Patients with cancer who suffer severe distress are more likely to miss appointments during the course of their radiation therapy (RT) and be admitted to the hospital, according to a 

 conducted by researchers in the radiation oncology department of Massey Cancer Center in Richmond, Virginia.

Researchers collected distress scores on all patients receiving RT between 2015-2016. Only patients receiving external beam radiotherapy with definitive intent were included in the study, and distress was measured using the NCCN Distress Thermometer and Problem List. Distress scores were separated into 4 categories: severe (7-10), moderate (6-4), low (1-3), and none (0).

Among the 54 patients completing the distress tools, there was a significant association between a severe distress score and both missing at least 1 appointment and having a hospital admission during treatment.

Of patients with severe distress scores, 57% missed at least 1 appointment compared with 18% of those patients with no, low, or moderate distress. Half of patients with severe distress scores were admitted during treatment, while only 11% of patients with no, low, or moderate distress were admitted.

The use of distress tools may help identify patients receiving RT (and perhaps other types of cancer treatment) earlier so that distressing symptoms can be addressed and hospitalization avoided, the researchers wrote.

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Patients with cancer who suffer severe distress are more likely to miss appointments during the course of their radiation therapy and be admitted to the hospital.

Distress During Radiation Therapy Linked to Missed Appointments and Hospitalization

Heavy, long-term alcohol consumption is known to be one of the many risk factors associated with developing cancer. But, does having 1 alcoholic drink a day increase your chances of developing the disease, too?

The Cancer Prevention Committee of the American Society of Clinical Oncology (ASCO) recently published a 

The article reflects ASCO’s position that while the greatest risks of developing various cancers are associated with heavy, long-term alcohol consumption, even low alcohol consumption (defined as less than 1 drink per day) or moderate consumption (up to 2 drinks per day for men, and 1 drink per day for women) can increase the risk of cancer.

How alcohol affects disease treatment outcomes is unknown. ASCO plans to include research on consuming alcohol during cancer treatment in its research agenda.

In addition, ASCO plans to provide leadership in the cancer community on this issue, including public education on the risks between alcohol abuse and certain types of cancer, as well as the need for evidence-based strategies that prevent excessive consumption of alcohol.

The American Society of Clinical Oncology (ASCO) recently published a special article in the Journal of Clinical Oncology that idicated that even one alcoholic drink per day can increase cancer risk. 

Low Alcohol Consumption Can Increase the Risk of Cancer

Childhood cancer survivors face job lock more often than siblings, according to a 

Researchers from pediatric cancer treatment centers across the United States and Canada examined the effects of childhood cancer treatment on adult employment. They identified the prevalence of job lock—staying at a job to keep work-related health insurance&mdash;among childhood cancer survivors and compared their employment data to that of a random sample of siblings.

Among the 522 study participants, 394 were survivors (54.5% men) and 128 were siblings (51.5% men). Job lock was reported by 23.2% of survivors compared with 16.9% of siblings.

The researchers found that job lock was more common among survivors reporting previous health insurance denial and difficulties paying medical bills. Job lock was also more frequent among women and in survivors who had a severe, disabling, or life-threatening health condition.

“Job lock is common among long-term childhood cancer survivors who are employed full-time,” wrote the authors. These survivors may be hesitant to change employment because of health insurance and financial implications.

This study underscores the need to eliminate pre-existing conditions as a reason to deny or penalize (eg, increased health insurance premiums) childhood survivors’ access to continued health insurance in adulthood.c

Job Lock Is Common Among Childhood Cancer Survivors

Eligibility for clinical trials historically has been very conservative and included exclusion criteria that prevented or limited some patients with cancer from enrolling.

However, on October 2, 2017, the American Society of Clinical Oncology, Friends of Cancer Research, and the Food and Drug Administration published clinical trial eligibility recommendations in a 

 that aim to broaden who can be accepted into clinical trials.

The groups noted that excessively restrictive eligibility criteria can extend the time to accrue patients, limit the generalizability of the trial results, and compromise information on the trial’s benefit-risk profile.

They examined specific eligibility criteria including the presence of brain metastases, minimum age for clinical trial enrollment, presence of HIV infection or organ dysfunction, and prior and concurrent malignancies.

