Pub Date : 2019-03-01DOI: 10.6004/jadpro.2019.10.2.14
Look: • Does the patient appear uncomfortable? • Does the patient appear unwell? • Is there an obvious rash? • Is the patient scratching during the visit? • Is skin integrity intact? • Are there skin changes? » Xerosis (dry skin) » Changes in skin pigment or color • Is there oral involvement of the rash? • Does the rash involve the genitalvaginal region? The scalp? Listen: • Does the patient have pruritus with or without rash? • Is there a rash with or without pruritus? • Are symptoms interfering with ADLs? • With sleep? • Have symptoms worsened? Recognize: • Is there a history of dermatitis, preexisting skin issues (psoriasis, eczema, wounds, prior radiation to region, etc.)? • Laboratory abnormalities consistent with other etiologies (e.g., eosinophils on complete blood count, liver function abnormalities) Appendix A. Care Step Pathway: Skin Toxicities
{"title":"Care Step Pathway Tools for Immune-Related Adverse Event Assessment and Management","authors":"","doi":"10.6004/jadpro.2019.10.2.14","DOIUrl":"https://doi.org/10.6004/jadpro.2019.10.2.14","url":null,"abstract":"Look: • Does the patient appear uncomfortable? • Does the patient appear unwell? • Is there an obvious rash? • Is the patient scratching during the visit? • Is skin integrity intact? • Are there skin changes? » Xerosis (dry skin) » Changes in skin pigment or color • Is there oral involvement of the rash? • Does the rash involve the genitalvaginal region? The scalp? Listen: • Does the patient have pruritus with or without rash? • Is there a rash with or without pruritus? • Are symptoms interfering with ADLs? • With sleep? • Have symptoms worsened? Recognize: • Is there a history of dermatitis, preexisting skin issues (psoriasis, eczema, wounds, prior radiation to region, etc.)? • Laboratory abnormalities consistent with other etiologies (e.g., eosinophils on complete blood count, liver function abnormalities) Appendix A. Care Step Pathway: Skin Toxicities","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"63 - 95"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44255581","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 : 2019-03-01DOI: 10.6004/JADPRO.2019.10.2.4
R. Mahtani, L. Hineman
Although breast cancer is a heterogeneous disease, approximately 20% to 25% of patients diagnosed with breast cancer have amplification of the HER2 gene. The FDA approval of trastuzumab for the treatment of HER2-positive (HER2+) metastatic breast cancer in 1998 represented a major breakthrough for patients with HER2+ disease. In 2006, the FDA extended its approval for use in the adjuvant setting. In recent years, trials have been conducted to identify the appropriate duration of therapy in combination with chemotherapy. More recently, trials incorporating newer HER2-targeted therapies have been conducted. Some trials have demonstrated the importance of considering neoadjuvant HER2-directed therapies for selected patients with HER2+ disease, highlighting the fact that achieving pathologic complete response has important prognostic implications. In order to continue treatment and optimize patient safety, the effective and timely management of treatment-related adverse events (AEs) is crucial. As they are on the front lines of patient care, advanced practitioners need to be able to assess the clinical implications of recent advances and integrate them into practice. One area of unmet need in the management of metastatic HER2-positive disease is the treatment of brain metastases, with several promising therapies under investigation. Using several case studies as a foundation, this article highlights current and emerging data on HER2-directed therapies, outlines strategies for managing AEs, and reviews the key issues surrounding brain metastases and associated novel therapies under investigation.
