Nurses are uniquely positioned to optimize clinical benefit with sotorasib (Lumakras) for patients with non–small cell lung cancer through thorough agent education and effective adverse event (AE) support, according to a presentation of the nursing experience in the phase 1/2 CodeBreaK 100 trial (NCT03600883), which was presented at the 47th Annual Oncology Nursing Society Congress.

Overall, the most effective symptom management in sotorasib will be related to gastrointestinal (GI) TRAEs. Based on the experience of the study authors, nurses can best prevent grade 3/4 adverse events in patients receiving sotorasib by educating them on the use of antidiarrheals, such as loperamide, encouraging them to adhere to a bland diet and increase fluid intake, as well as educate them on the use of antiemetics, such as ondansetron or prochlorperazine. If patients do present with GI tract–related AEs, management should involve coordination across the entire oncology care team and follow the guidance provided in the product package insert.

Furthermore, nurses who encourage patients to proactively communicate safety concerns and review urgent care can help facilitate continued treatment with this novel therapy. In this trial, nurses found that informational handouts and clear instructions to use prophylactic medication at first signs of nausea and diarrhea can be effective in preventing grade 3/4 AEs.

“By helping patients identify and manage AEs, nurses can facilitate continued treatment,” Askia Dozier MS, BSN, RN, CCRC, said in a poster presentation of the findings.

Sotorasib is an oral targeted therapy which functions by inhibiting KRAS G12C. In May 2021, the 

 for the treatment of patients with locally advanced or metastatic 

 G12C–mutant NSCLC who have not received prior therapy.

 from the CodeBreaK 100 study indicated the agent’s efficacy and tolerability in this patient population. At a 2-year follow-up, patients receiving the targeted therapy achieved an overall survival (OS) rate of 32.5% (95% CI, 25.0%-40.2%); furthermore, the overall response rate associated with the drug was 40.7% (95% CI, 33.3%-48.4%) and the disease control rate (DCR) was 83.7% (95% CI, 77.3%-88.9%).

Additionally, the median duration of response (DOR) was 12.3 months (95% CI, 7.1-15.0), and 50.6% (95% CI, 37.4%-62.4%) of responders were in response for at least 12 months. The median progression-free survival was 6.3 months (95% CI, 5.3-8.2) and the median OS was 12.5 months (95% CI, 10.0-17.8).

In the trial, investigators assessed sotorasib orally once daily at 960-mg in 357 patients with 

 p.G12C– mutant advanced solid tumors. Enrolled patients were heavily pretreated and their diseases had progressed beyond standard therapy. The median age was 63 years (range, 31-96).

Overall, the drug was associated with low-grade, reversible toxicities. The most reported any grade treatment-related AEs (TRAEs) in CodeBreaK 100 included GI tract AEs, including diarrhea (22.4%), nausea (12.0%), and vomiting (5.6%). The median low-grade onset times were 30 days (interquartile range [IQR], 4.0-70.0), 15 (IQR, 3.0-65.0), and 21 (IQR, 9.5-71.0) days; the median grade 3 onset times were 40 days (IQR, 20.5-52.5), 12 (NA), and 11 (NA) days, respectively. Across all GI reactions (n = 120), the median onset time was 13 days (IQR, 3.0-50.5) for all-grade events and 37 days (IQR, 12.0-51.0) for grade 3 incidences (n = 13).

The median TRAE duration for resolved symptoms was 20 days for diarrhea, 12 for nausea, and 2.5 days for vomiting.

Furthermore, among these common GI TREAEs, 1 patient discontinued treatment because of vomiting. No patients needed to discontinue on account of nausea and diarrhea.

Gastrointestinal AEs were primarily low grade; 3.6% were grade 3, and there were no grade 4 or 5 AEs reported.

The sotorasib prescribing information states that treatment should be stopped in the event of grade 3/4 nausea, vomiting, or diarrhea. Following resolution of these AEs, treatment can be resumed at a lower dose. Throughout the trial, treatment-related diarrhea resulted in dose reductions/interruptions in 5.9% of patients, while nausea and vomiting led to 2.5% of 0.8% patients, respectively.

