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Advanced Practitioners in Hematology and Oncology: State of the Workforce 血液学和肿瘤学高级医师:从业人员现状
Pub Date : 2023-11-01 DOI: 10.6004/jadpro.2023.14.7.10
Sandra Kurtin, PhD, ANP-BC, AOCN, FAPO, Carolyn Grande, CRNP, AOCNP, Megan May, PharmD, BCOP, FAPO, FHOPA, Andrea Edwards, PA-C, Steven Wei, EdD, MS, MPH, PA-C, DFAPPA, Brianna Hoffner, MSN, ANP-BC, AOCNP, FAPO, Wendy Vogel, MSN, FNP, AOCNP, FAPO
Advanced practitioners (APs), including nurse practitioners (NP), physician assistants (PA), pharmacists, and nurses with advanced degrees, including advanced practice registered nurses (APRNs), play a critical role in quality, timely, and expert cancer care. Burnout, retention, and resilience have been studied in physician groups. However, there is a paucity of data specific to APs in hematology and oncology. The Advanced Practitioner Society for Hematology and Oncology (APSHO) conducted an online survey that used validated tools to measure burnout and work-life balance among APs who are members of APSHO. Among the 366 respondents completing all items of the Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS), participants felt engaged (34.2%) but overextended (37.4%) and reported burnout (17.8%). These results indicate a need to evaluate workloads, improve communication, and deploy strategies for support and advocacy to improve work-life balance within this group. The stability of the AP workforce is essential to excellence in patient care, provider resilience, and cancer outcomes. Creating a culture of open communication and strong AP leadership with data streams and metrics specific to the hematology and oncology workforce will help to inform health systems, consumers of health care, professional societies, educational institutions, and APs. Systematic and regular assessment of burnout and barriers to work-life balance for APs is essential to sustained adaptation of strategies to reduce burnout and retain APs.
包括执业护士 (NP)、医生助理 (PA)、药剂师和拥有高级学位的护士(包括高级执业注册护士 (APRN))在内的高级执业医师 (AP) 在提供优质、及时和专业的癌症护理方面发挥着至关重要的作用。对医生群体的职业倦怠、留任和适应能力进行了研究。然而,专门针对血液学和肿瘤学高级执业医师的数据却很少。血液学和肿瘤学高级从业者协会(APSHO)进行了一项在线调查,使用经过验证的工具来衡量血液学和肿瘤学高级从业者协会会员中的职业倦怠和工作与生活的平衡。在完成了马斯拉赫职业倦怠量表(Maslach Burnout Inventory,MBI)和工作生活领域调查(Area of Worklife Survey,AWS)所有项目的 366 名受访者中,有 34.2% 的受访者感到工作投入,但有 37.4% 的受访者感到工作过度,还有 17.8% 的受访者报告了职业倦怠。这些结果表明,有必要对这一群体的工作量进行评估,加强沟通,并制定支持和宣传战略,以改善工作与生活的平衡。亚太地区医务人员队伍的稳定性对于卓越的患者护理、医疗服务提供者的应变能力和癌症治疗效果至关重要。通过血液学和肿瘤学医务人员的数据流和指标,创建一种开放的沟通文化和强有力的医务人员领导力,将有助于为医疗系统、医疗保健消费者、专业协会、教育机构和医务人员提供信息。系统、定期地评估全科医生的职业倦怠和工作与生活平衡的障碍,对于持续调整策略以减少职业倦怠和留住全科医生至关重要。
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引用次数: 0
Characterization and Management of Adverse Reactions in Patients With Unresectable Hepatocellular Carcinoma Treated With Lenvatinib 伦伐替尼治疗无法切除的肝细胞癌患者不良反应的特征与管理
Pub Date : 2023-11-01 DOI: 10.6004/jadpro.2023.14.7.4
Anna Jones, FNP-C, Paola Degregorio, PA-C, Max W. Sung, MD, Zahra Ramji, BSN, Min Ren, PhD, Ari D. Baron, MD
Aims: Advanced practice providers (APPs) play a vital role in monitoring for and managing adverse reactions (ARs). As lenvatinib ARs can resemble cirrhosis (commonly presenting with hepatocellular carcinoma [HCC]), APP input is important for timely detection and management of ARs and to promote medication adherence. Design: The goal of this post-hoc analysis of the REFLECT trial was to characterize key ARs associated with lenvatinib, and to discuss management strategies. Methods: In REFLECT, patients with unresectable HCC were randomized to either daily lenvatinib (12 mg/day for patients who weighed ≥ 60 kg or 8 mg/day for those < 60 kg) or sorafenib 400 mg twice daily. Adverse events in the lenvatinib arm were grouped into ARs (hypertension, fatigue, palmar-plantar erythrodysesthesia syndrome, proteinuria, and decreased appetite) per the United States Prescribing Information (USPI) for lenvatinib. Results: Key ARs in the lenvatinib arm (n = 476) generally occurred within months of starting lenvatinib. Some cases of proteinuria, decreased appetite, and diarrhea were first reported at about 2 years of treatment. Conclusions: The onset of key ARs associated with lenvatinib treatment can be predicted and generally be managed (per the lenvatinib USPI and REFLECT) by withholding lenvatinib and resuming it at a reduced dose after the severity decreases. However, lenvatinib should generally be discontinued if the AR is life-threatening.
