There is some low-level evidence to suggest that the use of medical marijuana or cannabinoids may reduce the common adverse events associated with chemotherapy treatment in patients with cancer, according to data presented in a poster at the Oncology Nursing Society’s 46th Annual Congress.

The results, according to study author Erica Walter, RN, OCN, show that alternative therapeutic options — such as medical marijuana or cannabinoids — may be useful in patients who fail to respond to conventional treatments that help in reducing chemotherapy-related adverse events.

“Our poster is a result of a lot of interesting questions from cancer patients and families asking our nurses and providers about using medical marijuana for treating the adverse events of their chemotherapy,” Walter, of the Lipson Cancer Institute at Rochester Regional Health System in New York, said during the presentation.

The most common adverse event, according to Walter, that patients with cancer experience while receiving chemotherapy include nausea and vomiting, decreased appetite, anxiety, and sleep disorders.

Using a PICO approach, the researchers aimed to answer if the use of medical marijuana or cannabinoids are an effective treatment option for reducing these common adverse events. They conducted a literature review of the Medline and CINAHL databases and identified six articles that included data from adults with cancer undergoing chemotherapy from 2012 to 2018.

A consensus from the six article reviews demonstrated that cannabinoids were superior to placebo in reducing chemotherapy-related adverse events and in general, similar to standard anti-emetics alone or in combination. There was low level evidence suggesting that cannabinoids were associated with the improvement of nausea and vomiting attributed to the chemotherapy. Moreover, anxiety and sleep problems improved, but were not considered statistically significant. The reviews also demonstrated that appetite in patients receiving chemotherapy slightly increased.

“Experts agree on medical marijuana's therapeutic potential but call for more expanded research into its beneficial properties and stricter production standards,” Walter said. “Medical marijuana and cannabinoids may help alleviate some of the common adverse events of chemotherapy, but it's unclear whether they're superior to traditional anti-emetics.”

There’s an increased risk of short-term adverse events such as psychoactive effects, decreased concentration and loss of balance that need to be considered for patient safety, according to Walter. Additionally, she said, providers should consider possible interactions with a patient’s current medications. 

“The choice for using cannabinoids should be tailored to each patient taking into account issues such as cost, regulatory policy and personal preference,” she said.

Walter concluded noting that further studies are needed to assess the potential use of medical marijuana and cannabinoids as well as to classify the effectiveness and the safety for each.

“Our unit will need to pursue educational opportunities on this subject as more of our patients are seeking out medical marijuana as a treatment option for their adverse events,” she said. “Understanding the potential use and risks will be important to ensure the best outcomes for our patients.”

Bellian L, Casselbury M, Davis L, et al. Medical Marijuana Use in Oncology Patients. Presented at: the Oncology Nursing Society 46th Annual Congress. April 20, 22, 27, 29, 2021.

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Data presented at the Oncology Nursing Society’s 46th Annual Congress demonstrates that there is low level evidence that suggests medical marijuana or cannabinoids may reduce chemotherapy-related adverse events in patients with cancer.

Medical Marijuana May Reduce Common Chemotherapy AEs; More Research Needed

Although nursing and pharmacy staff responded positively to a new Chemotherapy Education Policy mandating pre-treatment patient education and defining standards for the process, it failed to meet its goals of increasing the quality of that education and decreasing the instances of patients receiving education on the day of their first dose, according to a poster presentation at this year’s Oncology Nursing Society Annual Congress.

The researchers aimed to standardize and increase the quality of the pre-treatment chemotherapy education process and to decrease the amount of patients receiving “same day chemo teaches,” or learning about their treatment on the day of their first dose, to reduce patient anxiety and increase understanding.

“At our National Comprehensive Cancer Network (NCCN)-designated ambulatory oncology center, patients are educated about their treatment by both nurses and pharmacists,” said Martha Read, MSN, RN, OCN, of the Seattle Cancer Care Alliance, during the presentation. “There was a lack of consistency in the educational content covered, the materials that were given to the patient and when the education took place.”

To reach these goals, a chemotherapy education committee comprised of providers, pharmacists, nurses, supportive care and patient education services developed a policy to standardize the education process, with identified benchmarks. These changes defined standards for educational materials and acceptable online resources, educational content (common side effects, treatment schedule, supportive care, when to contact team), documentation and education scheduling of pre-treatment and a 3-day post-treatment follow up call from the clinic nurse.