Dozier A, Futzpatrick V, Liu D, Hull J, Varrieur T, McGuire L. Nursing experience with patients receiving sotorasib for KRAS G12C-mutated solid tumors: follow-up from the phase 1/2 CodeBreaK 100 study. Presented at: 47th Annual ONS Congress; April 27-May 1, 2022, Anaheim, CA. Abstract 390.

FDA approves first targeted therapy for lung cancer mutation previously considered resistant to drug therapy. News release. FDA; May 28, 2021. Accessed April 10, 2022. 

Dy GK, Govindan R, Velcheti V, et al. Long-term outcomes with sotorasib in pretreated KRASp.G12C-mutated NSCLC: 2-year analysis of CodeBreaK100. Presented at: 2022 AACR Annual Meeting; April 8-13, 2022, New Orleans, LA. Abstract CT008.

Articles

Oncology nurses present their experiences treating patients with sotorasib in the phase 1/2 CodeBreaK 100 trial and optimal symptom management strategies to improve patient outcomes with the drug.   

Nurse Takeaways: How to Improve a Patient’s Experience With Sotorasib and Optimize NSCLC Treatment

An effective approach to improving nurse responsiveness on an inpatient oncology unit may be through a dot-centered hourly rounding column, according to findings presented at the 47th Annual Oncology Nursing Society Congress.

This hourly rounding column, which was rolled-out at Smilow Cancer Hospital at Yale New Haven, was designed in consideration of RNs’ and personal care assistants’ (PCA) preexisting workloads. The innovation does not add documentation to their workflow but rather makes preexisting data points more visible.

“We saw an increase on all 4 units in nurse responsiveness, simply by highlighting

how frequently a nurse and patient care associate patient load is seen within the hour,” lead study author Brianna Lutz, MSN, RN, OCN, said in an interview with 

Built into the patient list in EPIC, the flowchart uses colored dots to show which patients have been attended to in the past hour. A green dot indicates that patients have been attended to within the past hour, while a red dot indicates that it has been over 1 hour since they received nurse attention.

When conducting rounds, if a nurse documents on any of the following data points, the dot automatically turns green: vital signs, pain assessment intake/output, fall risk interventions, activity, ambulation, hygiene, positioning and Medical Administration Records documentation. A red dot immediately prompts the RN or PCA to conduct a targeted hourly round immediately.

For this implementation, targeted hourly rounding includes screening of a patient’s pain, position, proximity to personal items, toileting needs, and preferences, and is conducted by either a registered nurse or patient care association. Targeted hourly rounding is critical to both patient safety and patient experience. The Press Ganey was chosen as a metric of targeted hourly rounding since it measures performance of quality care using the indicator “Response of Hospital Staff.”

As of February 2021, all 4 involved units (hematology, medical oncology, women’s health, and surgery) experienced an increased in the monthly average responsiveness score after implementation of the hourly rounding column. The average monthly “N” for each unit, according to Press Ganey data, were 3.5 (hematology), 4.8 (medical oncology), 45.3 (women’s health) and 53.6(surgery). In addition, staff have expressed satisfaction with the system and appreciate for the ability to visualize hourly rounding status and streamlined documentation.

“Historically, we have 4 separate siloed units. Historically, their first Ganey scores for responsiveness are on the lower side,” Lutz explained. “However, by implementing the hourly rounding column, we were able to have a real time visualization of the number of times that nurses and our patient care associates were in the room every hour without adding any burden to their workflow.”

Of note, the team created an instructional video explaining the rationale and goal of the implementation staff so they would understand that this was not a punitive action.

“The video was crucial, because we actually did see that some nurses in inpatient units felt like [this intervention] was a little bit punitive,” Lutz said.

“[They worried] that if their nurse leader saw that 3 out of 4 of their patients were red [dots], that they were in trouble or that they were lagging behind in their workflow,” she added. “We showed that video at safety huddles, and staff meetings across the 4 inpatient units. That small group of us who had worked on the project [shared the video] with the end users, so we did not have to rely on a middleman to the purpose and the intention. That was very important.”

Thus far, feedback has been positive, she added. Moving forward, broader implementation of this system may be appropriate across more units and systems.

