The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) jointly delineated chemotherapy administration safety standards in 2009. Those standards were created in response to the need for standardization in chemotherapy administration and subsequently have been used in clinical practice and ASCO’s Quality Oncology Practice Initiative certification program. The standards were updated in 2011, 2013, and 2016.

The 2016 standards update (published in January 2017)

 was led by a working group from ASCO and ONS. Representatives from the American Society of Pediatric Hematology/Oncology and the Association of Pediatric Hematology Oncology Nurses were added when the group decided that the standards should apply to pediatric oncology. A literature review was performed and updated standards were drafted and posted for public comments.

The ASCO/ONS chemotherapy administration safety standards were reordered to better reflect the sequential process of chemotherapy ordering, preparation, and administration. The first section of the standards contains standards for a safe healthcare environment, including staff qualifications and education. Other sections focus on treatment planning, patient education, and consent to treatment. There are now updated standards on patient monitoring, including adherence, toxicities, and complications.

Pediatric considerations, such as measuring a child’s height with each treatment cycle as well as having a licensed pharmacist review chemotherapy orders for patients under age 18, are new standards. Additional chemotherapy labeling requirements were added, including specific items to be included on medications dispensed from the healthcare setting that are to be taken at home.

Sequencing of administration when applicable and total number of products to be given when medication is provided in divided doses, represent new labeling standards. Each product should be labeled with the total number of products to be administered and the individual products sequence within that total grouping; for example, 1 of 5, 2 of 2, etc.

Another new standard is that upon chemotherapy preparation, a second person approved by the healthcare setting to prepare parenteral chemotherapy verifies the drug vial(s), concentration, drug volume or weight, diluent type and volume (when applicable), and administration fluid type, volume, and tubing.

The standard on treatment goals has been clarified to provide examples. Goals of treatment need to be included in treatment plans and/or orders and state treatment intent (eg, cure disease, prolong life, or reduce symptoms). Clearly stating the goal of treatment not only guides treatment decisions and care planning, but also helps guide conversations with the patient and family.

A patient education standard has been expanded to state that patients are provided with verbal and written or electronic information as part of an education process prior to the first administration of chemotherapy. Previously, written patient education materials were print only; however, as electronic materials have proliferated, the standards were updated to reflect their use.

Although ASCO/ONS standards on intrathecal chemotherapy preparation and labeling were a component of the earlier standards, a new standard on vincristine administration has been added. Vincristine, when inadvertently administrated intrathecally, can cause paralysis and oftentimes is a lethal medication error.

To reduce the likelihood of this happening, vinca alkaloids need to be administered by intravenous infusion (via minibags) in facilities in which intrathecal medications are administered. Intrathecal medications should be administered immediately after a timeout, double-check procedure that involves 2 licensed practitioners or other personnel approved by the healthcare setting to prepare or administer chemotherapy.

The ASCO/ONS chemotherapy administration safety standards are minimum expectations for ordering, preparing, and administering chemotherapy. They are applicable to a variety of settings and across treatment populations, including pediatric oncology. Some or all of the standards can be incorporated into practice. For some healthcare settings, such as small office practices, the standards may be aspirational, whereas in other settings, they guide day-to-day practice.

Neuss MN, Gilmore TR, Belderson KM, et al. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. 

Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, is an oncology nursing consultant and editor-in-chief of

Articles

Recent recent update to ASCO/ONS standards for chemotherapy administration safety include considerations for a safe healthcare environment, treatment planning, patient education, and consent.

What's New in the Updated Chemotherapy Administration Safety Standards?

Vincristine has been around for decades, and for at least the past 10 years, safety experts and organizations have recommended infusing vincristine in minibags rather than administering it in a syringe using a bolus or “push” administration technique. Inadvertent intrathecal administration of vincristine is neurotoxic and depending on when the error is detected (eg, during administration when a partial dose has been given versus following administration when the entire dose has been administered), patients may be permanently paralyzed or even die.

Making the simple change to administering vincristine in minibags has not been universally accepted. Tragically, in some oncology facilities, vincristine continues to be administered using a syringe and inadvertent intrathecal administration has occurred. It seems unfathomable that this could occur since vincristine is packaged with multiple warning stickers and overwraps, and the recommendation to infuse vincristine in minibags has been around for at least 10 years.

