Ever have that moment when you need concise, nurs&shy;ing-focused information about a new drug or complex treatment protocol, but it doesn’t exist? Find it chal&shy;lenging to keep up with guideline updates? Wonder how other facilities address nursing issues such as determining staffing needs, assessing clinical competency, and evalu&shy;ating medical surveillance programs for staff who admin&shy;ister hazardous drugs? If so, you are not alone; it’s very likely that if you have a need for information on a certain topic, so do other nurses.

It can also be daunting when an online query regarding a new treatment regimen brings several thousand search results. We now have information at our fingertips at the point of care, but who has time to sort through the massive amount of information that now exists? More impor&shy;tantly, much of this information may not be relevant to nursing practice.

So, what can be done to address the need for concise, nursing-focused information that optimizes care for people with cancer? The answer, of course, is 

content written for and by oncology nurses

Before you assemble that list of reasons someone else and not you should be writing for publication, consider the following: Who better to write about pressing nursing issues than those experiencing them? Who better to identify the gaps in the published literature?

Publishing opportunities for nurses are more expansive than ever. In addition to traditional journal articles and text&shy;book chapters, there are newer ways of disseminating infor&shy;mation, such as online articles, 

, and study guides. Listservs and online message boards such as the Oncology Nursing Society’s Member Community are also options. Important information can sometimes be conveyed to nurse colleagues in just a few paragraphs or bullet points—it is a myth that a published work has to be long form.

Many available resources can guide nurses through the writing process. The website Nurse Author & Editor (naepub.com) archives articles on specific aspects of writing and provides links to publishing opportunities for nurses. Writing mentorship programs, such as the one offered by the 

connect experi&shy;enced nurse authors with new writers.

Writing mentors can be helpful allies not only in getting started with writing but also in staying focused and meeting timelines. Seek out mentors at your facility or in your local nursing program. Many faculty members are expected to collaborate with clinicians on writing for publication. Or consider collaborating with an interprofessional author&shy;ship group. Adding the perspective of a pharmacist or social worker, for instance, can enhance content.

What should you write about? Start by jotting down topics that you would like to know more about or need to know more about, such as the latest cancer screening guidelines. Ask your nursing colleagues about which topics they would like more information. Read nursing journals and attend journal club meetings (or start a club) to discuss research study findings and clinical articles. Information already in print can trigger additional questions or ideas for topics. For example, if study data support the effectiveness of a new treatment regimen, there are a host of possibilities for subse&shy;quent articles, such as on dosing considerations, how to best administer the treatment, and managing adverse events.

How to get started? Create an outline, list how your article fills the gaps identified in another article, jot down ideas as they come to you, focus on a specific topic, review research findings and identify nursing implications, or present a case study of an interesting patient. Get started writing. Don’t obsess over the perfect first sentence; often, the first sentence is one of the 

things that experienced nurse authors write.

Keep writing. All too often, what could have been an important and urgently needed article ends up abandoned in a computer file or desk drawer. It takes time, but writing can be accomplished in short spurts as well as dedicated blocks of time. It may be helpful to set goals, such as writing for 30 minutes every day or 2 hours each week. Don’t get bogged down in how the information is presented—just get it down on paper or on your computer screen. It’s easy to rearrange information, expand or delete sections, and write an introduction and summary once you have the raw material. Sometimes it becomes apparent that there is so much information that more than 1 publication is needed to cover the chosen topic. This is a good thing, because the best way to become an experienced nurse author is to keep publishing!

is a one-stop resource for learning about publishing in oncology nursing. It includes articles on searching for oncol&shy;ogy-related information, identifying topics, converting school papers to publishable articles, authorship considerations, and tips on writing journal articles and book chapters.

Have a tip for your colleagues about writing for nurse publications? Share it on social media, and tag with 

Articles

Oncology nurses want to read news and research written by other nurses.
 

