Journal of the Advanced Practitioner in Oncology最新文献

Psychoemotional distress affects patients with cancer, including patients with a diagnosis of a malignant brain tumor. Empathy, professional expertise, and conversational skills are required to ensure successful communication with patients. The purpose of this study was to assess whether knowing the communication needs of patients would be helpful to neuro-oncologists before meeting with them. Patients in our neuro-oncology center were asked to complete the National Comprehensive Cancer Network Distress Thermometer (DT) and a study-specific questionnaire on patients' expectations for communication with the treating physician. The questions targeted issues such as attention/caring and awareness of their disease and prognosis. Importance ratings were compared between patients, with high vs. low distress scores to analyze the impact of distress on the patient's needs in physician-patient communication. A total of 81 patients completed the DT and questionnaire. One third (n = 27) had IDH wild-type astrocytoma, and 42 patients (51.9%) were undergoing therapy for primary or recurrent disease. Mean distress was 4.88 (standard deviation ± 2.64) in the whole cohort, and 56.8% of patients had a high distress score (≥ 5 on a 10-point scale). All issues were assessed as important or very important for communication by the majority of patients, and importance ratings increased in patients with high distress levels for most items. Mean importance ratings correlated significantly with distress scores (p < .001). Distress was increased in neuro-oncology patients. Patients with higher distress levels considered issues of both attention/caring and medical information about the disease as more important than patients with lower distress levels. Using distress assessment may help physicians and advanced practitioners to tailor the contents of their discussion for successful communication with patients.

The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic malignancies. For many of these agents, predictive biomarker testing is necessary to determine the presence of such alterations in order to select patients who are most likely to respond, and to avoid the use of ineffective and potentially harmful alternative therapy. Recent technological advances such as next-generation sequencing have facilitated the identification of targetable biomarkers in patients with cancer and thus help inform treatment decisions. Moreover, new molecular-guided therapies and associated predictive biomarkers continue to be discovered. For some cancer therapeutics, regulatory approval requires the use of a companion diagnostic to ensure proper patient selection. Advanced practitioners therefore need to be aware of current biomarker testing guidelines regarding who should be tested, how and when to test, and how these results can guide treatment decisions using molecular-based therapies. They should also recognize and address potential barriers and disparities in biomarker testing to ensure equitable care for all patients, and assist in educating patients and colleagues alike on the importance of testing and integration into clinical practice to enhance outcomes.

Implicit bias affects patient care every day, and not just in oncology. It impacts decision-making in already vulnerable populations such as the historically marginalized racial and ethnic groups, the LGBTQI+ population, patients with disabilities, and patients with low socioeconomic status or low health literacy. At JADPRO Live 2022 in Aurora, Colorado, panelists took a deep look at implicit bias and its impact on health inequities. They then discussed best practices for increasing equity and representation in clinical trials, ways to facilitate equitable communication and interactions with patients, and finally shared steps that advanced practitioners can take to minimize the impact of implicit bias.

There has been an increasing number of approvals for targeted therapies and immunotherapies in oncology in the past decade. This has changed the treatment paradigm for many solid tumors and hematologic malignancies, and therefore the outcomes of patients with cancer. Advanced practitioners should be up to date with advances in cancer biomarker testing and its implications for the use of targeted therapy and immunotherapy to integrate this information into clinical decision-making.

During JADPRO Live 2022, Jenni Tobin, PharmD, reviewed the indications of newly approved therapies in hematologic malignancies (including those for multiple myeloma, lymphoma, and acute leukemia) approved from late 2021 to late 2022. Dr. Tobin discussed their unique mechanisms of action, administration, and how to monitor for and manage side effects associated with these new therapeutics.

During JADPRO Live 2022, Donald C. Moore, PharmD, BCPS, BCOP, DPLA, FCCP, discussed investigational therapeutic agents in the drug development pipeline. Dr. Moore highlighted agents that represent either a new drug class, a novel mechanism of action, a rethinking of how to approach treating a disease, or those that have recently received FDA Breakthrough Designation status that advanced practitioners should be aware of.

The incidence of cancers such as colorectal cancer, head and neck cancer, and melanoma has increased in younger patients. The number of cancer survivors is also increasing in the US. Pairing these facts together, there are many people with cancer for whom pregnancy and fertility concerns are crucial aspects of their oncologic and survivorship care. For these patients, understanding and having access to fertility preservation options is an essential part of their care. At JADPRO Live 2022, a panel of experts from diverse professions provided perspectives on the consequences for the treatment landscape after the Dobbs v. Jackson decision.

The risk of developing venous thromboembolism (VTE) is four to seven times higher in patients with cancer than in those without. At JADPRO Live 2022, presenters discussed risk factors and assessing patients for VTE, as well as how to protect patients against VTE in both the inpatient and outpatient clinic settings. They reviewed selecting an appropriate anticoagulation treatment, including the choice of agent and duration of treatment for the patient with cancer, and finally the steps needed to assess and treat patients experiencing therapeutic anticoagulation failure.

Recent advances in molecular diagnostics have led to the characterization of an increasing number of actionable genomic alterations and immune-based signatures, which have facilitated the development of many highly effective cancer therapies. In addition to their prognostic value, some of these biomarkers have been shown to have predictive value and have had a significant impact on clinical decision-making. The presence of these therapeutic targets can thus aid health-care professionals to select the optimal therapies and avoid use of ineffective, potentially toxic ones. Earlier agents were generally approved for only one or a limited number of malignancies and/or stages, but more recent approvals encompass multiple tumor types that bear a common molecular alteration regardless of tumor type (i.e., tumor-agnostic indications). The expanding use of tumor-agnostic biomarkers has the potential to greatly broaden the use of these therapies to a wider patient population. Yet the rapidly increasing number of tumor-specific and tumor-agnostic biomarkers, and the continually changing treatment guidelines regarding the use of targeted agents and associated testing requirements, present challenges for advanced practitioners to remain current on these topics and their ability to apply these advances to clinical care. Here, we review predictive oncology biomarkers currently in use and their role in clinical decision-making, including those specified in product prescribing information and clinical practice guidelines. Current clinical guidelines regarding recommended targeted therapies for selected malignancies, and when molecular testing should be performed, are discussed.