Consensus recommendations were formulated, based on an evidence-based review, consideration of patient populations, and consultation with the research community.

The researchers determined that patients with treated or clinically stable brain metastases should be routinely included in trials, and only excluded if there is compelling rationale.

In initial dose-finding trials, pediatric-specific cohorts need to be included based on strong scientific rationale for benefit. Later phase trials in diseases that span adult and pediatric populations should include patients older than 12 years.

HIV-infected patients who are healthy and have low risk of AIDS-related outcomes should be included absent specific rationale for exclusion. Renal function criteria should enable liberal creatinine clearance, unless the investigational agent involves renal excretion.

Patients with prior or concurrent malignancies should be included, especially when the risk of the malignancy interfering with either safety or efficacy endpoints is very low. 

The groups noted that clinical trial enrollment criteria should strive for inclusiveness and exclusion criteria should be evidence-based.

The American Society of Clinical Oncology, Friends of Cancer Research, and the Food and Drug Administration published clinical trial eligibility recommendations in a special issue of the Journal of Clinical Oncology that aim to broaden who can be accepted into clinical trials.

Expanded Clinical Trial Eligibility Criteria

Advanced practice nurses, such as nurse practitioners (NPs), are increasingly specializing in their areas of practice. In response, specialty nursing organizations have delineated the scope and standards of advanced practice in these specialty areas.

The American Association of Critical-Care Nurses (AACN) first issued the 

AACN Scope and Standards for Acute Care Nurse Practitioner Practice 

in 2006, updated them in 2012, and on November 14, 2017 issued its 

 that describes the specialty’s evolving role in critical care nursing.

The new edition reflects advances in critical care knowledge, practice, and technology and aligns with the Consensus Model for Advanced Practice Nursing Regulation. This updated edition addresses the full scope of practice for Acute Care NPs, including pediatric acute care.

Similarly, the Oncology Nursing Society (ONS) publishes the

Statement on the Scope and Standards of Oncology Nursing Practice: Generalist and Advanced Practice

 The statement includes required educational preparation for oncology NP practice, certification, and credentialing, and describes standards of advanced practice oncology nursing care and standards of professional practice.

Advanced Practice Scope and Standards

Breast cancer, the most common cancer diagnosed in women in the United States, is the second leading cause of cancer death among women after lung cancer.

To track trends in disease incidence, mortality, and survival the American Cancer Society (ACS) analyzes data every 2 years.

In the US, a woman has a 1 in 8 lifetime risk of being diagnosed with breast cancer. Approximately 252,710 new cases of invasive breast cancer and 63,410 cases of in situ breast carcinoma are expected to be diagnosed among women in the US in 2017. Additionally, an estimated 40,610 women are expected to die this year from the disease.

The median age at diagnosis is 62 years. However, median age at diagnosis and death varies between black women and white women. Black women are diagnosed with breast cancer at a median age of 59 years compared with white women at 63 years. The median age at breast cancer death is 70 years for white women compared with 62 years for black women.

Most breast cancers (81%) occur in women aged 50 and older, and 89% of breast cancer deaths occur in this age group.

The ACS notes that improving access to care, especially screening and early detection, could reduce and hopefully eliminate the racial disparity in breast cancer mortality.

Breast cancer, the most common cancer diagnosed in women in the United States, is the second leading cause of cancer death among women after lung cancer.
To track trends in disease incidence, mortality, and survival the American Cancer Society (ACS) analyzes data every 2 years.

Disparity in US Breast Cancer Mortality

A recent study examined the incidence of liver cancer in many countries around the world and found that although it is among the leading causes of cancer deaths, in most cases, it can be prevented.  

The Global Burden of Disease Liver Cancer Collaboration—an international group of researchers&mdash;reported

 on primary liver cancer incidence and mortality for 195 countries or territories from 1990 to 2015.

 on October 5, 2017, included global, regional, and national estimates on the burden of the disease attributable to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, and other causes.

Researchers found that there were 854,000 liver cancer diagnoses and 810,000 deaths globally in 2015 attributed to the disease. HBV accounted for 265,000 deaths from liver cancer (33%), alcohol for 245,000 (30%), HCV for 167,000 (21%), and other causes for 133,000 (16%) deaths.

Cases of liver cancer increased by 75% between 1990 and 2015, of which 47% are attributed to an aging population and 35% to population growth.

