Journal of the advanced practitioner in oncology最新文献

Once an individual has been identified as a carrier of an inherited cancer-predisposing gene or pathogenic germline variant (PGV), there are measures that have been proven to prevent and diagnose the associated cancers at an earlier, more curable stage. Consequently, patients who are offered and undergo testing are afforded opportunities and health-care information that profoundly affect their lives and the lives of their family members who choose to be tested as well. For years, the debate over the controversial topic of whether all patients should be offered germline testing for cancer-predisposing PGVs centered around questions of the analytical sensitivity of the assays (i.e., the ability of the test to correctly identify those who carry a PGV), legal implications for those identified as PGV carriers, cost to the health-care system, and the uncertain management implications of test results. Currently, the standard of care is to offer testing to individuals where the anticipated benefits of testing outweigh the harms. Here, the ethical question of whether all patients have the right to testing for PGVs is considered.

Background: Advanced practice providers (APPs) who care for patients with hematologic malignancies perform bone marrow aspiration and biopsies (BMBXs). Invasive bedside procedures are often taught through the observational training method, which can lead to inconsistencies.

Problem: The purpose of this project was to create and evaluate a standardized educational curriculum incorporating simulation with a task trainer for bone marrow transplant (BMT) APPs. The project aimed to reduce BMBX incident reporting events, improve BMBX knowledge, and increase APP self-reported confidence.

Methods: Pre- and post-test surveys were utilized for knowledge assessment of BMBX procedures and specimen allocation. Program delivery occurred on five occasions to accommodate the needs of the team. Each program was delivered over 3 hours and included an educational Microsoft PowerPoint and three breakout sessions: BMBX kit review; simulation on task trainer; and review of BMBX specimen collection procedures. Knowledge assessment surveys were compared through descriptive and statistical analysis.

Results: BMBX incident reporting events decreased from 1.92 events per month pre-implementation to 1.2 events per month post-implementation. Overall, BMBX knowledge increased from 41.02% on pre-test surveys to 65.72% on post-test surveys. Participant self-reported confidence improved by a mean difference of -1.85 based on a 5-point Likert scale, t(12) = -1.85 (p ≤ .0001, 95% confidence interval = -2.49 to -1.2).

Implications: This project suggests that the use of simulation with task trainers is beneficial when paired with a standardized educational curriculum. Simulation training for APPs who perform BMBX improves procedural knowledge, increases self-reported confidence, and can reduce incident reporting events.

In the randomized phase II DREAMM-2 study, single-agent belantamab mafodotin demonstrated deep and durable responses and a manageable safety profile in triple-class refractory relapsed/refractory multiple myeloma (RRMM). We present patient-reported outcomes (PROs) from this study for patients treated with the approved dose of belantamab mafodotin (2.5 mg/kg q3w). Disease and treatment-related symptoms, health-related quality of life (HRQOL), functioning, and patient-reported ocular changes were assessed using questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life questionnaires EORTC-QLQ-C30 and EORTC-QLQ-MY20, Ocular Surface Disease Index [OSDI], and the National Eye Institute Visual Functioning Questionnaire 25 [NEI VFQ-25]) at baseline, during treatment (every 3 or 6 weeks), and at the end of treatment (EOT). Eye examinations were conducted at baseline, prior to each treatment cycle, and at EOT. Patients reported ocular symptoms in the OSDI and NEI VFQ-25 questionnaires, with the median time to worst severity of 45 to 64 days depending on symptoms considered. Some limitations in driving and reading were reported. Ocular symptoms were improved and median time to recovery was 23.5 to 44.0 days. EORTC-QLQ-C30 data suggest core MM symptoms (including fatigue and pain), overall HRQOL, and patient functioning were maintained while patients continued belantamab mafodotin treatment, even if meaningful worsening of vision-related symptoms occurred. These PRO results, together with the clinical efficacy of belantamab mafodotin, support its use in patients with RRMM and further evaluation of its use at earlier lines of therapy.

