Lindsay Fischer is the Associate Editor at ONN. She joined MJH life sciences in 2021 after graduating from Rutgers University with majors in both English and Spanish and a minor in creative writing. When she is not writing, or researching the latest oncology nursing news, Lindsay is an amateur backpacker and rollerblader. Email Lindsay at lfischer@mjhlifesciences.com

Health care professionals working with patients during the COVID-19 pandemic reported reduced burnout and emotional exhaustion following treatment with CBD therapy, according to findings published in 

Despite the potential efficacy of this treatment, consideration before taking CBD is still warranted due to the potential undesired adverse events (AEs) associated with the therapy, the study authors wrote.

The BONSAI study (NCT04504877) assessed a total of 118 health care professionals. Participants were randomly designated to receive either CBD at 300 mg (150 mg twice daily) for 28 days in addition to standard care, or standard care alone.

The 61 participants who received CBD reported significant decreases in emotional exhaustion on days 14 (4.14 points; 95% CI, 1.47-6.80), 21 (4.34 points; 95% CI, 0.94-7.73), and 28 (4.01 points; 95% CI, 0.43-7.59).

“Burnout among health care workers is an important issue for health care systems, with a direct impact on quality of care,” the study authors wrote. “No pharmacological treatment is currently available for the prevention or treatment of burnout symptoms and emotional exhaustion among frontline health care professionals working with patients with COVID-19, even though several studies have reported that depression, anxiety, insomnia, and PTSD symptoms are more common in this population. Therefore, the results of the present study could have a relevant impact on the mental health of health care staff worldwide.”

The primary outcomes in the trial were emotional exhaustion and burnout symptoms, which were evaluated using an emotional exhaustion subscale on a Brazilian version of the Maslach Burnout Inventory–Human Services Survey for Medical Personnel.

Secondary outcomes included anxiety, depression, and PTSD symptoms and were evaluated through the Brazilian versions of the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire, the 9-item Patient Health Questionnaire, and the PTSD Checklist from the 

Diagnostic and Statistical Manual of Mental Disorders. 

Mood and burnout were also assessed through the Clinical global Impression scale and the daily Ecological Momentary Assessment.

In addition, researchers took blood samples at baseline, as well as on days 7, 14, 21, and 28 to measure proinflammatory cytokine levels, CBD plasma levels, and other general laboratory measurements.

The standard-of-care treatment that both cohorts received included motivational and instructional videos on low-impact physical exercise as well as weekly consultations with psychiatrists who provided psychological support. Other measures to foster a supportive working environment included personal protective equipment, work schedule modification, ongoing testing, and the hiring of new personal.

Notable AEs (occurring in greater than 10% of participants) included somnolence, fatigue, increased appetite, diarrhea, weight gain, and lethargy. These symptoms were consistent across both treatment groups, except for increased appetite, which was higher in the control arm compared with the treatment arm (14 vs 5 participants, respectively).

Five of those 61 participants also experienced serious AEs and discontinued CBD treatment. Notably, all 5 experienced a full recovery. AEs included 4 cases of elevated liver enzymes (1 critical and 3 mild cases) and 1 severe case of pharmacodermia. In addition, 1 participant in the experimental arm also reported mild pharmacodermia. No participants with elevated liver enzymes experienced an increase greater than 2-fold normal levels of total serum bilirubin.

“Cannabidiol may act as an effective agent for the reduction of burnout symptoms among a population with important mental health needs worldwide,” the study authors concluded. “However, it is necessary to balance the benefits with potential adverse and undesired effects when making decisions regarding the use of this compound.”

Trial limitations include the lack of a double-blind placebo-controlled design, as well as short follow-up periods, small sample size, and single-intervention dose. Future research should seek to obtain more broadly applicable results by incorporating a double-blind placebo-controlled clinical trial approach, longer follow-up periods, multiple dosage interventions, and a multicenter design.

