Journal of the advanced practitioner in oncology最新文献

Background: Proper nutrition is known to hasten healing, reduce treatment-related morbidity, and improve outcomes. Children with high-risk solid tumors often have gastrostomy tubes (GTs) placed for supplemental nutrition during cancer therapy. Gastrostomy tubes, however, are not without risks, and many patients develop erythema concerning for infection at the stoma site. Gastrostomy complications are described in the literature, but knowledge regarding this topic is limited.

Methods: In this retrospective descriptive study, the authors reviewed 3 years of clinical data regarding pediatric patients with solid tumors who had GTs at a pediatric medical center. Descriptive statistics were used to describe the incidence of erythema concerning for infection, identify factors most likely to be associated with this complication, and understand how erythema impacts the completion of cancer therapy.

Results: In a sample of 58 children with high-risk solid tumors who had GTs placed between 2018 and 2021, 53% developed erythema concerning for infection. More subjects who experienced episodes of GT erythema had neuroblastoma (48%), tubes placed after the start of cancer therapy (74%), and erythema during periods of neutropenia (71%). Only one subject experienced a treatment delay due to GT erythema.

Discussion: Despite the rate of GT erythema among study subjects, most completed cancer therapy without delay related to this complication. Additionally, the incidence of stoma site erythema was notably less when tubes were placed prior to the start of cancer therapy. Therefore, the authors recommend GT placement prior to therapy start when possible and further attention be paid to this complication during cancer therapy.

Carcinoid heart disease (CHD) is a rare cardiac complication that occurs most commonly in patients with advanced neuroendocrine tumors and is a known sequela of carcinoid syndrome. Neuroendocrine tumors most widely associated with CHD include tumors in the small bowel, followed by lung, large bowel, pancreatic, appendiceal, and ovarian neoplasms. Carcinoid syndrome is a paraneoplastic syndrome caused by the release of serotonin and other substances from neuroendocrine tumors. It results in a spectrum of symptoms, including diarrhea, flushing, bronchospasm, and symptoms of congestive heart failure. Without treatment and for patients with advanced heart failure, the prognosis of CHD can be less than a year. Management of CHD is often challenging as patients typically present late, and the disease can progress rapidly. Therefore, optimal management of these patients requires close collaboration among various specialties to quantify disease burden, delay the progression of valvular disease, and determine the most effective surgical and medical management strategies depending on the cardiac manifestations to improve quality of life and reduce mortality. This involves a collaborative team, including cardiology and oncology, and often involves many other disciplines, including hepatobiliary and cardiovascular surgeons, endocrinologists, anesthesiologists, and gastroenterologists.

Cold agglutinin disease (CAD) is a rare type of autoimmune hemolytic anemia (AIHA) distinct from warm antibody AIHA. One of the ways it is distinct is that CAD is usually not responsive to corticosteroids compared with warm antibody AIHA. Historically, CAD therapy has been limited to immunotherapy or chemoimmunotherapy with varying responses. Cold agglutinin disease also poses a risk for thrombosis and mortality. For patients, fatigue tends to be a common symptom of CAD. The hallmark of CAD is complement-mediated hemolysis, which makes complement inhibitors a critical therapeutic option for patients. Previously, eculizumab, a C5 inhibitor, had limited therapeutic effect for CAD. More recently, sutimlimab, a C1s inhibitor, was shown in two phase III studies to be an efficacious treatment for CAD, improving hemoglobin, hemolysis, and fatigue. However, there is a paucity of medical literature on CAD and on sutimlimab in particular that is geared toward advanced practice providers (APPs). This article aims to provide APPs with a background in CAD and a focus on sutimlimab, assisting these providers in caring for patients with CAD receiving this therapy.

Patients undergoing chimeric antigen receptor (CAR) T-cell therapy may experience side effects including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), neutropenia, and infection. Growth factor has historically been used to treat neutropenia; however, its role in CAR T-cell therapy is not well explained. Existing data on the safety and efficacy of growth factor are conflicting. The purpose of this integrative review was to explore the safety and efficacy of growth factor in adult patients with hematologic malignancies undergoing CAR T-cell therapy. A literature review was conducted using PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), and Scopus databases. A total of 2,635 articles were retrieved. Four studies were included that looked at the use of growth factor in the CAR T-cell setting. Safety outcomes evaluated included CRS, ICANS, neutropenic fever and/or infection, and neutropenia duration. Efficacy outcomes evaluated included CAR T-cell expansion and treatment response. The literature suggests that growth factor may not increase CRS prevalence, but may lead to an increased grade of CRS, namely grade 2. Growth factor administration does not have any association with ICANS toxicity, CAR T-cell expansion, or treatment response. Its use may not necessarily lead to decreased infection rates but may shorten the duration of neutropenia. Practice implications for providers working with this unique patient population include using growth factor early in the course of CAR T-cell therapy as treatment to shorten the duration of neutropenia rather than infection prophylaxis.

