Journal of the advanced practitioner in oncology最新文献

Purpose: An advanced practice provider (APP) career advancement pathway was developed to promote clinical excellence, enhance job satisfaction, reduce turnover, and improve retention at a major metropolitan National Cancer Institute-designated comprehensive cancer center.

Data sources: A comprehensive literature search was conducted using the PubMed electronic database.

Conclusions: The Memorial Sloan Kettering Cancer Center (MSKCC) Advance Model, MSK's APP Career Advancement Pathway of Excellence Theoretical Model, was established by integrating principles and tenants from the Strong Model of Advanced Practice Nursing and Benner's Novice to Expert model. It comprises seven domains of scholarly engagement: direct comprehensive care, research, drivers of change, education, publications and professional leadership, technology and innovation, and mentorship. The model serves as the foundation for the formal career pathway program known as the MSK Ascend Program. The MSK Ascend Program recognizes and honors APP engagement in professional development, establishes a structured pathway for recognition and promotion, and provides a foundation for the continuous development and advancement of APP practice at MSK.

Implications: Leadership support and commitment are critical to the successful implementation and sustainability of the Ascend Program. This commitment continues to drive professional growth and satisfaction among APPs. The development and iterative refinement of the program exemplify adaptability and an enduring dedication to advancing the MSK APP community.

The multikinase inhibitor regorafenib has improved outcomes for patients with metastatic colorectal cancer (mCRC) following failure of standard therapies. However, regorafenib may be associated with treatment-emergent adverse events (TEAEs) requiring dose modifications. The regorafenib dose-optimization study (ReDOS) investigated a systematic method for titrating regorafenib up to the highest tolerable dose through a prospective evaluation of a first-cycle dose-escalation strategy, compared with standard dosing in patients with refractory mCRC. ReDOS met its primary endpoint, with more patients starting cycle 3 in the dose-escalation group (43%) vs. the standard-dose group (26%; p = .043). The safety profile was consistent with previous reports, and the incidence of regorafenib-related grade 3 TEAEs was generally lower in the dose-escalation group vs. the standard-dose group in cycles 1 and 2. Secondary endpoints showed that dose escalation did not negatively impact efficacy. Initiating regorafenib below the approved standard dose (160 mg/day) improves tolerability and allows health-care professionals to individualize the dose during cycles 1 and 2 without reducing overall drug exposure. This strategy provides an evidence-based guide to optimize regorafenib dosing and improve tolerability without compromising efficacy, allowing patients to remain on regorafenib for longer and potentially improve outcomes. This review provides a clinically relevant appraisal of ReDOS and the implications for patient management from the perspective of oncologists, advanced practice providers, and pharmacists.

Background: Adverse events (AEs) are unintended, harmful effects that occur in clinical trials, particularly in early-phase oncology clinical trials (EPOCT), where the risk of adverse effects from experimental therapies is high. Effective AE identification and management are essential for ensuring patient safety, improving outcomes, and advancing research. Advanced practice providers (APPs) play a key role in detecting and managing AEs, serving as a bridge between clinical care and research. However, their full impact on EPOCT remains underexplored.

Purpose: This integrative review examines existing literature on AE identification, reporting, and management in EPOCT. It explores the role of APPs in managing AEs, emphasizing their impact on patient outcomes, clinical trial efficiency, and oncology science.

Methods: A systematic search of peer-reviewed literature from 2020 to 2025 was conducted using various databases. Inclusion criteria were studies addressing AE management in EPOCT, patient-reported outcomes (PROs), and APP roles. Studies unrelated to oncology, AE management, or health-care providers were excluded.

Results: Findings highlight the variability in AE reporting and the growing utility of electronic PRO tools in capturing timely and accurate data. Advanced practice providers contribute significantly to outpatient AE management, reducing emergency visits and improving treatment adherence. However, challenges remain, including underreporting with clinician-based tools, lack of standardized APP training, and limited comparison to physician-led AE management.

Conclusion: APPs serve as key players in enhancing AE reporting and improving clinical trial processes. Future research should focus on standardizing structured training programs for APPs and comparative studies assessing the effectiveness of APP-led care.

Background: Updated American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) antiemetic guidelines recommend olanzapine for the prophylactic treatment of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC). Inadequate treatment of CINV can result in compounding physical sequelae, ultimately affecting patients' tolerance and recovery throughout chemotherapy treatment. Regional Michigan Oncology Quality Consortium (MOQC) data have identified a wide range of compliance rates in the appropriate prescribing of olanzapine. Literature has shown that olanzapine is safe and effective for the treatment of acute and delayed CINV.

Purpose: The purpose of this quality improvement (QI) project was to improve the compliance rate of appropriate prescribing of olanzapine for CINV for adult patients receiving HEC within the project site's outpatient oncology clinic.

Methods/procedures: The project was based on the Plan-Do-Study-Act (PDSA) model and implemented in an outpatient oncology clinic in a Midwestern urban area over a 6-month time period. A multidisciplinary and interactive education program was delivered to providers. Pre- and post-intervention data were collected by impartial, independent auditors. At monthly provider staff meetings, a presentation was provided to prescribers supplying information on the updated antiemetic guideline recommendations and the pharmacodynamics of olanzapine. An olanzapine frequently asked questions (FAQ) sheet was also provided to reinforce the reviewed material.

Results: Data collected following implementation showed an increase in appropriate prescribing of olanzapine from 82.05% to 94.74% (n = 76). A standard deviation Z-test for two population proportions showed the positive change in compliance rate was statistically significant at p < .05 where p was calculated at .02852. A sustainability audit 1 year after completion showed the rate of appropriate prescribing of olanzapine at 92.59% (n = 27), representing a decrease of 2.15 percentage points. A standard deviation Z-test demonstrated the decrease in comparative compliance rates was not statistically significant at p < .05.