How are these horrific events still occurring? The National Comprehensive Cancer Network (NCCN) notes that 125 deaths have been reported in the United States and abroad since the inception of vincristine use in the 1960s. In addition to published case reports, an unknown number of inadvertent intrathecal vincristine administration events have gone unreported. The commonality in these events is twofold: vincristine was prepared in a syringe, and policies and procedures were not followed. Vincristine was mistakenly injected into the central nervous system rather than given intravenously. This type of error is entirely preventable.

The NCCN, which is best known for its evidence-based chemotherapy treatment and symptom management templates and guidelines, took the unusual step on November 16, 2016 of launching a formal campaign called Just Bag It to promote vincristine safety. It is the first time the NCCN has taken a narrow and very specific safety issue and mandated a practice change for NCCN institutions. The NCCN now joins the Institute for Safe Medication Practices (ISMP), The Joint Commission, the World Health Organization, and the Oncology Nursing Society in advocating for vincristine minibag infusions.

In addition, the updated 2016 American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards (in press) now explicitly state that vincristine is administered in minibags in facilities in which intrathecal medications are administered. 

Pushback about vincristine minibag infusions has centered around two concerns. The first is what some have called the unintended consequence of vincristine infusions, which is an increased risk of vesicant extravasation injuries. However, data suggest that this risk is very low regardless of how vincristine is administered.

When 68 cancer treatment centers in Australia standardized vincristine administration to minibag infusions only, researchers tracked the incidence of vinca alkaloid extravasations. When syringes were previously used to administer 37,084 doses of vincristine, 11 extravasations occurred (0.03%). When 7255 doses of vincristine were administered as minibag infusions, 3 extravasations occurred (0.041%). The researchers concluded that the extravasation incidence was similar and infrequent.

A second issue is the cost differential between syringe and minibag vesicant administration. A minibag of intravenous solution and tubing exceed the cost of a syringe. In addition, a greater amount of pharmacy and nursing time is required to prepare and administer minibags of chemotherapy. However, these concerns are minimal when considered in the context of the degree of harm that may occur from inadvertent intrathecal vincristine administration.

One component of NCCN’s campaign for vincristine safety is recognizing healthcare facilities that have implemented vincristine minibag infusions. All 27 NCCN member institutions have policies that align with NCCN’s recommendations for vincristine safety and are listed on the Just Bag It website (

Other facilities are invited to notify NCCN of their adherence to the Just Bag It campaign by tweeting 

and completing an online form. The question for oncology nurses is: Is 

 facility on the list, and if not, how soon will it be?

Gilbar P & Carrington CV. Vinca alkaloid extravasation: Incidence from administration via syringes and minibags [Abstract 94]. 

Asia-Pacific Journal of Clinical Oncology

The NCCN's Just Bag It campaign looks to put an end to the inadvertent inthrathecal administration of vincristine.

Just Bag It Campaign Promotes Safe Vincristine Administration

American Society of Clinical Oncology (ASCO) guidelines are updated periodically. An ASCO task force reviewed 7 existing guidelines on cervical cancer screening and conducted 4 systematic literature reviews. They also performed a cost effectiveness analysis of various screening recommendations, and issued updated cervical cancer screening guidelines in October 2016.

Human papillomavirus (HPV) DNA testing is recommended in all settings in which this testing is available. Visual inspection with acetic acid may be used in settings without HPV testing capability, and this screening is recommended for women aged 30-49 1 to 3 times per lifetime. Treatment options are cryotherapy or loop electrosurgical excision procedure in these “basic” settings.

In settings in which HPV testing is available, recommended age ranges and frequencies by setting are as follows: maximal (eg, extensive testing and treatment availability): ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if 2 consecutive negative tests at 5-year intervals, then every 10 years; and limited (eg, minimal testing and treatment availability, which includes HPV testing): ages 30 to 49, every 10 years. Colposcopy is recommended for abnormal triage results. Loop electrosurgical excision procedure (or ablation) is recommended treatment. Twelve-month posttreatment follow-up is recommended in all settings.

Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months.

This guideline has been endorsed by the International Gynecologic Cancer Society and the American Society for Colposcopy and Cervical Pathology and is available 

New ASCO guidelines for cervical cancer screening recommend HPV DNA testing.

New Updates for Cervical Cancer Screening

Although primary hepatocellular cancer or “liver cancer” is a relatively rare cancer, its incidence in the United States increased 72% from 2003-2012. Less than half (43%) of the 40,000 people diagnosed each year have early-stage disease, and their 5-year survival rate is only 31%.

