Neuroendocrine cancers are a rare heterogeneous subset of tumors, but with newer diagnostic testing and advances in our understanding of this uncommon disease, we have seen an increase in the incidence each year. One of the most recently approved treatments for the disease is peptide receptor radionuclide therapy (PRRT). There are key steps oncology nurses should take to ensure safety for both patients and providers on PRRT.

The PRRT program at Rush University Medical Center requires a multidisciplinary approach, which is necessary to plan and implement a successful PRRT program. At the core of the team is the nursing staff, who are critical in preparing and administering the treatment. Patient education regarding postprocedure radiation safety is also key.

Neuroendocrine tumors (NETs), including gastroenteropancreatic NETs, or GEP-NETs, arise from neuroendocrine cells of either the stomach, gut, or pancreas or from other organs such as the lung, ovary, and thyroid.

Lutetium Lu 177 dotatate (Lutathera) is a radiolabeled somatostatin analog and PRRTtargeted therapy approved by the FDA in January 2018 for the treatment of somatostatin receptor—positive GEP-NETs in the second-line setting.

 Patients who qualify for PRRT therapy should undergo receptor-based imaging, such as a dotatate scan, to assess receptor status prior to initiating treatment. Lu 177 dotatate works by binding to somatostatin receptors and emitting radiation to treat NETs. Serious adverse events (AEs) may include loss of renal function, pancytopenia, and secondary myelodysplastic syndrome.

A limited number of sites across the United States offer PRRT, and Rush University Cancer Center was the first institution in Illinois to offer imaging with a dotatate scanner and treatment with PRRT therapy.

Lu 177 dotatate carries radiation directly into a cell, killing tumor cells. Because of its mechanism of action, utilization of this therapy requires safe-handling practices for the prevention of radiation exposure and contamination.

 To create our outpatient PRRT program, a working group that included physicians, pharmacists, nuclear medicine staff, radiation safety, financial services, and nurses was formed to address the complex process of administering this treatment in the ambulatory setting within the Nuclear Medicine Department.

A space dedicated to patients receiving these treatments, including a separate bathroom, was necessary to minimize the risk of exposure to other patients and staff. Nursing took the lead in identifying key capital expenses, nurse staffing, and education to ensure safe administration. These included an intravenous pump, portable workstation on wheels, monitoring system for vital signs, and monitoring during a hypersensitivity reaction. The oncology nurses set up the entire working environment, arranging the space for the nuclear medicine physician and administering the amino acid solution. A 2-channel pump and proper set up to dispense the radionucleotide via the pump is needed to properly provide the therapy. First, however, patients receive an amino acid solution 30 minutes prior to the infusion, which protects their kidneys by decreasing the amount of radiation they absorb. There are several types of amino acid formulations. Patients may also require aggressive antiemetic prophylaxis, as this treatment can be highly emetogenic.

The patient’s blood and body fluids are considered radioactive during the administration of treatment, so proper personal protective equipment and supplies for contamination and potential spills must be in place. To ensure patients and staff are safe from potential radiation exposure, a radiation safety officer or health physicist is always present during administration.

Patients are monitored by an oncology nurse during the entire infusion. Some AEs that may occur include nausea, vomiting, diarrhea, and, rarely, neuroendocrine hormonal crises, for which there is a 1% risk. If the patient experiences this rare phenomenon, presenting symptoms may include diarrhea, flushing, hypotension, and bronchoconstriction during or within a 24-hour period.

 The nurses taking care of these patients are certified in advanced cardiovascular life support and trained on how emergency response.

Within 4 to 24 hours post treatment, the patient is given a long-acting octreotide injection. This can help to decrease potential AEs. Providing this injection requires an additional level of coordination with the ambulatory infusion pharmacy in order for the medication to be delivered to the Nuclear Medicine Department for administration. The oncology nurse is also educated on all pre- and posttreatment care. They will educate the patient on what to expect before, during, and after the infusion. Prior to the patient leaving, the radiation safety officer or health physicist reiterates the importance of radiation safety and gives the patient information to take home. The nurse will continue to follow up with the patient after they leave to monitor for AEs.

