Pub Date : 2022-03-01Epub Date: 2022-03-25DOI: 10.6004/jadpro.2022.13.2.3
Kirtishri Mishra, Erin Jesse, Laura Bukavina, Emily Sopko, Itunu Arojo, Austin Fernstrum, Al Ray, Amr Mahran, Adam Calaway, Seneca Block, Lee Ponsky
Background: Music is a safe and cost-effective intervention that can reduce postoperative pain and anxiety. We investigated the effects of music therapy on postoperative recovery in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP).
Methods: Subjects were males 18 years and older undergoing RALP at a single tertiary care institution. Patients were randomized to music or control groups. The music group received 30 minutes of music in the recovery area and on postoperative day (POD) 1, while the control group was not provided postoperative music. Inpatient narcotic use (morphine milligram equivalent, or MME) and outpatient narcotic use were measured, and the State-Trait Anxiety Inventory (STAI) survey was completed on POD 1 and POD 7 by an inpatient advanced practitioner (AP). T-test and Chi-square were used to compare the groups. Linear regression was used to adjust for age, blood loss, and inpatient MME.
Results: A total of 40 patients were prospectively recruited. There was no statistically significant difference in the hourly MME (2.06 [0.71-3.17] vs. 1.55 [0.83-3.37]) or total MME (49.52 [17-76] vs. 37.25 [20-69]) used in the music vs. non-music arms, respectively. Evaluation of STAI questionnaire revealed no overall differences in anxiety levels among the two groups on POD 1 or POD 7. After adjusting for age, blood loss, and inpatient MME use, patients assigned to the music intervention had a 26% reduction in post-hospitalization use.
Conclusion: Our prospective randomized study suggests that music can be an AP-driven adjunct to facilitate postoperative patient comfort and reduce narcotic use upon discharge in prostate cancer patients.
背景：音乐是一种安全且具有成本效益的干预措施，可以减轻术后疼痛和焦虑。我们研究了音乐疗法对机器人辅助腹腔镜前列腺切除术（RALP）患者术后恢复的影响：受试者为在一家三级医疗机构接受 RALP 手术的 18 岁及以上男性。患者被随机分为音乐组和对照组。音乐组在恢复区和术后第 1 天 (POD) 播放 30 分钟音乐，而对照组术后不播放音乐。住院麻醉剂使用量（吗啡毫克当量，或 MME）和门诊麻醉剂使用量进行了测量，并由一名住院高级执业医师（AP）在术后第 1 天和第 7 天完成了状态-特质焦虑量表（STAI）调查。采用 T 检验和卡方检验对各组进行比较。线性回归用于调整年龄、失血量和住院 MME：共招募了 40 名患者。音乐组和非音乐组的每小时 MME（2.06 [0.71-3.17] vs. 1.55 [0.83-3.37] ）和总 MME（49.52 [17-76] vs. 37.25 [20-69]）分别没有明显的统计学差异。对 STAI 问卷的评估显示，两组患者在 POD 1 或 POD 7 的焦虑水平总体上没有差异。在对年龄、失血量和住院期间使用的 MME 进行调整后，接受音乐干预的患者住院后使用的 MME 减少了 26%：我们的前瞻性随机研究表明，音乐可以作为 AP 驱动的辅助手段，提高前列腺癌患者术后的舒适度，减少出院时麻醉剂的使用。
{"title":"Impact of Music on Postoperative Pain, Anxiety, and Narcotic Use After Robotic Prostatectomy: A Randomized Controlled Trial.","authors":"Kirtishri Mishra, Erin Jesse, Laura Bukavina, Emily Sopko, Itunu Arojo, Austin Fernstrum, Al Ray, Amr Mahran, Adam Calaway, Seneca Block, Lee Ponsky","doi":"10.6004/jadpro.2022.13.2.3","DOIUrl":"https://doi.org/10.6004/jadpro.2022.13.2.3","url":null,"abstract":"<p><strong>Background: </strong>Music is a safe and cost-effective intervention that can reduce postoperative pain and anxiety. We investigated the effects of music therapy on postoperative recovery in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP).</p><p><strong>Methods: </strong>Subjects were males 18 years and older undergoing RALP at a single tertiary care institution. Patients were randomized to music or control groups. The music group received 30 minutes of music in the recovery area and on postoperative day (POD) 1, while the control group was not provided postoperative music. Inpatient narcotic use (morphine milligram equivalent, or MME) and outpatient narcotic use were measured, and the State-Trait Anxiety Inventory (STAI) survey was completed on POD 1 and POD 7 by an inpatient advanced practitioner (AP). T-test and Chi-square were used to compare the groups. Linear regression was used to adjust for age, blood loss, and inpatient MME.