{"title":"Advances in HER2-Positive Breast Cancer: Novel Therapies and Adverse Event Management","authors":"R. Mahtani, L. Hineman","doi":"10.6004/JADPRO.2019.10.2.4","DOIUrl":"https://doi.org/10.6004/JADPRO.2019.10.2.4","url":null,"abstract":"Although breast cancer is a heterogeneous disease, approximately 20% to 25% of patients diagnosed with breast cancer have amplification of the HER2 gene. The FDA approval of trastuzumab for the treatment of HER2-positive (HER2+) metastatic breast cancer in 1998 represented a major breakthrough for patients with HER2+ disease. In 2006, the FDA extended its approval for use in the adjuvant setting. In recent years, trials have been conducted to identify the appropriate duration of therapy in combination with chemotherapy. More recently, trials incorporating newer HER2-targeted therapies have been conducted. Some trials have demonstrated the importance of considering neoadjuvant HER2-directed therapies for selected patients with HER2+ disease, highlighting the fact that achieving pathologic complete response has important prognostic implications. In order to continue treatment and optimize patient safety, the effective and timely management of treatment-related adverse events (AEs) is crucial. As they are on the front lines of patient care, advanced practitioners need to be able to assess the clinical implications of recent advances and integrate them into practice. One area of unmet need in the management of metastatic HER2-positive disease is the treatment of brain metastases, with several promising therapies under investigation. Using several case studies as a foundation, this article highlights current and emerging data on HER2-directed therapies, outlines strategies for managing AEs, and reviews the key issues surrounding brain metastases and associated novel therapies under investigation.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"136 - 153"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47548351","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 : 2019-03-01DOI: 10.6004/JADPRO.2019.10.2.5
Lynn Weatherby, Lynne Brophy
CASE STUDY Ms. X is a 23-year-old female who presented to clinic with stage 2A endometrial cancer of the ovary. At her first visit, Ms. X was prescribed paclitaxel and carboplatin on day 1 for 6 cycles. During the visit, the nurse noted Ms. X could not keep her hands out of her hair; she continually played with it. The nurse, judging by Ms. X’s body language, suspected she valued her hair. Ms. X revealed she had been doing some research and wanted to use a cold cap to try and prevent alopecia during her treatment. On the first day of chemotherapy, Ms. X came to the clinic with her mother. They brought a manual cap for scalp cooling and a cooler of dry ice. Her mother was to serve as a "capper" and change the cap at 20- to 30-minute intervals during treatment to keep her scalp cool. Ms. X was made comfortable in an infusion bed, and the cap was applied 30 minutes prior to the start of therapy. Ms. X’s mother changed the dry ice caps every 20 minutes throughout the infusion. Ms. X then left it on for 90 minutes following her chemotherapy. After 6 cycles of chemotherapy, Ms. X still had all her hair. She appeared to have retained 100% of her hair, although she estimates that she lost about 5% of her hair. During therapy, she followed the instructions outlined in Table 1. Ms. X reported that she rented the cap for $500 per month and paid $45 per week for the dry ice. Her mother also had to miss work to be the "capper," and this added to the out-of-pocket costs of scalp cooling.
{"title":"Scalp Cooling: A Patient’s Experience","authors":"Lynn Weatherby, Lynne Brophy","doi":"10.6004/JADPRO.2019.10.2.5","DOIUrl":"https://doi.org/10.6004/JADPRO.2019.10.2.5","url":null,"abstract":"CASE STUDY Ms. X is a 23-year-old female who presented to clinic with stage 2A endometrial cancer of the ovary. At her first visit, Ms. X was prescribed paclitaxel and carboplatin on day 1 for 6 cycles. During the visit, the nurse noted Ms. X could not keep her hands out of her hair; she continually played with it. The nurse, judging by Ms. X’s body language, suspected she valued her hair. Ms. X revealed she had been doing some research and wanted to use a cold cap to try and prevent alopecia during her treatment. On the first day of chemotherapy, Ms. X came to the clinic with her mother. They brought a manual cap for scalp cooling and a cooler of dry ice. Her mother was to serve as a \"capper\" and change the cap at 20- to 30-minute intervals during treatment to keep her scalp cool. Ms. X