All patients receiving PRRT therapy are considered releasable under current US Nuclear Regulatory Commission (NRC) and NRC agreement state regulations. The regulations require that they receive instructions on how to minimize radiation dose to family members and the public. Prior to the patients leaving the facility, they are all given a wallet card with precautions for how to interact with the public for 7 days after treatment. These precautions include remaining at least 3 feet from adults for 3 days and from children and pregnant women for 7 days, use a separate toilet, sit while urinating and flush twice after each use, drink plenty of fluids, and more. There are many pieces to building a PRRT program within an ambulatory setting. This process takes careful planning with multiple departments. Given the risk of radiation exposure, radiation safety is a vital part to ensuring safe patient care and protecting staff. The oncology nurse must have extensive training on radiation safety and possible AEs, as well as knowledge of what education to give the patient.

In our cancer center, our team is made of many key stakeholders and clinicians from several departments. However, the nursing team is at the center of the planning and execution of this PRRT program and has been an integral part of the development of this program within our academic ambulatory center.

1.Boucher J, Sommers R. Targeted therapy: new radiolabeled somatostatin analogs to treat gastroenteropancreatic neuroendocrine tumors. 

 2018;22(5): 565-568. doi: 10.1188/18.cjon.565-568.

2. Hosono M, Ikebuchi H, Nakamura Y. et al. Manual on the proper use of lutetium-177-labeled somatostatin analogue (Lu-177-DOTA-TATE) injectable in radionuclide therapy (2nd ed.). 

 2018;32(3):217-235. doi: 10.1007/s12149-018-1230-7.

3. Strosberg J, El-Haddad G, Wolin E, et al; 

lu-dotatate for midgut neuroendocrine tumors. 

 2017;376(2):125-135. doi: 10.1056/NEJMoa1607427

Articles

Partner Perspectives

Development of a Safe Administration PRRT Process in an Ambulatory Academic Setting

With a cancer diagnosis, there are myriad complex financial issues that may impact patients, their families, and caregivers. In 2013, researchers coined the term “financial toxicity” to refer to the financial adverse effects induced by the cost of cancer treatment.

 Research shows that not addressing the contributing factors of financial toxicity creates distress, anxiety, and depression and threatens a patient’s optimum health.

Nurses can play a role in helping patients mitigate or manage the financial toxicity of a cancer diagnosis by ensuring they have access to critical information about cancer-related rights and resources. With this information, patients can make educated decisions about their work, finances, and insurance coverage, which are 3 key contributors to the financial toxicity of a cancer diagnosis.

Getting and keeping adequate health insurance coverage is the primary means to minimizing financial toxicity. Nurses can help uninsured patients get enrolled in health insurance coverage and for those who are insured, nurses can help make changes to their coverage to lower their out-of-pocket costs and improve the adequacy of coverage moving forward.

For individuals with a new diagnosis or who are still in treatment, there are ways to minimize expenses and access financial assistance options. Those who have completed the bulk of their cancer care may be most concerned with managing medical bills and rebuilding their credit. Individuals who have triaged most of the financial impact of their diagnosis and treatment may be more focused on adopting long-term financial strategies.

A cancer diagnosis may have significant shortand long-term effects on employment and income for patients and caregivers. A patient with a new diagnosis has employment options that might vary based on their situation. These include working through treatment, working part time, taking time off, making a career change, filing for short- or long-term disability benefits to replace their wages while taking time off, resigning, or retiring. Caregivers are also often faced with employment decisions.

The inability to work and the subsequent loss in income can contribute to the financial burden of a cancer diagnosis. Nurses can point individuals with cancer and their caregivers to 3 key places to look for information about their employment rights and benefits:

Having a better understanding of their employment rights can help individuals continue to work or maintain their income, while taking time off from work, through:

• Short- or long-term disability insurance policies purchased directly from an insurance company or offered by their employer

• The 2 federal long-term disability programs: Social Security Disability Insurance and Supplemental Security Income

For patients facing financial toxicity, Triage Cancer, a national nonprofit organization that provides education on practical and legal issues for cancer survivors and caregivers, offers an Insurance and Finance Intensive program. The program is a free full-day training with in-depth information on health and disability insurance and managing finances after a diagnosis. For nurses and other healthcare professionals, the organization also offers an array of Quick Guides and checklists that can help steer financial-related conversations with patients. Triage Cancer also hosts CancerFinances.

org, an interactive site that helps people navigate their finances after a cancer diagnosis and connects them to financial assistance.