“Our team of the oncology cluster and our EPIC analysts were really crucial and working collaboratively with kind of all of those key stakeholders was really helpful,” she said. “We are working now to roll this out beyond the oncology service line; it really has utility for all patient care levels and doesn't need to be siloed just to oncology.”

Lutz B, Crouch L, Sanchis D. Improving nurse responsiveness on inpatient oncology units. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract 220.

An hourly rounding column helped make integrated data points more visible and improve nurse responsiveness on an inpatient floor. 

How to Improve Nurse Responsiveness on an Inpatient Oncology Unit 

The use of a discharge lounge for patients undergoing stem cell transplant may prove an effective and safe strategy for facilitating swifter discharge and preventing bottlenecking, according to Stephanie Jackson, DNP, MSN, RN, AOCNS, BMTCN.

Jackson served as an investigator on a poster presentation regarding the utility of such a discharge lounge that was recently presented at the 47th Annual ONS Congress. In an interview with 

®, she highlights the significance of this intervention and its potential to ease the burden for night shift nurses.

Historically, these patients were not always able to use the discharge lounge because of neutropenia and immunosuppression concerns, she explains. However, during COVID-19, it became a priority to help patients discharge as swiftly as possible to reduce their time in the hospital and increased risk of infection.

Through the collaboration between the Observational Unit Discharge Lounge and Oncology/SCT Unit, this ongoing project has demonstrated that this innovation may result in earlier bed availability for patients being admitted later in the day or in the evening.

Videos

Stephanie Jackson, DNP, MSN, RN, AOCNS, BMTCN, discusses how collaboration between an oncology unit and discharge lounge can improve discharge times for patients who have undergone stem cell transplantation.  

Stephanie Jackson Discusses the Feasibility of a Discharge Lounge for Stem Cell Transplant Units

Oncology nurses found the use of a medication extension set to be a feasible and comfortable method of administering subcutaneous hyaluronidase injections, according to a poster presented at the 47th Annual Oncology Nursing Society Congress.

Volunteer nurses across 6 pilot sites were asked to use the medication extension set for 6 injections and to answer a corresponding survey. Notably, 100% of nurses reported difficulties or complaints with traditional needle injections, while only 20% of nurses experienced problems with the novel method and 0% reported difficulty with dexterity using the extension set. Furthermore, 80% of respondents indicated a preference for the extension set over a traditional needle.

“The survey results were favorable for use of extension set over the use of the needle,” Sarah Digirolamo, RN, of Yale New Haven Health Smilow Greenwich, said in a presentation of the findings. “Eighty percent of our respondents reported that they would prefer to use the extension system.”

In 2017, Greenwich Hospital began administering subcutaneous injections which contained hyaluronidase. The hospital currently administers rituximab (Rituxan), daratumumab (Darzalex), and pertuzumab (Perjeta) with trastuzumab (Herceptin). The administration of these injections can take between 3 to 8 minutes to administer and can be uncomfortable for nurses because of the length of time they need to be in close proximity to the patient.

“It can be really hard to push some of those drugs (through a traditional needle),” Digirolamo explained. “It takes 3 to 8 minutes to push and not only are you hurting your hands, [but] you could be moving the needle into the patient. With the extension side, it is just easier to push it through.”

She added that once the COVID-19 pandemic hit the world, their health care system implemented social distancing guidelines, like many others.

“Nurses noted that social distancing always was a challenge when delivering patient care but was especially compromised while administering subcutaneous injections. It became apparent that there was a need for other administration options to address the concerns of improper body mechanics, increase the ease of device to administer these medications and promote social distancing during the administration of these medications, all while maintaining safety and comfort for their patients.”

To this end, they decided to consult with nursing professionals, development specialists, pharmacists, a patient education specialist, and frontline staff to explore possible alternatives. The selection criteria for their alternative included approval for subcutaneous use, availability, staff familiarity, and presence of safety features (a needle safety lock to protect both the nurse and the patient). Ultimately, the team chose to initiate use of a medication extension set.

Digirolamo noted that throughout the project, some nurses raised concerns about the residual medication that would be in the syringe extension, particularly because there is a small amount of tubing between the syringe and the patient to mitigate the dosing errors. The team therefore educated their nurses to conduct “air locking” or “air sandwich technique” before and after administering the drugs.