</p><p><strong>Results: </strong>A total of 40 patients were prospectively recruited. There was no statistically significant difference in the hourly MME (2.06 [0.71-3.17] vs. 1.55 [0.83-3.37]) or total MME (49.52 [17-76] vs. 37.25 [20-69]) used in the music vs. non-music arms, respectively. Evaluation of STAI questionnaire revealed no overall differences in anxiety levels among the two groups on POD 1 or POD 7. After adjusting for age, blood loss, and inpatient MME use, patients assigned to the music intervention had a 26% reduction in post-hospitalization use.</p><p><strong>Conclusion: </strong>Our prospective randomized study suggests that music can be an AP-driven adjunct to facilitate postoperative patient comfort and reduce narcotic use upon discharge in prostate cancer patients.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"13 2","pages":"121-126"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.6004/jadpro.2022.13.2.12
J. Zurko, N. Epperla, -. Im, ran Nizamuddin, P. Torka, K. David, T. Ollila, B. Hess, Jonathon B. Cohen, R. Ferdman, Jieqi Liu, Sayan Mullick, Chowdhury, Kaitlyn L. O'Shea, Jason T. Romancik, R. Bhansali, E. Harris, M. Sorrell, R. Masel, L. Fitzgerald, C. Galvez, J. Winter, B. Pro, Léo, I. Gordon, A. Danilov, N. Shah, G. Shouse, Vaishalee, P. Kenkre, S. Barta
884 Outcomes and Treatment Patterns in Patients With Aggressive B-Cell Lymphoma After Failure of Anti-CD19 CAR T-Cell Therapy Joanna C. Zurko, MD, Narendranath Epperla, MD, MS, Imran Nizamuddin, MD, Pallawi Torka, MD, Kevin A. David, MD, Thomas A. Ollila, MD, Brian T. Hess, MD, Jonathon B. Cohen, MD, MS, Robert Ferdman, MD, Jieqi Liu, MD, Sayan Mullick Chowdhury, DO, PhD, Kaitlyn O’Shea, PhD, Jason Romancik, MD, Rahul Bhansali, MD, Elyse Harris, MD, Mckenzie Sorrell, D.O., Rebecca Masel, Lindsey Fitzgerald, MD, Carlos Galvez, MD, Shuo Ma, MD, Jane N. Winter, MD, Barbara Pro, MD, Leo I. Gordon, MD, Alexey V. Danilov, MD, PhD, Deborah M. Stephens, Nirav N. Shah, MD, Geoffrey Shouse, PhD, Vaishalee P. Kenkre, MD, Stefan K. Barta, MD, MRCP, MS and Reem Karmali, MD, MSc Visit https://doi.org/10.1182/blood-2021-147433 for a complete list of contributor affiliations and full graphics. Background: Anti-CD19 chimeric antigen receptor T-cell therapy (CART) is a highly active therapy for relapsed/refractory (R/R) aggressive B-cell lymphoma. Nonetheless, most patients (pts) ultimately develop progressive disease (PD). There is little guidance on the optimal treatment approach(es) for these pts. We performed a multicenter retrospective analysis with a primary objective to assess treatment patterns and outcomes in pts with R/R aggressive B-cell lymphoma who develop PD after anti-CD19 CARTs. Methods: Pts with aggressive B-cell lymphoma treated with anti-CD19 CART between 2015 and 2020 across 12 US academic medical centers were included. Demographic and clinical characteristics were collected along with CART toxicities and response. Regimens administered as salvage post CART were assessed. Univariate analyses (UVA) were performed to determine impact of demographic and clinical variables on survival outcomes. All p-values were two-tailed. Survival curves were calculated using the KaplanMeier method. Results: A total of 400 pts received anti-CD19 CARTs and were included for analysis. For the entire cohort: median PFS and OS from time of CART infusion were 11 months [mo] and 27 mo respectively. On log-rank testing, pts who received ≥3 lines of pre-CART therapy and those with refractory disease pre-CART had significantly worse PFS (p=0.004 & 0.001) and OS (both p<0.001). With median follow-up 22.4 mo, 190 pts (48%) had PD after CART; demographic and clinical