Fortunately, new treatment modalities and clinical trial results are promising. Yet despite these advances, the 5-year survival rate for metastatic liver cancer is a dismal 3%. The Centers for Disease Control and Prevention (CDC) also note that the mortality rate for liver cancer is increasing faster than the  rate for any other type of cancer.

Some of the risk factors associated with the development of liver cancer include obesity, type II diabetes, heavy alcohol consumption, cirrhosis, non-alcoholic fatty liver disease, an autoimmune disease called primary biliary cirrhosis, and inherited metabolic diseases, such as hereditary hemochromatosis. A few rare diseases increase the risk of liver cancer (eg, tyrosinemia, porphyria, Wilson disease). Long-term exposure to aflatoxins, produced by a fungus that contaminates certain grains, and exposure to the chemicals vinyl chloride and thorium dioxide are associated with the development of liver cancer. Long-term anabolic steroid use slightly increases the risk of liver cancer, whereas corticosteroids do not increase the risk of liver cancer.

A major contributing factor for liver cancer is infection with hepatitis B or C. Worldwide, chronic infection with hepatitis causes 80% of all primary liver cancers. In the United States, hepatitis disproportionately affects Asian Americans and Pacific Islanders; although they make up less than 5% of the population, they account for more than half of Americans infected with hepatitis B. In fact, two of three Asian Americans with hepatitis B are unaware that they are infected.

The CDC now recommends hepatitis B testing for anyone born in Asia or the Pacific Islands (except New Zealand and Australia) and anyone born in the United States, who was not vaccinated at birth, and has at least one parent who was born in East or Southeast Asia (except Japan) or the Pacific Islands (except New Zealand and Australia).

Although there is no vaccine to prevent hepatitis C, there is an effective vaccine against hepatitis B infection. Receiving all three doses of hepatitis B vaccine provides greater than 90% protection to infants, children, and adults who are immunized before being exposed to the virus. In fact, the hepatitis B vaccine is known as the “world’s first anticancer vaccine.” In many countries, including the United States, vaccinating newborns with the hepatitis vaccine has reduced the number of new cases of liver cancer caused by hepatitis B.

The American Association for the Study of Liver Diseases issued screening recommendations for liver cancer, and they include screening people at high risk for developing liver cancer and screening people who are awaiting liver transplants. Screening should include ultrasound imaging in conjunction with alfa-fetoprotein (AFP) blood test monitoring (the AFP is not sensitive nor specific enough to be used alone). People with chronic hepatitis B or C infection need to be screened every 6 months.

The treatment of liver cancer depends on the stage of the disease and patient factors (eg, comorbidities, expected lifespan, the patient’s goals). Options may include surgery (partial hepatectomy or liver transplant), tumor ablation or embolization, radiation therapy, targeted therapy, and chemotherapy. A number of clinical trials are enrolling people diagnosed with liver cancer.

Because liver cancer is an uncommon disease, patients may benefit from referral to national and online resources. Online support for patients with liver cancer includes the American Liver Foundation (

), a dedicated program of the Hepatitis B Foundation. The site includes a directory of liver cancer specialists and liver cancer treatment centers, informational webinars, resources for healthcare providers, and information on new drugs and clinical trials.

Numerous unproven “cures” and treatments for liver cancer are advertised online, which may appeal to both the newly diagnosed as well as those who have not responded to treatment. As oncology nurses, we can help our patients navigate through the misinformation and identify reputable sources of information. For patients with liver cancer, as well as many other types of cancer, the best outcomes occur when patients make informed, evidence-based decisions.

__________________________________________________________________________

With the mortality rate for liver cancer rising faster than the mortality rate for any other cancer, it is important that oncology nurses are aware of risk factors, screening, and treatments so they can pass information on to their patients.

What You Need to Know About Liver Cancer

Although there are more than 14 million cancer survivors in the United States—some of them childhood cancer survivors&mdash;as many as 40% continue to experience persistent treatment-related pain. At least 37 causes have been implicated in this pain, and among them are postsurgical sequelae (eg, lymphedema, post-amputation phantom pain), chemotherapy-related toxicities (eg, peripheral neuropathy), hormonal side effects (eg, arthralgias and myalgias), radiation-related adverse effects (eg, plexopathies, fistula formation), and graft-versus-host disease and other complications following stem cell transplantation.

