Journal of the advanced practitioner in oncology最新文献

Introduction: Despite standard prevention strategies, obinutuzumab carries a significant risk of infusion-related reactions (IRRs) for patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Reported rates of IRRs vary in phase III clinical trials evaluating obinutuzumab-containing regimens. Although obinutuzumab has a higher rate of severe (grade 3 and higher) IRRs than rituximab, clinical risk factors predicting IRR have not been identified, and therefore strata informing patient-specific risk of IRR have not been applied in practice.

Methods: This multicenter, retrospective evaluation of patients with CLL/SLL estimated the incidence of obinutuzumab-related IRRs and evaluated risk factors for the development of IRR in a real-world population.

Results: 68 patients with untreated or previously treated CLL/SLL were included in the analysis, with the majority being older adult (median age = 70) males (61.8%) with Rai stage III and IV CLL. All-grade IRRs occurred in 25% of patients, and severe IRRs occurred in 1.5% of patients. Of the variables evaluated, absolute lymphocyte count was a significant predictor (p ≤ .05) of the odds of experiencing an IRR in patients receiving obinutuzumab.

Conclusion: Obinutuzumab IRR rates in a real-world population were comparable to most phase III clinical trial results succeeding implementation of split dosing and standard premedication. Absolute lymphocyte count is a statistically significant predictor for increased odds of experiencing an IRR. Future research evaluating risk-adapted obinutuzumab administration strategies is needed to recommend a specific approach.

Pancreatic cancer is one of the most fatal cancers in the United States. Currently, it is the third leading cause of cancer-related deaths, and it is estimated that by 2030, it will be the second leading cause of cancer-related deaths behind lung cancer. It has poor overall survival rates, even with aggressive treatment. Quality of life is low in this patient population, due to poor prognosis at diagnosis and complex symptomatology. The purpose of this article is to explore the role of the advanced practitioner in the diagnosis, treatment, and symptom management of pancreatic cancer.

The BRAF V600E mutation aberrantly activates the mitogen-activated protein kinase (MAPK) pathway, subsequently resulting in uncontrolled cellular proliferation, survival, and dedifferentiation. Approximately 2% of patients with non-small cell lung cancer (NSCLC) have a BRAF V600E mutation. BRAF and MEK inhibitor combination therapy targets two kinases within the MAPK pathway. Encorafenib (Braftovi) and binimetinib (Mektovi) are potent oral inhibitors of BRAF and MEK, respectively. With the recent US Food and Drug Administration approval of encorafenib plus binimetinib, adult patients with BRAF V600E-mutated metastatic NSCLC have an additional treatment option. In the phase II PHAROS study, encorafenib plus binimetinib achieved the primary endpoint of objective response rate by independent review committee and exhibited a manageable safety profile in this patient population. This article provides an overview of the efficacy and safety of encorafenib plus binimetinib and uses a fictional patient case to illustrate the role of advanced practice providers in providing individualized patient care and identifying and managing adverse reactions.

Bispecific antibodies (BsAbs) have emerged as crucial therapeutic agents for patients with relapsed/refractory diffuse large B-cell lymphoma, multiple myeloma, and most recently, lung cancer. These therapies have demonstrated remarkable efficacy in clinical trials; however, multidisciplinary collaboration is essential to ensure optimal patient outcomes amid the operational complexities associated with BsAb therapy. As BsAbs are being prepared for broader adoption, clinicians and treatment centers must navigate operational challenges, including financial considerations, patient selection, caregiver involvement, and transitions of care. Centers must also be knowledgeable to manage toxicities such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. We therefore convened a panel of academic and community practice pharmacists with experience using BsAbs in clinical trial and standard-of-care settings to provide comprehensive recommendations with a focus on successful onboarding and operationalization of BsAb therapies.

Molecular profiling (MP), which involves testing tissue, blood, or other body fluids to identify biomarkers, has become increasingly important in cancer treatment. Genomic tumor sequencing, a specific type of MP, is commonly used to identify specific gene variants or proteins that can be targeted for treatment. Germline testing is also routinely recommended for certain cancers. Low levels of genomic literacy among cancer patients, coupled with increasingly complex test results, challenge clinicians to communicate results and provide appropriate education. In addition, patients may have varying preferences for the level of information they desire and are able to process. This state-of-the-art review explores cancer patients' expectations, attitudes, knowledge, satisfaction, and concerns as they undergo molecular profiling. A search was conducted through four databases to identify studies from 2016 to 2022 to explore cancer patients' knowledge and preferences regarding genomic testing. Nineteen studies met the inclusion criteria. Most studies revealed that people with cancer have low levels of knowledge regarding MP, albeit with significant variability. Patients primarily desired MP to identify new treatment options and increase survival. While patients relied on their providers to interpret test results, they wanted to be informed of all results, mainly if those results might guide treatment decisions or future care planning. Most patients, especially those with low genomic/genetic knowledge, tended to overestimate the personal benefits of MP. Further study is needed to provide tailored education to fulfill patients' information needs.

Cancer treatments induce multiple unwanted side effects that often go unrelieved, resulting in emergency room (ER) visits. Oncology clinics have established triage clinics (TCs) for symptom management, thereby improving access to care and decreasing ER utilization. In addition, evidence proves that validated patient-reported outcome (PRO) tools support improved symptom management and decreased ER visits. This quality improvement project aimed to determine if or to what degree implementing the MD Anderson Symptom Inventory (MDASI) tool decreases emergency room visits, with or without hospitalizations, in a South Florida outpatient oncology clinic. The MDASI tool was implemented in a TC during symptom management telephone triage. A statistically significant difference was observed in community ER visits and hospitalizations using a significance level of p < .05. The pre-implementation (n = 14, 29.8%) and post-implementation (n = 10, 23%) values (χ² [N = 47] = 12.66, p = .008) confirmed a reduction in ER visits by 6.8 percentage points. In addition, pre-implementation (n = 8, 17%) and post-implementation (n = 10, 21%) values (χ² [N = 47] = 25.69, p = .006) confirmed a mean increase of two more hospitalizations (4%) in patients after MDASI implementation, likely reflecting an improved patient understanding of appropriate ER utilization. The MDASI tool supported early symptom assessment and management while identifying patient knowledge gaps. This project confirms that PRO tools allow patients to assign meaning to their symptoms, improve communication, and reduce unnecessary ER visits.

Purpose: Initiation of early palliative care (PC) is vital in order to assure that the physical, psychological, spiritual, and social needs of patients and their families are addressed before, during, and after treatment for a serious illness. According to the World Health Organization, PC is patient-and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. It is holistic care that addresses the physical, psychosocial, and spiritual needs of patients and their families.

Methods: To improve early PC in the oncology setting, a free educational series was established for advanced practice providers (APPs). Evaluations were obtained and a post-survey was completed.

Results: Evaluation results were positive; staff liked the case presentations and the topics covered. A post-survey was completed. Results demonstrated that most APPs were familiar with basic concepts of symptom management as well as the holistic needs of patients and their families. One area that did not improve was the concept that PC is compatible with aggressive treatment.

Conclusions: A PC lecture series for APPs was well received by participants. Participants were able to demonstrate knowledge regarding delivery of PC but failed to understand that PC can be delivered simultaneously with aggressive therapy.

Recommendations: Education regarding PC through the disease process and appropriate referrals to PC specialty need to be reinforced. Educating APPs in early PC is beneficial, and creative methods of teaching need to be further explored.

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.