variables of pts with and without PD are detailed in Table 1. Biopsy to confirm PD and assess CD19 status was done in 69 pts (36%) with CD19 negative relapse seen in 11 (16%). Of pts with PD, median PFS and OS from time of PD was 83 days (in pts who received salvage) and 174 days (for all PD pts) respectively. Pts with PD were more likely to have elevated LDH (p=0.001) and extranodal disease (p=0.003) at apheresis. For pts with PD after CART: 125 (65.5%) received further therapies. Pts were more likely to receive salvage therapies if their best response to CART was CR (p=0.026) or PR (p=0.015). Response rates of
884抗CD19 CAR T细胞治疗失败后侵袭性B细胞淋巴瘤患者的预后和治疗模式Joanna C.Zurko，医学博士，Narendranath Epperla，医学博士、Imran Nizamuddin，医学博士；Pallawi Torka，医学博士：Kevin A.David，医学博士。Thomas A.Ollila，医学医学博士：Brian T.Hess，医学博士，医学博士Jason Romancik、医学博士Rahul Bhansali、医学博士Elyse Harris、医学主任Mckenzie Sorrell、医学博士Rebecca Masel、医学博士Lindsey Fitzgerald、医学博士Carlos Galvez、医学博士Shuo Ma、医学博士Jane N.Winter、医学博士Barbara Pro、医学博士Leo I.Gordon、医学硕士Alexey V.Danilov、医学博士Deborah M.Stephens、医学博士Nirav N.Shah、医学教授Geoffrey Shouse、医学博士Vaishalee P.Kenkre、医学博士Stefan K.Barta、医学博士MRCP和医学博士Reem Karmali访问https://doi.org/10.1182/blood-2021-147433以获取投稿人隶属关系的完整列表和完整的图形。背景：抗CD19嵌合抗原受体T细胞疗法（CART）是一种治疗复发/难治性（R/R）侵袭性B细胞淋巴瘤的高效疗法。尽管如此，大多数患者（pts）最终发展为进行性疾病（PD）。关于这些pts的最佳治疗方法，几乎没有什么指导。我们进行了一项多中心回顾性分析，主要目的是评估抗CD19 CART后发生PD的R/R侵袭性B细胞淋巴瘤患者的治疗模式和结果。方法：纳入2015年至2020年间在12个美国学术医疗中心接受抗CD19 CART治疗的侵袭性B细胞淋巴瘤患者。收集人口统计学和临床特征以及CART毒性和反应。评估了作为CART后救助站管理的团。进行单变量分析（UVA），以确定人口统计学和临床变量对生存结果的影响。所有p值都是双尾的。使用KaplanMeier方法计算存活曲线。结果：共有400名患者接受了抗CD19 CART治疗，并纳入分析。对于整个队列：CART输注后的中位PFS和OS分别为11个月和27个月。在对数秩检验中，接受≥3行CART前治疗的患者和CART前患有难治性疾病的患者的PFS（p=0.004&0.001）和OS（均<0.001）显著较差。中位随访22.4个月，190名患者（48%）在CART后出现PD；表1详细列出了患有和不患有帕金森病的患者的人口统计学和临床变量。69名患者（36%）进行了活检以确认PD并评估CD19状态，11名患者（16%）出现CD19阴性复发。在PD患者中，自PD发生时起，中位PFS和OS分别为83天（接受抢救的患者）和174天（所有PD患者）。PD患者在单采时更可能出现LDH升高（p=0.001）和结外疾病（p=0.003）。CART后PD患者：125例（65.5%）接受了进一步治疗。如果Pts对CART的最佳反应是CR（p=0.026）或PR（p=0.015），则他们更有可能接受挽救性治疗。选择的一线和二线治疗的有效率以及CART失败后接受的一线治疗的PFS如图1所示。polatuzumab、bendamustine和利妥昔单抗的ORR和CR最高（pola-BR；73%和40%），其次是BTK抑制剂（BTKi；50%和38%）和双特异性抗体（bsAb）（50%和25%）。接受BTKi治疗的7名患者中有5名患者有非生发中心（GC）来源细胞（COO；1名COO未知）。在对数秩检验中，单采时LDH升高的患者（p=0.003）和IPI中等/高的患者（p=0.013）的PFS较差，《肿瘤杂志》2022；13（补充2）：25-32https://doi.org/10.6004/jadpro.2022.13.2.12这是Cr ea tiv e C om m on s A ttr ibu tio n n on-C om m cia l n on-d er iva tiv e l ice ns e的三个部分，即它的非结构化无nco m er cia l A和非私有化、三个部分、一个在一个y m d ium中的操作过程，以及它的内部或外部。
{"title":"ASH Highlights and Commentary: Additional Topics of Interest","authors":"J. Zurko, N. Epperla, -. Im, ran Nizamuddin, P. Torka, K. David, T. Ollila, B. Hess, Jonathon B. Cohen, R. Ferdman, Jieqi Liu, Sayan Mullick, Chowdhury, Kaitlyn L. O'Shea, Jason T. Romancik, R. Bhansali, E. Harris, M. Sorrell, R. Masel, L. Fitzgerald, C. Galvez, J. Winter, B. Pro, Léo, I. Gordon, A. Danilov, N. Shah, G. Shouse, Vaishalee, P. Kenkre, S. Barta","doi":"10.6004/jadpro.2022.13.2.12","DOIUrl":"https://doi.org/10.6004/jadpro.2022.13.2.12","url":null,"abstract":"884 Outcomes and Treatment Patterns in Patients With Aggressive B-Cell Lymphoma After Failure of Anti-CD19 CAR T-Cell Therapy Joanna C. Zurko, MD, Narendranath Epperla, MD, MS, Imran Nizamuddin, MD, Pallawi Torka, MD, Kevin A. David, MD, Thomas A. Ollila, MD, Brian T. Hess, MD, Jonathon B. Cohen, MD, MS, Robert Ferdman, MD, Jieqi Liu, MD, Sayan Mullick Chowdhury, DO, PhD, Kaitlyn O’Shea, PhD, Jason Romancik, MD, Rahul Bhansali, MD, Elyse Harris, MD, Mckenzie Sorrell, D.O., Rebecca Masel, Lindsey Fitzgerald, MD, Carlos Galvez, MD, Shuo Ma, MD, Jane N. Winter, MD, Barbara Pro, MD, Leo I. Gordon, MD, Alexey V. Danilov, MD, PhD, Deborah M. Stephens, Nirav N. Shah, MD, Geoffrey Shouse, PhD, Vaishalee P. Kenkre, MD, Stefan K. Barta, MD, MRCP, MS