目的:高级医疗服务提供者(APP)在监测和管理不良反应(ARs)方面发挥着重要作用。由于来伐替尼的不良反应可能与肝硬化相似(通常表现为肝细胞癌[HCC]),因此APP的参与对于及时发现和管理不良反应以及促进用药依从性非常重要。设计:这项REFLECT试验的事后分析旨在描述与来伐替尼相关的主要ARs,并讨论管理策略。方法在REFLECT试验中,无法切除的HCC患者被随机分配为每日服用来伐替尼(体重≥60公斤的患者为12毫克/天,体重<60公斤的患者为8毫克/天)或索拉非尼400毫克,每日两次。根据来伐替尼的美国处方信息(USPI),来伐替尼治疗组的不良事件分为ARs(高血压、疲劳、掌跖红斑综合征、蛋白尿和食欲下降)。结果来伐替尼治疗组(n = 476)的主要AR一般发生在开始服用来伐替尼的几个月内。一些蛋白尿、食欲下降和腹泻病例在治疗约2年后首次报告。结论与来伐替尼治疗相关的主要ARs的发生是可以预测的,一般情况下(根据来伐替尼USPI和REFLECT)可通过暂停来伐替尼治疗,待严重程度减轻后再减量恢复治疗。然而,如果AR危及生命,通常应停用来伐替尼。
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引用次数: 0
Early-Stage Breast Cancer, EGFR-Mutated NSCLC, and High-Risk Melanoma: 2023 ASCO Annual Meeting Highlights for the Advanced Practitioner 早期乳腺癌,egfr突变的非小细胞肺癌和高风险黑色素瘤:2023年ASCO年会重点关注高级从业者
Pub Date : 2023-09-01 DOI: 10.6004/jadpro.2023.14.6.10
Lisa Kottschade, APRN, MSN, CNP, FAPO
Lisa Kottschade, APRN, MSN, CNP, FAPO, of Mayo Clinic, discusses encouraging results of a trial examining adjuvant ribociclib plus estrogen therapy in patients with stage II or III HR+/HER2− early breast cancer. She also discusses the use of the novel mRNA-4157 vaccine in combination with pembrolizumab as adjuvant therapy for resected high-risk melanoma. Finally, she analyzes the overall survival data reported in the ADAURA trial, which demonstrated a statistically significant disease-free and overall survival benefit for patients with EGFR-mutated stage IB to IIIA non–small cell lung cancer.
梅奥诊所的Lisa Kottschade, APRN, MSN, CNP, FAPO,讨论了一项研究II期或III期HR+/HER2 -早期乳腺癌患者的辅助核糖环尼加雌激素治疗的令人鼓舞的结果。她还讨论了新型mRNA-4157疫苗联合派姆单抗作为切除高危黑色素瘤的辅助治疗。最后,她分析了ADAURA试验中报告的总生存数据,该试验显示egfr突变的IB至IIIA期非小细胞肺癌患者的无病和总生存获益具有统计学意义。
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引用次数: 0
Racial Disparities, Advanced Ovarian Cancer, and HER2 Expression: 2023 ASCO Annual Meeting Highlights for the Advanced Practitioner 种族差异,晚期卵巢癌和HER2表达:2023年ASCO年会的高级从业者重点
Pub Date : 2023-09-01 DOI: 10.6004/jadpro.2023.14.6.9
Andrew S. Guinigundo, MSN, RN, CNP, ANP-BC
Andrew S. Guinigundo, MSN, RN, CNP, ANP-BC, of Cincinnati Cancer Advisors, discusses the effect of Medicaid expansion on racial disparities in mortality among patients with gastrointestinal malignancies. He also describes the phase III DUO-O trial, which evaluated therapies for patients with advanced ovarian cancer without a BRCA1/2 mutation. Finally, the first tumor-agnostic global study of fam-trastuzumab deruxtecan-nxki showed encouraging results in patients with different cancers.