“With the extension set, we are teaching them to conduct a little ‘air sandwich,’” she advised. “[This entails pulling the needle, putting some air in, and then pushing it through so that we are priming it and [the] drug goes all the way through.”

Digirolamo S, Gineo E, Roselli E, Bocchetta N, Sumpio Catherine. Administering subcutaneous (SubQ) hyaluronidase injections with a medication extension set (ExSet). Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P30.

A medication extension set may be the preferred method for subcutaneous hyaluronidase injections compared with a traditional needle. 

Medication Extension Set Makes Subcutaneous Hyaluronidase Injections Easier, More Comfortable in Cancer Treatment

Oncology nurses can serve as the key to ensure that cancer survivors receive the follow-up care they need, according to Michelle Mollica, PhD, MPH, RN, OCN.

Mollica, who is a senior advisor in the NCI Office of Cancer Survivorship and is consequently responsible for developing, supporting, and promoting research efforts focused on cancer survivorship, presented on individualized survivorship care plans at the 47th Annual Oncology Nursing Society Congress. During the meeting, she sat down with Oncology Nursing News® to discuss what nurses should know about survivorship care plans.

“Something I cannot stress enough is the importance of the oncology nurse in assessing the specific needs of cancer survivors and that [this] needs to happen early,” Mollica said. “Listen and be aware of what patients and survivors need from the point of diagnosis all the way through because those needs might change.”

 Could you discuss the basic framework of an effective survivorship care plan?

: A survivorship care plan is a tool that is meant to guide patients and survivors, as well as health care providers, for the necessary survivorship care. Ideally, the plan should have a summary of cancer history, pertinent health history, as well as treatment summaries, and a follow-up plan for what should occur in the future for that survivor. It should be tailored to the needs of the survivor, and their cancer type and treatment history.

How might care for a childhood cancer survivor differ from that of an adult or even an elderly patient?

Individuals who are diagnosed with cancer as children are at high risk for late- and long-term effects—symptoms that occur well after their treatment has ended. There is a real need to monitor for those impacts, especially things like cardiotoxicity and other symptoms, well after their treatment has ended.

That is different from an older adult who often is dealing with lots of other comorbid conditions: they might have diabetes or have other health issues that are in essence competing with their follow-up care for cancer. It is up to the older adult to coordinate their care in a way with their providers that makes the most sense based on their needs.

What are the challenges in caring for different populations, specifically rural cancer survivors?

Rural cancer survivors often have issues engaging and accessing survivorship care; they are less likely to receive a survivorship care plan or have a survivorship care discussion with their oncologist. They often have challenges engaging back with their primary care provider after their treatment has ended or knowing what types of treatment follow-up care they need.

Oncology nurses play a key role in sort of bridging that gap. They can help survivors know what's ahead, know how to access those resources, and [guide them through] supported self-management—[teaching] when to call if they have symptoms or issues that they think they may need to get checked out. The oncology nurse is key to both assessing the needs of survivors and educating patients, particularly for vulnerable populations like rural cancer survivors.

Which factors do you consider when determining a patient's level of risk?

Many professional organizations have recommended risk-based survivorship care, which means that survivorship care is tailored based on the needs of the survivor. That can include an assessment of factors that include risk for recurrence risk for second cancers, their likelihood for late- and long-term effects, and how many other comorbid conditions they have. It can also be based on things like level of social support: do they have someone to take them to their follow-up care visits? It is important to [consider these risks] and tailor the care based on these factors.

What are some challenges that can be linked to primary care coordination? How might a nurse help overcome those barriers?

Primary care providers are dealing with so many things daily. Seeing cancer survivors is just a small part of their day, although we have a growing number of survivors that are being seen in primary care. When survivors are transitioned back to primary care, either during or after treatment, it is essential that primary care providers know what type of care is needed and how to deliver that care for the survivor. I would say there are lots of challenges to doing that.

Engaging with primary care and having access to a primary care provider is always a challenge. In addition, primary care providers often need to be educated on the impact of new therapies like biotherapies and targeted therapies—these may have another host of symptoms that survivors need to worry about, as well as staying up with guidelines for cancer survivors.