and Reem Karmali, MD, MSc Visit https://doi.org/10.1182/blood-2021-147433 for a complete list of contributor affiliations and full graphics. Background: Anti-CD19 chimeric antigen receptor T-cell therapy (CART) is a highly active therapy for relapsed/refractory (R/R) aggressive B-cell lymphoma. Nonetheless, most patients (pts) ultimately develop progressive disease (PD). There is little guidance on the optimal treatment approach(es) for these pts. We performed a multicenter retrospective analysis with a primary objective to assess treatment patterns and outcomes in pts with R/R aggressive B-cell lymphoma who develop PD after anti-CD19 CARTs. Methods: Pts with aggressive B-cell lymphoma treated with anti-CD19 CART between 2015 and 2020 across 12 US academic medical centers were included. Demographic and clinical characteristics were collected along with CART toxicities and response. Regimens administered as salvage post CART were assessed. Univariate analyses (UVA) were performed to determine impact of demographic and clinical variables on survival outcomes. All p-values were two-tailed. Survival curves were calculated using the KaplanMeier method. Results: A total of 400 pts received anti-CD19 CARTs and were included for analysis. For the entire cohort: median PFS and OS from time of CART infusion were 11 months [mo] and 27 mo respectively. On log-rank testing, pts who received ≥3 lines of pre-CART therapy and those with refractory disease pre-CART had significantly worse PFS (p=0.004 & 0.001) and OS (both p<0.001). With median follow-up 22.4 mo, 190 pts (48%) had PD after CART; demographic and clinical variables of pts with and without PD are detailed in Table 1. Biopsy to confirm PD and assess CD19 status was done in 69 pts (36%) with CD19 negative relapse seen in 11 (16%). Of pts with PD, median PFS and OS from time of PD was 83 days (in pts who received salvage) and 174 days (for all PD pts) respectively. Pts with PD were more likely to have elevated LDH (p=0.001) and extranodal disease (p=0.003) at apheresis. For pts with PD after CART: 125 (65.5%) received further therapies. Pts were more likely to receive salvage therapies if their best response to CART was CR (p=0.026) or PR (p=0.015). Response rates of","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"13 1","pages":"25 - 32"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46203285","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 : 2022-03-01Epub Date: 2022-03-25DOI: 10.6004/jadpro.2022.13.2.6
Yelena Shames, Mimma Errante, Nana Prempeh Keteku
Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction, which is characterized by the production of autoimmune antibodies to acetylcholine or muscle-specific kinase receptors, causing an error in transmission of nerve impulses to various muscles. The hallmark of myasthenia gravis is "grave or serious" fluctuating muscle weakness. Ocular, respiratory, bulbar, and skeletal muscles are most commonly affected; therefore, patients often present with fatigable ptosis, blurry vision, diplopia, change in facial expression, dysphagia, dysarthria, dyspnea, and limb weakness. Many medications, including fluroquinolone, aminoglycoside, magnesium sulfate, quinidine, and select beta blockers, are known to unmask or exacerbate symptoms of myasthenia gravis. Although the pathogenesis is not entirely understood, T lymphocytes are thought to play a role by blocking the acetylcholine receptors and causing antibody production. In the era of new immune-modulating therapies emerging for treatment of different cancers, their role in inducing a proinflammatory state has become apparent, thus highlighting a clear need to increase awareness about their role in inducing myasthenia gravis or myasthenia-like symptoms.
