Journal of the advanced practitioner in oncology最新文献

Advanced practitioners (APs), including nurse practitioners (NPs), physician assistants (PAs), clinical nurse specialists, and pharmacists, are pivotal in health care. Despite their critical role, record numbers of APs are leaving the profession, primarily due to poor work-life balance, which contributes to burnout and high turnover rates. This article explores the impact of administrative time on AP job satisfaction and retention, drawing from recent surveys and case studies. Findings indicate that dedicated administrative time significantly enhances job satisfaction and reduces burnout, with data showing that APs with administrative time are less likely to leave their roles. The Advanced Practitioner Society for Hematology and Oncology (APSHO) prioritized addressing AP burnout in 2024 by advocating for structured administrative time. Following an extensive review of the literature and survey data, the APSHO Administrative Time Subcommittee recommends 8 hours of administrative time per week as reasonable for a full-time AP in clinical outpatient practice. Additionally, this committee proposes a comprehensive model for implementing administrative time. The call to action is clear: to sustain a high-quality health-care workforce, it is essential to support APs through policies that promote work-life balance, retention, and operational efficiency.

Imetelstat is a first-in-class, direct, and competitive inhibitor of telomerase enzymatic activity that selectively induces apoptosis of malignant clones and allows for recovery of erythropoiesis. Imetelstat was approved by the United States Food and Drug Administration in June 2024 and the European Medicines Agency in March 2025 for the treatment of certain patients with lower-risk (low to intermediate-1) myelodysplastic syndromes (LR-MDS) with transfusion-dependent anemia who have failed or lost response to or are ineligible for erythropoiesis-stimulating agents. Imetelstat is infused at 7.1 mg/kg (active dose, equivalent to 7.5 mg/kg sodium salt) intravenously over 2 hours once every 4 weeks. In the pivotal IMerge trial in LR-MDS, significantly more patients treated with imetelstat vs. placebo, respectively, achieved ≥ 8-week RBC-transfusion independence (TI; 40% [95% confidence interval [CI] = 30.9-49.3] vs. 15% [95% CI = 7.1-26.6]) and ≥ 24-week RBC-TI (28% [95% CI = 20.1-37.0] vs. 3% [95% CI = 0.4-11.5]). The safety profile of imetelstat was characterized primarily by cytopenias, including neutropenia (incidence of 74% any grade and 68% grade 3-4 events) and thrombocytopenia (75% and 62%, respectively). Grade 3 to 4 hematologic events occurred early in the treatment and had a median duration of 1.9 weeks for neutropenia and 1.4 weeks for thrombocytopenia; cases resolved to grade ≤ 2 within 2 weeks in 81% and 86% of cases, respectively, with limited severe complications. This review highlights key topics related to the use of imetelstat in patients with LR-MDS, including its mechanism of action, clinical efficacy and safety data, dosing and administration, management of adverse events, and notable clinical practice implications.

Understanding clinical information can be challenging for patients, their caregivers, and other lay audiences because of complex scientific concepts, interventions, procedures and/or evaluated outcomes. It is also challenging for health-care providers to effectively communicate such medical research to patients, which is essential for patients' informed involvement in shared decision-making (SDM). Advanced practice providers (APPs) are on the frontlines of care, often providing detailed and extensive education for patients in and outside of clinical trials. In recent years, scientific researchers, particularly those involved in clinical trial research, have been increasingly using plain language summaries (PLS) to summarize journal publications and conference abstracts in easy-to-read nontechnical language while providing key findings and implications. In this review article, we aim to provide an overview of PLS and show by using published examples, how such communication tools may assist APPs to communicate medical research effectively to patients. This evolving form of scientific communication may be useful to APPs, not only for translating the findings of clinical trials and other health-care research to patients and their caregivers, but also facilitate informed SDM, help them keep up to date on the latest clinical research, and share research perspectives with their care teams.