Additionally, Triage Cancer offers a series of animated videos on key topics, from choosing the right insurance plan to managing adverse effects at work.

Data show patients aren’t being connected to available resources to help with these issues.1 Nurses can help bridge that gap. But if nurses wait for the day that a patient asks for help with one of these issues, that day may never come, because many people don’t even know what questions to ask, let alone that their healthcare team might have the answers or know where to find them. As research continues to demonstrate the impact of cancer-related financial toxicity and show that health literacy and health insurance literacy are prime factors in access to quality healthcare and improved health outcomes, Triage Cancer will continue to provide free education for patients, caregivers, and healthcare professionals.

Zafar SY, Abernethy A. Financial toxicity, part I: a new name for a growing problem. 

Oncology (Willison Park). 2013;27(2):80-81, 149.

.Population-based assessment of cancer survivors’ financial burden and quality of life: A prospective cohort study. 

Ramsey SD, Bansal A, Fedorenko CR, Blough DK, et al. Financial insolvency as a risk factor for early mortality among patients with cancer. 

Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D. Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. 

Kale HP, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. 

Rechis R, Reynolds KA, Beckjord EB, Nutt S, Burns RM, Schaefer JS. 

“I Learned to live with it” is not good enough: challenges reported by post-treatment cancer survivors in the Livestrong surveys: a Livestrong report.

d1un1nybq8gi3x.cloudfront.net/sites/default/files/what-we-do/reports/LSSurvivorSurveyReport_final_0.pdf

Research shows that not addressing the contributing factors of financial toxicity creates distress, anxiety, and depression and threatens a patient’s optimum health.

Training Nurses to Help Patients Manage Financial Toxicity

Medical care alone is not enough to make and keep a patient healthy. Total wellness requires an understanding of not only social determinants of health, but also how they impact the health outcomes of our patients. Examples may include financial insecurity, housing, employment, health literacy, social support, access to care, and access to food.

According to Healthy People 2020, “Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

We cannot assume that how a person dresses and where they live automatically excludes them from financial burden, food insecurity, and other barriers. Due to high deductibles and co-pays, even patients who have insurance are often underinsured. Job loss can also deplete a family’s savings and force them to seek support for food and other financial assistance programs. Even when resources are available, patients often struggle with asking for help due to the significant shame and stigma that can accompany these needs. As a result, patients and their families suffer in silence.

Oncology nurses can help patients break down these feelings of stigma and shame. We can begin by understanding the sensitivity of these topics and then script our conversations to ensure they understand that they are not alone, resources are available, and we care. Nurses must be present by listening and responding with empathy.

Questions can easily be incorporated into normal conversations and prefaced with the following: “Today, even with insurance, many people find they are struggling to find food and other financial resources. You are not alone. Food is important to your health and the health of your family.” Multiple health assessments and validated tools are available for screening. Many cancer programs have integrated the National Comprehensive Cancer Network (NCCN) Distress Screening Thermometer into their practice.

 Although the tool is not perfect, it can help to identify areas of concern before they become a crisis.

Identifying patients at risk for food insecurity is equally important, especially if this is not being asked during a normal assessment. The Hunger Vital Sign

 is an excellent example. This 2-item assessment has high sensitivity and specificity, and it has been validated in households with children as well as in high-risk adults. The 2 items are as follows:

1. Within the past 12 months, we worried whether our food would run out before we got money to buy more.

2. Within the past 12 months, the food we bought just didn’t last, and we didn’t have money to get more.

Oncology nurses, are often on the front line with identifying clinical and nonclinical barriers that can impact their patient’s outcomes.

Understanding social determinants of health are important when having sensitive conversations. Screening all patients is not a guarantee, but asking questions in an empathetic manner can open up conversations and develop a longstanding relationship of trust. Patients are more likely to confide their fears when they realize they are not alone and someone truly cares.

US Office of Disease Prevention and Health Promotion. Social determinants of health. Healthy People 2020 website. 

healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

 Published 2014. Updated June 28, 2019. Accessed June 2019.

NCCN Distress Thermometer and problem list for patients. NCCN website. 

nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf

 Published February 23, 2018. Accessed June 2019.

 Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity

. 2010;126(1):e26-32. doi: 10.1542/peds.2009-3146.