重症肌无力是一种影响神经肌肉接头的自身免疫性疾病，其特征是产生针对乙酰胆碱或肌肉特异性激酶受体的自身免疫抗体，导致神经冲动向各种肌肉的传递出现错误。重症肌无力的特征是 "严重或严重 "的波动性肌无力。眼肌、呼吸肌、口唇肌和骨骼肌最常受到影响；因此，患者通常表现为疲劳性眼睑下垂、视力模糊、复视、面部表情改变、吞咽困难、构音障碍、呼吸困难和四肢无力。许多药物，包括氟喹诺酮、氨基糖苷、硫酸镁、奎尼丁和某些β受体阻滞剂，都会掩盖或加重重症肌无力的症状。虽然发病机制尚不完全清楚，但人们认为 T 淋巴细胞通过阻断乙酰胆碱受体和导致抗体产生而发挥作用。在治疗不同癌症的新型免疫调节疗法不断涌现的时代，T 淋巴细胞在诱发促炎状态方面的作用已变得显而易见，因此，我们显然有必要提高人们对其在诱发重症肌无力或肌无力样症状方面作用的认识。
{"title":"Myasthenia Gravis: A Rare Neurologic Complication of Immune Checkpoint Inhibitor Therapy.","authors":"Yelena Shames, Mimma Errante, Nana Prempeh Keteku","doi":"10.6004/jadpro.2022.13.2.6","DOIUrl":"https://doi.org/10.6004/jadpro.2022.13.2.6","url":null,"abstract":"<p><p>Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction, which is characterized by the production of autoimmune antibodies to acetylcholine or muscle-specific kinase receptors, causing an error in transmission of nerve impulses to various muscles. The hallmark of myasthenia gravis is \"grave or serious\" fluctuating muscle weakness. Ocular, respiratory, bulbar, and skeletal muscles are most commonly affected; therefore, patients often present with fatigable ptosis, blurry vision, diplopia, change in facial expression, dysphagia, dysarthria, dyspnea, and limb weakness. Many medications, including fluroquinolone, aminoglycoside, magnesium sulfate, quinidine, and select beta blockers, are known to unmask or exacerbate symptoms of myasthenia gravis. Although the pathogenesis is not entirely understood, T lymphocytes are thought to play a role by blocking the acetylcholine receptors and causing antibody production. In the era of new immune-modulating therapies emerging for treatment of different cancers, their role in inducing a proinflammatory state has become apparent, thus highlighting a clear need to increase awareness about their role in inducing myasthenia gravis or myasthenia-like symptoms.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"13 2","pages":"151-157"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01Epub Date: 2022-03-25DOI: 10.6004/jadpro.2022.13.2.2
Christa Braun-Inglis, Leigh M Boehmer, Laura J Zitella, Brianna Hoffner, Yurii B Shvetsov, Jeffrey L Berenberg, Randall A Oyer, Al B Benson
Background: Oncology advanced practitioners (APs), including nurse practitioners, clinical nurse specialists, physician assistants, and clinical pharmacists contribute significantly to quality cancer care. Advanced practitioners enhance value across the spectrum of cancer care. Research is an underdeveloped component of quality care, as well as an underdeveloped component of AP practice. Understanding research-related attitudes and roles of APs could lead to enhanced clinical trial accrual, conduct, and protocol development.
Methods: A nationwide survey addressing attitudes, beliefs, and roles of APs regarding clinical research was distributed by the Association of Community Cancer Centers (ACCC) and Harborside in early 2020.
Results: 408 oncology APs completed the survey. Thirty-five percent practice in an academic setting and 62% in the community. Nearly all respondents believe clinical trials are important to improve care, and over 90% report clinical trials are available at their practice. About 80% report being comfortable discussing the topic of clinical trials with patients and are involved in the care of trial participants. Sixty percent are comfortable discussing available trials, and 38% routinely explore available trials with patients. While 70% report approaching eligible patients about trials, only 20% report doing so "a great deal" or "a lot." Ninety percent report that APs should play a role in clinical research, and 73% want to be more involved. Barriers identified to greater AP clinical trial involvement include lack of time, inadequate awareness of trial specifics, and a lack of a formal role in protocol development and leadership.
Conclusions: Advanced practitioners are engaged and interested in clinical trials and believe clinical research is important to improve cancer care. Multidisciplinary team integration, trials-related education, and policy change are needed to employ APs to their full potential within cancer clinical trials.