The American Society of Clinical Oncology (ASCO) recently released guidelines on pain management for adult cancer survivors. The multidisciplinary working group, led by oncology nurse 

, PhD, RN, used the National Cancer Institute’s Office of Cancer Survivorship definition of a 

 (a person with a history of cancer who is beyond the acute diagnosis and treatment phase) in its review of the literature and creation of the guidelines—the first to address the unique pain management needs of cancer survivors, ASCO noted.

Key guideline recommendations include screening for pain at every patient encounter; assessing for the risk of adverse effects of opioids to minimize misuse and abuse; and using nonpharmacologic interventions, such as physical medicine and rehabilitation, integrative therapies (eg, acupuncture), interventional therapies, and psychological approaches, such as hypnosis.

Of note is that some of these recommendations may be nurse-led or guided (eg, meditation, guided imagery, music therapy, distraction, relaxation exercises) or taught to family members (eg, massage, heat/cold application).

Also recommended is using systemic non-opioid analgesics (NSAIDS, acetaminophen) and adjuvant analgesics (selected antidepressants and anticonvulsants) to relieve chronic pain and/or improve physical function, and following state regulations that allow access to medical cannabis or cannabinoids for patients with chronic pain after considering the potential benefits and risks of the available formulations.

ASCO offers several resources and tools to assist practitioners in following these new guidelines on its 

. In addition to a link to the full guidelines, published in the 

, also available are methodology and data supplements, a summary table of the recommendations, patient information about the guidelines, and a set of 23 PowerPoint or PDF slides that can be used for educational purposes.

Oncology nurses can use the guidelines and related resources in a variety of ways. First, we need to assess cancer survivors for the presence of chronic pain and collaborate with other providers in determining the cause of the pain. When pain is present (even minimally), we need to identify strategies that may alleviate the pain. We’ve all cared for patients who view pain as a “tradeoff” for having their cancer cured or in remission, and we need to educate these patients about pain management. In addition, we need to educate the healthcare team, which includes oncologists, radiation therapists, physical therapists, social workers, and pharmacists, about these new guidelines on managing chronic pain among cancer survivors.

Circulate the summary recommendations to staff, and post the recommendations where they can be viewed by staff—and patients! Consider presenting a brief overview of the guidelines using the already-prepared slide deck (only 23 slides!).

If you have a knowledge deficit about a pain management modality, it’s likely that other nurses will as well, so request a formal or informal educational program from the appropriate provider. For instance, invite providers who perform spinal cord stimulation or peripheral nerve stimulation to provide an overview of these pain management modalities. Learn more about the effectiveness of other measures, such as acupuncture, and identify the providers in your institution or community that offer these measures. Lastly, conduct or support the needed research in the area of long-term pain control among cancer survivors.

Paice JA, Portenoy R, Lacchetti C, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline [published online before print July 25, 2016]. 

ASCO recently released guidelines on pain management for adult cancer survivors, developed by a multidisciplinary working group, this guideline is the first to address the unique pain management needs of cancer survivors.

Pain Management for Cancer Survivors

 Quality of life is a concept that oncology nurses are very familiar with. Most nurses would say that quality of life is very important in our patients’ lives. However, it’s also important in our lives as we deliver patient care.

Most of us are familiar with assessing or measuring quality of life (QOL) from a patient’s perspective. We now have tools that enable us to measure the QOL of professionals who deliver care to patients.

One of these tools is the Professional QOL or ProQOL Scale, which measures the positive and negative effects of professionally caring for others. The ProQOL 5, available in 21 languages at no cost on the website 

 is the latest version of the tool. The 30-question rating tool has subscales for measuring the frequency of compassion satisfaction, burnout, and compassion fatigue in the month prior to completing the questionnaire. Self-scoring directions, along with information on how to interpret the results of the subscales, are detailed on the website.

While many tools focus only on the negative consequences of providing care, the ProQOL 5 includes a subscale on compassion satisfaction, or the positive aspects of caring for others in a professional role. Compassion fatigue, on the other hand, is a manifestation of the negative aspects and may include the symptoms of exhaustion, frustration, anger, and depression.

Another subscale measures burnout. From the research perspective, burnout is associated with feelings of hopelessness and difficulties in dealing with work or in performing a job effectively. These negative feelings usually have a gradual onset, and typically reflect the feeling that job performance makes no difference, or they can be associated with work overload and/or a non-supportive work environment.

