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What Do Patients With Cancer Know, or Want to Know, About Genomic Tumor Sequencing and Genetic Testing? A State-of-the-Art Review. 关于肿瘤基因组测序和基因检测,癌症患者知道或想知道什么?最新的评论。
Pub Date : 2024-09-11 DOI: 10.6004/jadpro.2024.15.8.14
Lisa Stewart, Linda D Ward

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.

分子谱分析(MP)涉及检测组织、血液或其他体液以识别生物标志物,在癌症治疗中变得越来越重要。肿瘤基因组测序是一种特殊类型的MP,通常用于识别可靶向治疗的特定基因变异或蛋白质。生殖系检测也被常规推荐用于某些癌症。癌症患者的基因组知识水平较低,再加上检测结果越来越复杂,这给临床医生传达结果和提供适当的教育带来了挑战。此外,患者可能对他们想要和能够处理的信息水平有不同的偏好。这篇最新的综述探讨了癌症患者在接受分子谱分析时的期望、态度、知识、满意度和关注点。通过四个数据库进行了搜索,以确定2016年至2022年期间的研究,以探索癌症患者对基因组检测的知识和偏好。19项研究符合纳入标准。大多数研究表明,尽管存在显著差异,但癌症患者对MP的了解程度较低。患者主要希望MP能够确定新的治疗方案并提高生存率。虽然患者依赖于他们的提供者来解释测试结果,但他们希望被告知所有的结果,主要是如果这些结果可能指导治疗决策或未来的护理计划。大多数患者,特别是那些基因组/遗传知识较低的患者,倾向于高估MP的个人益处。需要进一步的研究来提供量身定制的教育,以满足患者的信息需求。
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引用次数: 0
Implementing a Validated Multi-Symptom Assessment Tool During Telephone Triage to Reduce Oncology Patient Emergency Room Visits. 在电话分诊中实施有效的多症状评估工具以减少肿瘤患者急诊室就诊。
Pub Date : 2024-09-11 DOI: 10.6004/jadpro.2024.15.8.12
Kristin Neves

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.

癌症治疗会产生多种意想不到的副作用,往往无法缓解,导致急诊室(ER)访问。肿瘤诊所已经建立了分诊诊所(TCs)进行症状管理,从而改善了获得护理的机会并降低了急诊室的利用率。此外,有证据证明,经过验证的患者报告结果(PRO)工具支持改善症状管理和减少急诊室就诊。本质量改进项目旨在确定MD安德森症状清单(MDASI)工具的实施是否或在多大程度上减少了南佛罗里达州门诊肿瘤诊所的急诊就诊,无论是否住院。MDASI工具在症状管理电话分诊期间在TC中实施。社区急诊就诊和住院率差异有统计学意义,p < 0.05。实施前(n = 14, 29.8%)和实施后(n = 10, 23%)的数值(χ2 [n = 47] = 12.66, p = 0.008)证实急诊就诊减少了6.8个百分点。此外,实施前(n = 8,17%)和实施后(n = 10,21%)的数值(χ2 [n = 47] = 25.69, p = 0.006)证实,实施MDASI后,患者住院率平均增加了两次(4%),这可能反映了患者对适当利用急诊室的理解有所提高。MDASI工具支持早期症状评估和管理,同时确定患者知识差距。该项目证实,PRO工具允许患者为他们的症状分配意义,改善沟通,减少不必要的急诊室就诊。
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引用次数: 0
Expanding the Toolbox: A Palliative Care Lecture Series for Oncology Advanced Practice Providers. 扩展工具箱:肿瘤学高级实践提供者的姑息治疗系列讲座。
Pub Date : 2024-09-11 DOI: 10.6004/jadpro.2024.15.8.13
Heidi Mason, April Bigelow, Christina Conrad, Karen Harden, Deborah Price, Diane Bohn, Natasha Mason

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.

目的:早期启动姑息关怀(PC)对于确保病人及其家属在重病治疗前、治疗期间和治疗后的生理、心理、精神和社会需求得到满足至关重要。根据世界卫生组织的定义,姑息关怀是以病人和家属为中心的护理,通过预测、预防和治疗痛苦来优化生命质量。它是一种整体护理,能满足患者及其家属在身体、社会心理和精神方面的需求:方法:为了改善肿瘤科的早期 PC,我们为高级医疗服务提供者(APP)开设了免费的系列教育课程。结果:评估结果是积极的:评估结果是积极的;员工们喜欢案例演示和所涉及的主题。完成了一项事后调查。结果显示,大多数 APP 熟悉症状管理的基本概念以及病人及其家属的整体需求。一个没有得到改善的方面是,他们不知道 PC 与积极治疗是相容的:为 APP 举办的 PC 系列讲座深受参与者欢迎。与会者能够展示有关 PC 传播的知识,但未能理解 PC 传播可与积极治疗同时进行:建议:需要加强有关 PC 在疾病过程中的作用以及适当转诊至 PC 专科的教育。对 APP 进行早期 PC 教育是有益的,需要进一步探索创造性的教学方法。
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引用次数: 0
Is it Cellulitis Again? Erythema Concerning for Infection in Children With High-Risk Solid Tumors Who Have a Gastrostomy Tube. 又是蜂窝织炎?有胃管的高危实体瘤患儿出现红斑,可能会引发感染。
Pub Date : 2024-09-01 DOI: 10.6004/jadpro.2024.15.6.2
Kristen L Dalton, Meredith R Johnson

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.