Crippa JAS, Zuardi AW, Guimarães FS, et al. Efficacy and safety of cannabidiol plus standard care vs standard care alone for the treatment of emotional exhaustion and burnout among frontline health care workers during the COVID-19 pandemic: a randomized clinical trial. 

 2021;4(8):e2120603. doi:10.1001/jamanetworkopen.2021.20603

Articles

Health care professionals who treated patients throughout the COVID-19 pandemic and received CBD therapy reported less burnout and emotional exhaustion than those solely receiving standard-of-care treatment. 

CBD May Alleviate Burnout, Exhaustion in Health Care Professionals 

Money itself is nothing more than printed paper or a digital number on a computer. Too many people get emotionally caught up with trying to achieve a number in their bank account and lose track of the real meaning of money—a means of exchange for such things as vacations, college education, helping others, time spent with loved ones, etc. The list goes on.

You must identify those things in life that you want money to support. Money itself is rarely the goal. In fact, I would argue that people’s lives can be broken down into 5 distinct areas that contribute to them being happy and fulfilled in life. Those are 

career, relationships, self-care, selflessness, and spirituality

When it comes to overall wellness and life contentment, all these areas of your life must be moving in harmony. Have you ever had a conflict with someone you are close with and then tried to compartmentalize it while at work? Or have you ever been on a family vacation and been distracted by constant work emails? If you have experienced either of these, you will understand how all life areas are truly intertwined no matter how good you are at compartmentalizing your life.

Therefore, understanding what is important to you in these 5 areas will be helpful when crafting plans.

Assessment: Are You on Track to the Right Goals?

This is the time to check your current financial trajectory and identify how it aligns with your short- and long-term life goals. Some may find that they were chasing monetary goals that will have no effect in improving their well-being. We are taught that more money equals more happiness, but that is not necessarily the case. Studies show that an individual salary of $75,000 per year satisfies emotional well-being but that there is no further progress beyond an annual income of $75,000.

With that said, before we can identify if we are on track, we need to establish our life goals that bring us more well-being and fulfillment. Although this may seem like an easy task, you will find that “happiness” can be an ambiguous term and hard to quantify outside of the obvious things that bring positive emotions into your life. Because we need specificity when it comes to crafting plans, we must turn to the latest evidence-based research in the positive psychology domain to help.

Martin Seligman, the father of the positive psychology movement, developed the PERMA model to help us get a grip on what exactly happiness means and how to create well-being in our lives. PERMA stands for 

ccomplishment. Below we will evaluate each of these areas and how we might incorporate them into our life plan.

: These are the things that elicit those positive emotions that are most synonymous with happiness, such as buying that new car, going on that trip, and winning that award.

: These are the activities that you lose track of time doing or do after a stressful day/week to “reset” yourself, such as exercise, a hobby, or even your work.

: These are the things you do to foster deeper relationships with your family, loved ones, and friends.

: What things do you do that give you a sense of meaning or that you are serving others and/or a higher purpose? Some find this by working their job, mentoring, donating, volunteering for a charity, etc.

 These are things that we set goals around and take steps to attain. Our society fosters and rewards accomplishment during the early stages of life (school, sports, etc), but many forget that this must be maintained to continue the sense of well-being. In adulthood, accomplishment could include running marathons, receiving promotions, or even hitting a new personal best in the gym.

Write down the things that you do currently in each of these areas and determine how much time and money you spend on that activity. Research suggests that those who have a more even spread across the 5 categories

 experience markedly more well-being in life and tend to flourish more than those who do not. Once you establish your baseline, write out what you would do to bolster each area of PERMA in your life if money were no object. 

 are your true goals that are worth building a financial plan around.

Use a professional to assess your financial trajectory toward those newfound goals while you examine your current habits and nonmonetary trajectories in the various areas of your life. This will shine light on opportunities for improvement or course-correcting that the plan should be built around.