was made comfortable in an infusion bed, and the cap was applied 30 minutes prior to the start of therapy. Ms. X’s mother changed the dry ice caps every 20 minutes throughout the infusion. Ms. X then left it on for 90 minutes following her chemotherapy. After 6 cycles of chemotherapy, Ms. X still had all her hair. She appeared to have retained 100% of her hair, although she estimates that she lost about 5% of her hair. During therapy, she followed the instructions outlined in Table 1. Ms. X reported that she rented the cap for $500 per month and paid $45 per week for the dry ice. Her mother also had to miss work to be the \"capper,\" and this added to the out-of-pocket costs of scalp cooling.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"158 - 165"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43469931","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 : 2019-03-01DOI: 10.6004/JADPRO.2019.10.2.7
K. Ownby
Distress is experienced by many cancer patients, adversely affecting quality of life and cancer care. Although it is often manageable, it remains woefully underidentified and underreported. Distress can occur anytime during the cancer experience and is associated with depression, anxiety, missed appointments, and adverse outcomes. In 1999, the National Comprehensive Cancer Network (NCCN), recommended routine screening for distress in all cancer patients. The Distress Thermometer (DT) was developed as a simple tool to effectively screen for symptoms of distress. The instrument is a self-reported tool using a 0-to-10 rating scale. Additionally, the patient is prompted to identify sources of distress using a Problem List. The DT has demonstrated adequate reliability and has been translated into numerous languages. The tool is easy to administer and empowers the clinician to facilitate appropriate psychosocial support and referrals.
{"title":"Use of the Distress Thermometer in Clinical Practice","authors":"K. Ownby","doi":"10.6004/JADPRO.2019.10.2.7","DOIUrl":"https://doi.org/10.6004/JADPRO.2019.10.2.7","url":null,"abstract":"Distress is experienced by many cancer patients, adversely affecting quality of life and cancer care. Although it is often manageable, it remains woefully underidentified and underreported. Distress can occur anytime during the cancer experience and is associated with depression, anxiety, missed appointments, and adverse outcomes. In 1999, the National Comprehensive Cancer Network (NCCN), recommended routine screening for distress in all cancer patients. The Distress Thermometer (DT) was developed as a simple tool to effectively screen for symptoms of distress. The instrument is a self-reported tool using a 0-to-10 rating scale. Additionally, the patient is prompted to identify sources of distress using a Problem List. The DT has demonstrated adequate reliability and has been translated into numerous languages. The tool is easy to administer and empowers the clinician to facilitate appropriate psychosocial support and referrals.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"175 - 179"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41402395","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 : 2019-03-01DOI: 10.6004/jadpro.2019.10.2.6
S. Caulfield, Christine C. Davis, Kristina F. Byers
Breast cancer is the most frequently diagnosed cancer in women globally. Genetic mutations can increase the risk of developing breast cancer. Inherited germline mutations in BRCA1 and BRCA2 tumor suppressor genes (gBRCAm) account for 5% to 10% of breast cancer cases. The recent approval of olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, in HER2-negative, metastatic breast cancer provides an additional treatment option for patients with a gBRCAm. Inhibition of PARP results in the trapping of the PARP-DNA complex at replication forks, causing single-strand breaks to become double-strand breaks (DSBs). PARP trapping and the accumulation of DSBs ultimately leads to cell apoptosis. Cells deficient in BRCA1/2 are particularly sensitive to the effects of PARP inhibition, as cells lacking these functional proteins are unable to repair DSBs, resulting in synthetic lethality. The phase III OlympiAD trial showed a progression-free survival benefit but no overall survival benefit, leading to the US Food and Drug Administration approval of olaparib. The purpose of this article is to describe current data regarding the use of olaparib in metastatic breast cancer, its role in the treatment of patients with a gBRCAm, and the clinical implications of its approval for oncology advanced practitioners.
