Diagnosing and treating a patient with a less common cancer can be challenging for practitioners, yet with greater awareness and better diagnostics more of these rare cancers are likely to show up in the clinic.

For this month’s cover story, we talked with a variety of experts on these cancers, and they all agree that to successfully identify and treat them, “knowledge is power.” Whether it’s a myeloproliferative neoplasm or a slow-growing neuroendocrine tumor, understanding the symptoms of rare cancers is paramount. As Mount Sinai Hospital’s Dr. Richard Warner, an expert on carcinoid and neuroendocrine tumors (NETs), wisely points out: “If you don’t suspect it, it you can’t detect it.” NETs, for example, bring symptoms like diarrhea and flushing which are common in many other conditions, and can sometimes be misdiagnosed for years.

Diagnosis is only the beginning. Once a rare cancer is identified, finding specialist guidance and resources is critical not only for the practitioner, but also for the patient and caregiver, who need places to turn to for reliable information and to find individuals to share their experiences with through online communities and support groups.

In some of these rare cancers, misunderstanding and even stigma add yet another layer of complexity. As 

 Editor-in-Chief Lisa Schulmeister writes in her column this month, “Not So Pretty In Pink,” although diagnosis and treatment of male breast cancer is similar to that of breast cancer in women, the experience of breast cancer among men is very different. These men often feel very alone, having a diagnosis which accounts for only 1% of all breast cancers. Similarly, as nurse and anal cancer survivor Michele Longabaugh writes in her guest column, “What I Wish My Nurse Knew About Anal Cancer,” she had no idea how isolating being diagnosed with a rare cancer could be, but that “pales in comparison to the ‘solitary confinement’ that a stigmatized cancer like anal cancer can carry.”

A feeling of isolation is not unique to the rare cancer experience. Also in this issue, we talk with sexual health and survivorship expert Dr. Michael Krychman about the impact of cancer on intimacy. Krychman urges nurses and other clinicians to raise these issues with patients and survivors during clinic visits, because doing so can yield relatively simple solutions to improve their quality of life.

As always, we welcome your suggestions and feedback on our coverage, and thank you for reading.

Articles

When You Hear Hoof Beats, Think Zebras

The FDA has been very busy lately granting approvals for a host of new anticancer agents, drug combinations, and indications. This is truly heartening news for the oncology community, and there’s more to come.

Yet as nurses know well, certain side effects of treatment like cognitive complaints and peripheral neuropathy can be stubbornly persistent, and for a sizeable subset of survivors, these symptoms negatively impact their quality of life long after treatment ends.

Fortunately, solutions are available for one of the more common treatment-related adverse events—chemotherapy-induced nausea and vomiting (CINV)&mdash;and new options have been recently approved by the FDA. Another welcome development is FDA clearance of the first scalp cooling system which has been shown to significantly reduce the hair loss which can accompany anticancer treatment.

Unfortunately, some patients and survivors remain reluctant to discuss certain symptoms with their clinicians in the erroneous belief that side effects like CINV and insomnia are just “something that I have to live with, because I have cancer.” Nurses know better, and as our coverage this month shows, asking patients simple questions about how they are sleeping, or probing any worries over expected nausea from chemotherapy, can lead to remedies— pharmacologic and behavioral&mdash;that can improve their quality of life during and after treatment.

Many of the insights we share in this issue from side effect management experts emanate from our team coverage of last month’s first-ever Cancer Survivorship Symposium, a unique collaboration of oncology and primary healthcare professionals, all working toward the same goal: crafting better models of coordinated and individualized care to improve the quality of life for cancer survivors. This month, we also welcome a new member of our Strategic Alliance Partnership program, the Johns Hopkins School of Nursing, a global leader in nursing and healthcare and one of the nation’s top-ranked accredited nursing school programs. In this issue, Associate Professor Jennifer Wenzel, PhD, RN, sheds light on the critical need to increase minority participation in clinical trials.