Most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusions and injection practices, as well as interventions to reduce excessive alcohol consumption, noted the study authors.

Liver Cancer Incidence Increased Worldwide

Chemotherapy-induced peripheral neuropathy (CIPN) occurs fairly frequently in patients. It is most often associated with treatment with paclitaxel.

CIPN can be long-lasting and debilitating for a patient and, therefore, disrupt quality of life. It can also potentially lead to dose reduction and, in some cases, discontinuation of the agent causing the CIPN.

 shows multivitamin use may be associated with reduced risk of CIPN.

A team of researchers from across the United States identified a cohort of women with breast cancer receiving paclitaxel as part of a clinical trial (SWOG 0221). They examined their use of dietary supplements before diagnosis and during treatment.

Supplement use was evaluated in relation to CIPN, which was assessed by completing the National Cancer Institute Common Terminology Criteria for Adverse Events and the self-reported Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity subscale.

The study examined 1,225 women, who were asked to complete questionnaires at the time of their breast cancer diagnosis. A second questionnaire, given 6 months later, assessed supplement use in relation to CIPN during paclitaxel treatment.

Researchers determined that multivitamin use before diagnosis was associated with reduced symptoms of CIPN. Use during treatment was marginally inversely associated with CIPN. Other supplement use, either before diagnosis or during treatment, was not significantly associated with CIPN.

Multivitamin use may be associated with reduced risk of CIPN, although individual dietary supplement use did not appreciably affect risk, according to the study authors.

They also note that use of multivitamins could reflect other behaviors that were not examined, such as good nutrition, which may cause or contribute to a reduction in CIPN.

The researchers recommend prospective randomized trials of vitamin supplementation, and note that recommendations for supplement use or changes in clinical practice are not warranted based on the results of their study.


CIPN can be long-lasting and debilitating for a patient and, therefore, disrupt quality of life. It can also potentially lead to dose reduction and, in some cases, discontinuation of the agent causing the CIPN.

Multivitamins May Reduce Risk of CIPN

On October 10, 2017, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement on education about skin cancer prevention.

The USPSTF recommends that clinicians provide counseling on sun protection behaviors to parents of children with fair skin beginning when the child is 6 months old. This counseling should extend to young adults with fair skin up to age 24.

For adults over 24 years old with fair skin, the Task Force recommends clinicians consider the individual’s risks for skin cancer in their decision to provide counseling.

In addition, the USPSTF found that there is not enough evidence to determine if counseling adults about skin self-exams is beneficial or harmful.

All patients at risk for skin cancer should be advised to use sunscreen, wear protective clothing, and avoid tanning beds.

More research is needed to determine counseling of patients with other skin types, as well as the benefits and harms of counseling about skin self-examination, according to the USPSTF.

On October 10, 2017, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement on education about skin cancer prevention.
 

Educating Patients on Skin Cancer Prevention

Nearly a month after Hurricane Maria left a path of destruction in Puerto Rico, the island is still trying to pick up the pieces.

, is the disruption in production of mini-bags of IV solutions of normal saline and dextrose in water, which are manufactured by Baxter International.

The healthcare company is headquartered in Deerfield, Illinois, but has manufacturing sites in Puerto Rico where these mini-bags are produced. In a 

 from Baxter International, the company stated that limited production at its facilities resumed a week following the Category 4 storm, powered by diesel generators.

To combat the shortage, Baxter International initiated an allocation system for hospitals and clinics based on past purchases.

And, as of last week, the Food and Drug Administration (FDA) gave the company permission to import normal saline and other solutions from its manufacturing facilities in

 to help ease shortages in the United States.  

 said that more than four dozen FDA-approved drug making facilities are located in Puerto Rico, including ones owned by Pfizer Inc., Merck, Eli Lilly, Johnson & Johnson, Bristol-Myers Squibb and Amgen. Many of these manufacturers produce agents used in the treatment of cancer, and it is unclear at this point if weather-related disruptions will affect the manufacturing of these agents.

“Baxter remains focused on helping ensure patients have continued access to the products and therapies they need,” stated the press release.

Nearly a month after Hurricane Maria left a path of destruction in Puerto Rico, the island is still trying to pick of the pieces.

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