Andrew S. Guinigundo, MSN, RN, CNP, ANP-BC,辛辛那提癌症顾问,讨论了医疗补助扩大对胃肠道恶性肿瘤患者死亡率种族差异的影响。他还介绍了三期DUO-O试验,该试验评估了无BRCA1/2突变的晚期卵巢癌患者的治疗方法。最后,fam-曲妥珠单抗deruxtecan-nxki的首次肿瘤不可知全球研究在不同癌症患者中显示出令人鼓舞的结果。
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引用次数: 0
Knowing Your Target: Altered Mental Status From an Unsuspected Source 了解你的目标:从一个未知的来源改变精神状态
Pub Date : 2023-09-01 DOI: 10.6004/jadpro.2023.14.6.8
Sarah Hemstetter, MSN, CRNP, AOCNP
Daratumumab is a human monoclonal antibody targeting CD38 that is used in the treatment of multiple myeloma. In addition to being a target for cancer-related treatment, CD38 also plays a significant role in the immune response to infection. CD38 deficiency can increase susceptibility to several bacterial infections. This article discusses the case of a 52-year-old female with a history of IgG multiple myeloma status post autologous stem cell transplant with relapse who was receiving therapy with daratumumab, lenalidomide, and dexamethasone. She presented to the emergency department with a history of 3 to 4 days of generalized weakness, poor appetite, nausea, vomiting, watery stools, and fevers. Her symptoms did not improve with initial fluid resuscitation and broad-spectrum antimicrobials; instead, she experienced progressive neurological decline. This case illustrates how utilizing targets for cancer-directed treatments can also affect immune function, which may leave patients susceptible to unique infections that may not otherwise be commonly encountered. Therefore, advanced practitioners must understand the functional role of these targets and the sequelae that could occur when expression is altered by pharmacological therapies to allow for expeditious recognition and management.
Daratumumab是一种靶向CD38的人单克隆抗体,用于多发性骨髓瘤的治疗。除了作为癌症相关治疗的靶点外,CD38在感染的免疫反应中也起着重要作用。CD38缺乏会增加对几种细菌感染的易感性。本文讨论了一例52岁女性,自体干细胞移植后IgG多发性骨髓瘤复发病史,接受达拉单抗、来那度胺和地塞米松治疗。她以3至4天的全身性虚弱、食欲不振、恶心、呕吐、水样便和发烧病史就诊于急诊科。她的症状在最初的液体复苏和广谱抗菌素治疗后没有改善;相反,她的神经功能出现了进行性衰退。这个案例说明了利用癌症靶向治疗也会影响免疫功能,这可能会使患者容易受到原本不常见的独特感染。因此,高级从业者必须了解这些靶点的功能作用,以及当药物治疗改变表达时可能发生的后遗症,以便快速识别和管理。
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引用次数: 0
Relapsed/Refractory Multiple Myeloma, DLBCL, and CLL: 2023 ASCO Annual Meeting Highlights for the Advanced Practitioner 复发/难治性多发性骨髓瘤,DLBCL和CLL: 2023 ASCO年度会议的高级从业者重点
Pub Date : 2023-09-01 DOI: 10.6004/jadpro.2023.14.6.11
Oxana Megherea, PharmD, BCOP
Oxana Megherea, PharmD, BCOP, of the Hospital of the University of Pennsylvania, discusses the MonumenTAL-1 study of talquetamab in relapsed/refractory multiple myeloma. She also summarizes a subgroup analysis of elderly patients enrolled in the phase III POLARIX study and results of a phase III study of ibrutinib, obinutuzumab, and venetoclax vs. ibrutinib plus obinutuzumab (IO) for treatment-naive older patients with chronic lymphocytic leukemia.