After implementing the new education policy, the percentage of patients receiving chemotherapy education on the same day as their first day of treatment dropped from 33% to 28%. While the number went down, and nursing and pharmacy staff responded positively to the changes, Read explained, post-intervention, “same day chemo” teaches still happened between 41-48% of the time.

“Our next steps are to identify the barriers to providing pre-treatment chemotherapy education prior to the first day of treatment,” said Read. “And also, to provide additional education to reinforce the standards that were set in our policy.”

The researchers also plan to evaluate the implementation of the three-day follow up call obtaining patient feedback on the education experience.

Read M. Improving Chemotherapy Patient Education through Standardization: Does a Policy Help? Presented at: Oncology Nursing Society 46th Annual Congress; April 20, 22, 27, and 29, 2021. ePoster 1536. https://ons.confex.com/ons/2021/cp/eposterview.cgi?eposterid=1536

While staff at a NCCN-designated oncology center responded positively to a new Chemotherapy Education Policy, its implementation did not increase the quality of education or decrease the incidence of “same day chemo teaches”, according to data presented at the ONS Annual Congress.

Chemotherapy Education Policy Fails to Increase Education and Decrease ‘Same Day Chemo’ Teaching

A Disease-Specific Care (DSC) certification from The Joint Commission not only can improve care for patients with cancer, but can also elevate the role of clinical nurse specialists, according to a presentation at the Oncology Nursing Society’s 46th Annual Congress.

“Disease-specific care certification focuses to provide a framework work for continuous reliable care and gives proof your program meets standards and verifies improvement activity,” said Kathy Burns, MS, APRN-CNS, AGCNS-BC, of The Ohio State’s James Cancer Hospital.

The James Cancer Hospital is one of only 3 hospitals in the United States to receive DSC certification for acute leukemia.

“Basically, your program is doing what you are saying it's doing provides accountability decreases undesirable variations and care advances patient outcomes, endorses cultural excellence provides the community with a confidence that the program is providing the quality of care that it is marketing, and delivering objectives of the certification are a lasting commitment to Clinical Excellence for all of us,” Burns said.

Burns is also 1 of more than 72,000 clinical nurse specialists nationwide – a role that she says is vital in the healthcare arena.

“We drive practice change in the organization. advocate to improve patient outcomes mentor evidence-based practice projects, which I have to say is one of my favorites. we are required to take a course and [evidence-based practices] and then we are required to maintain those competencies. We collaborate on complex patient care issues with multidisciplinary teams throughout the system, promote standards and patient care and safety,” she said.

Clinical nurse specialists can also help their institutions achieve a DSC certification by recommending and implementing strategies to improve care and meet disease-specific indicators like:

Developing policies, procedures, results of tracers, and mock surveys to improve safety

Ensuring compliance with clinical practice and evidenced-based care

“Certification programs must demonstrate a systematic approach to care delivery and analysis,” Burns said. “Being at the table, we can help define strategies to improve quality.”

Burns K, Brown S. Disease Line Clinical Nurse Specialist: The Journey to Obtaining Disease-Specific Care Certification from The Joint Commission. Presented at: The Oncology Nursing Society 46th Annual Congress. April 20, 22, 27, and 29, 2021.

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A single-center program for enhancing patient-provider relationships was able to improve staff member’s understanding of adult education, and in turn, positively effect patient satisfaction scores over time, according to data presented in a poster at the Oncology Nursing Society’s 46th Annual Congress.

This program, developed for the Trinitas Comprehensive Cancer Center in Elizabeth, New Jersey, set out to educate nurses, medical assistants, receptionists, and secretarial staff about patient interactions and to assess their needs. The program will continue to be evaluated through attendance to the program and pre- and post-test intervention assessment; program effectiveness valuation will be conducted by patient-satisfaction surveys.

“In our post program [assessment], our staff showed a better understanding of what adult education is all about and how adults view and learn new knowledge,” Aida Brito, MSN, RN, OCN, lead study author, said in her presentation of the data.

The investigators set out to improve the patients experience based on existing data that indicate health care quality and patient satisfaction go hand in hand. The Ask Me 3 tool and the Oral Exchange Rating Tool, Part 3 were used to educate staff about patient interactions. Pre-program learning-needs assessments and tests were used to determine individual perceptions of the role they play in a patient-provider interaction. All staff then attended the program, and a post-test was given to assess understanding of the content.

Staff members included registered nurses, medical assistants, concierges, patient guides, and medical secretaries. A needs assessment showed that clinicians were interested in learning more about quality of life and critical lab values, symptom management and assessment, and ethical issues.

