Journal of the advanced practitioner in oncology最新文献

The Centers for Disease Control and Prevention and U.S. Public Health Service recommend that clinicians prioritize coprescribing take-home naloxone (THN) for patients with cancer receiving opioids in high doses or in the presence of a concomitant high-risk medication. Despite this, THN coprescribing rates remain low. The aim of this quality improvement project (QIP) was to determine if the implementation of an electronic health record (EHR) alert could result in increased THN coprescribing rates in patients with cancer at risk for opioid overdose. This pre- and post-intervention QIP was conducted in an outpatient medical oncology clinic in the Mountain West region of the US. Opioid prescriptions for the management of cancer-related pain totaling ≥ 100 morphine milligram equivalents (MME) per day or with a concomitant high-risk medication were eligible for inclusion (N = 224). An EHR alert was developed to notify the provider when eligibility criteria were met, prompting them to coprescribe THN. The primary outcome measure to increase THN coprescribing rates for opioid prescriptions totaling ≥ 100 MME per day was 38% at the end of the post-intervention period, a 29 percentage point increase from baseline (odds ratio [OR] = 6.57, 95% confidence interval [CI] = 1.85-23.39, p = .003). The coprescribing rate for opioid prescriptions with a high-risk medication was 57% at completion of the project, a 53 percentage point increase from baseline (OR = 30.67, 95% CI = 8.91-105.59, p < .001). This project established the practicality and success of THN coprescribing alert implementation and can be utilized as a roadmap for other practices to achieve safe opioid prescribing for patients with cancer.

In the field of oncology, anticipating test results, particularly pathology, can be distressing. This case discusses the personal experience of an oncology clinician who became an oncology patient and navigated the anxiety of awaiting pathology results during her melanoma diagnosis. By sharing these personal insights, this case can hopefully help patients manage the psychological stress of waiting for test results and help to inspire clinicians to make small practice changes, which may help decrease this stressful burden for patients.

With the rapid growth of nurse practitioner (NP) and physician assistant (PA) programs nationwide, health systems face increasing demands for clinical rotations, particularly in specialized areas such as oncology. Baptist MD Anderson Cancer Center developed a standardized scoring system, the Advanced Practice Provider Clinical Rotation in Oncology Scoring System (APP CROSS), to address this challenge. This feasibility study assesses the implementation, practicality, and effectiveness of the APP CROSS in streamlining the evaluation and selection of APP clinical rotation candidates. The scoring system was designed to align with strategic health-system goals, such as stabilizing the workforce, community engagement, and enhancing quality care, using criteria that include system employment, prior rotations, oncology experience, personal statement quality, proximity to graduation, and preferred school enrollment. Scoring criteria include employment within the health system, previous rotations, oncology experience, quality of personal statements, proximity to graduation, and enrollment in preferred schools. While initially tailored for oncology, the tool's principles are generalizable. Early data suggest the APP CROSS promotes objective student selection, enhancing recruitment and retention potential. Future studies are warranted to assess long-term outcomes related to APP retention and preceptor satisfaction.

Background: Chimeric antigen receptor (CAR) T-cell therapy has emerged as a highly effective treatment for relapsed or refractory multiple myeloma (MM). However, manufacturing CAR T cells can take 3 to 4 weeks, leaving patients vulnerable to disease progression during this waiting period. Bridging therapy aims to address this gap by controlling disease and improving CAR T-cell efficacy.

Objectives: This review summarizes the role of bridging therapy in CAR T-cell therapy for MM, focusing on the rationale and goals of bridging therapy, timing of initiation, infection risk management, selection of bridging regimens, and clinical implications, including patient education and communication.

Methods: Relevant literature on CAR T-cell therapy and bridging therapy in MM was reviewed, including clinical trials and real-world data.

Findings: Bridging therapy may be crucial for some patients, particularly for those with rapidly progressive disease. The optimal timing for initiating bridging therapy remains under investigation, but it can begin as soon as leukapheresis is completed. Prophylactic antibiotics or antivirals and close monitoring are essential for preventing infections during this period. The choice of bridging regimen depends on individual patient characteristics and prior therapies. Effective patient education and communication between local oncology teams and CAR T-cell centers are critical.

Implications: Bridging therapy plays a vital role in optimizing CAR T-cell therapy outcomes for MM patients. Further research is needed to define the optimal use of bridging therapy in this evolving treatment landscape.

Background: Breast cancer is the most commonly diagnosed cancer globally and the second leading cause of death among US women. Advanced breast cancer (ABC) may lead to significant physical changes like fungating tumors, which can deeply affect body image and quality of life (QOL). Despite the prevalence of body image issues in patients with cancer, few studies examine these issues in the ABC population. Understanding this relationship is crucial to addressing patients' psychosocial needs and improving overall QOL.

Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to assess the impact of body image on QOL in ABC patients. Searches in PubMed, Embase, and PsycInfo yielded four studies that met inclusion criteria, including both qualitative and quantitative designs.