Do the Write Thing

 agents are receiving expedited approval from the Food and Drug Administration (FDA). The upside of moving these agents from clinical trials to patients so quickly is that patients receive proven life-saving treatment sooner. The danger lurks in the amount of time available to collect data on adverse events (AEs) associated with the agents.

An analysis of new oncology drug approvals from 2012 to 2016 found that 42 of 43 of the FDA-approved drugs were reviewed using at least 1 of the 4 FDA expedited review pathways: breakthrough therapy designation, acceler&shy;ated approval, fast track, and priority review. This trend is expected to continue for the foreseeable future.

In April 2018, the Oncology Nursing Society (ONS) launched the “Recognize It, Report It” campaign to promote reporting of AEs associated with drugs given FDA expedited approval. Immunotherapy clinical trials used well-defined controlled patient populations, and now that these agents are widely administered in community settings, AEs not seen before are occurring. In addition, their management is challenging, especially for those that mimic other AEs. For example, dyspnea and fever often are first associated with pneumonia in a patient receiving cancer treatment; however, in a patient who has received immunotherapy, they could be due to cytokine storm-causing pneumonitis.

In November 2017, the Society for Immunotherapy of Cancer released consensus recommendations for recognizing and managing immune-related AEs. This advice is expan&shy;sive and includes pre-immunotherapy screening guidelines, a systems-based review of possible AEs and their manage&shy;ment, and information about uncommon events and infusion reactions. The recommendations were created as a “living document,” with updates made as new agents and new drug combinations become available.

In February 2018, the American Society of Clinical Oncology, in collaboration with the National Comprehensive Cancer Network, published guidance on management of immune-related AEs in patients treated with immune check&shy;point inhibitor therapy. Their recommendations are based on toxicity grades for specific organ systems.

The ONS “Recognize It, Report It” campaign encourages nurses to document and report immunotherapy-related AEs (IRAEs) to increase the body of knowledge about these events. Nurses are on the frontline of care and often are the first, and sometimes the only, healthcare providers that receive patient reports of infrequently occurring or previously unreported AEs. In addition, nurses usually are the first to observe immu&shy;notherapy-induced infusion reactions.

Therefore, we need to be knowledgeable about 

these AEs, their detection, and their management

. We also need to be aware of the process for reporting AEs to the FDA.

 has a link for voluntarily reporting AEs and another to sign up to receive safety alerts. The reporting process can be completed online using checkboxes and narrative text boxes for deidentified patient information; AE date, description, and outcome; and relevant tests and patient’s medical history. Once completed and submitted, there is an option for viewing, printing, and saving the report as a PDF document. An email is then sent to the person submitting the report to confirm receipt. The FDA reviews the AE reports and evaluates the need for regulatory action, such as updating drug labeling to include information about reported AEs.

In addition to being aware of the FDA AE reporting process, nurses should delineate institutional policies and procedures for reporting. Ideally, an interprofessional (IP) process would be used, with oncologists, oncology nurses, pharmacists, and others involved in the care of patients receiving immuno&shy;therapy discussing AE observations prior to reporting them. One or 2 staff members should be tasked with reporting to help ensure consistency in MedWatch reporting and insti&shy;tutional tracking of AEs. The IP team also should consider publishing a case report or series when previously unreported AEs occur.

IRAEs can occur as these agents are infusing. Symptoms may include fever, rigor, pruritus, hypotension, dyspnea, chest discomfort, rash, angioedema, wheezing, and tachy&shy;cardia, as well as anaphylaxis requiring emergency measures. Nurses need to be prepared to manage these AEs, especially those in which escalation of care and transfer to an emer&shy;gency department or intensive care unit is needed.

IRAEs also may occur after active treatment has completed. Therefore, close patient follow-up is critical. Because little is known about long-term effects and outcomes, nurses have the opportunity to create and implement follow-up assessment criteria. This may include expanding nursing assessment to incorporate specific questions about newly emerging AEs, such as uveal effusion. Patients need to be asked about their vision, floaters, flashing lights, eye redness, light sensitivity, visual distortion, and eye pain. Patients’ eyes can be examined for redness and light sensitivity. As with other immunotherapy-re&shy;lated AEs, prompt detection of ocular AEs is crucial.