{"title":"Olaparib: A Novel Therapy for Metastatic Breast Cancer in Patients With a BRCA1/2 Mutation","authors":"S. Caulfield, Christine C. Davis, Kristina F. Byers","doi":"10.6004/jadpro.2019.10.2.6","DOIUrl":"https://doi.org/10.6004/jadpro.2019.10.2.6","url":null,"abstract":"Breast cancer is the most frequently diagnosed cancer in women globally. Genetic mutations can increase the risk of developing breast cancer. Inherited germline mutations in BRCA1 and BRCA2 tumor suppressor genes (gBRCAm) account for 5% to 10% of breast cancer cases. The recent approval of olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, in HER2-negative, metastatic breast cancer provides an additional treatment option for patients with a gBRCAm. Inhibition of PARP results in the trapping of the PARP-DNA complex at replication forks, causing single-strand breaks to become double-strand breaks (DSBs). PARP trapping and the accumulation of DSBs ultimately leads to cell apoptosis. Cells deficient in BRCA1/2 are particularly sensitive to the effects of PARP inhibition, as cells lacking these functional proteins are unable to repair DSBs, resulting in synthetic lethality. The phase III OlympiAD trial showed a progression-free survival benefit but no overall survival benefit, leading to the US Food and Drug Administration approval of olaparib. The purpose of this article is to describe current data regarding the use of olaparib in metastatic breast cancer, its role in the treatment of patients with a gBRCAm, and the clinical implications of its approval for oncology advanced practitioners.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"167 - 174"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41518558","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 : 2019-01-01DOI: 10.6004/JADPRO.2019.10.1.4
Nadia E. K. DePaola, Heather Coggins
Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma, first reported in 1997. It is pathologically confirmed as a CD30-positive, anaplastic lymphoma kinase (ALK)–negative ALCL by immunohistochemistry. Unlike systemic ALK-negative ALCL, breast implant–associated disease has a much more favorable prognosis overall. In most cases, BIA-ALCL will present with delayed seroma more than 1 year after breast implantation indicated for either cosmetic or reconstructive purposes. The average onset of seroma presentation is 8 to 9 years after implantation. Breast implant–associated anaplastic large cell lymphoma may arise in one of two distinct forms: either in situ or infiltrative disease. In situ disease is confined within a seroma, while infiltrative disease may present with lymph node involvement either with or without palpable breast mass or tumor. Infiltrative disease has an overall worse prognosis in regards to disease-related mortality, up to 40% within 2 years. Appropriate pathological consultation with an experienced hematopathologist and oncologist is imperative when making a diagnosis of BIA-ALCL. There are several theorized risk factors associated with the disease; however, the exact pathophysiology is not yet known. Our objective in writing this review article is to provide an overview of what we know about the epidemiology, disease characteristics, and current management strategies. In doing so, we aim to bring awareness and familiarity to the advanced practitioner population in recognizing and treating BIA-ALCL.
{"title":"Breast Implant–Associated Anaplastic Large Cell Lymphoma: What We Know","authors":"Nadia E. K. DePaola, Heather Coggins","doi":"10.6004/JADPRO.2019.10.1.4","DOIUrl":"https://doi.org/10.6004/JADPRO.2019.10.1.4","url":null,"abstract":"Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma, first reported in 1997. It is pathologically confirmed as a CD30-positive, anaplastic lymphoma kinase (ALK)–negative ALCL by immunohistochemistry. Unlike systemic ALK-negative ALCL, breast implant–associated disease has a much more favorable prognosis overall. In most cases, BIA-ALCL will present with delayed seroma more than 1 year after breast implantation indicated for either cosmetic or reconstructive purposes. The average onset of seroma presentation is 8 to 9 years after implantation. Breast implant–associated anaplastic large cell lymphoma may arise in one of two distinct forms: either in situ or infiltrative disease. In situ disease is confined within a seroma, while infiltrative disease may present with lymph node involvement either with or without palpable breast mass or tumor. Infiltrative disease has an overall worse prognosis in regards to disease-related mortality, up to 40% within 2 years. Appropriate pathological consultation with an experienced hematopathologist and oncologist is imperative when making a diagnosis of BIA-ALCL. There are several theorized risk factors associated with the disease; however, the exact pathophysiology is not yet known. Our objective in writing this review article is to provide an overview of what we know about the epidemiology, disease characteristics, and current management strategies. In doing so, we aim to bring awareness and familiarity to the advanced practitioner population in recognizing and treating BIA-ALCL.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"54 - 61"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44983452","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 : 2019-01-01DOI: 10.6004/jadpro.2019.10.1.7
Kelley D. Mayden
Oncology advanced practice providers (APP) play a critical role in providing cancer care to patients and families. Given the rate of scientific advancement, APPs are challenged to keep with the pace of science and acquire tools for successful practice. One such tool is evidence-based practice (EBP). Mastery of the competencies is obligatory and will assist APPs with the incorporation of EBP into clinical practice, and thus ensure the highest quality of patient care, forge the best patient outcomes, and reduce health-care expenditures. Advanced practice providers who achieve competency and proficiency have a professional responsibility to mentor others and assume leadership roles to help cement EBP as the standard of care.