Preventing burnout and nipping it in the bud when it occurs is the responsibility of both the nurse and the workplace. On the personal level, we all need to be able to speak up and ask for help or request a break. Proactive workplaces routinely survey staff to assess the workload and care delivery, and identify ways to increase job satisfaction without compromising care.

For instance, a busy infusion center implemented a policy that prohibited chemotherapy administration appointments after 2 PM on Fridays, which for the most part, ensured that the staff would be able to finish their work on time. As one nurse noted, this simple strategy enabled her to look forward to the start of the weekend rather than dread the end of the work week.

An interesting component of the ProQOL 5 is its ability to generate a secondary traumatic stress score, which measures the impact of secondary exposure to stressful events. In other words, this type of stress is caused by identifying with others who are experiencing stress, and is termed

. The symptoms of this type of stress are rapid in onset and associated with a specific event. Symptoms may include anxiety and fear, “reliving” or thinking about the event, avoiding things that are reminders of the event, and difficulty sleeping.

Perhaps the most illustrative example of secondary traumatic stress occurred in a small oncology practice I visited. I was told about the worst-ever day in the lives of the staff there; the founding oncologist of the practice walked out of an exam room, said he didn’t feel well, and collapsed. Despite the best efforts of the staff, the oncologist could not be revived, and as one nurse said, “It still haunts me every day even though it happened last year.”

The ProQOL.org website lists online resources that range from training and continuing education programs to advocacy organizations. One example is the Compassion Fatigue Awareness Project and its parent organization, Healthy Caregiving (

). This website offers training materials with the goal of aiding caregivers in practicing “authentic, sustainable self-care.” As oncology nurses, we need to not only recognize that quality of life applies to us as well as our patients, but we must also identify ways to sustain the quality of our professional lives.

Lisa Schulmeister, MN, RN, ACNS-BC, FAAN is an oncology nursing consultant and editor-in-chief of 

We now have tools that enable us to measure the quality of life of professionals who deliver care to patients. 

Quality of Life: Not Just for Patients

 The man stands at the counter in the Breast Center at my local community hospital, and before he has a chance to speak, the receptionist points to the door and tells him that the hospital and testing registration areas are down the hall. I’m waiting to have a mammogram, and hear the man say that he, too, is scheduled for a mammogram. A few minutes later, we both are dressed in pink flowered gowns as we sit in the mammography waiting area, which has pink-striped wallpaper, pink chairs, and even pink carpet. The man is visibly uncomfortable here, and tells me that he went to a surgeon to remove what he thought was a cyst, but the surgeon suspects breast cancer. “I didn’t even think men could get breast cancer,” he adds.

Breast cancer is rare among men; only 1% of all breast cancers occur in men. However, the American Cancer Society estimates that 2600 men will be diagnosed with breast cancer in 2016 and 440 men will die from the disease. For men, the lifetime risk of getting breast cancer is 1 in 1000, whereas for women, it’s about 1 in 8. This rate increases in men with genetic mutations to 1% to 5% with 

Men generally don’t consider themselves at risk for breast cancer; consequently, it’s not unusual for men to be diagnosed with a more advanced cancer compared with women diagnosed with breast cancer. Men also have a shorter life expectancy after a breast cancer diagnosis.

While women typically choose lumpectomies for breast cancer, a lumpectomy is usually not an option for men because their tumors most commonly occur behind the nipple in an area with little breast tissue. Most men also don't have reconstructive surgery after a mastectomy. Nipple reconstructive surgery is available, but men may not be aware of this option. Although diagnosis and treatment of male breast cancer is similar to the diagnosis and treatment of female breast cancer, the experience of breast cancer among men is very different.

Mammography facilities need procedures for performing mammograms on men that recognize the need for sensitivity. Having men enter the imaging area from a side door, providing gender-neutral gowns, and avoiding waiting areas decorated in pink and filled with women are simple strategies that can reduce men’s unease.

Men newly diagnosed with breast cancer need a great deal of support, in part because of how rare breast cancer is in men, and because the typical reaction to a breast cancer diagnosis is one of disbelief. Even clinicians may shy away from intervening because of their unfamiliarity with male breast cancer. Referral to breast cancer support groups may actually not be helpful and may change the dynamic of the group, which is typically all female. However, there are resources available to men with breast cancer. The website 

 was launched in 2009 by a brother and sister who had both been diagnosed with breast cancer. They encountered difficulty in locating information about breast cancer in men, and created the dedicated website.

 in January 2016 published a book titled Breast Cancer inFocus: 

, which is a guide intended to serve as a resource to help men cope with a breast cancer diagnosis and prepare them for issues that they are likely to face. Issues include the stigma of a breast cancer diagnosis, the general lack of knowledge about breast cancer in men, and limited research about its treatment.