Oncology nurses can help survivors navigate those challenges. They can help educate patients and what they should bring to their primary care provider. They can also make contact with the primary care provider and in many cases, advanced practice oncology nurse practitioners are actually providing that survivorship care and bridging that gap.

How can patients be proactive in helping to manage their care plans or even coordinating with their care team to individualize it?

It is important for patients to know what questions need to be asked and to ask as many questions as early and often as possible. That includes: what type of care do I need to receive? What is this going to look like for me as I transition either off treatment, or in these periods where I might not be treated? Who should I see and when, and making sure that that's all included in their survivorship care plan and using that as a tool to navigate their care?

Patients also need to be empowered to reach out if they experience any symptom that they aren't familiar with or is new to them. This is because, often, symptoms emerge that we might not be aware of between visits, and they need to know to reach out to their provider and ask questions.

Michelle Mollica, PhD, MPH, RN, OCN, senior advisor in the NCI Office of Cancer Survivorship, discusses different long-term care considerations for nurses caring for patients with cancer. 

Oncology Nurses Play Pivotal Role in Survivor Follow-Up Care

Brianna Lutz, MSN, RN, OCN, Smilow Cancer Hospital at Yale New Haven, discusses a flowchart built within EPIC that allows nurses on an oncology unit to view the workflow across the unit and better identify which patients require attention via targeted rounding.

Lutz recently presented on the topic at the 47th Annual Oncology Nursing Society Congress. In an interview with 

®, she explains how her team developed and rolled out the system, and how it improves workflow across the unit.

Lutz and her team collaborated to identify a series of data points that already exist within the nurse’s workflow, such as vital signs, pain assessment intake/output, fall risk interventions, activity, ambulation, hygiene, positioning and Medical Administration Record documentation. Every time a nurse documents one of these items, their patient’s dot automatically turns green within the system; signaling to colleagues that this patient has been attended to within the past hour. If a patient has a red dot, then this signals that he or she has not been checked on within the hour and a nurse, or personal care assistant, should make a targeted round to care for that patient.

Brianna Lutz, MSN, RN, OCN, discusses a red-and-green dot hourly column that shows which patients with cancer have been attended to in the past hour. 

Brianna Lutz on How to Improve Nurse Responsiveness on an Inpatient Oncology Unit

Compassion does not [cause] fatigue but burnout can, Patricia Jakel, RN, MN, AOCN, explains. “Compassion cannot fatigue. That is not a true terminology. [Compassion] is like an endless well; you [just] have to make sure that you put back into it.”

Jakel, an advanced practice nurse at University of California Los Angeles Health, and coeditor-in-chief of 

spoke at a well-being discussion at the 47th Annual Oncology Nursing Society Congress. In the lecture, she addressed how the oncology nurse can put themself first both professional and personally and what they require from their institutions to deliver quality care to their patients.

Nurses need to be supported by their institutions, says Jakel. This does not mean gifts or lunches, but resources for staff. There needs to be knowledge that there will be a full team of nurses helping on a night shift, for example.

Furthermore, creating thoughtful boundaries are essential to longevity, she notes, adding, “If you are mindful and you are present with that patient, and not thinking about—and I am guilty of this—'I have to pick up my son at preschool’ or ‘I've got to do this [or that]’, and you really spend the time with them, [you can] walk out of the hospital and say ‘OK, that is behind me. I need to move forward and be mindful of my family and be mindful of what I need to do now.’ That [will] really restore your compassion.”

Patricia Jakel, RN, MN, AOCN, discusses burnout and compassion fatigue in acute oncology care.

Patricia Jakel Comments on Combating Burnout in the Acute Care Setting

The level of invasiveness surrounding fertility preservation can differ greatly between young men and women with cancer and so oncology nurses should be conscience of this when crafting conversations about family planning with adolescent or young adult patients, according to Donna Herrera Bell, MSN, APRN, FNP-C.

Bell is a nurse practitioner with The University of Texas MD Anderson Cancer Center who spent 14 years working at Children’s Cancer Hospital with children and adolescents with leukemia and lymphoma. Recently, she helped develop a Pediatric Onco-Fertility consult service with MD Anderson.