{"title":"Role of Oncology Advanced Practitioners to Enhance Clinical Research.","authors":"Christa Braun-Inglis, Leigh M Boehmer, Laura J Zitella, Brianna Hoffner, Yurii B Shvetsov, Jeffrey L Berenberg, Randall A Oyer, Al B Benson","doi":"10.6004/jadpro.2022.13.2.2","DOIUrl":"https://doi.org/10.6004/jadpro.2022.13.2.2","url":null,"abstract":"<p><strong>Background: </strong>Oncology advanced practitioners (APs), including nurse practitioners, clinical nurse specialists, physician assistants, and clinical pharmacists contribute significantly to quality cancer care. Advanced practitioners enhance value across the spectrum of cancer care. Research is an underdeveloped component of quality care, as well as an underdeveloped component of AP practice. Understanding research-related attitudes and roles of APs could lead to enhanced clinical trial accrual, conduct, and protocol development.</p><p><strong>Methods: </strong>A nationwide survey addressing attitudes, beliefs, and roles of APs regarding clinical research was distributed by the Association of Community Cancer Centers (ACCC) and Harborside in early 2020.</p><p><strong>Results: </strong>408 oncology APs completed the survey. Thirty-five percent practice in an academic setting and 62% in the community. Nearly all respondents believe clinical trials are important to improve care, and over 90% report clinical trials are available at their practice. About 80% report being comfortable discussing the topic of clinical trials with patients and are involved in the care of trial participants. Sixty percent are comfortable discussing available trials, and 38% routinely explore available trials with patients. While 70% report approaching eligible patients about trials, only 20% report doing so \"a great deal\" or \"a lot.\" Ninety percent report that APs should play a role in clinical research, and 73% want to be more involved. Barriers identified to greater AP clinical trial involvement include lack of time, inadequate awareness of trial specifics, and a lack of a formal role in protocol development and leadership.</p><p><strong>Conclusions: </strong>Advanced practitioners are engaged and interested in clinical trials and believe clinical research is important to improve cancer care. Multidisciplinary team integration, trials-related education, and policy change are needed to employ APs to their full potential within cancer clinical trials.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"13 2","pages":"107-119"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138465273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.6004/jadpro.2022.13.2.10
Kathryn T. Maples, PharmD, BCOP
This supplement to JADPRO provides an overview of several abstracts that were presented at the 2021 ASH Annual Meeting, along with expert commentary that aims to contextualize the information presented at ASH for the advanced practitioner. Kathryn T. Maples, PharmD, BCOP, of Emory University, evaluates data on antibody therapy, which has become a critical component in the treatment of multiple myeloma. Dr. Maples reviews outcomes of multiple myeloma patients after progressing on a bispecific antibody and the efficacy and safety profiles of two BCMA- and CD3-targeting bispecific antibodies, elranatamab and teclistamab.
{"title":"ASH Highlights and Commentary: Multiple Myeloma","authors":"Kathryn T. Maples, PharmD, BCOP","doi":"10.6004/jadpro.2022.13.2.10","DOIUrl":"https://doi.org/10.6004/jadpro.2022.13.2.10","url":null,"abstract":"This supplement to JADPRO provides an overview of several abstracts that were presented at the 2021 ASH Annual Meeting, along with expert commentary that aims to contextualize the information presented at ASH for the advanced practitioner. Kathryn T. Maples, PharmD, BCOP, of Emory University, evaluates data on antibody therapy, which has become a critical component in the treatment of multiple myeloma. Dr. Maples reviews outcomes of multiple myeloma patients after progressing on a bispecific antibody and the efficacy and safety profiles of two BCMA- and CD3-targeting bispecific antibodies, elranatamab and teclistamab.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"13 1","pages":"7 - 13"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44069147","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 : 2021-11-01DOI: 10.6004/jadpro.2021.12.8.8
Abstracts from JADPRO Live 2021
摘要来自JADPRO Live 2021
{"title":"Abstracts From JADPRO Live 2021","authors":"","doi":"10.6004/jadpro.2021.12.8.8","DOIUrl":"https://doi.org/10.6004/jadpro.2021.12.8.8","url":null,"abstract":"Abstracts from JADPRO Live 2021","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45918795","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 : 2021-11-01DOI: 10.6004/jadpro.2021.12.8.9
Kristi Orbaugh, RN, MSN, RNP, AOCN, Val R. Adams, PharmD, FCCP, BCOP, FHOPA, Theresa W. Gillespie, PhD, MA, RN, FAAN
Cyclin-dependent kinase (CDK) 4/6 inhibitors are revolutionizing care for patients with advanced and metastatic hormone receptor–positive (HR+) and human epidermal growth factor receptor 2–negative (HER2–) breast cancer. These oral agents, often combined with other hormone-based therapy, have demonstrated considerable success in clinical trials and are used widely in oncology practices. CDK4/6 inhibitors are also being investigated for the treatment of early stage HR+, HER2– breast cancer. The addition of abemaciclib to adjuvant endocrine therapy improved invasive disease-free survival and distant relapse-free survival compared with endocrine therapy alone in patients with HR+, HER2–, node-positive, high-risk early breast cancer, and is now FDA-approved as adjuvant treatment in this setting. Here we review recent clinical data supporting the use of CDK4/6 inhibitors in both early and metastatic breast cancer. In addition, an expert faculty panel will discuss practical strategies to promote and improve adherence and side effect management in patients being treated with oral CDK4/6 inhibitors.