Aim: This study aimed to analyze articles that discussed the effect of music as adjunctive therapy to traditional treatments of pediatric cancer patients compared to a control of no music therapy.

Background: Cancer is a leading cause of death in children, with over 400,000 children diagnosed annually. During standard oncologic treatments, children often experience psychological and physical adverse effects. The use of music therapy can provide numerous supportive benefits to pediatric patients as adjunctive treatment in reducing psychological and physical burdens.

Design: This was a systematic review of English-language articles from PubMed.

Methods: Nine outcome articles were utilized in this systematic review, including quantitative and qualitative reviews of case studies, interviews, historical accounts, randomized control trials, and other systematic reviews.

Results: The study found increased quality of life (QOL) involving dimensions of mood, cognition, relaxation, self-esteem, vitality, and a sense of community involving interpersonal relationships. The implementation of music therapy in pediatric oncology patients decreased stress/distress and pain. Qualitative data suggests QOL dimensions of localization and control of feelings, sense of community involving social roles and ecological health, stress, distress, and pain, improved in pediatric oncology patients receiving music therapy.

Conclusion: The literature supports music therapy as a complementary treatment during traditional therapies to help decrease stress and pain in children and improve quality of life and sense of community. Therefore, music therapy as an adjunctive therapy should be implemented into standard practice.

Melanoma is the fifth most common cancer in the United States, with over 7,000 deaths annually. Although most patients diagnosed with early-stage (stage I or II) disease have an excellent prognosis, two out of three patients who die from melanoma were initially diagnosed in early stages. Thus, additional methods to identify which patients are at risk of poor outcomes are needed. DecisionDx-Melanoma is a 31-gene expression profile (31-GEP) molecular risk stratification test that predicts an individual's risk of recurrence or metastasis in patients with cutaneous melanoma (CM). Here, we describe a 61-year-old man who presented with a spot on his upper scalp. A biopsy confirmed malignant melanoma measuring > 3.87 mm, with ulceration and mitotic rate 2 to 3/mm². CT, PET, and MRI scans did not reveal metastasis. Following wide local excision and sentinel lymph node biopsy, he was diagnosed with stage IIB CM. Due to the presence of high-risk features, 31-GEP testing was ordered, which revealed Class 2B (high-risk) CM. Due to the high-risk 31-GEP result, the patient was treated off-label with nivolumab for 1 year and received follow-up surveillance scans every 3 months for 3 years. At his last follow-up in April 2022, scans continued to show no recurrent or metastatic disease. The patient continues dermatologic screening every 6 months. The 31-GEP test provides valuable additional information to help clinicians make personalized, risk-based treatment and surveillance plans for patients with CM.

Many targeted therapies to treat genetic mutations in non-small cell lung cancer (NSCLC) have been developed. Amivantamab (Rybrevant), a bispecific antibody targeting the epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition factor, was approved by the US Food and Drug Administration in 2021 for the treatment of adult patients with locally advanced or metastatic NSCLC EGFR exon 20 insertions, whose disease progressed on or after platinum-based chemotherapy. Amivantamab is administered intravenously weekly for 4 weeks, then every 2 weeks starting at Week 5, as 1,050 mg (body weight [BW] < 80 kg) or 1,400 mg (BW ≥ 80 kg), with the first dose split over 2 days. Infusion-related reactions (IRRs) are common with amivantamab and may present as chills, dyspnea, nausea, chest discomfort, and vomiting. To aid in the prevention, diagnosis, and treatment of IRRs, we evaluated infusion duration, IRR timing, and IRR severity in this post hoc analysis of patients who received amivantamab in CHRYSALIS. Infusion duration decreased over time, with a median infusion time at Cycle 1 Day 1 (C1D1) of 4.70 hours (1,050 mg) and 5.08 hours (1,400 mg), decreasing to 2.20 and 2.25 hours, respectively, by C1D22. Of the 273 IRRs, 98% occurred on C1D1 or C1D2, with median onset and time to resolution of 60 minutes. Most IRRs occurred during the infusion, were low grade, and were manageable with intervention strategies or treatment modifications. Advanced practitioners are critical in preventing, diagnosing, and managing IRRs, including educating patients and families, accurately administering infusions, prescribing premedications, and closely monitoring for IRRs.