Journal of the advanced practitioner in oncology最新文献

Background: Patients on clinical trials experience numerous quality of life (QOL) concerns, including those associated with advancing disease. This pilot project tested the feasibility and initial outcomes of an advanced practice registered nurse (APRN)-led intervention for patients with gastrointestinal (GI) tumors transitioning after completing a phase I trial.

Objectives: The objectives were to (1) Develop the "Transitions" care plan intervention based on prior research to support patient QOL including symptom management, psychosocial and spiritual support, and care after trial completion; (2) Test the feasibility of the intervention in a sample of patients with GI tumors; and (3) Evaluate the impact of the Transitions care plan intervention on improved care and QOL.

Methods: A single-group, convenience sample of patients with GI tumors completing phase I clinical trials was accrued at a National Cancer Institute-designated Comprehensive Cancer Center in the western US. Patients completed questionnaires at baseline, 3 months, and 6 months. Interviews were conducted at 3 months for further understanding of patient needs. A Transitions care plan for the patient was developed by the APRN in collaboration with the patient and medical oncologist. Chart audits were conducted to capture supportive services referrals and completions. Key variables included domains of QOL, distress, and use of supportive care services.

Results: Patients (N = 37) had significant needs for support across all QOL domains. The Transitions care plan model was valuable in assessing QOL needs, facilitating patients' understanding of disease status, and providing access to supportive care services.

Implications: APRNs can develop a model of care to support patients completing clinical trials.

Background: Fatigue is a prevalent symptom among cancer patients, even after completing treatment. The National Comprehensive Cancer Network Guidelines recommend incorporating physical activity as a strategy to combat cancer-related fatigue.

Objectives: The goal was to develop and implement an evidence-based translational research quality improvement project to improve fatigue in patients starting oral cancer treatment.

Methods: Outpatient oncology nurses (registered nurses and licensed practical nurses) responsible for educating patients starting treatment for cancer were provided education about the walking program. The information was incorporated into education for patients starting oral chemotherapy. Nursing knowledge, beliefs, and attitudes were evaluated before and after the subject-intensive education. Patient study participants were provided with pedometers and completed the Brief Fatigue Inventory and a survey about their beliefs and attitudes before and after implementing the walking program.

Outcomes: Fatigue scores showed a slight decrease post intervention but not a statistically significant difference. Advanced-stage cancer showed a near-significant relationship with increased fatigue levels. Nursing knowledge improved by 13%, and nurses reported increased confidence in six of nine topics. Nursing barriers to education shifted from personal comprehension to a need for resources.

Recommendations: Patients diagnosed with advanced-stage cancer should receive timely fatigue prevention and management education. In addition, educating nurses to address this knowledge deficit is imperative. The information gathered from this project presents an opportunity for further research using a walking plan and nursing education to improve current interventions used to reduce cancer-related fatigue.

In developed countries, the lifetime risk of developing breast cancer among women is 11%. Therefore, screening asymptomatic women for breast cancer is widely accepted as preventive health care. Mammography is the primary imaging modality for the detection of breast abnormalities. Digital breast imaging detects 90% of symptomatic or asymptomatic cancers. The sensitivity, specificity, and negative predictive values of this modality are each about 90%. As a standard of care, the Breast Imaging Reporting and Data System (BI-RADS) is used to quantify increasing degrees of positive predictive values in mammography. This can help clinicians identify abnormalities that may need additional imaging studies or biopsies. To reduce false-negative breast cancer screening results, efforts have focused on increasing the sensitivity of mammography or supplementing it with ultrasound or MRI. Advanced practitioners are strategically positioned to detect incongruities between imaging techniques and physical assessments. With increased knowledge, advanced practitioners are better prepared for shared decision-making discussions regarding follow-up imaging procedures. The case report in this article describes a 10-year discordance of imaging that proved to be high-grade ductal carcinoma in situ (DCIS) and offers a hypothesis of the physiology to explain this discordance. A better understanding of breast imaging will enable the advanced practitioner to recommend the most appropriate follow-up study for patients.