背景:众所周知,适当的营养可加速伤口愈合、降低与治疗相关的发病率并改善预后。患有高风险实体瘤的儿童在接受癌症治疗期间,通常会放置胃造瘘管(GT)以补充营养。然而,胃造瘘管并非没有风险,许多患者的造口部位会出现红斑,这可能与感染有关。文献中对胃造口术并发症进行了描述,但有关这方面的知识却很有限:在这项回顾性描述性研究中,作者回顾了一家儿科医疗中心 3 年来对实体瘤儿科患者进行胃造口术的临床数据。研究采用了描述性统计方法来描述与感染有关的红斑发生率,确定最有可能与这种并发症相关的因素,并了解红斑如何影响癌症治疗的完成:在2018年至2021年期间置入GT的58名高风险实体瘤患儿样本中,53%的患儿出现了感染性红斑。更多出现GT红斑的受试者患有神经母细胞瘤(48%)、在癌症治疗开始后置入管子(74%)以及在中性粒细胞减少期间出现红斑(71%)。只有一名受试者因GT红斑而延误了治疗:讨论:尽管研究对象中GT红斑的发生率较高,但大多数人都完成了癌症治疗,没有因这一并发症而延误治疗。此外,在癌症治疗开始前放置胃管,造口部位红斑的发生率明显较低。因此,作者建议尽可能在治疗开始前放置胃管,并在癌症治疗期间进一步关注这一并发症。
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引用次数: 0
How Do We Achieve Value-Based, Patient-Centered Care? 我们如何实现以价值为基础、以患者为中心的医疗服务?
Pub Date : 2024-09-01 DOI: 10.6004/jadpro.2024.15.6.1
Beth Faiman
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引用次数: 0
Carcinoid Heart Disease. 类癌性心脏病
Pub Date : 2024-09-01 DOI: 10.6004/jadpro.2024.15.6.3
Nicole Kuhnly, Jessica Shank Coviello, Catherine A Kobza, Devesh A Patel, Jacqueline S Lagoy, Mary-Ann L Cyr

Carcinoid heart disease (CHD) is a rare cardiac complication that occurs most commonly in patients with advanced neuroendocrine tumors and is a known sequela of carcinoid syndrome. Neuroendocrine tumors most widely associated with CHD include tumors in the small bowel, followed by lung, large bowel, pancreatic, appendiceal, and ovarian neoplasms. Carcinoid syndrome is a paraneoplastic syndrome caused by the release of serotonin and other substances from neuroendocrine tumors. It results in a spectrum of symptoms, including diarrhea, flushing, bronchospasm, and symptoms of congestive heart failure. Without treatment and for patients with advanced heart failure, the prognosis of CHD can be less than a year. Management of CHD is often challenging as patients typically present late, and the disease can progress rapidly. Therefore, optimal management of these patients requires close collaboration among various specialties to quantify disease burden, delay the progression of valvular disease, and determine the most effective surgical and medical management strategies depending on the cardiac manifestations to improve quality of life and reduce mortality. This involves a collaborative team, including cardiology and oncology, and often involves many other disciplines, including hepatobiliary and cardiovascular surgeons, endocrinologists, anesthesiologists, and gastroenterologists.

类癌性心脏病(CHD)是一种罕见的心脏并发症,最常见于晚期神经内分泌肿瘤患者,也是类癌综合征的一种已知后遗症。与类癌性心脏病最广泛相关的神经内分泌肿瘤包括小肠肿瘤,其次是肺、大肠、胰腺、阑尾和卵巢肿瘤。类癌综合征是一种由神经内分泌肿瘤释放血清素和其他物质引起的副肿瘤综合征。它会导致一系列症状,包括腹泻、潮红、支气管痉挛和充血性心力衰竭症状。如果不进行治疗,心力衰竭晚期患者的预后可能不足一年。心脏病的治疗通常具有挑战性,因为患者通常发病较晚,而且病情发展迅速。因此,这些患者的最佳治疗需要各专科的密切合作,以量化疾病负担,延缓瓣膜疾病的进展,并根据心脏表现确定最有效的手术和药物治疗策略,从而提高生活质量并降低死亡率。这需要一个包括心脏病学和肿瘤学在内的协作团队,并经常涉及许多其他学科,包括肝胆和心血管外科医生、内分泌科医生、麻醉科医生和消化科医生。
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引用次数: 0
Sutimlimab for Cold Agglutinin Disease. 治疗冷凝集素病的 Sutimlimab。
Pub Date : 2024-09-01 DOI: 10.6004/jadpro.2024.15.6.4
Mark Reid, Bethany A Fedutes Henderson