Oxana Megherea,药学博士,BCOP,宾夕法尼亚大学医院,讨论了talquetamab治疗复发/难治性多发性骨髓瘤的monument -1研究。她还总结了参加POLARIX III期研究的老年患者的亚组分析,以及ibrutinib、obinutuzumab和venetoclax与ibrutinib + obinutuzumab (IO)治疗初治老年慢性淋巴细胞白血病患者的III期研究结果。
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引用次数: 1
Providing Care During Cancer Drug Shortages. 在癌症药物短缺期间提供护理。
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.1
Beth Faiman
Drug shortages have become a global phenomenon, reaching an all-time high and affecting nearly every therapeutic area of medicine. Even short-term drug shortages cause deleterious effects in critical populations such as our patients with cancer or blood disorders. The lack of available therapies leads to treatment delays and suboptimal regimens, and creates a strain on the health-care system (McBride et al., 2022). While cisplatin and carboplatin remain in short supply, hundreds of other drugs ranging from antibiotics to normal saline flushes and supportive mediations are also running low, plaguing patients and clinicians.
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引用次数: 0
Quality of Life in Adult Cancer Patients With Underage Children: An Integrative Review. 有未成年子女的成年癌症患者的生活质量:一项综合综述。
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.4
Gabriela Mota-George, Ashley Martinez, Joyce E Dains

As many as 24.7% of cancer patients are also parents to children younger than 18 years of age. This population faces unique challenges, and quality of life in parental cancer patients has not been well studied. This integrative review assessed parental cancer patients' quality of life. PubMed and Scopus were searched using the following terms: quality of life, distress, anxiety, coping, emotion, social support, employment, work, psychosocial, physical, function, parental cancer, and parents with cancer. English publications conducted within the past 15 years that used an objective instrument to measure quality of life in adult cancer patients with children 18 years of age or younger were included. Studies with an intervention focus were excluded. After review of 672 articles, nine studies met the criteria for inclusion. Several instruments were utilized to measure quality of life. Some parental cancer patients reported decreased quality of life when compared with other cancer patients and the general population at diagnosis and years after. Parental cancer patients may be at an increased risk of decreased quality of life. With this understanding, health-care providers should complete comprehensive assessments routinely so that these patients' unique needs may be more adequately addressed.

多达24.7%的癌症患者同时也是18岁以下儿童的父母。这一人群面临着独特的挑战,父母癌症患者的生活质量尚未得到很好的研究。这项综合评价评估了父母癌症患者的生活质量。PubMed和Scopus使用以下术语进行搜索:生活质量、痛苦、焦虑、应对、情感、社会支持、就业、工作、心理社会、身体、功能、父母癌症和患有癌症的父母。在过去的15年里,使用客观的工具来衡量成年癌症患者的生活质量,这些患者的孩子年龄在18岁或以下。以干预为重点的研究被排除。在审查了672篇文章后,有9项研究符合纳入标准。使用了几种仪器来测量生活质量。与其他癌症患者和一般人群相比,一些父母患有癌症的患者在诊断时和诊断后几年的生活质量有所下降。父母患有癌症的患者生活质量下降的风险可能会增加。了解了这一点,卫生保健提供者应定期完成全面评估,以便更充分地解决这些患者的独特需求。
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引用次数: 0
Managing Drug Interactions With Oral Anticancer Treatments. 管理药物相互作用与口服抗癌治疗。
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.7
Lisa K Lohr, Kimball T Blake, Cindy M Chan, Sabrina Sturm, Gavyn T Walsh

The use of oral anticancer treatments is widespread and vital to modern cancer treatment. Novel oral chemotherapy and targeted therapy treatments continue to receive US Food and Drug Administration approval every year, making knowledge of these agents a necessity for practitioners working in oncology. Many oral anticancer agents are prone to drug interactions that can contribute to adverse effects and decrease therapy efficacy. Potential drug-drug interactions include (1) interactions with CYP3A4 inhibitors and inducers, (2) interactions related to gastric acid suppression, (3) interactions related to prolongation of the cardiac QT interval, (4) interactions related to anticoagulant medications, and (5) drug-food and drug-herb interactions. Identifying potential drug interactions and appropriately managing them is key to preventing adverse effects and ensuring maximum efficacy while on oral anticancer therapy. Management of adverse effects increases patient compliance, ensures medication safety, and allows patients to remain on therapy. This article discusses the mechanisms of interactions and types of interacting medications. Specific recommendations are discussed.