Because of the rarity of breast cancer in men, it’s often difficult for men to locate a support group for men or find a “buddy” who has been diagnosed with the same disease. Men with breast cancer can connect online with other men with breast cancer by visiting the discussion board forum “Male Breast Cancer” at www.Breastcancer.org.

Historically, research on breast cancer has only involved women, which limits how research findings can be applied to men with breast cancer. Fortunately, research on the causes, prevention, and treatment of breast cancer in men is now under way in many facilities around the world.

Lisa Schulmeister, MN, RN, ACNS-BC, FAAN is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.

Men newly diagnosed with breast cancer need a great deal of support, in part because of how rare breast cancer is in men, and because the typical reaction to a breast cancer diagnosis is one of disbelief. 

Not So Pretty in Pink

 Returning to work following cancer treatment is a topic that is extensively covered on cancer survivorship webpages. Working while undergoing cancer treatment has not received as much attention, and even less attention has been given to people who continue working after being diagnosed with metastatic cancer. In most cases, people with metastatic disease have a limited life expectancy and often are advised to leave their jobs so that they can focus on treatment and activities other than work, such as travel and spending more time with friends and family.

A research team from the University of Wisconsin-Madison analyzed the Eastern Cooperative Oncology Group’s “Symptom Outcomes and Practice Patterns (SOAPP)” study data to identify factors associated with employment changes among people with metastatic cancer. A surprising finding was that among the 668 people in the analysis, 236 (35%) worked full- or part-time. Better performance status and non-Hispanic white ethnicity/race were associated with continuing to work despite a metastatic cancer diagnosis. Interestingly, the type of cancer, type of cancer treatment, and time since diagnosis did not affect employment status.

The researchers noted that their data raise a number of unique survivorship issues that have previously been overlooked. Whether working by choice, necessity, or both, working provides social interaction and support, and may serve as a distraction from cancer symptom burden. A high burden of symptoms was the most likely factor that caused people to leave their jobs. Fatigue, drowsiness, memory and cognitive impairment, and numbness were the most common symptoms that prompted termination of employment.

These study findings remind us all to not assume that people diagnosed with metastatic disease will want to quit work, and instead are a call to action to reframe our initial assessment. We need to ask patients with newly diagnosed metastatic disease how they view and value their work, including work around the home. We also need to discuss the expected course of disease and how their jobs could be impacted. For those who choose or need to continue working, we need to identify ways to manage treatment- and disease-related symptoms. We also need to support our patients emotionally, especially those who closely identify themselves with their work. Helping people find meaning in their lives is critical during this time.

In addition, from a practical standpoint, we need to examine how our treatment facilities are supporting (or not supporting) people who continue to work during treatment. This not only includes the people with metastatic disease, but anyone undergoing cancer treatment who continues to work. Although many prefer to receive treatment on a Friday afternoon, far too many treatment facilities have policies that prohibit treatment after a set time, such as 2 PM. Very few have treatment appointments after work on Friday evening—a time that many working people prefer.

Our patients also may have questions about workplace rights and discrimination, which is a topic that few nurses or even physicians are able to accurately and comprehensively address. Referral to social services is helpful, but these services may not be available in some practice settings, such as small office practices. There is information available online through 

 the American Cancer Society, LIVESTRONG, and Equal Employment Opportunity Commission websites. Providing patients with information about their legal rights empowers them to make informed decisions about work-related questions and concerns.

These new research findings that suggest at least one-third of our patients with metastatic disease continue to work merit changes in the way in which we assess our patients, when we administer treatment, and how we support these patients. We must not assume that the diagnosis of metastatic disease is reason enough to advise patients to stop working.

 Tevaarwerk AJ, Lee J, Terhaar A, et al. Working after a metastatic cancer diagnosis: factors affecting employment in the metastatic setting from ECOG-ACRIN’s Symptoms Outcomes and Practice Patterns study. 

New research findings that suggest at least one-third of our patients with metastatic disease continue to work merit changes in the way in which we assess our patients.

Lisa Schulmeister, MN, RN, ANCS-BC, FAAN