As President Dwight D. Eisenhower once said: “Plans are nothing. Planning is everything.”

This planning process is much more than just developing a financial plan to get you to an end point. This holistic approach will allow you to uncover your unique blueprint for well-being in life as opposed to simply a plan for more legal tender. By finding those things that bring eudaimonia and creating steps to attain them in your life, you can find an infinite flame and entirely change the reason you get up in the morning.

Michael Foley, CFP, CSLP, is a comprehensive financial advisor at North Star Resource Group and offers complementary, no-obligation student loan counseling for medical professionals in training. Contact him at Michael.Foley@NorthStarFinancial.com


1. Kahneman D, Deaton A. High income improves evaluation of life but not emotional well-being. 

. 2010;107(38):16489-16493; doi:10.1073/pnas.1011492107

2. Kern ML, Waters LE, Adler A, White MA. A multidimensional approach to measuring well-being in students: application of the PERMA framework. 

. 2015;10(3):262-271. doi:10.1080/17439760.2014.936962

This holistic approach will allow you to discover your unique blueprint for well-being in life rather than focusing solely on amassing wealth.



Applying Positive Psychology to Financial Planning 

Patients with low-grade intermediate-risk non–muscle invasive bladder cancer (NMIBC) experienced significant, durable responses following treatment with non-surgical primary chemoablation using the mitomycin-containing reverse thermal gel UGN-102, according to findings from the phase 2b OPTIMA II trial (NCT03558503) published in 

Results showed that among 63 patients who received 1 or more installation of UGN-102, 65% (n = 41; 95% CI, 52.0%-76.7%) achieved a complete response (CR) at 3 months. Of these patients, 95.1% (n = 39) remained disease free at 6 months; at 9 months and 12 months, 73.2% (n = 30) and 61.0% (n = 25) of patients, respectively, continued to be free of disease.

Although the median duration of CR was not estimable, the probability of experiencing a durable response 9 months after CR was estimated to be 72.5% (95% CI, 54.4%-84.3%) per Kaplan-Meier analysis.

“The data from the OPTIMA II trial represent a significant advancement in the development of UGN-102 for the treatment of low-grade intermediate-risk NMIBC and further support the contention that non-surgical therapy for this disease is both technically feasible and clinically meaningful,” Mark Schoenberg, MD, chief medical officer at UroGen, stated in a press release.2 “With UGN-102, our goal is to change the treatment paradigm in [this population] by enabling non-surgical chemoablation. These results provide an important validation of our approach to treating low-grade disease, and our rationale for the continued evaluation of UGN-102 in the ongoing phase 3 ATLAS study.”

For patients with low-grade intermediate-risk NMIBC, the standard-of-care treatment is transurethral resection of bladder tumors (TURBTs). Adjuvant chemotherapy is recommended per US guidelines; however, peer-reviewed literature suggests this is not frequently utilized in clinical practice due to fear of permanent damage to the bladder, inconvenience, and lack of confirmation of malignancy.

Adjuvant intravesical immunotherapy is also recommended, although national shortages of Bacillus Calmette–Guérin (BCG) have complicated this approach for those with low-grade disease. Because of these factors, patients with low-grade intermediate-risk NMIBC frequently undergo repetitive TURBTs, which exposes them to the risks that come with general anesthesia.

UGN-102 is an investigational drug that was developed for primary nonsurgical treatment in this patient population. The agent is comprised of mitomycin, and a proprietary reverse thermal hydrogel that is utilized to reconstitute mitomycin prior to instillation. Moreover, the reverse thermal properties of UGN-102 allow for local administration of mitomycin as a liquid in a cooled state; after instillation, this converts to a semi-solid gel depot at body temperature.

Additionally, prolonged exposure of tumor cells to mitomycin is hypothesized to improve chemoablation vs aqueous preparations of the drug, and the mechanism of tumor cell destruction by mitomycin is largely attributed to DNA alkylation and resulting inhibition of DNA synthesis.