Professionally Speaking

Find ways to bring up these topics in patient conversations, while mitigating feelings of shame.

Navigating Sensitive Topics: From Food Security to Insurance Coverage

For nearly 10 years, I lived in the metropolitan Washington, DC, area. At any given time, our oncology unit was representative of a mini United Nations. You name the country, we had a patient from there. In the Fairfax County region of northern Virginia where I lived, over 100 languages were spoken within the elementary school system. I found myself practicing in a melting pot of immigrants, foreign visitors, and a considerable population where English was spoken only sporadically or as a second language. I became intrigued by the degree of this diversity I was exposed to, as this was not my norm in my formative years. I subsequently made it my mission to foster not only my own cultural sensitivity, but also that of my colleagues.

On the oncology unit, we established a series of “Brown Bag” lunches where we invited professional colleagues born outside the United States to have lunch with us to share with nursing staff their country’s beliefs, practices, and norms. I chaired the multicultural task force for my hospital. Our group organized lunches for hospital staff where restaurant owners from over 20 countries set up tables with their most popular foods for us to sample. It was a great event! We subsequently created a program on our computer system where staff could access information about a variety of cultural and religious norms— something that there was an established need for at the institution.

 Common phrases in Spanish, Korean, Vietnamese, Mandarin, and Farsi were on this site, and the nursing staff identified the most common statements or questions that were needed. A nurse could subsequently show the non-English equivalent of a phrase to the patient/ family to inform and educate them about what would be transpiring. Phrases such as, “You will be taken for an x-ray,” “Point to where it hurts,” or “This is the medicine to help you sleep” were translated. Our efforts were a huge success both for our patients throughout our hospital system and for our professional staff who were eager to enhance their cultural connections.

Now, more than 20 years later, this agenda of cultural sensitivity is even more pressing within our specialty. This is particularly true in the Unites States where our demographics are undergoing radical change. Consider the following:

• Non-Caucasians will more than double between 2012 and 2060 to represent 57% of the American populace;

• Within the past 5 years, Asians have doubled in number, now representing 8% of the US population:

• Hispanics are the most rapidly growing minority group in the Unites States; unfortunately, cancer in this group is diagnosed at earlier ages and the patients have mortality rates higher than non-Hispanics.

As the country evolves and becomes more diverse, the presentation of prominent cancers will change, too. Immigrants may present with risk factors associated with their country of origin. Cancers associated with lifestyle factors (ie, diet, smoking, obesity) and viral exposure (ie, human papillomavirus, hepatitis B) may increase in regions with high numbers of select immigrant groups. This may influence the need for cancer-specific community education and screening in specific regions. Case in point is Asian immigrants living on the West Coast not receiving hepatitis vaccinations in their formative years and now being vulnerable to primary hepatocellular cancers.

Being culturally astute is much more than knowing cancer rates and risk factors specific to ethnicity and country origins. It requires sensitivity to numerous issues linked with patient and family attitudes and behaviors exhibited within the US healthcare system. These include participation in screening, interpersonal exchange using the word “cancer”; diagnosis disclosure; the roles of diet, rest, and complementary approaches; acceptance of care provided by other genders; role of the family in decision making; and symptom reporting.

 Of critical importance is the role of cultural sensitivity within the paradigm of end-of-life care. This is inclusive of religious orientation, communication of family norms, reluctance to withdraw life support, responses to pain, and the implementation of rituals at the end of life.

 Because of this broad scope of influence, health professionals’ perceptions, attitudes, and behaviors related to those of other cultures must be addressed. Considerable personal awareness underscores this sensitivity.

Most cultural norms are culturally prescribed. Those from outside the United States can differ from our American standard, often leading to judgmental reactions and frequent labeling of these interactions as “difficult.” The diversity of our American mosaic requires reflection. Does the traditional staunch New England norm of nondisclosure of feelings differ from those reared in the more liberal West Coast culture of expression? It is time to mandate all professionals consider their bias as our future portends a dramatically different cultural environment.

Boyle DA, Sheridan M, McClary J & White J. A multifocal education strategy to enhance hospital-based cultural competency in professional staff. 

U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now

. [online] Census.gov. 201. Available at: https://www.census.gov/newsroom/releases/archives/population/cb12-243.html [Accessed 7 Jun. 2019].