口服抗癌治疗的应用广泛,对现代癌症治疗至关重要。新的口服化疗和靶向治疗每年都继续获得美国食品和药物管理局的批准,这使得肿瘤学从业人员必须了解这些药物。许多口服抗癌药物容易发生药物相互作用,从而产生不良反应并降低治疗效果。潜在的药物-药物相互作用包括(1)与CYP3A4抑制剂和诱导剂的相互作用,(2)与胃酸抑制相关的相互作用,(3)与心脏QT间期延长相关的相互作用,(4)与抗凝药物相关的相互作用,以及(5)与药物-食物和药物-草药的相互作用。识别潜在的药物相互作用并适当管理它们是预防不良反应和确保口服抗癌治疗效果最大化的关键。对不良反应的管理可提高患者的依从性,确保用药安全,并使患者继续接受治疗。本文讨论了相互作用的机制和相互作用药物的类型。讨论了具体建议。
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引用次数: 0
Can You Establish the Cause of This Patient's Shortness of Breath? 你能确定这个病人呼吸短促的原因吗?
Pub Date : 2023-07-01 DOI: 10.6004/jadpro.2023.14.5.8
Allison Trail, Jane Rogers, Jaffer Ajani

Mr. B is a 56-year-old man diagnosed with metastatic HER2-positive gastroesophageal adenocarcinoma. He received front-line leucovorin, 5-fluorouracil, and oxaliplatin (FOLFOX) and trastuzumab for 10 months before restaging imaging revealed progressive disease. He then received second-line trastuzumab deruxtecan. His treatment was complicated by several admissions felt to be unrelated to his cancer therapy. He was discharged after an episode of pneumonia on a steroid taper with prophylactic trimethoprim/sulfamethoxazole. Once he recovered, he was given a fourth dose of chemotherapy. About a week later, wheezes were noticed on physical exam, and he was given a 5-day course of levofloxacin. Around the same time, he also finished his steroid taper. Twelve days after his dose of chemotherapy, he presented to the emergency room with 3 to 4 days of progressive shortness of breath and dry cough following the completion of levofloxacin without symptom improvement. A CT scan showed increasing airspace opacities and multifocal areas of consolidation. Blood, nasal, and sputum cultures were negative. A bronchoscopy was performed that did not reveal findings concerning for capillaritis. He was ultimately diagnosed with drug-induced pneumonitis/interstitial lung disease (ILD). Mr. B continued to experience worsening hypoxic respiratory failure despite continuous IV steroids. He was discharged to an inpatient hospice facility where he passed away 2 weeks later. Drug-induced pneumonitis/ILD should be considered in all patients receiving trastuzumab deruxtecan who develop progressive shortness of breath or other respiratory complaints.

B先生是一名56岁的男性,诊断为转移性her2阳性胃食管腺癌。他接受了一线亚叶酸钙、5-氟尿嘧啶、奥沙利铂(FOLFOX)和曲妥珠单抗治疗10个月,然后重新分期成像显示疾病进展。然后他接受了二线曲妥珠单抗德鲁西替康治疗。他的治疗因几次被认为与癌症治疗无关的入院而变得复杂。他在一次肺炎发作后出院,服用类固醇减量治疗和预防性甲氧苄啶/磺胺甲恶唑。康复后,他接受了第四次化疗。约一周后体检发现患者有喘息症状,给予左氧氟沙星5天疗程。大约在同一时间,他也停止了类固醇的使用。化疗12天后,患者在完成左氧氟沙星治疗后出现3 - 4天进行性呼吸短促和干咳,但症状无改善。CT扫描显示空域混浊增加和多灶实变区。血、鼻、痰培养均为阴性。进行支气管镜检查,未发现有关毛细血管炎的发现。最终诊断为药物性肺炎/间质性肺病(ILD)。尽管持续静脉注射类固醇,B先生的缺氧呼吸衰竭仍在恶化。他被送至临终关怀医院,两周后去世。在所有接受曲妥珠单抗德鲁德替康治疗的出现进行性呼吸短促或其他呼吸系统不适的患者中,应考虑药物性肺炎/ILD。
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引用次数: 0
期刊
Journal of the Advanced Practitioner in Oncology
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