For the open-label, single-arm, phase 2 OPTIMA II trial, investigators sought to evaluate the safety and efficacy of UGN-102 in patients with low-grade intermediate-risk NMIBC. The trial was conducted from October 2018 to October 2020 at 20 sites throughout the United States and Israel.

To be eligible for enrollment, patients needed to be 18 years or age or older, have low-grade intermediate-risk NMIBC that was diagnosed via a cold cup biopsy, and negative voiding cytology for high-grade disease within 6 weeks prior to screening. Patients also had to have acceptable organ and bone marrow function.

Those with past or present muscle-invasive or metastatic urothelial carcinoma, concurrent upper tract urothelial carcinoma, a history of carcinoma in situ within the past 5 years, high-grade papillary urothelial carcinoma within the prior 2 years, or previous treatment with BCG for urothelial carcinoma within the prior 2 years were excluded.

Study participants received 6 weekly intravesical instillations of UGN-102, which was comprised of mitomycin at 75 mg in 56 mL admixture with reverse thermal hydrogel to equal 1.33 mg/mL. Treatment could be postponed for up to 4 weeks in the event of a urinary tract infection (UTI) or other adverse effects (AEs).

The ablative effect of the agent was evaluated at a 3-month visit, 4 to 6 weeks after the last weekly instillation, as well as 3 months after treatment initiation, and response was determined through visual assessment, biopsy of remaining lesions, and voided urine cytology. A complete response was defined as a cystoscopy that indicated no remaining tumors, negative urine cytology, and no detectable disease.

Patients who achieved a CR participated in monthly check-ins to report any AEs and were assessed for evidence of disease recurrence at 6, 9, and 12 months following the first instillation of UGN-102.

The primary end point of the study was the percentage of patients with a CR at the 3-month visit. The secondary end point was durable CR in patients who achieved CR at the 3-month visit, defined as the percentage of patients with no detectable disease at 6, 9, and 12 months following treatment initiation.

The median age in all treated participants (n = 63) was 68.0 years (range, 33.0-96.0), and 90% completed all 6 protocol-specified instillations of UGN-102. Additionally, 57.2% of patients were older than 65 years, 39.7% were older than 75 years, and most were male (60.3%) and White (87.3%). Additionally, 77.8% of patients had recurrent low-grade NMIBC, and 44.4% had had previous episode within 1 year of the current diagnosis. Moreover, 82.0% of patients had multiple visible tumors, and 27.9% had tumors that were larger than 3 cm in size.

Patients with recurrent disease underwent a median of 3.0 (range, 0.0-13.0) prior TURBTs, with 75.5% having undergone more than 2 prior TURBTs, and 57.1% having undergone more than 3 prior TURBTs.

Additional data showed that 13 patients reported disease recurrence, and 3 patients ended the study early due to AEs (n = 1), death (n = 1), or concerns regarding COVID-19 (n = 1).

In terms of safety, 90.5% of patients experienced treatment-emergent AEs (TEAEs), and 63% were considered to be related to study treatment. Additionally, 8% of patients reported more than 1 serious TEAE, although none of these effects were related to the study treatment.

One patient experienced 4 serious TEAEs, which included cardiac disorder, hematuria, pneumonia, and klebsiella pneumonia. Moreover, 1 patient reported 2 serious TEAEs in the form of chronic obstructive pulmonary disease and stress cardiomyopathy. Three patients each experienced 1 serious TEAE, which included acute myeloid leukemia, gastroenteropancreatic neuroendocrine tumor disease, and metastatic urothelial carcinoma.

Six patients reported at least 1 TEAE that resulted in treatment discontinuation. One patient reported the following 3 TEAEs: dysuria, micturition urgency, and penile erythema. Five patients experienced 1 of the following TEAEs: lower urinary tract symptoms (n = 2), hand dermatitis, rash generalized, and urinary retention.