Immunotherapy is perhaps the fastest evolving cancer treatment today. However, with progress has come concern about the limited body of knowledge of the AEs associated with these agents. Oncology nurses have a pivotal role in expanding this body of knowledge through the identification, documentation, and reporting of IRAEs. 

Vadola LA, Pond MA, Winter-Vann A, Whitsell R. Faster approvals? Trends in the use of FDA’s expedited approval programs for oncology medications. 

. 2017;(suppl 15):e18270. ascopubs.org/doi/abs/10.1200/JCO.2017.35.15_suppl.e18270.

Fuerst ML. New guidelines outline management of immunotherapy side effects. MedPage Today website. medpagetoday.com/reading-room/asco/immunotherapy/71026. Accessed June 27, 2018. doi: 10.1186/s40425-017-0300-z.

Puzanov I, Diab A, Abdallah K, et al; Society for Immunotherapy of Cancer Toxicity Management Working Group. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. 

. 2017;5(1):95. 10.1186/s40425-017-0300-z.

Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. 

. 2018;36(17):1714-1768. doi: 10.200/JCO.2017.77.6385.

Not enough is known about immunotherapy-related adverse events, so it is important to report unusual or
previously unreported ones to the FDA.

Recognize and Report It

Bedside handoffs between nurses are useful in relaying information to collaborative or subsequent healthcare providers at the point of care.

In addition, when done optimally, bedside handoffs involve the patient, which can lead to greater understanding of the plan of care, health status, medication list, and discharge plans. Patients also may feel an increase in respect from healthcare providers.

Nurses who participate in bedside handoffs have reported perceptions of improvement in staff communication and collaboration and noted an increase in team-based decision making. Nurses also have reported perceptions of increased accountability, improvement in patient safety, and reduced medical errors. In addition, bedside handoffs may improve chart documentation and promote continuity of care.

A group of nurse researchers led by Carlin Callaway, RN, DNP, NP, from the University of Colorado Cancer Center in Aurora, designed a study to evaluate bedside handoffs, the teach-back method, and discharge bundles on an inpatient oncology unit at a large military treatment facility. Patient activation scores, readmission rates, staff satisfaction, and anecdotal feedback from patients and nursing staff were collected prior to and following implementation of a multifaceted approach incorporating all 3 elements of the handoff protocol.

The teach-back method is well known to most nurses, and involves patients verbally repeating and explaining what has been taught to them. As patients describe their understanding of the healthcare plan, the nurse teacher can correct any misunderstandings and fill gaps in the patient’s understanding. The teach-back method has been associated with reduced readmission, and also enhances the patient’s participation in their own care.

Discharge bundles refer to patient education tools that are designed to collectively increase a patient’s understanding of self-care at home, and can include medication lists, checklists, and advanced care planning information. Ideally, discharge bundles are implemented 

, used throughout the patient’s stay, and reviewed at the time of hospital discharge.

Patient engagement refers to actions that patients take to manage their health regardless of where they are (e.g. hospital, home). Involving patients in their own care may reduce injuries, such as those as a result of falling, and reduce or prevent errors. For example, 

 who are familiar with their medications are better able to detect a dose or drug error.

The patient activation surveys were completed by 49 patients with cancer before implementation of the protocol, and 71 completed the patient activation surveys after implementation. The average Patient Activation Measure (PAM)—a 13-item self-report on knowledge, skill, and confidence in managing the patient’s own health&mdash;before and after implementation were not significantly different (73.2 vs. 68.35), indicating that patients were active in self-care.