{"title":"Evidence-Based Oncology Practice: Competencies for Improved Patient Outcomes","authors":"Kelley D. Mayden","doi":"10.6004/jadpro.2019.10.1.7","DOIUrl":"https://doi.org/10.6004/jadpro.2019.10.1.7","url":null,"abstract":"Oncology advanced practice providers (APP) play a critical role in providing cancer care to patients and families. Given the rate of scientific advancement, APPs are challenged to keep with the pace of science and acquire tools for successful practice. One such tool is evidence-based practice (EBP). Mastery of the competencies is obligatory and will assist APPs with the incorporation of EBP into clinical practice, and thus ensure the highest quality of patient care, forge the best patient outcomes, and reduce health-care expenditures. Advanced practice providers who achieve competency and proficiency have a professional responsibility to mentor others and assume leadership roles to help cement EBP as the standard of care.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"84 - 87"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42594743","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 : 2019-01-01DOI: 10.6004/JADPRO.2019.10.1.2
R. Musanti, Y. Chao, K. Collins
Exercise is recommended for cancer survivors, as it mitigates treatment side effects and improves overall wellness. Therefore, survivors attend community-based exercise programs and report positive results, but published evaluations of outcomes of these programs are scarce in the literature. The objective of this study is to validate the anecdotal reports of the physical fitness and quality of life benefits of the LIVESTRONG at the YMCA program. A retrospective analysis of deidentified data consisting of 17 program cohorts of the LIVESTRONG at the YMCA program (n = 88) was conducted. Statistically significant improvements were seen when compared to baseline in the physical fitness measures of the 6-minute walk, the chest and leg presses, the sit-and-reach test, and the one-leg stand test, as well as in the domains of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) Profile, a health-related quality of life questionnaire. These domains are physical function, anxiety, depression, fatigue, social role satisfaction, and pain. The anecdotal impression that participation in the LIVESTRONG at the YMCA program improves physical fitness and subjective quality of life perceptions was supported by statistical analysis of the subjective and objective pre- and postprogram measurements for this data set. Exercise in this cancer-specific community exercise program is likely to improve physical fitness and quality of life outcomes.