Following her presentation at the 47th Annual Oncology Nursing Society Congress about eliminating barriers to conversations around fertility preservation in AYA patients with cancer, Bell met with 

® to discuss how nurses can help improve fertility conversations with these populations.

Conversations With Young Men Center on Family Building

“With men, we conduct fertility-risk counseling, we look at what the risks are—according to the type of treatment that they have either received or plan to receive—and then make recommendations about fertility preservation,” Bell explained.

With men, Bell said, fertility preservation is much less invasive and, therefore, fertility conversations should revolve around a young man’s desire for family building in the future. Men who have undergone puberty can bank sperm prior to receiving any type of chemotherapy, radiation, surgery, etc., which may pose a risk to their fertility. However, providers should understand that patients with low-fertility risk and low desire for biological children may choose to forego additional appointments and clinical visits.

“Some young men have never considered [family building, while] some young men have very clear goals about what their desires are for future family building,” Bell said in the interview. “They say, ‘Yes. I want to have biologic children in the future.’”

In contrast, some young men may be open to the idea of adoption or non-biological children in the future and may feel that navigating a sperm bank is too much of a burden while also undergoing a cancer diagnosis. The important thing for an oncology nurse to emphasize to these patients is that once treatment has begun, the window for fertility preservation has closed.

“A great example is for young men with acute myeloid leukemia,” said Bell. “Their initial chemotherapy is going to be low risk in terms of fertility. However, if they do not respond [to frontline chemotherapy,] their treatment will change, and will usually require more aggressive treatment, which will change that risk of fertility for them, but the window to preserve fertility will have already closed since they’ve started chemotherapy.”

Therefore, it is important for nurses to have those candid conversations with young men, she emphasized, and to make it clear that those risks may change.

Young Women Must Consider Timeliness and Invasiveness of Procedures

Fertility preservation for women is both more invasive and more time consuming than that for men—meaning that the decision can become a bit more complex for females.

“Fertility preservation for women is invasive,” said Bell. “It involves oocyte retrieval, where medications are given so the ovary will mature an oocyte for retrieval.”

Unfortunately, this process takes at least 14 days to complete which, in turn, can mean that women must delay their cancer treatment by at least a couple weeks to undergo the oocyte retrieval process. This delay can represent a significant barrier to women considering fertility preservation, especially if their cancer is advanced and their oncologists feels that that it’s not safe to delay treatment by 2 weeks. Therefore, cancer stage and fertility risk are important conversations to have with young women during this process.

Similar to men, different treatment types pose different fertility risks: if the ovary will be undergoing radiation, this may pose a risk as different chemotherapies represent different degrees of potential harm. However, unlike men, age may also play a role in determining risk in adolescent or young adult women.

“Girls are born with all the eggs we are going to have, and we don't ever make any more,” explained Bell. “Our window of fertility opens at puberty, and it closes at menopause. Usually around age 50.”

For older women, in their late 20s or early 30s, for example, the ovarian reserve is already lower than that of a 16-year-old woman. Thus, the older a woman is means she is more sensitive to fertility risk than one who is younger. Age is also an important factor to consider as well, she explained.

Once again, Bell suggests asking patients the following questions: “What are your family building goals? Have you thought about what you want your family to look like? What are options that you are open to pursuing?”

“Having those individual discussions with patients, partners, and families, is really key to helping that adolescent or young adult feel like this is not something that's being taken from them,” she said.

Many young adults that Bell meets feel as though fertility is 1 more thing that cancer has jeopardized for them. Therefore, it is vital that providers take the time to ensure that patients understand their potential risks, and options available to them, to decrease any potential decisional regret they may feel as survivors.

Unfortunately, fertility preservation for young patients is not covered by most insurances. Some organizations help to cover some of these costs; however, even with these resources, a procedure such as oocyte cryopreservation may still be close to $7000 out of pocket for a patient—a patient who only recently received a cancer diagnosis.

Although not everyone may be able to afford fertility preservation procedures, every provider can afford to take the time to have a meaningful conversation about these options with newly diagnosed patients, according to Bell.

“Everyone can have this discussion, and every patient should feel empowered about making these decisions and having this choice,” she said.