Conclusion/interpretations: Audit data obtained following the implementation of the QI project revealed a statistically significant improvement, which supported the hypothesis that providing education based on the PDSA model is an effective method to improve the compliance rate of appropriate olanzapine prescribing for CINV in patients receiving HEC. The result reflects the growing body of evidence confirming the validity of the PDSA model.

Exogenous blood factor products, such as recombinant or human-derived factor VIIa, factor VIII, factor IX, and von Willebrand factor, are crucial for treating various bleeding disorders, but come with high risks and costs. Effective formulary management and development of institutional evidence-based guidelines for blood factor products are essential to maximize patient outcomes and minimize adverse events through an interprofessional approach. This article details the steps and considerations involved for the development of a blood factor product formulary and management at an academic medical center.

Rearrangements of the anaplastic lymphoma kinase (ALK) gene are present in about 3% to 7% of patients with non-small cell lung cancer (NSCLC) and are the key drivers of cancer cell proliferation in ALK-positive NSCLC. ALK tyrosine kinase inhibitors (TKIs) are potent oral inhibitors of the abnormal ALK protein and are standard first-line treatments for patients with ALK-positive metastatic NSCLC (mNSCLC). Lorlatinib is a brain-penetrant, third-generation ALK TKI that was approved by the US Food and Drug Administration in 2018 for the second- or third-line treatment of patients with ALK-positive mNSCLC and in 2021 for first-line treatment, based on the results of the phase III CROWN study (NCT03052608). The recent 5-year results of the CROWN study showed that median progression-free survival had yet to be reached in the lorlatinib group, corresponding to the longest progression-free survival reported with any single-agent molecular targeted treatment in advanced NSCLC and all metastatic solid tumors (Solomon et al., 2024). These results, along with the extended intracranial efficacy and consistent safety profile of long-term lorlatinib treatment, are unprecedented in patients with ALK-positive mNSCLC. This Grand Rounds article summarizes the efficacy, safety, and tolerability of lorlatinib after 5 years and includes a fictional patient case to demonstrate how advanced practice providers contribute to personalized patient care and the identification and management of adverse events.

Introduction: As oral anticancer agents become more prominent in the treatment landscape, their expanded use may raise concerns, such as nonadherence, adverse events, drug monitoring, and high costs. Clinical pharmacists (CPs) provide patient education and medication management to address these concerns. To understand the services and communication offered, interviews were conducted with clinical pharmacists in oncology clinics.

Methods: Telephone interviews were conducted with pharmacists from oncology clinics across the US. The interviews evaluated clinical support services provided by CPs for patients on oral chemotherapy, and facilitators and barriers CPs face in implementing communication with the oncology team. The function and support of CPs in this context were assessed.

Results: A total of 16 pharmacists were interviewed. As a result, three overarching themes were identified pertaining to typical roles: (1) CPs provide key support to oncology patients; (2) CPs face logistical, coordination, and communication challenges when supporting oncology patients, and (3) CPs contribute to patient safety and quality of care outside of direct patient care. A total of eight subthemes were identified.

Conclusion: CPs provide high-quality care to patients according to national guidelines. However, they continue to be pulled in various directions to fill gaps that exist in the patient care pathway. This leads to pharmacists feeling unsupported, leading to burnout. Many CPs expressed not billing for services provided, making it difficult to advocate for additional supportive resources.

Advanced practice providers (APPs) are integral members of radiation oncology care teams yet remain underrepresented in clinical research leadership. This article explores the barriers, opportunities, and strategic pathways for expanding APP-led research, particularly in patient-reported outcomes (PROs) and health services research. Despite APPs' daily proximity to symptom management, patient communication, and care delivery workflows, systemic challenges such as limited protected time, inconsistent credentialing policies, and lack of mentorship inhibit broader scholarly engagement. National initiatives like The Patient-Reported Outcomes Tools: Engaging Users and Stakeholders (PROTEUS) Consortium offer accessible tools and funding opportunities to promote rigorous, patient-centered PRO integration in trials and clinical practice. By aligning APP strengths with national research priorities and supporting protected time, mentorship, and clearer principal investigator pathways, institutions can unlock a critical avenue for innovation. Advancing APP-led research is not just an investment in professional development but also a strategic imperative to ensure radiation oncology research is as patient-centered, inclusive, and impactful as the care it aims to improve.

This study explores drivers of satisfaction in modern care teams in which clinical and support staff are fragmented between work locations and communication methods with a large workload of digital messages. It explores the association of team culture, communication, perceived staffing, and work location on team satisfaction in an outpatient hematology and oncology practice at a large academic medical center. Clinic observation sessions and interviews with clinicians were conducted to identify potential drivers of staff satisfaction. Subsequently, a 21-question survey was developed to assess drivers correlated with care team staff satisfaction. The anonymous survey was sent to clinical and non-clinical staff. A total of 586 staff received the survey, and 278 (47%) completed the survey. Team culture/collaboration, ability to get information, and sufficient staffing were associated with high team satisfaction. Team culture/collaboration was most correlated with an individual's team satisfaction. Clinicians who spent time in a shared team workspace had 21 percentage points higher overall satisfaction. Clinicians preferred in-person communication while support staff preferred asynchronous messaging. This study highlights the importance of building team culture for strong staff satisfaction. Practices should consider colocation of clinical teams within a shared workroom space to improve satisfaction. Colocation may be a way to support positive team culture.