Results: The studies revealed that body image disturbances contribute to emotional distress, diminished intimacy, and social isolation. Quantitative studies showed statistically significant correlations between body image dissatisfaction and lower QOL, with greater body appreciation associated with improved emotional and cognitive functioning.

Conclusion: Body image significantly influences QOL in ABC patients, but research in this area remains limited. Further studies are necessary to understand this relationship and develop interventions that address body image concerns, potentially improving QOL for this underserved population.

Substance use disorders (SUDs) among women with gynecologic cancers pose challenges to treatment adherence, patient well-being, morbidity, and mortality. Despite the prevalence of SUDs, routine screening practices have not been widely adopted. This quality improvement project implemented the Revised Opioid Risk Tool (ORT-OUD) to screen for SUDs among gynecologic oncology patients. The aims were to provide a referral to addiction psychiatry in a minimum of 80% of patients who screened as high risk and demonstrate the feasibility of ORT-OUD implementation in clinical practice, with at least 75% of advanced practice providers (APPs) reporting it as feasible. The ORT-OUD was offered to all patients aged 18 years or older, consented, and were on the APPs' schedules during the project implementation period (3 months). Patients completed the ORT-OUD privately, and APPs reviewed and scored the tool. Patients with scores of 3 or higher were offered a referral to addiction psychiatry. Advanced practice providers were then given a survey to assess their perception of the project's feasibility. Descriptive statistics were used to track referral rates and APP perceptions. Of 134 patients screened, 9.7% were identified as high risk for SUDs. Of those patients, 76.9% accepted a referral to addiction psychiatry. One hundred percent of APPs reported the ORT-OUD implementation as feasible. Challenges identified included time needed to explain the screening tool and patients' perceptions of the screening tool questions. This project successfully identified a proportion of gynecologic oncology patients at risk for SUDs and facilitated access to specialized care. Challenges in the screening process highlight the importance of patient education and communication strategies.

Tumor Treating Fields (TTFields) therapy specifically disrupts cellular processes necessary for cancer cell viability and tumor progression through the delivery of electric fields from a portable medical device. Patients with solid tumors such as glioblastoma experience significantly improved overall survival when receiving TTFields therapy concomitant with other standard-of-care therapies. TTFields therapy is also well tolerated and allows patients to maintain their quality of life. It is currently approved for the treatment of newly diagnosed and recurrent glioblastoma, pleural mesothelioma, and metastatic non-small cell lung cancer. Advanced practice providers (APPs), such as nurse practitioners, physician assistants, pharmacists, and other advanced oncology professionals, play key roles in the multidisciplinary team when implementing TTFields therapy. Advanced practice providers with prescribing authority can prescribe TTFields therapy after completing a one-time certification training. During the treatment decision-making process, APPs are poised to have in-depth conversations with patients and caregivers about TTFields therapy to help them grasp key concepts regarding efficacy and safety, how to properly use and integrate the device into their daily lives, cost of therapy, and how to get help using the various patient assistance programs. In addition, APPs play important roles in supporting optimal patient adherence and managing adverse events to ensure improved survival outcomes.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive, orphan hematologic malignancy that expresses CD123 and frequently presents in skin, bone marrow, blood, and viscera. Tagraxofusp is a first-in-class CD123-targeted therapy and the only US-approved drug to treat BPDCN. Approval was based on a pivotal, multicenter, phase II study (NCT02113982), the largest prospective BPDCN trial to date, in which tagraxofusp monotherapy demonstrated durable clinical responses across treatment-naive and relapsed/refractory BPDCN, and often resulted in patients proceeding to stem cell transplant following tagraxofusp-induced remissions. Advanced practitioners (APs) are critical in providing comprehensive and consistent monitoring, supportive care management for adverse events, and patient education. A core specialized interdisciplinary team coupled with AP-led management optimizes tagraxofusp treatment. This paper reviews best practices for the clinical management of patients with BPDCN receiving tagraxofusp in the context of the US package insert and APs' real-world management approaches.

Background: Indications for the use of cytomegalovirus (CMV)-neg-ative and irradiated blood products (IRBP) are not standardized and are often poorly understood by providers. This project evaluated the use of a transfusion algorithm in an outpatient oncology clinic to reduce the risk of transfusion-associated graft-vs.-host disease (TA-GVHD) and eliminate the improper use of CMV-negative and irradiated blood products.

Objectives: The aim of this project was to increase the correct use of CMV-negative and irradiated blood products at an outpatient oncology clinic by establishing a transfusion algorithm, to evaluate the effectiveness of clinical transfusion algorithms on the use of specialty blood products, and to educate providers on TA-GVHD.

Methods: This quasi-experimental project compared 12 weeks of transfusion data before the implementation of a transfusion algorithm to 12 weeks of transfusion data after the algorithm was introduced. A preand post-test survey measured the satisfaction and the impact of the education.

Findings: The transfusion algorithm resulted in a clinically significant increase in the correct use of both CMV-negative and irradiated blood products at an outpatient oncology clinic. The education in-services provided to staff about TA-GVHD and the indications for irradiated blood product resulted in a significant increase in provider knowledge on ordering specialty blood products.