Have you visited our website recently? Nursing.OncLive.com has a new look, showcasing more of the latest news on the homepage and spotlighting articles from our growing cadre of nurse contributors. If you would like to use this forum to share your insights periodically with your peers on all things oncology nursing, please email Lauren Green (

) for more information and to share your ideas and suggestions.

The FDA has been very busy lately granting approvals for a host of new anticancer agents, drug combinations, and indications. 

Improving Quality of Life Throughout the Care Continuum

What a year it has been for FDA approvals in oncology! With the holidays upon us, there is much to be thankful for in the world of cancer research, where advances in understanding tumor biomarkers have ushered in a host of new personalized therapies for many patients.

Perhaps nowhere was this progress more evident this year than in lung cancer, an area where more strides have been made in the last 5 years than in the previous four decades. This year alone, two immunotherapies—nivolumab and pembrolizumab&mdash;joined targeted agents approved previously for patients whose tumors harbor an 

 mutation. For patients who become resistant to their 

 therapies as most do, the FDA also accelerated its approval of osimertinib, the first agent cleared to treat these resistant tumors. These developments and more have been welcome news for patients, expanding their treatment options and extending survival.

No matter what the treatment, however, the oncology nurse remains front and center in supporting patients and their families throughout their lung cancer journey. In our cover story this month, Thoracic Oncology Nurse Navigator Betsy Hullender Quinn, a 40-year veteran of the nursing profession and an 

 advisory board member, walks us through the many facets of her job coordinating the thoracic oncology program at Memorial Health Care in Tennessee. Quinn works tirelessly to make sure her patients get the right scans and see their medical and radiation oncologists quickly, while connecting them with whatever resources they need to optimize their treatment outcomes and quality of life.

Also this month, we launch a new column—The Social Nurse&mdash;by another advisory board member and social media expert Carol Bush. In her inaugural column, Bush explains how even just dipping a toe into the world of Twitter can help nurses tap into the collective knowledge of their peers, engage in informative discussions, and participate in collaborative projects whenever and wherever they like.

You can find other columns from Bush and our cadre of 

contributors on our website, Nursing.OncLive.com. We encourage you to share your perspectives with us through this forum—please contact Lauren Green (

) to learn more about this opportunity or to share your suggestions.

What a year it has been for FDA approvals in oncology! With the holidays upon us, there is much to be thankful for in the world of cancer research, where advances in understanding tumor biomarkers have ushered in a host of new personalized therapies for many patients.


Celebrating a Season of Hope and Progress

More and more Americans are embracing complementary medicine to help manage their illnesses alongside conventional therapies, and in oncology, nurses know well how important these interventions can be to improving patient and survivor quality of life.

In this month’s cover story, we talk with several experts who rightly recognize the oncology nurse’s critical role in this arena—not only in supporting patients’ efforts to find relief from the rigors and emotional stressors of a cancer diagnosis and treatment, but also in optimizing the safe use of integrative approaches.

This role includes opening up a dialogue with patients about complementary therapies, identifying licensed providers who have experience treating patients with cancer and survivors, and making sure that those therapies patients are adding to their conventional treatments become part of routine nursing assessments.

A healthy diet is an essential aspect of holistic care of the patient with cancer right through to the survivorship phase, and in this issue, oncology nutrition experts from the John Theurer Cancer Center offer a wide array of ideas and strategies for promoting patients’ nutritional health during treatment and to assist them in maintaining healthy eating habits after treatment and thus lower their risk of recurrence.

Also in this issue, we feature our recent interview with one of the leading experts in the field of occupational exposure to toxic substances, Melissa McDiarmid, MD, MPH, who heads the Division of Occupational and Environmental Medicine at the University of Maryland. McDiarmid, who was named an Oncology Nursing Society honorary member last year, says that the evidence is in on the carcinogenic, reproductive, and other health risks posed by exposure to hazardous drugs, and it’s time to stop arguing and focus on the solution. We couldn’t agree more.