The most frequently reported TEAEs were dysuria (41%), urinary frequency (21%), hematuria (16%), micturition urgency and UTI (14%), and fatigue (11%).

“The significant treatment response and sustained durability observed in this trial indicate that UGN-102 has the potential to become a non-surgical alternative for these chronically relapsing patients who typically undergo repetitive surgeries,” William C. Huang, MD, FACS, professor of urology and radiology and vice chair of Urology at NYU Langone Health and principal investigator of the OPTIMA II trial, stated in a press release. “Even more encouraging is that 12 months after treatment was initiated, approximately 73% achieved durable response.”

Chevli KK, Shore ND, Trainer A, et al. Primary chemoablation of low-grade intermediate-risk non-muscle-invasive bladder cancer using UGN-102, a mitomycin-containing reverse thermal gel (Optima II): A phase 2b, open-label, single-arm trial. J Urol. Published online August 26, 2021. doi:10.1097/JU.0000000000002186

The Journal of Urology publishes results of UroGen Pharma’s phase 2b study of UGN-102 in patients with low-grade intermediate risk non-muscle invasive bladder cancer (LG IR-NMIBC). News release. UroGen Pharma Ltd. October 5, 2021. Accessed October 7, 2021. https://bit.ly/2Z8vgoY

This article was originally published on OncLive as "UGN-102 May Provide Alternative to Repetitive Surgery in Low-Grade Intermediate-Risk NMIBC”

Approximately 73% of patients with NMIBC who experienced a complete response after non-surgical primary chemoablation using mitomycin-containing reverse thermal gel UGN-102 remained disease free at 9 months.

UGN-102 Induces Durable Responses in Patients with Low-Grade Intermediate-Risk NMIBC

Investigators participating in the phase 2 ACE-Breast03 trial (NCT04829604) aim to determine whether the novel antibody-drug conjugate (ADC), ARX788, represents a safe and effective treatment option for patient with metastatic HER2-positive breast cancer whose disease has progressed beyond other HER2-directed therapies, according to a news release from Keck Medicine of the University of Southern California (USC).

The global registration study is currently enrolling patients who experienced resistance to or disease progression on regimens containing ado-trastuzumab emtansine (T-DM1; Kadcyla), fam-trastuzumab deruxtecan-nxki (Enhertu), and/or tucatinib (Tukysa).

“At USC Norris [Comprehensive Cancer Center], we treat a large volume of patients with HER2-positive, metastatic breast cancer and we have found that resistance to existing therapies is a major issue,” said global lead principal investigator Janice Lu, MD, PhD, a medical oncologist with Keck Medicine and medical director of the USC Comprehensive Breast Oncology Program, in the news release.1 “We are excited to lead this effort in assessing a possible alternative solution for breast cancer patients and hope to expand our ability to provide effective personalized care.”

ARX788 is an ADC that combines a HER2-directed monoclonal antibody with Amberstatin269, which can destroy cancer cells and prevent new cell growth.

Prior findings from phase 1 trials demonstrated encouraging antitumor activity with ARX788 in patients with HER2-overexpressing solid tumors.2 The overall response rate (ORR) was 74% with 1.5 mg/kg of ARX788 in patients with HER2-positive breast cancer and 67% in patients with HER2-overexpressing solid tumors. Across both populations, the disease control rate (DCR) was 100%.

In the phase 2 trial, patients will receive an intravenous infusion of ARX788 every 4 weeks.3 Two hundred patients are estimated to enroll.

The primary end point of the study is ORR by RECIST v1.1 criteria over 2 years; secondary end points include duration of response, best percent change in the sum of the longest diameters of measurable tumors, best overall response, DCR, progression-free survival, overall survival, number of patients experiencing treatment-emergent adverse effects, maximum serum concentration for ARX788, total antibody, and pAF-AS269, trough concentration for ARX788, total antibody, and pAF-AS269, area under the serum concentration-time curve for ARX788, total antibody, and pAF-AS269, and incidence of anti-drug antibodies following administration of ADX788.