The nursing satisfaction survey was completed by 33 nurses before implementation of the bedside change-of-shift report, and 32 of them completed it after implementation. Staff satisfaction trended toward improvement on all 10 items after implementing the bedside change-of-shift report system. The readmission rate decreased from 32% to 25% during the study period, most likely due to implementation of the discharge “bundles” (detailed take-home educational materials) followed by use of the teach-back method.

, suggest that having a consistent, structured discharge protocol enhances staff satisfaction and may reduce hospital readmissions.

A study evaluating the implementation of a multifaceted approach to bedside handoffs incorporating the teach-back method and discharge bundles on an inpatient oncology unit at a large military treatment facility showed that patient education reduced patient readmission rate.
 

Structured Bedside Handoffs Benefit Patients, Nursing Staff

Patients undergoing a bone marrow aspiration and biopsy often experience anxiety prior to this invasive procedure and discomfort during. Nurse researcher Catherine Glennon, RN, MHS, OCN, NE-BC, from the University of Kansas Cancer Center in Kansas City, led a group of colleagues in conducting a study to determine if virtual reality is effective in reducing anxiety and pain prior to and during a bone marrow aspiration and biopsy.

Because virtual reality is a nonpharmacologic measure that has shown success as a distraction tool for other painful procedures, the researchers hypothesized that wearing virtual reality goggles that provide visual and auditory stimuli would distract patients and reduce anxiety and pain levels prior to and during the procedure. The virtual reality goggles fit tightly on the face and block out negative stimuli, such as the sights and sounds associated with setting up equipment.

Participants in this study included 49 patients in the virtual reality experimental group and 48 in the usual care group. Participants were assigned to the experimental group or the control group on an “every-other-one” basis, with even-numbered participants assigned to the virtual reality goggle treatment group and odd-numbered participants assigned to the usual care group. During the bone marrow aspiration and biopsy procedure, the experimental group was given virtual reality goggles prior to the procedure¾where they were offered a choice of 3 nature scenes accompanied by relaxing music¾and the control group received standard care, which included watching and listening to a television. Detailed statistical analysis was published in 

No statistically significant or clinically meaningful differences were noted between the groups in relation to pain or anxiety outcomes. More than half (51%) of the study participants reported some amount of anxiety reduction after the bone marrow aspiration and biopsy procedure, 28% reported an increase in anxiety, and 21% had no change in anxiety level. No significant differences were observed between the groups related to the expected and actual amounts of pain reported. The average number of anti-anxiety and pain medications required by each group did not differ significantly. Twenty participants received anti-anxiety and pain medications during the bone marrow aspiration and biopsy procedure, including 12 participants in the control group and 8 in the experimental group.

The major finding was that participants who wore virtual reality goggles during the bone marrow aspiration and biopsy procedure did not experience a statistically significant decrease in pain and anxiety—a finding that is inconsistent with the study’s hypotheses. Participants in both the experimental and control groups reported a decrease in pain and anxiety levels from pre- to post-procedure. It is possible that the participants were relieved to have the procedure over with and consequently reported reduced pain and anxiety compared to pre-procedure levels. Also, since the control group listened and watched television, it is possible that television served as a distraction from the pain and anxiety associated with the procedures.

This study provides more information on the applicability of virtual reality to distract patients prior to and during bone marrow aspiration and biopsy. Virtual reality is a non-invasive and non-pharmacologic intervention that may have utility in distracting patients from other unpleasant procedures. It also is easy and fairly inexpensive to implement, and one set of goggles can be sanitized and used on multiple patients.

Researchers conducted a study to determine if virtual reality is effective in reducing anxiety and pain prior to and during a bone marrow aspiration and biopsy.

Virtual Reality as a Distraction Tool

Most oncology nurses associate the abbreviation MM with multiple myeloma, but there’s a new MM now in use: medical marijuana. To date, 31 states, the District of Columbia, Guam, and Puerto Rico have approved MM for certain medical uses, including cancer-related adverse events (AEs).