Our strategic alliance partners are once again sharing practical ideas to enhance cancer and survivor care, among them, the “Heels of Hope” patient navigation program at the UNC Lineberger Cancer Center where volunteers team up with patient advisors and healthcare staff to provide nonclinical support to patients—identifying and resolving barriers to care and providing emotional support. At the Smilow Cancer Hospital at Yale-New Haven, an innovative writing program is helping patients to heal by sharing their stories, and at Case Western Reserve University’s Frances Payne Bolton School of Nursing, leaders are placing a priority on ensuring that oncology nurses are trained to provide quality palliative care to patients and their family caregivers.

We hope these research highlights, conference coverage, and expert insights will help you in your practice. We invite you to share your comments and suggestions, and as always, thank you for reading.

More and more Americans are embracing complementary medicine to help manage their illnesses alongside conventional therapies, and in oncology, nurses know well how important these interventions can be to improving patient and survivor quality of life.


Caring for the Whole Patient-for Nurses, It Comes Naturally 

We continue to marvel at the tremendous strides made in cancer care, a record of progress that means millions of people are now surviving cancer, and many for a very long time. Yet this good news brings its own set of challenges for today’s healthcare practitioners, because cancer treatments like chemotherapy and radiation can have lasting effects such as cardiotoxicity and recurrent cancers that may appear many years later.

 this month, we explore how vigilant monitoring of survivors is essential and how precision medicine can identify those individuals most at risk of these effects and make sure they get the appropriate screenings and follow-up care.

Late effects of a cancer diagnosis are not only physical of course and can include fear of recurrence, lingering depression, and sexual challenges. Our editors were on hand in Washington, DC, for the 2015 World Congress on Psycho-Oncology, interviewing presenters about their latest research to help patients cope with the distress of a cancer diagnosis and manage those symptoms which can sometimes be overlooked, but are so important to overall quality of life. The meeting marked the first time the American and international psychosocial oncology societies met jointly, an impressive assembly of more than 900 experts from 49 countries.

 on a therapy option that we first covered in 2011—hot chemotherapy bath. We talked with experts in hyperthermic intraperitoneal chemotherapy (HIPEC) about how the treatment is being used in practice today to treat a variety of gastric and gynecologic malignancies. Selecting the right patients for HIPEC is essential, and nurses play a critical role in supporting them throughout this extensive procedure and long period of recovery.

 featured in this issue of Oncology Nursing News touch on two critical issues in cancer care today. Joan Such Lockhart of Duquesne University School of Nursing makes a strong case for the need to improve cancer knowledge among all healthcare practitioners, so that they can effectively treat the burgeoning numbers of survivors who they will be seeing in their clinics. And Katherine Yeager of the Nell Hodgson Woodruff School of Nursing at Emory University takes on the all-important issue of cancer pain, an issue of critical importance, with studies showing that 40% of patients with cancer do not get adequate relief from pain.

We welcome your feedback and suggestions on topics you’d like to see in the pages of this journal and on our website, Nursing.OncLive.com. Please reach out to 

We continue to marvel at the tremendous strides made in cancer care, a record of progress that means millions of people are now surviving cancer, and many for a very long time. 

Keeping Watch: Monitoring Survivors for Late Treatment Effects

When some 30,000 oncology practitioners, researchers, and patient advocates gather each year for the annual meeting of the American Society of Clinical Oncology (ASCO), we’ve come to count on some pretty important research updates emerging from that gathering. This year’s meeting—ASCO’s 51st&mdash;proved no exception.

In this month’s cover story, we present some highlights of the meeting, alongside perspectives written by your peers on the impact these developments may have on your practice.

Progress on the immunotherapy front continued to grab headlines at ASCO, among them, nivolumab demonstrating superiority over docetaxel in the treatment of a number of lung cancer subtypes and pembrolizumab showing real promise in the treatment of hard-to-treat advanced head and neck cancer. ASCO brought more good news on the survivorship front, with researchers reporting that survivors of childhood cancers are living longer due to better treatments and improved follow-up care. We cover all of these developments and more in our special 2-credit CE activity, beginning on page 26.