{"title":"Fitness and Quality of Life Outcomes of Cancer Survivor Participants in a Community Exercise Program","authors":"R. Musanti, Y. Chao, K. Collins","doi":"10.6004/JADPRO.2019.10.1.2","DOIUrl":"https://doi.org/10.6004/JADPRO.2019.10.1.2","url":null,"abstract":"Exercise is recommended for cancer survivors, as it mitigates treatment side effects and improves overall wellness. Therefore, survivors attend community-based exercise programs and report positive results, but published evaluations of outcomes of these programs are scarce in the literature. The objective of this study is to validate the anecdotal reports of the physical fitness and quality of life benefits of the LIVESTRONG at the YMCA program. A retrospective analysis of deidentified data consisting of 17 program cohorts of the LIVESTRONG at the YMCA program (n = 88) was conducted. Statistically significant improvements were seen when compared to baseline in the physical fitness measures of the 6-minute walk, the chest and leg presses, the sit-and-reach test, and the one-leg stand test, as well as in the domains of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) Profile, a health-related quality of life questionnaire. These domains are physical function, anxiety, depression, fatigue, social role satisfaction, and pain. The anecdotal impression that participation in the LIVESTRONG at the YMCA program improves physical fitness and subjective quality of life perceptions was supported by statistical analysis of the subjective and objective pre- and postprogram measurements for this data set. Exercise in this cancer-specific community exercise program is likely to improve physical fitness and quality of life outcomes.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"24 - 37"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47988853","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 : 2019-01-01DOI: 10.6004/jadpro.2019.10.1.1
P. Viale
Studies regarding safe levels of alcohol consumption are relatively easy to find in the literature. However, the conclusions of the studies vary, and it’s easy to get confused over the most accurate recommendations regarding the consumption of alcohol. In fact, it’s difficult to truly understand where alcohol falls into place regarding health and risks/benefits. And recent data have emerged to eclipse our current beliefs regarding safe alcohol consumption. What are we supposed to believe is the truth?
{"title":"The Debate Over Alcohol Consumption: How Much Is Too Much?","authors":"P. Viale","doi":"10.6004/jadpro.2019.10.1.1","DOIUrl":"https://doi.org/10.6004/jadpro.2019.10.1.1","url":null,"abstract":"Studies regarding safe levels of alcohol consumption are relatively easy to find in the literature. However, the conclusions of the studies vary, and it’s easy to get confused over the most accurate recommendations regarding the consumption of alcohol. In fact, it’s difficult to truly understand where alcohol falls into place regarding health and risks/benefits. And recent data have emerged to eclipse our current beliefs regarding safe alcohol consumption. What are we supposed to believe is the truth?","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"18 - 19"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43734405","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 : 2019-01-01DOI: 10.6004/JADPRO.2019.10.1.5
Tanya J. Uritsky
Opioid-induced constipation (OIC) is a common adverse effect associated with opioid therapy, with many patients never developing tolerance to this effect. There are many traditional laxatives available to help patients combat this symptom, yet OIC may not reliably respond to conventional treatment. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have a place in the treatment of refractory OIC, when traditional laxatives have not resulted in effective laxation. There are a number of PAMORAs now available, and methylnaltrexone is the only PAMORA indicated for the treatment of OIC in adults with advanced illness, as well as for patients with chronic noncancer pain, including patients with chronic pain related to prior cancer treatment who do not require frequent opioid escalation. Advanced practitioners need to have an understanding of how and when to best use these medications for the different indications in patients with advanced illness or chronic noncancer-related pain.
{"title":"Methylnaltrexone: Peripherally Acting µ-Opioid Receptor Antagonist","authors":"Tanya J. Uritsky","doi":"10.6004/JADPRO.2019.10.1.5","DOIUrl":"https://doi.org/10.6004/JADPRO.2019.10.1.5","url":null,"abstract":"Opioid-induced constipation (OIC) is a common adverse effect associated with opioid therapy, with many patients never developing tolerance to this effect. There are many traditional laxatives available to help patients combat this symptom, yet OIC may not reliably respond to conventional treatment. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have a place in the treatment of refractory OIC, when traditional laxatives have not resulted in effective laxation. There are a number of PAMORAs now available, and methylnaltrexone is the only PAMORA indicated for the treatment of OIC in adults with advanced illness, as well as for patients with chronic noncancer pain, including patients with chronic pain related to prior cancer treatment who do not require frequent opioid escalation. Advanced practitioners need to have an understanding of how and when to best use these medications for the different indications in patients with advanced illness or chronic noncancer-related pain.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"10 1","pages":"62 - 67"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43228828","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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