Journal of the advanced practitioner in oncology最新文献

At JADPRO Live 2023 in Orlando, Lisa M. Holle, PharmD, BCOP, FHOPA, FISOPP, briefed advanced practitioners on key US Food and Drug Administration approvals from late 2022 to late 2023. Dr. Holle described indications, mechanisms of action, and monitoring and management of side effects of new therapies in solid malignancies.

At JADPRO Live 2023 in Orlando, Rebecca L. Rezac, PharmD, BCOP, summarized key information on US Food and Drug Administration approvals from late 2022 to late 2023. Dr. Rezac described indications, mechanisms of action, and monitoring and management of side effects of new therapies for hematologic malignancies.

At JADPRO Live 2023 in Orlando, presenters provided an overview of best practices in the diagnosis, classification, and management of patients with localized and metastatic prostate cancer. They covered selecting appropriate therapies based on patient clinical presentation and treatment goals, as well as managing side effects and interventions for modifiable health risks in patients with prostate cancer.

At JADPRO Live 2023, presenters discussed the implications of biomarker testing, pivotal clinical trials leading to recent FDA approvals, and evidence-based best practices for monitoring and managing adverse events associated with molecular targeted and combination therapies for patients with metastatic non-small cell lung cancer.

At JADPRO Live 2023, presenters discussed recent updates to clinical practice in metastatic HER2-positive metastatic breast cancer. During the session, they reviewed review recent FDA approvals, the clinical relevance of HER2-low status, and evidence-based practices for managing adverse events associated with novel HER2 agents.

There has been an increasing number of approvals for targeted therapies in oncology in the past decade, changing the treatment paradigm for many solid tumors and hematologic malignancies. At JADPRO Live 2023, presenters provided an in-depth review of cancer biomarkers, including testing methodology, recommended therapies, and how advanced practitioners can integrate results into clinical decision-making.

Background: Occupational exhaustion, or burnout, is characterized with three components: emotional exhaustion, depersonalization, and sense of decreased personal accomplishment. Advanced practice providers (APPs) in oncology care are at particular risk for burnout.

Methods: This was a prospective, comparative, descriptive study utilizing a convenience sample of oncology APPs who completed the Advanced Practice Provider Oncology Web Education Resource (AP-POWER; formerly Oncology Nurse Practitioner Web Education Resource, or ONc-PoWER), developed to provide educational content for new oncology APPs. The study purpose was to utilize the AP-POWER alumni to describe the level of burnout (Maslach Burnout Inventory) as well as resilience (Brief Resilience Scale) after at least 1 year in oncology practice, and to compare these scores according to the number of APP oncology practice years.

Results: Of the 133 questionnaires emailed, 30 were returned (22.6% response) and 27 completed (20.3%). Within the Maslach Burnout Inventory, the mean score of the emotional exhaustion subscale was 25.19 (standard deviation [SD] 12.74; high degree of occupational exhaustion), depersonalization 7.74 (SD 5.98; moderate degree), and personal achievement 31.85 (SD 6.20; low degree). The resilience scores had a mean of 22.52 (SD 3.37; normal range). Resiliency was positively associated with personal accomplishment. There was no difference in burnout among newer (< 3 years) and more experienced (> 3 years) oncology APPs.

Discussion: Oncology APPs report key indications of burnout, including a high degree of emotional exhaustion and moderate depersonalization, which was not mitigated through resiliency.

Conclusions/implications: The results are worrisome. Burnout scores for oncology APPs are high. Resiliency is present but is not protective for burnout. Strategies must be developed institutionally to support these key cancer care providers.

Infusion-related reactions (IRRs) are a recognized concern for chemotherapy, biologic agents, and newer immunotherapies. Antihistamines are frequently recommended to prevent or manage these reactions. For over 60 years, diphenhydramine has been the only H₁ antihistamine for intravenous (IV) administration. It has been considered the standard of care as part of premedication regimens to prevent IRRs associated with these therapies despite the lack of a US Food and Drug Administration (FDA)-approved indication and no evidence of efficacy data. Intravenous cetirizine was approved in 2019 for acute urticaria treatment, making it the only second-generation H₁ antihistamine that can be administered intravenously. Compared with diphenhydramine, cetirizine has an improved safety profile with less sedation, fewer contraindications, lower incidence of anticholinergic side effects, and minimal risk of adverse events in elderly patients. A head-to-head study demonstrated that IV cetirizine is as effective as IV diphenhydramine in reducing IRRs and may decrease chair time, treatment center visits, and the need for rescue medication. Over the past 3 decades, the FDA has addressed the issue of IRRs by mandating language regarding the requirement or recommendation for premedication in the label of over 50 FDA-approved infusion products. As more therapeutics have premedication required or recommended, IV cetirizine should be considered an antihistamine for preventing and treating IRRs. In this article, we describe a patient whose IRR was successfully managed with IV cetirizine and discuss first- vs. second-generation H₁ antihistamines and their use in treating and preventing IRRs.

Purpose: The purpose of this integrative literature review was to determine factors that increase the risk of immune checkpoint inhibitor (ICI)-related myocarditis in the cancer patient population.

Methods: A literature review was conducted using the following databases: PubMed, Scopus, and Cochrane Review. Dates searched were from inception through March 1, 2022. Inclusion criteria included English language, cancer patients receiving ICI treatment, and risk factors for myocarditis. Articles were excluded if they were a non-human study, duplicate, had an irrelevant title or content, or were a review or commentary.

Results: Patients with cancer who receive ICIs have an associated increased risk of myocarditis if they are older than 64 years, have a body mass index (BMI) greater than 28, and have a history of cardiovascular medication use.

Conclusions: Myocarditis remains a rare cardiovascular adverse effect of ICIs. However, the mortality risk among this subset of patients remains high. Additional prospective randomized-controlled trials would be beneficial to further determine a causal relationship between risk factors for ICI-related myocarditis. Risk stratification tools may allow oncology medical providers to identify patients at a higher risk of ICI-related myocarditis to increase earlier surveillance.