Cold agglutinin disease (CAD) is a rare type of autoimmune hemolytic anemia (AIHA) distinct from warm antibody AIHA. One of the ways it is distinct is that CAD is usually not responsive to corticosteroids compared with warm antibody AIHA. Historically, CAD therapy has been limited to immunotherapy or chemoimmunotherapy with varying responses. Cold agglutinin disease also poses a risk for thrombosis and mortality. For patients, fatigue tends to be a common symptom of CAD. The hallmark of CAD is complement-mediated hemolysis, which makes complement inhibitors a critical therapeutic option for patients. Previously, eculizumab, a C5 inhibitor, had limited therapeutic effect for CAD. More recently, sutimlimab, a C1s inhibitor, was shown in two phase III studies to be an efficacious treatment for CAD, improving hemoglobin, hemolysis, and fatigue. However, there is a paucity of medical literature on CAD and on sutimlimab in particular that is geared toward advanced practice providers (APPs). This article aims to provide APPs with a background in CAD and a focus on sutimlimab, assisting these providers in caring for patients with CAD receiving this therapy.

冷凝集素病(CAD)是一种罕见的自身免疫性溶血性贫血(AIHA),有别于温抗体型 AIHA。区别之一在于,与温抗体型自身免疫性溶血性贫血相比,冷凝集素病通常对皮质类固醇无反应。一直以来,CAD 的治疗方法仅限于免疫疗法或化学免疫疗法,但疗效各异。冷凝集素病还存在血栓形成和死亡的风险。对患者来说,疲劳往往是 CAD 的常见症状。CAD的特征是补体介导的溶血,这使得补体抑制剂成为患者的重要治疗选择。以前,C5 抑制剂 eculizumab 对 CAD 的治疗效果有限。最近,C1s 抑制剂 sutimlimab 在两项 III 期研究中被证明是治疗 CAD 的有效药物,可改善血红蛋白、溶血和疲劳。然而,有关 CAD,特别是有关 sutimlimab 的医学文献却很少,而且这些文献都是针对高级医疗人员 (APP) 的。这篇文章旨在为医生提供有关 CAD 的背景知识,并重点介绍 sutimlimab,以帮助他们护理接受这种疗法的 CAD 患者。
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引用次数: 0
Artificial Intelligence: How Is it Relevant to Advanced Practitioners? 人工智能:它与高级从业人员有何关系?
Pub Date : 2024-07-01 DOI: 10.6004/jadpro.2024.15.5.1
Beth Faiman
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引用次数: 0
How Can Oncology Nurses and Advanced Practice Providers Reduce the Burden of Chemotherapy-Induced Febrile Neutropenia in the US? 在美国,肿瘤护士和高级执业医生如何减轻化疗引起的发热性中性粒细胞减少症的负担?
Pub Date : 2024-05-22 DOI: 10.6004/jadpro.2024.15.8.5
Kristi Kay Orbaugh, Sandra Cuellar, Lisa Kennedy Sheldon

Background: Neutropenia and febrile neutropenia (FN) are serious complications of myelosuppressive chemotherapy and present a considerable burden to patients with cancer. Febrile neutropenia is associated with increased risks of infection and hospitalization, a particular concern during the coronavirus disease 2019 (COVID-19) pandemic. Oncology nurses and advanced practice providers (APPs; including nurse practitioners, physician assistants, advanced practice nurses, and pharmacists) play a vital role in the management of patients with cancer and the prevention of infections.

Objectives: The objectives of this article are to summarize the burden of chemotherapy-related neutropenia and FN in patients with cancer in the US and to evaluate the role of oncology nurses and APPs in preventing and managing FN.

Methods: This article provides a narrative review of US studies reporting on the burden of FN, FN during COVID-19, adherence to guidelines for the use of prophylactic granulocyte colony-stimulating factors (G-CSFs), the involvement of oncology nurses in FN prevention, management, and patient quality of life, and inappropriate and/or incomplete G-CSF treatment.

Findings: Despite advances in supportive care for patients with cancer receiving myelosuppressive chemotherapy, neutropenia and FN present a considerable burden to patients, particularly during the COVID-19 pandemic. Oncology nurses and APPs play a vital role in the appropriate and timely delivery of supportive care, which can improve patient outcomes and minimize treatment costs.