{"title":"CDK4/6 Inhibitors: Paving the Way for HR-Positive, HER2-Negative Early Breast Cancer","authors":"Kristi Orbaugh, RN, MSN, RNP, AOCN, Val R. Adams, PharmD, FCCP, BCOP, FHOPA, Theresa W. Gillespie, PhD, MA, RN, FAAN","doi":"10.6004/jadpro.2021.12.8.9","DOIUrl":"https://doi.org/10.6004/jadpro.2021.12.8.9","url":null,"abstract":"Cyclin-dependent kinase (CDK) 4/6 inhibitors are revolutionizing care for patients with advanced and metastatic hormone receptor–positive (HR+) and human epidermal growth factor receptor 2–negative (HER2–) breast cancer. These oral agents, often combined with other hormone-based therapy, have demonstrated considerable success in clinical trials and are used widely in oncology practices. CDK4/6 inhibitors are also being investigated for the treatment of early stage HR+, HER2– breast cancer. The addition of abemaciclib to adjuvant endocrine therapy improved invasive disease-free survival and distant relapse-free survival compared with endocrine therapy alone in patients with HR+, HER2–, node-positive, high-risk early breast cancer, and is now FDA-approved as adjuvant treatment in this setting. Here we review recent clinical data supporting the use of CDK4/6 inhibitors in both early and metastatic breast cancer. In addition, an expert faculty panel will discuss practical strategies to promote and improve adherence and side effect management in patients being treated with oral CDK4/6 inhibitors.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43704771","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 : 2021-11-01DOI: 10.6004/jadpro.2021.12.8.4
A. Clemmons, A. Gandhi, A. Clarke, S. Jiménez, Thuy T. Le, Germame Ajebo
Chemotherapeutic agents and radiation therapy are associated with numerous potential adverse events (AEs). Many of these common AEs, namely chemotherapy- or radiation-induced nausea and vomiting, hypersensitivity reactions, and edema, can lead to deleterious outcomes (such as treatment nonadherence or cessation, or poor clinical outcomes) if not prevented appropriately. The occurrence and severity of these AEs can be prevented with the correct prescribing of prophylactic medications, often called “premedications.” The advanced practitioner in hematology/oncology should have a good understanding of which chemotherapeutic agents are known to place patients at risk for these adverse events as well as be able to determine appropriate prophylactic medications to employ in the prevention of these adverse events. While several guidelines and literature exist regarding best practices for prophylaxis strategies, differences among guidelines and quality of data should be explored in order to accurately implement patient-specific recommendations. Herein, we review the existing literature for prophylaxis and summarize best practices
{"title":"Premedications for Cancer Therapies: A Primer for the Hematology/Oncology Provider","authors":"A. Clemmons, A. Gandhi, A. Clarke, S. Jiménez, Thuy T. Le, Germame Ajebo","doi":"10.6004/jadpro.2021.12.8.4","DOIUrl":"https://doi.org/10.6004/jadpro.2021.12.8.4","url":null,"abstract":"Chemotherapeutic agents and radiation therapy are associated with numerous potential adverse events (AEs). Many of these common AEs, namely chemotherapy- or radiation-induced nausea and vomiting, hypersensitivity reactions, and edema, can lead to deleterious outcomes (such as treatment nonadherence or cessation, or poor clinical outcomes) if not prevented appropriately. The occurrence and severity of these AEs can be prevented with the correct prescribing of prophylactic medications, often called “premedications.” The advanced practitioner in hematology/oncology should have a good understanding of which chemotherapeutic agents are known to place patients at risk for these adverse events as well as be able to determine appropriate prophylactic medications to employ in the prevention of these adverse events. While several guidelines and literature exist regarding best practices for prophylaxis strategies, differences among guidelines and quality of data should be explored in order to accurately implement patient-specific recommendations. Herein, we review the existing literature for prophylaxis and summarize best practices","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"810 - 832"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47989271","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 : 2021-11-01DOI: 10.6004/jadpro.2021.12.8.6
Jennifer L. Spicer
Abstract Retroperitoneal liposarcomas (RLPS) are rare tumors that have variable clinical behavior and complex treatment strategies based on presentation, histopathology, and genomics. Early identification is critical, and complete surgical resection remains the primary treatment, although chemotherapy and radiation are used on individual bases. Presenting symptoms are often nonspecific; therefore, a high degree of suspicion is essential for early diagnosis. In this report, the management of a 37-year-old otherwise healthy male with a large RLPS causing right groin/testicular pain is presented. After three evaluations in the emergency department, the patient was diagnosed and received two cycles of doxorubicin/ifosfamide/mesna (AIM) neoadjuvant chemotherapy. His physical exam on presentation for second opinion demonstrated a large palpable abdominal mass and fullness around the right spermatic cord. There was no appreciable change in tumor size or distant metastases on repeat scanning. Given some obstructive symptoms, a multidisciplinary team advised neoadjuvant radiation followed by radical resection of RLPS. Final pathology demonstrated a 31-cm grade II well-differentiated (WD) liposarcoma with low-grade dedifferentiation. Scattered foci of microscopic positive WD margins were noted, and the remainder of margins were negative. Genomic evaluation showed amplification of CDK4, MDM2, and FRS2. A concise literature review of common presentations, histopathology, genomics, and treatment information is discussed herein. Thorough physical exams, attention to subtle findings, appropriate medical imaging studies, and a high index of suspicion when evaluating vague symptomatology can lead to earlier diagnosis and treatment of RLPS, and ultimately better patient outcomes.