Gastrointestinal stromal tumors (GISTs) are considered rare, but they are one of the most common malignant mesenchymal tumors within the gastrointestinal tract, affecting 4,000 to 6,000 adults in the United States each year. Because gastrointestinal bleeding is often the initial symptom, a thorough and timely diagnostic workup is imperative to accurately diagnose a potentially deadly tumor. Endoscopic ultrasound is helpful when working through a differential diagnosis of subepithelial lesions and can help identify which mucosal layer the lesion originates from, as well as the density of the lesion; however, surgical resection is the standard of care for the treatment of a resectable nonmetastatic GIST. For recurrent GISTs, metastatic disease, or GISTs not amendable to resection, tyrosine kinase inhibitors are frequently used, with imatinib being used in the first-line setting. A multimodal treatment approach is often necessary to increase the chances of a permanent cure.

Pancreatic cancer is the third leading cause of cancer deaths in the United States. It has a 95% mortality rate within 5 years of the initial diagnosis. Pancreatic ductal adenocarcinoma is the most commonly diagnosed histotype. The average age at diagnosis is 70 years. Familial forms of pancreatic cancer have been associated with pathogenic variants in predisposing genes, including ATM, BRCA1, BRCA2, PALB2, CDKN2A, STK11, MLH1, and MSH2. Collecting information on the patient's family history may serve as a primary tool to screen an individual's risk for familial pancreatic cancer. More advanced screening options for individuals at risk include endoscopic ultrasonography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Due to pancreatic cancer's high mortality rate, routine screening of individuals at risk for developing familial pancreatic cancer may result in early diagnosis and improved survivability. This review aims to characterize the genetic risk factors associated with pancreatic cancer and recognize available screening options for at-risk individuals.

Cyclophosphamide remains a critical component to haploidentical transplant conditioning regimens. Post-transplant cyclophosphamide (PTCy) emerged as an effective component of graft-vs.-host disease (GVHD) prophylaxis in the nonmyeloablative haploidentical bone marrow transplant setting. The relative ease of administration compared with ex vivo manipulations and efficacy in reducing GVHD has led to increasing PTCy use in transplant centers around the world. The role of PTCy has expanded to haploidentical transplantation with myeloablative conditioning regimens and peripheral blood progenitor cells as the donor source. Moreover, encouraging results in GVHD management have been shown with the use of PTCy alone or in combination with other immunosuppressives in the human leukocyte antigen-matched donor setting. The toxicity profile of cyclophosphamide varies extensively depending on dose, duration, overall drug exposure, and, potentially, pharmacogenetics. This review highlights the pharmacology, pharmacokinetics, and toxic effects of cyclophosphamide and offers practical guidance for clinical application in the post-transplant setting. We summarize data on the management of high-dose cyclophosphamide toxicities and provide insights into the pharmacogenetic implications on drug efficacy and safety data.

Background: Oncology patients have tremendous symptom burden both physically and emotionally. Palliative care (PC) improves quality of life and prevents suffering. Advance care planning (ACP) empowers patients to articulate goals of their care. New guidelines call for palliative care to be provided and chemotherapy avoided the last 2 weeks of life. The American Society of Clinical Oncology (ASCO) recommends integrating palliative care within the oncology setting to achieve these outcomes. However, the best mode to provide this care remains unclear. A nurse practitioner/physician assistant (NP/PA)-based model from within the oncology clinic is a potential option.

Methods: A program evaluation was done to determine the effectiveness of the "My Choices, My Wishes" NP/PA-led program.

Results: From 2012 to 2018, the number of patients receiving PC/ACP visits increased from 2.6% to 19.4%. The percentage of patients receiving chemotherapy in the last 14 days of life decreased from 12.5% to 7.14%. The number of advance care directives completed increased from 17.5% to 37.5%.

Conclusion: This program was an effective way to provide PC/ACP for oncology patients. We still need to understand why patients pursue chemotherapy at the end of life. It is necessary to improve our communication techniques with patients and families in order to guarantee high-quality, high-value care.