 Patients are asking their oncology nurses if MM might help them and in some cases, after researching the topic themselves, asking very specific questions. Nurses need to be prepared to respond to questions on how MM is supplied and taken, its risks and benefits, and efficacy and safety considerations.

The Cannabis plant, commonly referred to as cannabis and known as marijuana, among other names, produces psychoactive compounds called cannabinoids. Synthetic medications containing cannabinoids, available by prescription, include dronabinol (Marinol) and nabilone (Cesamet). Cannabinoids can be inhaled as smoke or vapor or taken orally (eg, in brownies and other foods).

of using whole-plant cannabis versus synthetic cannabinoid formations. Researchers have explored the use of pharmaceutical cannabinoids, which contain 1 or 2 active ingredients. In contrast, MM often is derived from the entire plant and contains other compounds as well, including the cannabinoids and terpenes (fragrant oils that give cannabis its aroma). Therefore, MM cannot easily be compared with pharmaceutical cannabinoids. Some clinical trials have tested inhaled MM for its antiemetic properties, but not enough data exist for conclusive recommendations.

Potential benefits of MM for adult patients with cancer include appetite stimulation, chronic and neuropathic pain management, improved sleep, and control of chemotherapy-induced nausea and vomiting (CINV). AEs associated with MM include tachycardia, hypotension, muscle relaxation, and decreased gastrointestinal motility. Because cannabinoid receptors are not located in the brainstem areas that control respiration, lethal overdoses from cannabis and cannabinoids do not occur.

Safety considerations include MM use by children and young adults. At this time, the American Academy of Pediatrics has not endorsed pediatric MM use because of concerns about its effect on brain development.

 Plant-derived MM does not have a standardized dose and its optimal dosage is unknown, although the most common advice is to “start low and go slow.”

With inhaled MM, patients “self-titrate,” or adjust the dosage as needed. The goal is to consume the minimum amount needed for symptom relief. Most MM dispensaries also carry edibles that have been tested in independent labs to help ensure safety, and they are labeled with the amount of their ingredients. MM edibles are available as infusions (teas), powders to dissolve in drinks, gummies, mints, chocolate bars, and butter or oils. There are numerous websites that provide guidance on preparing foods containing MM; brownie recipes are among the most popular. MM brownies and other MM edibles should be stored securely in homes in which children and pets reside. In order to qualify for MM, a patient needs to have an approved diagnosed medical condition, which varies by state. After receiving a signed MM recommendation from a licensed physician, the patient applies for an MM card, also known as an MM identification, or cannabis card. This card allows the patient to enter medical dispensaries and purchase MM. The process is simple enough, but do patients really understand MM?

 abounds on the internet, and personal accounts of MM use are limited to individual experiences and are not generalizable to others. People using marijuana recreationally also share their recommendations online. Recreational use of marijuana differs from medicinal use, which can lead to confusion about MM dosing, preparation, and frequency of use. In response to the growing need for clinicians with cannabis expertise, the Society of Cannibas Clinicians was formed, and a US referral directory is maintained on its website.

Patients interested in exploring MM often start by asking their oncologists about it. However, only 30% of 237 US oncologists in a recent survey felt knowledgeable enough about MM to make recommendations (55% practiced in states in which MM wasn’t legalized). Nearly 80% reported discussing MM with patients, and 78% noted these conversations were initiated by patients and their families. The researchers concluded that there is a need for education about MM, as well as clinical trials and further study of MM.

More education is needed for clinicians and patients who may be interested in MM. The National Center for Complementary and Integrative Health maintains a web page containing information for healthcare professionals and con-sumers, some of which is in Spanish.

 The site also includes links to clinical practice guidelines and scientific literature.

Further research is needed because information about MM indications, dosing, drug interactions, and safety considerations is lacking. Comparative studies of MM and other treatments for CINV, anorexia, sleep disruption, and pain management are also needed to further define evidence-based management of these common conditions.