Objectives: Operationalizing workflows to manage cytokine release syndrome (CRS) in community practices presents challenges for multidisciplinary teams. Real-world experience was gathered from OneOncology community health-care professionals to establish best-prac-tice workflows for CRS management.

Methods: Qualitative data were gathered via focus groups from hematology-oncology MDs, PharmDs, and nurse providers (N = 13) with experience treating patients with bispecific T-cell-engaging antibodies (BsAbs). Theme matrix techniques facilitated analysis.

Results: Three themes were identified: (1) creating a coordinated workflow plan, (2) building network partnerships, and (3) understanding patient support. Workflow decisions were driven by community practices managing patients treated with BsAbs or partnering with sites for initial dosing and maintenance. Catalysts for developing CRS workflows included: FDA approval of BsAbs; BsAbs clinical trial experience; BsAbs on formulary; having patients receiving BsAbs; and practice champion(s) for protocol development. Key steps included defining communication during and after practice hours, designating training leads, and creating practice-specific plans for interdisciplinary team coordination. Inpatient admission processes developed with hospital staff and hospital staff training were fundamental for successful patient management. Communication processes among practice, pharmacy, and hospital staff throughout BsAbs treatment were established, along with methods to ensure the availability of CRS treatment if needed. Continuous patient/caregiver education on BsAbs treatment, monitoring for adverse events (particularly CRS), and how/when to access care were described.

Conclusions: BsAb use in community settings requires multidisciplinary coordination between practices and hospitals. Actions included identifying practice champions, establishing clear workflows for transitioning patients between inpatient and outpatient settings, and ensuring continuous training of staff, patients, and caregivers.

Background: Patient access to clinical trials has been identified as a key measure for delivery of quality cancer care. Effective recruitment and retention strategies remain an issue. Furthermore, clinical trial participants historically lack diversity. This project focused on advanced practice provider (APP) mentorship and paired clinical research support to enhance minority accrual to supportive care trials in Hawai'i.

Methods: Over a 1-year period, a formal mentorship program for six participating APPs and three clinical research coordinators (CRCs) in the Hawai'i Minority/Underserved National Cancer Institute Community Oncology Research Program (HI M/U NCORP) was implemented. An introductory meeting kicked off the project. The APP and CRC teams then met weekly for targeted screening and accrual to supportive care trials. Monthly meetings between the mentor and teams were conducted to discuss barriers, best practices, and problem solve issues.

Results: 26 unique accruals were obtained by the APP and CRC teams over the project period while increasing minority accrual. All six APPs are now actively enrolling to trials. Four of the six participating APPs are now reviewing protocols for the HI M/U NCORP for feasibility and scientific merit. Eight of the nine participating APPs and CRCs found the intervention to be acceptable and feasible.

Conclusions: Mentorship of APP and CRC teams can be a successful strategy in increasing accrual and participation of APPs in clinical trial activities. Measuring minority accrual based on this strategy is more complex and dependent on the APP location, clinical trial portfolio, APP patient panel and clinical interest, as well as the expertise of the APP.

Systemic mastocytosis (SM) exemplifies the diagnostic and management challenges associated with rare diseases, which often involve prolonged time to diagnosis, limited access to clinical experts, and persistent symptom burden. Advanced practitioners (APs) are increasingly responsible for the care of patients with rare and classical hematologic disorders. The Advanced Practitioner Society for Hematology and Oncology (APSHO) convened a multidisciplinary, AP-led steering committee to evaluate the AP role in managing SM, develop an online toolkit, and design surveys to identify best practices, unmet needs, and practical strategies for improving care for patients living with indolent systemic mastocytosis (ISM). The toolkit emphasizes early symptom recognition, integration of validated patient-reported outcome measures, and incorporation of disease-specific tools into clinical workflows and electronic medical records (EMRs). The emergence of targeted therapies, such as avapritinib for both advanced and indolent SM, has further highlighted the need for AP education on novel disease mechanisms and treatment strategies. This project demonstrates a replicable model for developing educational and clinical resources to support APs in managing rare diseases and improving patient-centered care.

