Journal of the advanced practitioner in oncology最新文献

Background: Adequate pain management continues to be an unmet need in patients with cancer. Pain is known to impact the quality of life. It is recommended that treatment plans include pharmacological and complementary non-pharmacological methods for managing pain. Music listening therapy is an evidence-based intervention used to manage acute and chronic pain in adult patients with cancer.

Methods: This evidence-based practice project applied the use of music therapy in adult patients with cancer experiencing moderate to severe pain despite current pharmacological treatment in a rural outpatient oncology clinic. Pre- and post-intervention pain scores were assessed using a numeric rating scale, and results were analyzed using a Wilcoxon signed-rank test.

Results: The results showed 83% of participants reported a reduction in pain intensity by at least one pain level after using music listening therapy. Additionally, 100% of participants expressed a willingness to continue music listening therapy at home as a self-guided technique to reduce pain severity.

Conclusion: The role of the advanced practice provider must include comprehensive pain management and pain monitoring to assess its impact on patient quality of life. Patients are more willing to perform complementary interventions that have minimal barriers to physical, economic, and environmental factors, particularly in rural settings where the lack of additional health resources is significant. Music listening therapy may be conducted in any environment with known positive impacts on acute and chronic pain. Therefore, music listening therapy is a viable non-pharmacological complementary intervention that should be included in the education provided to our patients in their fight against cancer.

Thrombocytopenia can be caused by various etiologies, one of which is immune-mediated destruction. Within the realm of immune thrombocytopenia, there can be multiple pathways and mechanisms that lead to platelet destruction. Finding the exact mechanism can be a crucial diagnostic step in deciding the most appropriate treatment of the platelet loss and in the therapeutic planning of a patient's comorbidities, especially in patients with malignancies. In this case report, we describe a patient with metastatic clear cell renal cell carcinoma who developed acute thrombocytopenia while preparing to initiate therapy for his malignancy.

Colorectal cancer (CRC) is a significant cause of morbidity and mortality, with incidence on the rise, particularly in younger adults. Surgery is a key treatment modality and often results in the construction of an ostomy, either temporary or permanent. This integrative review discusses psychosocial implications of ostomies in women with CRC. A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and PubMed. The search included articles published between January 1, 2012, and December 31, 2022. The search yielded 684 articles, with a total of six included in the final review. Articles were excluded for not being specific to CRC, not being specific to ostomates, lacking data specific to women, and focusing solely on sexual health. The main issues that emerged were the loss of bodily control, impaired social support and acceptance, social limitations, altered body image, and alterations in sense of self. This review found that factors such as time since surgery, age, relationship status, and cultural background may influence the degree of psychosocial impact of ostomies in women with CRC. Given these factors are substantial and multifaceted, future research should be directed at identifying the subset of women with ostomies as a result of CRC with high-risk demographics.

Purpose: The purpose of this quality improvement project was to evaluate the use of a posttransplant screening care guidelines template performed by advanced practice providers (APPs) that included standards of care and published recommendations from the American Society for Transplantation and Cellular Therapy (ASTCT) for adult allogeneic transplant patient survivors.

Methods: The theoretical framework used for this project was the Model for Improvement with the Plan-Do-Study-Act (PDSA) cycle process. A screening template was built to include institutional standards of care and recommendations from the ASTCT's guidelines within the electronic medical record system for APP use. Weekly chart reviews were performed for data extraction and assessment for APP documentation and completion of day +30 and day +100 posttransplant recommended screenings/testing. Data were documented and tracked utilizing Excel securely over a 3-month period.

Results: The APPs performed and documented the recommended screenings for 64% of patients at day +30 and for 80% of patients at day +100. Opportunities for unit and system improvements were identified to increase performance, expand utilization, allow clinicians to recognize complications earlier, and potentially improve patient outcomes.

Conclusion: This project addresses implications for APP care delivery and patient outcomes. Future project cycles' success will be ensured by utilizing the APP role at the maximum scope of practice.

Hematopoietic stem cell transplantation (HSCT) is an intensive treatment requiring the support of a caregiver. This role is a highly demanding responsibility, and caregivers often face distress. In a world that has become highly technological, the aim of this integrative review is to determine the availability and impact of remote interventions in reducing distress in caregivers of HSCT patients. A literature review was conducted using PubMed and Scopus databases. The search included articles published between January 1, 2013, and February 20, 2023. The search yielded 699 unique articles, of which four were included in the final review. The four included studies of the impact of remote interventions on distress or burden in caregivers of adult HSCT patients. Two organizing themes emerged: availability and impact. Availability encompassed intervention accessibility and delivery type while impact considered caregiver quality of life (QOL), mental health, and perceived usefulness. These themes were evaluated in the articles via a variety of validated assessment tools and structured interviews. Ultimately, this integrative review suggests that while remote interventions for caregivers of patients undergoing HSCT are relatively limited, initial studies are perceived as useful and are promising in their potential to improve caregiver QOL and mental health and reduce distress.