All oncology nurses should have a basic understanding of MM and be prepared to respond to patients’ questions about it. Patients using MM need to be educated to include it in their medication lists when talking with medical providers, especially those patients using edible MM products. Both patients and nurses need to stay abreast of developments in the emerging field of MM and be aware that more research is needed before MM can be considered an evidence-based symptom management approach.

State medical marijuana laws. National Conference of State Legislatures website. ncsl.org/research/health/state-medical-marijuana-laws.aspx. Updated June 27, 2018. Accessed August 1, 2018.

Cannibis and cannabinoids (PDQ)—health professional version. National Cancer Institute website. cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq#section/_1. Updated June 19, 2018. Accessed August 1, 2018.

MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. 

 2018;49:12-19. doi: 10.1016/j.ejim.2018.01.004.

Society of Cannibas Clinicians website. Cannabisclinicians.org. Accessed August 1, 2018.

Braun IM, Wright A, Peteet J, et al. Medical oncologists’ beliefs, practices, and knowledge regarding marijuana used therapeutically: a nationally representative survey study. 

 2018;36(19):1957-1962. doi: 10.1200/JCO.2017.76.1221.

Medical marijuana. National Center for Complementary and Integrative Health website. nccih.nih.gov/health/marijuana. Updated September 24, 2017. Accessed August 1, 2018.

What to know in responding to patients’ questions about benefits, risks, and access.

The New MM: Medical Marijuana

Brentuximab vedotin (BV; Adcetris), a CD30-directed antibody conjugated to a microtubule-disrupting agent, monomethyl auristatin E (MMAE), is used to fight several hematological malignancies. Adverse events (AEs) associated with BV may be serious, and nurses need to understand what they are, monitor for them, and treat them promptly.

BV is FDA-approved for the treatment of patients with relapsed classical Hodgkin lymphoma or relapsed systemic Anaplastic Large Cell Lymphomas (ALCLs).

 in patients with classical HL at high risk of relapse or progression following autologous hematopoietic stem cell transplantation (auto-HSCT).

 In addition, it is approved for patients with primary cutaneous ALCL, or CD30-expressing mycosis fungoides who have received prior systemic therapy and for patients with previously untreated stage III/IV classical Hodgkin HL in combination with chemotherapy.

Kathleen Clifford, RN, MSN, FNP-BC, AOCNP, from St. Luke’s Mountain States Tumor Institute in Boise, Idaho, and her colleagues published a detailed 

According to the article, the recommended dose and administration schedule for BV in patients with relapsed classical Hodgkin lymphoma or systemic ALCL, HL at high risk of progression after auto-HSCT, and patients with cutaneous ALCL or mycosis fungoides is 1.8 mg/kg administered as an IV infusion over 30 minutes every 3 weeks; and in previously untreated patients with classical Hodgkin lymphoma in combination with chemotherapy is 1.2 mg/kg up to a maximum of 120 mg BV is administered every 2 weeks for a maximum of 12 doses.

Several AEs are associated with BV treatment. 

 may be sensory or motor, and signs and symptoms can range from mild (tingling) to severe (burning, muscle aches). Peripheral neuropathy has patient safety considerations, so patients need to be assessed for risk of falling.

Peripheral neuropathy can be assessed through vibratory sensation, deep tendon reflexes, and touch. Early peripheral neuropathy may be noted by the patient, and include things such as difficulty buttoning a shirt or picking up a coin. Strategies for managing peripheral neuropathy include the use of gabapentin/pregabalin, duloxetine, tricyclic antidepressants, or a compounded topical gel containing baclofen, amitriptyline hydrochloride, and ketamine. Acupuncture and physical therapy also may be useful.

Neutropenia is a common AE related to BV treatment. Patients need to be informed about the possibility of developing neutropenia, the importance of temperature monitoring, and measures to protect themselves from infection. Neutropenia is managed through dose reduction and growth factor support.