Conversations surrounding fertility preservation may differ between young men and women with cancer, according to Donna Herrera Bell, MSN, APRN, FNP-C.

How To Approach Fertility Conversations With AYA Patients as an Oncology Nurse

Patients who undergo radiation therapy may experience a host of long-term side effects that their radiation team would be best equipped to deal with, explains Kate Sandstrom MSN, APRN-BC, AOCN.

Sandstrom currently works as a full-time nurse practitioner in the Department of Radiation Oncology at Seidman Cancer Center, University Hospitals Case Comprehensive Cancer Center, and recently gave a presentation on late side effects at the 47th Annual Oncology Nursing Society Congress.

In an interview ahead of her presentation with 

®, Sandstrom discusses resources available to patients who have undergone radiation therapy, and the importance of emphasizing to the patient that they continue to follow up with the radiation oncology team.

Kate Sandstrom, MSN, APRN-BC, AOCN, discusses the importance of including the radiation oncology team in a patient’s long-term care plan.

Kate Sandstrom on Ensuring Patient Follow-Up With Radiation Oncology Teams

Underlying factors may contribute to cancer-related cognitive impairment and stress in patients undergoing active cancer treatment, according to research presented at the 47th Annual Oncology Nursing Society Congress.

Moreover, individual risk needs to be a continuous discussion between patients and providers, according to Kate Oppegaard, a second-year PhD student at the University of California San Francisco School of Nursing. Suring her presentation, she explained that previous research has demonstrated a relationship between 

 and anxiety; however, the interaction of the two is not often studied as such.

“We know that both cognitive impairment and 

anxiety occur in a significant percentage of patients with cancer

. And both of these symptoms lead to decrements in quality of life for patients,” Oppegaard said during the presentation. “However, these two symptoms are evaluated independently rather than together. Therefore, the purpose of this study is to identify groups of patients with distinct co-occurring cancer-related cognitive impairment and anxiety profiles, and then evaluated for differences in demographic, clinical and stress characteristics among these groups.”

The study included 1,332 outpatients with cancer during their first or second cycle of chemotherapy. Patients completed a demographic questionnaire, a performance status scale, a self-administered comorbidity questionnaire and their toxicity from chemotherapy was rated.

Compared to patients with high cognitive function and low anxiety (57%) — the lowest level of symptom burden — patients with moderate cognitive function and moderate anxiety (34%) were more likely: to be younger, female, Hispanic, living alone, unemployed and report childcare or elder care responsibilities, back pain and depression, and have a lower functional status and household income. Additionally, they were less likely to be married or have a partner.

Patients with low cognitive function and high anxiety (8%) — those with the most symptom burden — were more likely to be: younger, Hispanic, unemployed and report stomach disease or ulcers, as well as back pain and depression. These patients were less likely to be married or have a partner and exercise on a regular basis. They also had lower functional status and household income.

When evaluating perceived stress, there was a significant difference among the three groups of patients. Those with a higher symptom burden reported significantly higher levels of perceived global stress and cancer-related stress. Patients in the two higher symptoms burden groups met criteria for either post-traumatic symptomatology or post-traumatic stress disorder.

The final measure was to evaluate how a person felt that they could handle adversity, which is measured on a scale of zero to 40 with higher scores indicating a higher self-perceived resilience — the average score in the general population is 31.8, Oppegaard explained. The results demonstrated that patients with higher symptom burden had lower scores, meaning they had lower self-perceived resilience and were below the general population.

Oppegaard said that these results may help nurses and other clinicians identify patients who may be at higher risk of developing cancer-related cognitive impairment and stress.

“Many factors can contribute to cancer related cognitive impairment and 

. And future research is needed to understand how unrelieved stress may contribute to the co-occurrence of these two symptoms,” she concluded.

Oppegaard K, Miaskowski C, Cooper B, et al. Unrelieved Stress Contributes to Higher Levels of Co-occurring Cancer-Related Cognitive Impairment (CRCI) and Anxiety in Outpatients Receiving Chemotherapy. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P286.

Unrelieved stress may contribute to cancer-related cognitive impairment and anxiety in patients undergoing chemotherapy.

ONS Annual Congress