{"title":"Retroperitoneal Liposarcoma: An Unusual Presentation of a Rare Cancer","authors":"Jennifer L. Spicer","doi":"10.6004/jadpro.2021.12.8.6","DOIUrl":"https://doi.org/10.6004/jadpro.2021.12.8.6","url":null,"abstract":"Abstract Retroperitoneal liposarcomas (RLPS) are rare tumors that have variable clinical behavior and complex treatment strategies based on presentation, histopathology, and genomics. Early identification is critical, and complete surgical resection remains the primary treatment, although chemotherapy and radiation are used on individual bases. Presenting symptoms are often nonspecific; therefore, a high degree of suspicion is essential for early diagnosis. In this report, the management of a 37-year-old otherwise healthy male with a large RLPS causing right groin/testicular pain is presented. After three evaluations in the emergency department, the patient was diagnosed and received two cycles of doxorubicin/ifosfamide/mesna (AIM) neoadjuvant chemotherapy. His physical exam on presentation for second opinion demonstrated a large palpable abdominal mass and fullness around the right spermatic cord. There was no appreciable change in tumor size or distant metastases on repeat scanning. Given some obstructive symptoms, a multidisciplinary team advised neoadjuvant radiation followed by radical resection of RLPS. Final pathology demonstrated a 31-cm grade II well-differentiated (WD) liposarcoma with low-grade dedifferentiation. Scattered foci of microscopic positive WD margins were noted, and the remainder of margins were negative. Genomic evaluation showed amplification of CDK4, MDM2, and FRS2. A concise literature review of common presentations, histopathology, genomics, and treatment information is discussed herein. Thorough physical exams, attention to subtle findings, appropriate medical imaging studies, and a high index of suspicion when evaluating vague symptomatology can lead to earlier diagnosis and treatment of RLPS, and ultimately better patient outcomes.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"12 1","pages":"854 - 862"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46157620","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 : 2021-11-01DOI: 10.6004/jadpro.2021.12.8.2
Linda Baer, Lauren Brister, Susan R. Mazanec
Background: Survivor recovery from hematopoietic cell transplantation (HCT) is long term, with significant physical and psychological morbidities that impact quality of life and reentry into personal and social lives. The optimal timing of when and how to deliver comprehensive HCT survivorship care is not well defined. Purpose: The purpose of this study was to design, implement, and evaluate an advanced practitioner (AP)-led pilot survivorship clinic incorporating an individual and group format for patients post HCT at the 1-year transition period. Methods: A survey assessing physical, social, emotional, and spiritual needs and concerns was mailed to a sample of patients who underwent HCT between 2009 and 2014. This phase 1 survey was utilized in the phase 2 design of an AP-led pilot survivorship clinic for patients post allogeneic HCT. A total of 15 patients were approached, out of which 7 enrolled over a 12-month period in the pilot survivorship clinic. Results: The needs assessment survey noted the most prevalent moderate to high concerns were in the emotional domain, with 52% of respondents identifying fear of cancer returning and new cancer developing. The pilot survivorship clinic incorporating a group visit format with multiple sessions was not feasible for both patients and APs within the context of a small- to medium-sized HCT program. Conclusion: The needs assessment survey underscored the importance of addressing all four quality of life domains in cancer survivors. A hybrid survivorship clinic with one comprehensive group visit may be beneficial for HCT survivors at the 1-year transition for small- to medium-sized HCT programs.
{"title":"Development and Implementation of an Advanced Practitioner–Led Survivorship Clinic for Patients Status Post Allogeneic Transplant","authors":"Linda Baer, Lauren Brister, Susan R. Mazanec","doi":"10.6004/jadpro.2021.12.8.2","DOIUrl":"https://doi.org/10.6004/jadpro.2021.12.8.2","url":null,"abstract":"Background: Survivor recovery from hematopoietic cell transplantation (HCT) is long term, with significant physical and psychological morbidities that impact quality of life and reentry into personal and social lives. The optimal timing of when and how to deliver comprehensive HCT survivorship care is not well defined. Purpose: The purpose of this study was to design, implement, and evaluate an advanced practitioner (AP)-led pilot survivorship clinic incorporating an individual and group format for patients post HCT at the 1-year transition period. Methods: A survey assessing physical, social, emotional, and spiritual needs and concerns was mailed to a sample of patients who underwent HCT between 2009 and 2014. This phase 1 survey was utilized in the phase 2 design of an AP-led pilot survivorship clinic for patients post allogeneic HCT. A total of 15 patients were approached, out of which 7 enrolled over a 12-month period in the pilot survivorship clinic. Results: The needs assessment survey noted the most prevalent moderate to high concerns were in the emotional domain, with 52% of respondents identifying fear of cancer returning and new cancer developing. The pilot survivorship clinic incorporating a group visit format with multiple sessions was not feasible for both patients and APs within the context of a small- to medium-sized HCT program. Conclusion: The needs assessment survey underscored the importance of addressing all four quality of life domains in cancer survivors. A hybrid survivorship clinic with one comprehensive group visit may be beneficial for HCT survivors at the 1-year transition for small- to medium-sized HCT programs.","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"12 1","pages":"775 - 783"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44406852","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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