Eligible patients must be 18 years of age or older with a life expectancy of at least 3 months, an ECOG performance status of 1 or lower, and adequate organ function. Patients must have at least 1 measurable lesion per RECIST v1.1 criteria and adequate tumor samples available for HER2 status confirmation. Patients with stable brain metastases are eligible for enrollment.

Patients with a history of interstitial lung disease, pneumonitis, or other clinically significant lung diseases within 12 months of enrollment, ocular events or active ocular infections, or congestive heart failure, unstable angina pectoris, unstable atrial fibrillation, or cardiac arrhythmia within 12 months of enrollment are not eligible for the study.

Currently, patients are being recruited from over 20 sites in the United States and Australia. An additional 150 sites are planned to open worldwide, including Europe and Asia.1

Additionally, the trial will be presented during the 2021 San Antonio Breast Cancer Symposium as an ongoing trial.

“If this drug is effective, it could provide a hopeful alternative to patients with a difficult prognosis and help them maintain a quality of life in ways that chemotherapy cannot,” Lu concluded.

USC Norris Comprehensive Cancer Center launches global clinical trial testing potential therapy for aggressive type of breast cancer. News release. Keck Medicine of USC. October 11, 2021. Accessed October 14, 2021. 

Hurvitz SA, Park H, Frentzas S, et al. Safety and unique pharmacokinetic profile of ARX788, a site-specific ADC, in heavily pretreated patients with HER2-overexpresing solid tumors: results from two phase 1 clinical trials. 

. 2021;39(suppl 15):1038. doi:10.1200/JCO.2021.39.15_suppl.1038

ARX788 in HER2-positive, metastatic breast cancer subjects (ACE-Breast-03) (ACE-Breast03). ClinicalTrials.gov. Updated October 6, 2021. Accessed October 14, 2021. 

https://clinicaltrials.gov/ct2/show/NCT04829604

This article was originally published on OncLive as “Trial Launches to Evaluate Novel ADC in Previously Treated HER2+ Breast Cancer”

The recently launched phase 2 ACE-Breast03 seeks to appraise the efficacy and safety of the novel antibody-drug conjugate, ARX788, in patients with metastatic HER2-positive breast cancer whose disease is resistant to previous targeted therapies.

New Clinical Trial Will Assess Novel ADC in Drug Resistant HER2+ Breast Cancer

Coordination between oncology and primary care teams to care for underinsured and uninsured cancer survivors remains a challenge, suggested a new study published in 

Investigators interviewed 93 health care providers in a qualitative study and asked them to describe opportunities and challenges to coordinate care between oncology and primary care teams. The study defined survivors as patients with a stage I, II, or II diagnosis, who have completed cancer treatment (including chemotherapy, radiation, and/or surgery) and who have initiated the surveillance stage of their cancer care journey.

Key challenges included difficulties accessing primary care providers (PCPs), a lack of communication between oncology and primary care teams, role delineation from both sides of the care continuum, and a lack of clinician knowledge and preparedness.

“These findings suggest that, given interdependencies between levels within a single health system, awareness and engagement by system leadership may be needed to create the conditions necessary to actualize and sustain communication across teams to support comprehensive cancer survivorship care,” wrote Bijal A. Balasubramanian, MBBS, PhD, and colleagues, in the paper. “One immediate target is closed-loop communication, ensuring both vertical and horizontal communication pathways. Health information technology tools may also foster team effectiveness by better identifying high-risk patients, monitoring outcomes, and managing task interdependence during transitions in care.”

Difficulty accessing primary care was 1 of the most common problems reported by patients, particularly for those without a preexisting PCP. Although oncology nurses routinely referred patients with chronic conditions such as diabetes and hypertension to primary care, many patients faced wait times longer than 6 months before being seen.