背景:中性粒细胞减少和发热性中性粒细胞减少(FN)是骨髓抑制化疗的严重并发症,给癌症患者带来了相当大的负担。发热性中性粒细胞减少症与感染和住院风险增加有关,这在2019年冠状病毒病(COVID-19)大流行期间尤其令人担忧。肿瘤护士和高级实践提供者(APPs);包括执业护士、医师助理、高级执业护士和药剂师)在管理癌症患者和预防感染方面发挥着至关重要的作用。目的:本文的目的是总结美国癌症患者化疗相关中性粒细胞减少症和FN的负担,并评估肿瘤护士和app在FN预防和管理中的作用。方法:本文对美国有关FN负担、COVID-19期间FN、预防性粒细胞集落刺激因子(G-CSF)使用指南的依从性、肿瘤科护士参与FN预防、管理和患者生活质量、不适当和/或不完整G-CSF治疗的研究进行了叙述性回顾。研究结果:尽管对接受骨髓抑制性化疗的癌症患者的支持治疗取得了进展,但中性粒细胞减少症和FN给患者带来了相当大的负担,特别是在COVID-19大流行期间。肿瘤科护士和应用程序在适当和及时提供支持性护理方面发挥着至关重要的作用,这可以改善患者的预后并最大限度地降低治疗成本。
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引用次数: 0
The Effect of Pelvic Floor Rehabilitation on Low Anterior Resection Syndrome After Colorectal Cancer Treatment. 盆底康复对结直肠癌治疗后下前切除术综合征的影响。
Pub Date : 2024-05-22 DOI: 10.6004/jadpro.2024.15.8.4
Shelby Jones, Alison Edie, Emily Troop, Joshua S Hill, Julie A Thompson

Purpose: Low anterior resection (LAR) is the preferred surgical treatment of rectosigmoid or rectal cancers. However, it is often associated with bowel dysfunction, which is termed low anterior resection syndrome (LARS). Daily bowel dysfunction symptoms have a detrimental effect on quality of life (QOL). Pelvic floor rehabilitation (PFR) can improve pelvic floor function and QOL among patients with LARS. This quality improvement (QI) project seeks to assess the prevalence of LARS and develop and incorporate PFR for the treatment and prevention of LARS.

Methods: A convenience sample of 20 patients met project inclusion. Thirteen patients participated. Individuals were categorized by diagnostic risk: low risk, high risk, and established. The intervention included 1-hour PFR sessions with the physical therapist (PT) and 5 minutes of daily self-led pelvic floor muscle exercises. Outcomes questionnaires included the LARS Score and Fecal Incontinence Quality of Life (FIQOL) Scale. Data were collected both pre- and post-colorectal cancer treatment.

Results: The overall prevalence of LARS was 76.9%, which was significantly higher than the retrospective cohort comparison rate of 21.8% (p < .001). The prevalence of major LARS was 89%, 83%, and 50% at the initial, second, and third sessions, respectively, representing a 44% relative decrease. Embarrassment was significantly affected among individuals with major LARS, although ongoing PFR facilitated improvement.

Conclusion: PFR is a valuable adjunct therapy for LARS, with continued sessions decreasing the overall prevalence among the cohort. Major LARS negatively impacts QOL measures early on in treatment but improves with continued PFR.

目的:低位前切除术是治疗直肠乙状结肠或直肠癌的首选手术方法。然而,它通常与肠功能障碍有关,这被称为前低位切除综合征(LARS)。日常肠功能障碍症状对生活质量(QOL)有不利影响。盆底康复治疗(PFR)可改善LARS患者的盆底功能和生活质量。这个质量改进(QI)项目旨在评估LARS的患病率,并开发和纳入PFR来治疗和预防LARS。方法:选取符合项目纳入标准的20例患者作为方便样本。13名患者参与。个体按诊断风险分类:低风险、高风险和已建立。干预包括与物理治疗师(PT)进行1小时的PFR会话和每天5分钟的自我盆底肌肉锻炼。结果问卷包括LARS评分和大便失禁生活质量(FIQOL)量表。数据收集于结直肠癌治疗前后。结果:LARS的总患病率为76.9%,显著高于回顾性队列比较的21.8% (p < 0.001)。在第一次、第二次和第三次治疗中,主要LARS的患病率分别为89%、83%和50%,相对下降了44%。严重LARS患者的尴尬感受到显著影响,尽管持续的PFR有助于改善。结论:PFR是LARS的一种有价值的辅助治疗方法,持续治疗可以降低队列中的总体患病率。主要的LARS对治疗早期的生活质量测量产生负面影响,但随着持续的PFR而改善。
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引用次数: 0
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Journal of the advanced practitioner in oncology
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