Petty M (2019). Disparities in hispanic care. 

Pham C, Fong TL, Zhang J, Liu L (2018). Striking racial/ethnic disparities in liver cancer incidence rates and temporal trends in California, 1988-2012. 

 110(11): djy051. Doi: 10.1093/jnci/djy051.

Licqurish S, Phillipson L, Chiang P, et al. Cancer beliefs in ethnic minority populations: A review and meta-synthesis of qualitative studies. 

. (2017) 26: e12556; doi: 10.1111/ecc.12556.

Schrank B, Rumpold T, Amering M, et al. Pushing boundaries — culture-sensitive care in oncology and palliative care: A qualitative study. 

Cope D.G. Cultural competency in nursing research. 

Nurse's Notes

The United States is home to people of many different backgrounds, making it important for oncology nurses to be culturally competent.

The Cancer-Culture Connection

Kelly Clegg, BSN, RN, CPHON - Photo credit: Kyle Kielinski

It’s a beautiful day at Happiness Is Camping (HIC), a free residential summer camp for children with cancer and their siblings, held in Hardwick, New Jersey. Children are laughing as they splash in the swimming pool, and a rousing game of beach volleyball is being played nearby.

Laura San Miguel, RN, PNP, who serves as the camp’s full-time summer nurse, smiles watching the campers play. She remembers a comment made by the camp’s longest non-nursing volunteer, a parent who lost a child to neuroblastoma and has battled stage IV breast cancer herself and who commutes from Florida each summer to volunteer. The mother put it best when she said, “Walt Disney was wrong, this is the happiest place on Earth,” San Miguel said.

Sleepaway camps, such as HIC, are held across the country throughout the year, offering pediatric patients and their siblings a chance to enjoy recreational opportunities, make new friends, and take a respite from hospitals and medical tests.

Although camp is a memorable rite of passage for all children, it represents unprecedented freedom for children and teens with cancer who have spent much of their lives undergoing medical treatments. Staffed by oncology nurses and other medical professionals in both paid and unpaid positions, the children who attend can have both a safe and memorable experience.

San Miguel first learned about HIC in 1995 while working as a staff nurse in pediatric oncology at Memorial Sloan Kettering Cancer Center in New York. She heard the camp was seeking volunteer medical personnel and decided to apply, and she has been volunteering at the camp ever since.

“HIC is a life-changing experience. The kids are amazing, and the gift of seeing the campers’ resilience and joy, their camaraderie and support, is priceless,” San Miguel says. “When I first started volunteering at camp, the nursing director told me I would get far more out of it than I ever put in, and she was right.”

Childhood cancer can be an isolating experience, but through recreation and other activities, these young campers are given the chance to gain independence, expand their horizons, and improve their self-confidence.

At HIC, the campers range in age from 6 to 15 years, and their siblings are invited to accompany them. Last year, San Miguel says the camp created a leadership program for 16- and 17-yearolds that runs over the course of 3 sessions.

“There was a 2017 study conducted by the University of Illinois that found adult survivors of pediatric cancer are 5 times less likely than their peers without cancer to get a job and 15 times less likely to go to college than their own siblings,” San Miguel says. “We created this program to combat these statistics and to teach life and communication skills, leadership training, and also science, technology, engineering, and math [STEM] workshops.”

San Miguel says children with cancer get so much out of the camps. She remembers meeting Adam, age 12, during her first summer as the full-time camp nurse.

“It was the first time he was going to be away from his family since his diagnosis,” San Miguel says. “He was nervous, and the high-dose steroids didn’t help. He was really homesick, but with our support, [he] talked himself through those first few days and had an amazing week. When his mom came to get him that Friday, she looked me in the eyes and said, ‘That was exactly what we all needed.’”

San Miguel says that experience showed her how camp also allows parents and caretakers time to reconnect while knowing their children are in a safe and supported environment.

“Adam came back every summer until he graduated into counselor age, and this will be his second summer as a counselor at HIC,” San Miguel says. “Camp is an amazing opportunity for the volunteer nurses (and doctors) to see our population out of a clinical setting. The experience has definitely made me both a better nurse and a better person.”

For nurses, summer camp provides the opportunity to see these children in a different light.