Our editorial team also was on hand for the 9th Annual Joining FORCES Against Hereditary Cancer Conference, held this year in Philadelphia. In this issue, we share expert insights on what the explosion in genetic testing options means for your patients. We also spoke with FORCE’s executive director about the group’s patient-powered ABOUT research registry that’s capturing real-world information from those directly or indirectly affected by hereditary cancer risk. Be sure to visit the OncNurseTV portal on Nursing.OncLive.com for more coverage of the FORCE meeting.

Also in this issue, we hear from oncology nurse navigator and Oncology Nursing News board member Penny Daugherty, who found herself in the unenviable position of switching places when her husband was diagnosed with melanoma. That experience allowed Daugherty to witness firsthand the difference a navigator can make: “After my experience as a wife who was by her husband’s side through his cancer diagnosis and surgery, I can say that I now fully understand the breadth—and the depth&mdash;of our role as nurse navigators.”

We couldn’t agree more, and we hope that you will find the research highlights and peer perspectives you find in this issue helpful in your daily practice.

When some 30,000 oncology practitioners, researchers, and patient advocates gather each year for the annual meeting of the American Society of Clinical Oncology (ASCO), we've come to count on some pretty important research updates emerging from that gathering. This year's meeting-ASCO's 51st-proved no exception.


Bringing You the Latest Updates From the Year's Largest Oncology Conference

It’s really no surprise that the buzz at the major oncology meetings these days centers on how immunotherapy is being deployed in the treatment of many hard-to-treat cancers—moving far beyond the melanoma setting where the approach has already proven so successful.

Following on the FDA’s approval of nivolumab to treat the squamous form of non—small cell lung cancer (NSCLC), more approvals are being pursued for immunotherapeutic agents to treat all subtypes of NSCLC buoyed by impressive clinical trial results. Additionally, at the recent annual meeting of the American Society of Clinical Oncology, findings from multiple clinical trials suggest that immunotherapies are gaining ground in renal cell carcinoma, pancreatic and liver cancer, glioblastoma, in the head and neck setting, and for hematologic malignancies, among others. And, importantly, researchers are beginning to discover how mutations, biomarkers, and an individual’s cancer cell DNA can help to identify which patients are most likely to respond to these new agents.

As exciting as these findings are, immunotherapy represents a whole new way of treating patients with cancer. This therapeutic approach presents a very different profile—and trajectory&mdash;of side effects, because unlike traditional chemotherapy agents, these immune-related adverse events may occur weeks and even months after treatment has begun. In the words of Marianne Davies, a thoracic nurse practitioner who has worked extensively with immunotherapies in the clinic, “patient education is incredibly important.”

Who better than the oncology nurse to be front and center in that effort?

, Davies and other experts offer insights on how you can help your patients understand the type of side effects to expect if they are candidates for immunotherapy, and they all stress that careful monitoring and early reporting of symptoms—no matter how small&mdash;is essential for patients to continue their treatment and reap the most benefit.

Also in this issue, we hear from an oncology nurse who tragically lost her husband to prostate cancer at a young age yet is determined to use that experience to raise awareness of how 

 mutations can be complicit in prostate cancer, especially in younger men with more aggressive tumors.

Technology continues to spread its tenets into practically every aspect of healthcare, and increasingly, patients are using web-based portals to see their test results, access information about their disease, and otherwise communicate electronically with their healthcare team. We talked with several experts about how these patient portals are working in practice, and the consensus seems to be that for the most part, oncology patients like them.

The field of cancer care is ever changing, and our goal is to bring you expert insights on these developments through the pages of this journal and our website Nursing.OncLive.com. Let us know what you’d like to learn more about, and as always, thank you for reading.

It's really no surprise that the buzz at the major oncology meetings these days centers on how immunotherapy is being deployed in the treatment of many hard-to-treat cancers-moving far beyond the melanoma setting where the approach has already proven so successful.

Mike Hennessy