Communication was another critical issue that concerned both oncology teams and PCPs. Investigators noted that oncology teams often expect the patient to communicate treatment symptoms to their PCP; however, because patient’s communication with PCPs are often less frequent and/or regular than their communication with their oncology team, and because cancer therapies can worsen preexisting chronic conditions, substantial consequences are a potential concern.

The lack of communication often translated into role delineation for cancer surveillance testing. For example, in the case of mammograms for survivors of breast cancers, both groups agreed that the oncology care team should manage surveillance for the first 5 years, however, they disagreed on who should manage surveillance for survivors of 10 years or more.

“Who is supposed to follow that cancer follow-up frequency? Is Oncology [going to] do it or primary care has to do it?” remarked one PCP in the study. “So, if they can put ‘We continue to follow’ [in the EMR], or if the patient is discharged from oncology and primary care has to follow up or whatever, then make that really more clear.”

“The ideal thing would be a survivorship program to see all survivors, at all stages. But [the Medical Oncology Clinic] doesn’t have the bandwidth to take all survivors now,” added an oncology clinician.

Some PCPs felt that it would be better for the oncology care team to maintain surveillance because it is common for patients to fall out of their primary care routine. One PCP even expressed that “Cancer is not like any other disease. We really have to be very careful. If you leave [cancer surveillance] with the PCP … [patients] might not show up ... I don’t want patients to fall through the cracks.”

Furthermore, a number of PCPs expressed that they felt uncomfortable managing cancer-related pain and prescribing medications to help manage long-term treatment-related adverse events (AEs). Many PCPs shared that they were unfamiliar with the AEs their patients were experiencing and the prescriptions commonly used to treat them.

“I have a patient with [brain metastases]…and he was started on 3 seizure medications, and he doesn’t have seizures but I guess they have a role in treating headaches. He’s on 3 medications that I am not familiar with. The last 3 [or] 4 months, the medication refill comes to me ... I am uncomfortable with these 3 medications. I don’t prescribe 3 seizure medications to treat a headache,” said a PCP.

“Care coordination for underinsured and uninsured cancer survivors with comorbidities will continue to be an important issue given changing US demographics, early detection, and advances in cancer therapies that have extended cancer survivorship,” concluded the study authors. “Without robust communication systems and care pathways between primary care and oncology, such patients are at risk of increasingly poor outcomes, exacerbated by the patchwork nature of the US health care system. Closed-loop communication, role clarification, leadership support, and health information technology improvements to comanage patients during care transitions may provide a start toward enhanced team-based care.”

One notable limitation was that investigators spoke to providers whose patients sought oncology and primary clinics that were owned and operated under the same governance. The authors acknowledged that patients who seek specialty care independent of their primary care might face more severe access barriers. Future research should seek to assess how to better facilitate communication across external oncology practice partners, in addition to clinics operating under the same governance as the PCP.

Balasubramanian BA, Higashi RT, Rodriguez SA, Sadeghi N, Santini NO, Lee SC. Thematic analysis of challenges of care coordination for underinsured and uninsured cancer survivors with chronic conditions. 

 2021;4(8):e2119080. doi:10.1001/jamanetworkopen.2021.19080

A recent study identified some of the key challenges in coordinated care for underinsured and uninsured cancer survivors who have initiated the surveillance stage of their journey.

Stronger Coordination with PCP a Necessity in Caring for Cancer Survivors  

CE lesson worth 0.5 contact hour that is intended to advanced practice nurses, registered nurses, and other healthcare professionals who care for patients with cancer.

 Continuing Education: October 2021

Serenity Mirabito MSN, RN, OCN is an oncology health writer and blogger. As a certified oncology nurse with a master's degree, her years of experience allow her to write with a relatable and humorous flair. Serenity is a strong advocate for oncology nurses everywhere so don't be surprised if you hear your own story in hers. You're welcome to reach out to Serenity by emailing her at 

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