Chimeric antigen receptor (CAR) T-cell therapy is a novel immunotherapy modality that has shown remarkable response rates in refractory hematologic malignancies, including multiple myeloma (MM). Cytokine release syndrome (CRS) and neurotoxicity are well-described side effects of this therapy. CAR T-cell therapy recipients are also at increased risk for infections due to immune dysfunction, history of multiple lines of therapy, history of lymphodepleting chemotherapy prior to cell infusion, and prolonged B-cell aplasia. Progressive multifocal leukoencephalopathy (PML) is an opportunistic disease of the central nervous system caused by the reactivation of JC virus (JCV) in the setting of immunosuppression, which leads to increased morbidity and mortality. Here, we present a patient treated with ciltacabtagene autoleucel for refractory MM who presented with PML around 2 months after receiving CAR T-cell therapy. This case emphasizes the risks for the development of PML in immunocompromised patients potentially related to persistent B-cell aplasia, hypogammaglobulinemia, and prolonged immunosuppression and discusses treatment approaches. Treatments for PML are mostly focused on reconstituting immunity. However, no adequate treatment strategy for PML has yet been established and further research is needed.

Talquetamab is a first-in-class G protein-coupled receptor family C group 5 member D (GPRC5D) and CD3-targeting bispecific antibody with > 71% overall response in patients with relapsed or refractory multiple myeloma who have progressed on three other drug classes. GPRC5D is highly expressed on myeloma cells, along with some expression in normal hair follicles, skin, and tongue. Its unique expression on these normal tissues results in a distinct pattern of adverse events (AEs), as observed in the phase I/II MonumenTAL-1 trial. GPRC5D-related AEs included oral side effects (e.g., dysgeusia, dysphagia, xerostomia) and dermatologic toxicities (e.g., skin, nail). These AEs can be managed by dose modifications, emollients, and/or topical or oral corticosteroids. Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome were consistent with the T-cell redirection mechanism of talquetamab and can be managed consistent with other trials of T-cell redirection therapies. Infection rates were mostly grades 1 or 2, and grade ≥ 3 infection rates were lower than B-cell maturation antigen-targeting bispecific antibodies; infections were treated with anti-infective agents. Adverse events were manageable and led to few treatment discontinuations. This review reports on talquetamab safety in MonumenTAL-1, with an additional pharmacy focus on strategies related to drug dispensing and clinical management.

Purpose: This study aimed to investigate the correlation between geographical factors, including rurality, persistent poverty counties, racial residential segregation, and adherence to colorectal cancer (CRC) screening among low-income uninsured and underinsured individuals in Texas.

Methods: Utilizing retrospective survey data collected by the A&M Texas Cancer Screening program from 2011 to 2022, linear mixed-effects models were employed. The models examined CRC screening adherence within the recommended time frame as the primary outcome, with geographical county-level characteristics (rurality, racial residential segregation, and persistent poverty) as the main predictors, controlling for other sociodemographic variables.

Findings: The linear mixed-effects analysis revealed that individuals residing in counties characterized by high racial residential segregation (OR = 0.54, 95% CI = 0.36-0.79) or persistent poverty (OR = 0.65, 95% CI = 0.45-0.92) were less likely to self-report having undergone any type of CRC screening within the recommended time frame compared to those in counties with lower racial residential segregation and non-persistent poverty. Conversely, residents of rural counties were more likely to report being up to date with CRC screening compared to their urban counterparts (OR = 1.8, 95% CI = 1.27-2.55).

Conclusions: The findings underscore the need for more targeted CRC screening promotion strategies tailored to low-income, uninsured populations residing in disadvantaged areas such as rural and persistent poverty counties, as well as those characterized by high racial residential segregation.