Introduction: The COVID-19 pandemic led to rapid changes in the delivery of oncology care. Studies examining the impact of the pandemic on the oncology workforce are largely limited to oncologists and nurses. This study was conducted to explore how the COVID-19 pandemic impacted the oncology physician assistant (PA).

Methods: A survey of oncology PAs was conducted in the fall of 2020. Multiple choice items and two open-ended questions explored how the COVID-19 pandemic may have impacted clinical practice. Burnout was assessed using the Maslach Burnout Inventory.

Results: Most participants worked in an academic center (63.7%), in medical oncology (73.3%), and in the outpatient setting (70.5%). Telemedicine was performed by 77.5% of PAs, and 34.7% of PAs reported being assigned to help cover other departments/specialties. Physician assistants performing telemedicine were found to have higher rates of burnout compared to those that did not perform telemedicine (47.3% vs. 15.6%; p = .0013). Surprisingly, burnout was significantly lower for PAs who were redeployed during the pandemic compared to those who were not (28.0% vs. 46.8%; p = .0285). There was no correlation in the rates of burnout based on changes in hours worked, base pay, bonus pay, continuing medical education funding, or working remotely.

Conclusion: The COVID-19 pandemic resulted in significant operational and workforce changes, which dramatically impacted the oncology PA. As the health-care landscape continues to adjust following the COVID-19 pandemic, future research should focus on the delivery of telemedicine to help identify opportunities to optimize this aspect of clinical practice and minimize the risk of burnout.

Chimeric antigen receptor (CAR) T-cell therapy has ushered in a transformative era in the management of relapsed/refractory hematologic malignancies. The extensive phase II trials targeting relapsed/refractory non-Hodgkin lymphoma, including diverse subtypes such as diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma, along with multiple myeloma and B-cell acute lymphoblastic leukemia, have culminated in the endorsement of various CAR T-cell products for these specific indications by the US Food and Drug Administration. Although CAR T-cell therapy has achieved remarkable success, it is important to recognize that this innovative approach often gives rise to notable toxicities and is frequently associated with a distinctive pattern of adverse effects. Advanced practice providers, including advanced practice nurses and physician associates, involved in the care of these patients should be able to recognize these toxicities and be versed in treatment strategies to mitigate their impact.

Background: Nurse practitioners (NPs) entering the malignant hematology specialty often lack hematology-specific knowledge needed for practice; many have reported they want and need more hematology education. Deficiencies in hematology education stem from the minimal amount of hematology content included in NP programs and during job orientation. Knowledge deficits among NPs are associated with unpreparedness to practice and feelings of anxiety, insecurity, inadequacy, and guilt. Self-efficacy (SE) is a correlate to NP knowledge acquisition and competency development.

Purpose: This was a process improvement effort to examine the impact of a malignant hematology education module on NP knowledge and SE to practice in malignant hematology.

Methods: A convenience sample of 11 NP participants were recruited during onboarding to a hematology department in a tertiary care cancer hospital in Southern California. Participants completed an online learning module containing education about hematological malignancies. A pretest and posttest design using questionnaires was employed for data collection. Knowledge and SE scores obtained before and after the intervention were compared to assess for improvement.

Results: Posttest NP knowledge scores increased by a mean of 2.4 points (20%; mean pretest: 7.1/12, posttest: 9.5/12), p < .05. Posttest scores for NP SE were similar to baseline (mean pretest: 32.6/40 points, posttest: 32.3/40), p > .05. Participants reported that the intervention was helpful in the onboarding process. Implications/Conclusion: The findings help establish the feasibility of a malignant hematology learning module in increasing knowledge for NPs during onboarding. Integrating an education module into NP job training may increase knowledge and preparedness to practice in malignant hematology.

Aplastic anemia (AA) is a bone marrow failure disorder resulting in peripheral pancytopenia and marrow hypoplasia. An alternative diagnosis of hypoplastic myelodysplastic syndrome (MDS) can overlap this diagnosis but is differentiated by the presence of dysplastic progenitor cells. Since AA can be characterized as an autoimmune disease directed against hematopoietic stem cells, its presence can potentially increase susceptibility to alternate malignancies. Hypoplastic MDS, however, can present itself in an extramedullary fashion solely or as a relapse of acute myeloid leukemia resulting in symptoms similar to those described in this case study. Solid tumor malignancies may also result in abnormal blood counts, creating a wide differential diagnosis. This manuscript presents a case of untreated AA in a patient presenting later with severe abdominal bloating.