“At camp, we’re able to connect with the kids on a different level than in the hospital setting,” says Kelly Clegg, BSN, RN, CPHON, clinical supervisor, radiation oncology, Perelman Center for Advanced Medicine at The Children’s Hospital of Philadelphia (CHOP) in Pennsylvania. Clegg is celebrating her fifth summer working at Ronald McDonald Camp, located 3 hours from Philadelphia, in the Pocono Mountains. “I leave the camp each year feeling rejuvenated.”

“CHOP pays for oncology nurses and doctors to donate a week of their time to working at the camp every 2 years,” Clegg explains. “It’s considered a privilege to work at the camp.”

Clegg says nurses care for simple medical problems including bruises and scrapes and also oversee children who are using urinary catheters or feeding tubes or are on oral chemotherapy. Each year, Clegg says 7 nurses and 1 nurse practitioner staff the camp. Nurse volunteers should have oncology experience, the ability to provide routine and emergency care to campers, and a high degree of patience and stamina.

“Children must be in stable condition to attend camp,” Clegg explains. “We have some campers who are in remission that we’ve been treating since they were children, and now they’re attending camp as teens.”

Clegg says some campers have also received a terminal diagnosis and camp symbolizes their chance to take part in many activities their healthy peers have taken for granted.

“For 1 week, they’re just kids, not [patients with] cancer,” Clegg says. “Our staff will go that extra mile to help them enjoy activities they may have thought they could never do.”

Golf carts and wheelchairs are often used at cancer camps to ensure children can easily navigate the area, and activities such as zip lining, swimming, and canoeing are modified to ensure all campers can participate. Clegg says staff often improvise in order to help campers make the most of their experience.

“We have assistive devices for children who may be in a wheelchair or have difficulty walking to safely enjoy the zip line,” Clegg says. “There was 1 patient who couldn’t run and always wanted to fly a kite, so we put her in the back of a golf cart with her kite high in the air so she could finally have the experience.”

Since the camp also invites siblings to attend, Clegg says it serves as a loosely based support group where campers can meet other children and families who have undergone similar experiences. Nurses are also encouraged to participate in the wide array of camp activities. Clegg admits she’s ridden the zip line at camp as well as arts and crafts and canoeing.

“Working at camp is an experience that definitely puts you out of your comfort zone,” Clegg admits. “And the rewards nurses receive in return are 10-fold.”

Morgan Smizer, BSN, first learned about Camp Quality in Wichita, Kansas, while working in the Pediatric Unit at Wesley Medical Center in Wichita. After picking up a brochure on the camp, she called to volunteer and has now been working there for 3 years, the past 2 as the camp’s medical director. Smizer recruits 6 volunteer nurses each year to help throughout the week. Since some nurses don’t have the availability to be present for the entire week, she makes a staggered schedule that works for everyone.

“Our nurses are present for every activity, every meal, and all of the things that happen during the course of the day,” Smizer says. “I do a thorough history and medication assessment from each camper’s personal profile prior, and then we all collectively arrange and organize all the medications for the week, scheduling them to be given in the morning, and at breakfast, lunch, dinner, and bedtime.”

Although Smizer works in a pediatric intensive care unit, where she sees a lot of oncology patients, she says caring for them at camp is very different.

“I get such joy out of seeing these kids outside of the hospital setting, not connected to any tubes, wires, or hoses, and just being able to be kids,” she says. “I love the bonds they form with me, the other kids, and volunteers at the camp. This camp gives a whole new meaning to nursing.” Smizer says campers are also appreciative of the camp experience and that nurses consistently receive positive feedback.

“Most of the campers say this is the 1 thing they look forward to most every year, more than Christmas, more than their birthday, more than anything,” Smizer says. “They get to see old friends from years past, make new friends, participate in endless activities, and be reminded they are kids who aren’t defined by cancer.”

Cover Story

Camps for patients and their families bring happiness both to the campers who attend and the nurses who work there.

August

Development of a Safe Administration PRRT Process in an Ambulatory Academic Setting

Training Nurses to Help Patients Manage Financial Toxicity

Navigating Sensitive Topics: From Food Security to Insurance Coverage

The Cancer-Culture Connection

A Dose of Sunshine: Nurses Who Volunteer at Oncology Camps for Kids Learn a Different Aspect of Care