Infusion-related reactions from BV treatment range from mild pruritus to anaphylaxis-like symptoms. These reactions generally occur within the first 2 BV treatment cycles. Patients need to be monitored during BV infusion, and if a reaction is suspected, the treatment should be stopped and appropriate medications for managing these reactions need to be given. Premedication is recommended for subsequent infusions.

Gastrointestinal AEs associated with BV treatment include nausea, diarrhea, vomiting, abdominal pain, and constipation. Management is dependent on the particular symptom. If diarrhea occurs, the patient should be tested for infection and assessed for colitis. Patients should be taught to report gastrointestinal symptoms, drink enough fluids, monitor weight (for gain or loss), and be referred to a dietician when needed for nutritional counseling.

Progressive multifocal leukoencephalopathy is a rare but fatal condition that occurs as a result of reactivation of John Cunningham virus. It has been reported in patients receiving BV and is included as a boxed warning. Symptoms can include progressive weakness, visual or speech impairment, headaches, seizures, and mental status or personality changes. Symptoms are evaluated by imaging, analysis of cerebrospinal fluid, and neurology consultations.

Other AEs that may occur include noninfectious pulmonary toxicities, hepatotoxicity, and pancreatitis. Since nurses are on the frontline of care, they need to be alert for various AEs associated with BV treatment and promptly initiate their management.

Clifford K, Copeland A, Knutzen G, Samuelson E, Grove L, Schiavo K. Brentuximab vedotin: A nursing perspective on best practices and management of associated adverse events. 

 2018, 22(4), E103-E114 DOI: 10.1188/18.CJON.E103-E114.

Adverse events (AEs) associated with brentuximab vedotin (BV; Adcetris) - used to treat hematological malignancies - may be serious, and nurses need to understand what they are, monitor for them, and treat them promptly.

Managing Adverse Events from Brentuximab Vedotin

Many patients with advanced cancer experience physical discomfort and declining ability to perform activities of daily living. In addition, they may experience depression and other types of emotional distress. While palliative care has shown positive outcomes among patients with advanced disease, palliative care programs often are focused on symptom control and advanced care planning.

Canadian researchers recently highlighted the need for supportive psychotherapy interventions that are individualized to the patient, brief, and easy to implement. They created the Managing Cancer and Living Meaningfully (CALM) intervention for patients with advanced cancer who had a life expectancy of at least 1 year. The researchers conducted a randomized-controlled trial to compare CALM with usual care (UC) for patients with advanced cancer. Results of the study were published in the 

use of specially trained clinicians to implement the CALM program

structured psychotherapy (3-6 sessions over 3-6 months)

referral to other providers when indicated (e.g., psychiatrist, palliative care).

Clinician training consisted of a 2-day intensive CALM training workshop followed by successful completion of at least 2 clinical cases under the supervision of one of the main researchers, along with ongoing case supervision by the researchers. Psychotherapy sessions were either individualized or included a spouse or family member as deemed appropriate by the patient and therapist. The sessions focused on symptom management and communication with healthcare providers, changes in self and relations with close others, spiritual well-being and the sense of meaning and purpose, and mortality and future-oriented concerns.

Assessments of depressive symptoms (primary outcome), death-related distress, and other secondary outcomes were conducted at baseline, 3 months (primary end point), and 6 months (trial end point). Patients were randomly assigned to CALM (151 patients) or UC (154 patients).

CALM participants reported less-severe depressive symptoms than UC participants at 3 months and at 6 months. CALM participants also more frequently made end-of-life preparation at 6 months than those receiving usual care.

Among participants who were not depressed at baseline, those who received CALM were less likely to report threshold symptoms at the primary endpoint, which suggests that CALM may help to prevent the onset of depressive symptoms that may otherwise grow over time in patients with advanced disease. No adverse events from the CALM intervention were identified.

The researchers concluded that CALM has the potential to provide a systematic approach for reducing or alleviating concerns about end-of-life issues for patients with advanced cancer.