Adoptive cell therapy with tumor-infiltrating lymphocytes (TILs) was recently approved for patients with advanced melanoma (metastatic or unresectable) previously treated with immune checkpoint inhibitors and BRAF/MEK targeted therapies (where appropriate). Tumor-infiltrating lymphocytes isolated from patient-derived tumor tissues enter the tumor microenvironment and recognize tumor-specific antigens, leading to the destruction of tumor cells. The multistep TIL cell therapy journey is led by a multidisciplinary health care team. Patients selected for TIL cell therapy undergo tumor tissue procurement for TIL generation, followed by preparative lymphodepletion before receiving a single-dose infusion of TIL and a short course of high-dose interleukin-2. Successful implementation of TIL cell therapy requires well-established procedures and workflows to select and screen patients, procure tumor tissue, administer TIL cell therapy, and monitor patients during treatment and after discharge. The advanced practice provider plays a central role in a patient's TIL treatment journey by planning and coordinating care across the health-care system, educating patients and staff, and providing direct and supportive patient care. Here, we review the treatment landscape for advanced melanoma and clinical data supporting TIL cell therapy. We also provide guidance related to patient selection, tumor tissue procurement, TIL cell therapy regimen, safety monitoring, symptom management, and post-discharge follow-up.

Background: Advance care planning (ACP) is an important aspect of care for the oncology patient population, leading to improved outcomes, less aggressive care toward the end of life, and reduced costs.

Purpose: The objective of this project was to increase ACP discussions and easily accessible documentation for patients with hematologic malignancies at increased risk of mortality based on a mortality prediction model. Additionally, the project aimed to avoid increasing perceived provider disruption to workflow.

Methods: A validated mortality prediction model utilized objective patient data to predict inpatient mortality. Providers caring for at-risk patients were notified, asked to consider an ACP discussion, and instructed on consistent and easily accessible ACP documentation. Retrospective chart reviews evaluated whether ACP discussions were documented and whether they used the suggested bookend format. After 4 months, a provider education session reinforced the importance of ACP and included a demonstration of the documentation process. After another 4 months, chart reviews assessed ACP documentation rates. Rates were compared before and after education to determine the effectiveness of the implementation. A provider survey assessed perceived disruption to workflow.

Results: Fifteen at-risk patients (eight before the education session and seven after the education session) were identified over 8 months. Three of eight patients (37.5%) had a documented ACP before the education session, and three of seven patients (42.9%) had a documented ACP discussion after the education session, which was not statistically significant. Most providers (83%) did not find the ACP implementation disruptive to workflow. Advance care planning documentation did not significantly increase after a provider education session, possibly due to low numbers of identified patients. However, 43% of at-risk patients after the education session had a documented ACP conversation, and most providers found bookends an efficient way to document ACP.

Conclusion: The survey findings suggest that the project received provider buy-in and that continuing the bookend documentation expectation is reasonable.

Advanced practice providers (APPs) are key members of the gastrointestinal (GI) surgical oncology team. For newly hired APPs, a comprehensive onboarding program provides guidance to help improve the quality of care provided to patients, as well as APP job satisfaction and retention. There is currently limited information on the components of a structured onboarding program for APPs in GI surgical oncology. The GI surgical oncology APP team identified the need to develop a standardized process with established competencies, education, evaluation, and mentorship. The development of the GI Surgical Oncology APP Onboarding Tool (GISOAPP-OT) provides a comprehensive, 12-month onboarding process that can be adapted for any surgical specialty to standardize and augment training in a complex cancer care environment.

Electrolyte imbalances are common in patients with cancer. They may arise from tumor- or treatment-related factors or other causes. These imbalances can lead to life-threatening oncologic emergencies, such as tumor lysis syndrome, syndrome of inappropriate antidiuretic hormone secretion, and hypercalcemia of malignancy. Early recognition and management are crucial to prevent serious complications and improve patient outcomes. Advanced practice providers must be aware of the symptoms in order to incorporate preventive measures and manage these abnormalities appropriately. This article will review the current evidence-based literature on electrolyte abnormalities and emergencies associated with electrolytes in the care of oncology patients.

Tongue cancer treatment often involves glossectomy and flap reconstruction. Since the tongue plays a vital role in swallowing, chewing, speaking, airway protection, and taste, it also plays a major role in the patient's quality of life (QOL) after reconstruction. Therefore, the flap that best preserves QOL should be determined. A literature review was conducted using PubMed, Scopus, and Ovid MEDLINE, with a total of 446 articles retrieved. Four studies were included in this integrative review, which all utilized the University of Washington Quality of Life questionnaire to assess QOL in tongue cancer patients post-glossectomy and flap reconstruction. The articles specifically compared radial forearm free flap to pectoralis major myocutaneous flap, submental island pedicled flap, anterolateral thigh flap, and lateral upper forearm flap. Based on the included articles, no flap significantly preserved QOL. However, a certain flap may be more suitable for a patient based on the patient's preferences, lifestyle, health status, and goals. Therefore, it is important for providers to complete a thorough history and assessment prior to surgery so that the flap chosen upholds the patient's goals and preserves overall QOL.