, Ashley Martinez, DNP, APRN, FNP-BC, Joyce E. Dains, DrPH, JD, APRN, FNP-BC, FNAP, FAANP, FAA","doi":"10.6004/jadpro.2023.14.7.6","DOIUrl":"https://doi.org/10.6004/jadpro.2023.14.7.6","url":null,"abstract":"Introduction: Cytomegalovirus (CMV) is a major cause of morbidity and mortality in stem cell transplant (SCT) patients. Cytomegalovirus hyperimmunoglobulin (CMV-HIG) therapy has been described in the solid organ transplant setting. However, no review has focused on preemptive use of intravenous CMV immunoglobulins in the SCT setting. This review aims to consolidate findings regarding the preemptive use of CMV-HIG for CMV viremia in SCT patients. Methods: PubMed and Scopus were searched using specific search criteria for publications from 2011 to 2021. Search terms were: cytomegalovirus, CMV, immunoglobulins, immunoglobulin, IVIG, CMVIG, hematopoietic stem cell transplantation, and stem cell. Included studies discussed stem cell transplantation, immunoglobulins, and cytomegalovirus. 366 articles were identified from the search. Five articles met the inclusion and exclusion criteria. Results: Preemptive CMV-HIG resulted in an overall response in 65% to 100% of patients with a clearance time of 14 to 21 days. Early use of CMV-HIG may shorten clearance time. No treatment-related mortality or serious adverse events were associated. Conclusion: CMV-HIG is an effective treatment option in SCT patients that is as safe as antivirals alone. Preemptive CMV-HIG with antivirals may provide the added advantage of reduced time to viremia clearance without adding renal injury. Larger, prospective studies are needed to evaluate CMV-HIG’s impact on time to viremia clearance and the effectiveness of preemptive CMV-HIG use with antivirals.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139296524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.6004/jadpro.2023.14.7.11
Sandra Kurtin, PhD, ANP-BC, AOCN, FAPO, Mailey L. Wilks, DNP, APRN-CNP, Heather Koniarczyk, MSN, APRN-CNP, AOCNP, Nicole Deline, MSN, APRN, FNP-C, AOCNP, Sara Toth, FNP-C, AOCNP, AGN-BC, Andrea Edwards, PA-C, Scott Rowley, DNP, APRN-CNP, AOCNP, Jason Astrin, DMSc, MBA, PA-C, DFAAPA, Wendy Vogel, MSN, FNP, AOCNP, FAPO
Advanced practitioners (APs) in hematology and oncology (heme/onc) practice and provide oversight across myriad settings, including outpatient, inpatient, specialty centers, infusion centers, and other care settings. Understanding the complexity of care within the specific role APs play in providing day-to-day services across the oncology service line and throughout the continuum of care is critical to developing productivity metrics that adequately reflect the value and scope of the heme/onc AP role. Productivity metrics specific to APs are lacking. Physician models, commonly applied to APs, do not adequately reflect the changing landscape of oncology services, and more importantly do not capture nonbillable services APs provide that are essential to run a practice safely, effectively, and efficiently. Here we describe results of the APSHO Productivity, Burnout, and Work-Life Balance Survey deployed to APSHO members in October 2022 with insight into the day-to-day workload of heme/onc APs, levels of burnout, and perceptions of work-life balance in their current role. Results of the survey confirm the significant amount of time APs spend performing tasks that are not billable but are crucial for access to care and treatment, patient safety, practice efficiency, and downstream revenue. Imperative to an agile and stable heme/onc workforce is an AP leadership structure. Advanced practitioner leaders are at the cornerstone of AP retention, yet metrics for measuring AP leader productivity are also lacking. Now, more than ever, it is essential to accurately describe and assign value to the broad scope of services APs and AP leaders bring to heme/onc practices.
{"title":"The Value of the Advanced Practitioner in Hematology and Oncology: Establishing Benchmarks","authors":"Sandra Kurtin, PhD, ANP-BC, AOCN, FAPO, Mailey L. Wilks, DNP, APRN-CNP, Heather Koniarczyk, MSN, APRN-CNP, AOCNP, Nicole Deline, MSN, APRN, FNP-C, AOCNP, Sara Toth, FNP-C, AOCNP, AGN-BC, Andrea Edwards, PA-C, Scott Rowley, DNP, APRN-CNP, AOCNP, Jason Astrin, DMSc, MBA, PA-C, DFAAPA, Wendy Vogel, MSN, FNP, AOCNP, FAPO","doi":"10.6004/jadpro.2023.14.7.11","DOIUrl":"https://doi.org/10.6004/jadpro.2023.14.7.11","url":null,"abstract":"Advanced practitioners (APs) in hematology and oncology (heme/onc) practice and provide oversight across myriad settings, including outpatient, inpatient, specialty centers, infusion centers, and other care settings. Understanding the complexity of care within the specific role APs play in providing day-to-day services across the oncology service line and throughout the continuum of care is critical to developing productivity metrics that adequately reflect the value and scope of the heme/onc AP role. Productivity metrics specific to APs are lacking. Physician models, commonly applied to APs, do not adequately reflect the changing landscape of oncology services, and more importantly do not capture nonbillable services APs provide that are essential to run a practice safely, effectively, and efficiently. Here we describe results of the APSHO Productivity, Burnout, and Work-Life Balance Survey deployed to APSHO members in October 2022 with insight into the day-to-day workload of heme/onc APs, levels of burnout, and perceptions of work-life balance in their current role. Results of the survey confirm the significant amount of time APs spend performing tasks that are not billable but are crucial for access to care and treatment, patient safety, practice efficiency, and downstream revenue. Imperative to an agile and stable heme/onc workforce is an AP leadership structure. Advanced practitioner leaders are at the cornerstone of AP retention, yet metrics for measuring AP leader productivity are also lacking. Now, more than ever, it is essential to accurately describe and assign value to the broad scope of services APs and AP leaders bring to heme/onc practices.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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