The researchers plan to discuss the mechanisms by which CALM exerts its effects in a separate publication, but theorize that CALM may be effective because patients with advanced disease have an increased opportunity to discuss issues and concerns with healthcare providers, are offered guidance on addressing the impact of advanced disease on their self-concept and family relationships, and may be able to find or strengthen a sense of meaning and purpose in life. They also have a safe place to express and manage fears and wishes about end-of-life care.

Nurses can use this information to consider collaborating with the oncology care team to explore initiating the CALM intervention or a similar supportive care program.

Canadian researchers recently created the Managing Cancer and Living Meaningfully (CALM) intervention for patients with advanced cancer who had a life expectancy of at least 1 year to address the need for supportive psychotherapy interventions that are individualized to the patient, brief, and easy to implement.

CALM Intervention May Reduce Distress in Patients With Advanced Cancer

Men are reported to be less likely to receive palliative care, according to research led by Fahad Saeed, MD, from the University of Rochester Medical Center in Rochester, New York, and colleagues.

To understand this disparity, the researchers conducted a cross-sectional analysis of data collected from 383 patients upon study entry in the Values and Options in Cancer Care (VOICE) clinical trial. In the study, published in the 

, patients were asked about their palliative care preferences—defined as “comfort care” with a focus on quality of life, but not a cure&mdash;in the event their oncologists informed them that further treatment would not be helpful.

Patients could respond saying definitely no, possibly no, unsure, possibly yes, and definitely yes. Patients preferring palliative care (definitely or possibly yes) were compared to all others.

The researchers found that women were more likely to prefer palliative care than men. The effect of education on palliative care preferences, which was also studied, was not statistically significant.

Although their study findings could not be generalized, the researchers concluded that gender differences in preferences for palliative care occurred in their study, and may account for gender disparities found in end-of-life care. Lastly, they recommended interventions be used to promote palliative care among men to help close this gender gap.

Women May Choose Palliative Care More Often than Men

A group of US researchers led by Ayush Sharma, MD, from the Mayo Clinic in Rochester, Minnesota, developed and validated a model to determine the risk of pancreatic cancer in people newly diagnosed with diabetes. They 

 from four cohorts of people diagnosed with diabetes from 2000-2015 (n = 1,561). The newly created predictive model, which they named Enriching New-onset Diabetes for Pancreatic Cancer (END-PAC), weighed scores for the 3 factors most strongly associated with pancreatic cancer-change in weight, change in blood glucose level, and age at onset of diabetes.

An END-PAC score of 0 (in 49% of patients) correlated with an extremely low risk for pancreatic cancer. An END-PAC score 

3 correlated with an increased risk of developing pancreatic cancer within 3 years.

The researchers concluded that significant weight loss, increased blood glucose levels, and older age at onset of diabetes may be useful in determining the risk of pancreatic cancer in people newly diagnosed with diabetes; however, further research is needed.

Significant weight loss, increased blood glucose levels, and older age at onset of diabetes may be useful in determining the risk of pancreatic cancer in people newly diagnosed with diabetes.

Pancreatic Cancer Risk Among People Newly Diagnosed with Diabetes

The Leukemia & Lymphoma Society (LLS) is known for its assistance to patients, but did you know that this organization also offers many resources for clinicians as well? A spectrum of free resources from online continuing education (CE) to publications is available at 

The recently released CE program, CAR T-Cell Therapy: The Nurse’s Role in Treating Patients, reviews patient selection considerations, treatment options, and information about possible acute and long-term adverse events and their management.

Trish Greene Back to School Program For Children With Cancer

free information and materials for parents and educators. The program was developed to encourage communication among parents, healthcare professionals, and school personnel to help ensure that children with cancer have a smooth transition from active treatment to return to school. Nurses who provide cancer care to pediatric patients may find these resources valuable.

The Leukemia & Lymphoma Society (LLS) is known for its assistance to patients, but did you know that this organization also offers many resources for clinicians as well?

Lisa Schulmeister, MN, RN, FAAN