Themes emerging from the Ask Me 3 pre- and post-tests were education, listening, questioning, understanding, and advocacy. The oral exchange rating summary average scores improved from the pre-program assessment at 29 to 58.4 post-program. Brito pointed out that fewer participants were assessed in the post-program (22 vs 16) due to resignations and medical leave.

Patient satisfaction scores improved from the second quarter (Q2) of 2020 through the first quarter (Q1) of 2021 in areas of emotional support and respect for patient preferences. When asked the question: “How often did you have confidence and trust in the cancer treatment staff treating you?” patient satisfaction scores improved from 76.8% in Q2 2020 to 92.6% in Q1 2021. To the question: “How often did the cancer treatment staff treat you with courtesy and respect” scores improved from 89.3% in Q2 2020 to 93.5% in Q4 2020 but were at 89.3% again in Q1 2021. Scores to: “How often did you have enough input or say in your care at this facility?” scores went from 60.4% in Q2 2020 to 74.1% in Q1 2021.

“Once our patient-provider trusting relationship improves this will in turn enhance health care quality thus improving patient experience and satisfaction,” Brito said. “It is our hope that through proper staff education and the use of the Ask Me 3 communication tool, our cancer patient population will feel confident and supported throughout their cancer experience.”

Brito A, Fryar J, Blecher C. Cultivating a patient-provider relationship of trust while enhancing/improving patient experience and satisfaction. Presented at: Oncology Nursing Society 46th Annual Congress. April 20, 22, 27 & 29, 2021. Virtual.

A poster presentation from the Oncology Nursing Society’s 46th Annual Congress describes a single-center clinician education program aimed at improving patient satisfaction.

Cancer Center Seeks to Improve Patient Experience, Satisfaction Through Communication Education With Staff

A lifestyle medicine clinic led by an advanced practice nurse and a dietician helped patients with a history of cancer learn more about health behaviors to potentially improve outcomes, according to a virtual poster presentation at the Oncology Nursing Society Congress.

“An oncology advanced practice nurse and dietician-led lifestyle medicine clinic really complements the standard cancer follow-up visit by expanding upon evidence-based health behaviors counseling to empower patients and improve outcomes,” Loren Winters, MSN, ANP-BC, OCN, oncology nurse practitioner at Massachusetts General Hospital Cancer Center, said during the presentation.

A third of all cancer cases in the United States are linked to diet and lifestyle, and an estimated 70% of all cancer survivors in this country are overweight or obese, according to the presentation. Diet and lifestyle counseling are a component of national guidelines for cancer prevention.

“Oncology nurses within the oncology care team share a key role in providing cancer-specific, evidence-based information and resources to aid in recovery after cancer treatment as well as to promote health behaviors,” Winters said during her presentation. “Typical cancer follow-up visits are time limited and often do not allow for a comprehensive lifestyle behaviors assessment and counseling.”

With the help of Carol Sullivan, MS, RD, CSO, LDN, senior clinical nutritionist at Massachusetts General Hospital Cancer Center, Winters and the lifestyle medicine multidisciplinary team at her institution created a program for patients with a history of cancer. The program was predominantly led by an advanced practice oncology nurse and an oncology registered dietician.

Once patients are referred to this program by their cancer team, they underwent consultations focused on education and motivation. These consultations emphasized the importance of a whole food plant-forward diet, restorative sleep, regular physical activity, avoidance of risky substances, stress management and positive social connections. Based on needs, patients had free access to webinars, exercise videos and referrals to other specialists or supportive care programs. All of these visits are now conducted through telehealth platforms due to the COVID-19 pandemic.

Winters and Sullivan received some insightful feedback on the program including that it had an empowering effect on them and it was specifically tailored to their needs.

“Future directions include shared medical or group visits to improve the patient experience by providing an interactive setting in which patients can learn and inspire each other to adopt lasting health behavior change,” Winters said during her presentation.

Winters L, Sullivan C. An Advanced Practice Nurse and Registered Dietitian Led Lifestyle Medicine Clinic. Presented at: the Oncology Nursing Society 46th Annual Congress. April 20, 22, 27, 29, 2021.

A clinic for patients with a history of cancer led by an advanced practice nurse and a dietician may empower patients to improve their lifestyles through diet and exercise, especially since it may have an impact on their outcomes and future risk for diseases.

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Medical Marijuana May Reduce Common Chemotherapy AEs; More Research Needed

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