This CE article is designed to serve as an update on cancer detection and prevention and to facilitate clinical awareness of current and new research regarding state-of-the-art care for those with or at risk for cancer.


Advanced practice nurses, registered nurses, and other health care professionals who care for cancer patients may participate in this CE activity.

Upon completion, participants should be able to:

• describe new preventive options and treatments for patients with cancer

• identify options for individualizing the treatment for patients with cancer

• assess new evidence to facilitate survivorship and supportive care for patients with cancer

ACCREDITATION/CREDIT DESIGNATION STATEMENT


Physicians’ Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669, for 1 Contact Hour.

It is the policy of Physicians’ Education Resource®, LLC (PER®), to ensure the fair balance, independence, objectivity, and scientific objectivity in all of our CE activities. Everyone who is in a position to control the content of an educational activity is required to disclose all relevant financial relationships with any commercial interest as part of the activity planning process. PER® has implemented mechanisms to identify and resolve all conflicts of interest prior to release of this activity.The planners and authors of this CE activity have disclosed no relevant financial relation-ships with any commercial interests pertaining to this activity.

1. Read the articles in this section in their entirety.

3. Complete and submit the CE posttest and activity evaluation.

This CE activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CE activity is for continuing medical nursing purposes only and is not meant to substitute for the independent medical judgment of a nurse or other health care provider relative to diagnostic, treatment, or management options for a specific patient’s medical condition.

The opinions expressed in the content are solely those of the individual authors and do not reflect those of PER®.

Awareness of Tepotinib-Associated Adverse Events May Optimize NSCLC Outcomes

Nurse-specific recommendations highlighting potential adverse events associated with tepotinib treatment may help increase time on treatment and lead to improved outcomes.

Guidance created for nurses provides strategies to identify and manage common adverse events (AEs) in patients receiving tepotinib (Tepmetko) to treat non–small cell lung cancer (NSCLC) with MET exon 14 (METex14) skipping, according to a poster presented at the 46th Annual Oncology Nursing Society Congress, held April 20 to 29, 2021.

Tepotinib is a MET tyrosine kinase inhibitor recently approved for the treatment of patients with NSCLC with METex14 skipping, which occurs in 3% to 4% of patients with this cancer.

“As with any anti-cancer therapy, it is important to promptly identify, prevent, and manage any adverse events,” Terri Alexander, MS, research nurse supervisor at The University of Texas MD Anderson Cancer Center in Houston, said during the presentation. “This can help minimize dose modifications [and] discontinuations and ensure that patients get maximal benefit from therapy. Effective AE management can also support patient quality of life. Within the multi-disciplinary team, nurses play an important role in AE management.”

Alexander and colleagues developed nurse-specific visual guidance for the early identification and management of the most common AEs associated with tepotinib therapy for NSCLC. This guidance was based on an analysis of AEs observed in 255 patients with METex14-skipping NSCLC in the VISION trial (NCT02864992), in addition to real-world nursing experience.

The AEs included in the guidance are peripheral edema; creatinine increase; gastro-intestinal AEs such as diarrhea, vomiting, and nausea; pleural effusion; interstitial lung disease; and liver enzyme elevations. Information about the frequency of each AE is provided, and strategies for monitoring and management are recommended.For example, the investigators note that low-grade peripheral edema is a common AE, even in fit patients; however, progression to established edema can make treatment more difficult. By routinely performing the monitoring steps described in the guidance (such as checking for skin erosions and weight gain), nurses can identify edema early and mitigate it using the suggested conservative management approaches, which include compression stockings and limb elevation.

“These recommendations can support nurses in timely and effective management of AEs with tepotinib,” Alexander said during the presentation. “Proactive approaches to mitigate AEs may help to improve quality of life. In addition, by increasing time on treatment, AE management may help improve outcomes for this elderly patient population.”

Alexander T, Ahn L, Berghoff K, Vlassak S, Lemmens L. Managing side effects of tepotinib treatment to optimize outcomes for patients with non-small cell lung cancer harboring METexon 14 skipping: expert guidance based on clinical experience. Presented at: 46th Annual Oncology Nursing Society Congress; April 20-29, 2021; Virtual. Abstract 8970. Accessed April 15, 2021. https://ons.confex.com/ons/2021/meetingapp.cgi/Paper/8970

NPs Play Crucial Role in Helping Patients With uHCC Avoid Premature Discontinuation of Lenvatinib

Nurse practitioners should educate patients and caregivers about how to manage key adverse reactions associated with lenvatinib to help ensure patients remain on treatment to maximize benefit.

Nurse practitioners (NPs) should routinely follow up with patients with unresectable hepatocellular carcinoma (uHCC) who are receiving treatment with lenvatinib (Lenvima) to help prevent premature discontinuation of therapy as a result of serious adverse events (AEs), according to study results presented in a poster at the 46th Annual Oncology Nursing Society Congress, held April 20 to 29, 2021.

“Nurse practitioners play a critical role in providing education, as well as monitoring for and managing adverse reactions that may arise during therapy, thereby alleviating patients’ and caregivers’ concerns about initiating and maintaining treatment,” said lead study author Anna Jones, FNP-C, of Pacific Hematology Oncology Associates in San Francisco, California, during a recorded presentation of the data.

Jones and colleagues conducted a post hoc analysis of data from the phase 3 REFLECT trial (NCT01761266), which led to the FDA approval of lenvatinib in previously untreated patients, to characterize key AEs associated with treatment and assess strategies to manage them. A focus of their report was the crucial role NPs play in educating patients regarding the management of AEs.

Jones noted that although lenvatinib was found to be noninferior to sorafenib (Nexavar) in terms of median overall survival, the primary end point of the REFLECT trial (13.6 months vs 12.3 months; HR, 0.92; 95% CI, 0.79-1.06), important secondary end points, such as progression-free survival, time to progression, and objective response rate, improved significantly with lenvatinib treatment (P < .0001).

Almost all (99%) of the 476 patients treated with lenvatinib in the REFLECT trial experienced treatment-emergent adverse events (TEAEs), with 75% of patients experiencing TEAEs of grade 3 or higher. The most common TEAEs were hypertension (45%), diarrhea (39%), and decreased appetite (34%). An evaluation of dose modifications due to treatment-related AEs revealed a 40% rate of dose interruptions, 37% dose reductions, and 9% premature treatment discontinuation among patients taking lenvatinib. Early AE recognition and management, Jones emphasized, is imperative to ensuring patients remain on therapy to maximize the benefits of lenvatinib. 

Characterization of Adverse Reactions and Their Frequency

Jones and colleagues reviewed the key adverse reactions (ARs; grouping of AEs per FDA definitions) that most frequently resulted in either dose reductions or interruptions of lenvatinib treatment. These ARs included fatigue, hyper-tension, palmar-plantar erythrodysesthesia syndrome, proteinuria, decreased appetite, and diarrhea. Of note, the investigators determined that these ARs all had a median time to first onset that was less than 10 weeks after treatment initiation. Median time to first onset was shortest for fatigue (3.4 weeks) and hypertension (3.7 weeks) and was longest for diarrhea (9.6 weeks) and decreased appetite (6.8 weeks).

 Among the key ARs, proteinuria (7%) and fatigue (6%) most often led to lenvatinib dose interruptions; fatigue (7%), decreased appetite (6%), and diarrhea (6%) most frequently led to dose reductions.“

Knowledge of this information is crucial for nurse practitioners to make patients and care-givers aware of when to expect these [adverse] effects and to review ways to alleviate them, as well as when to contact the health care team,” explained Jones. “Through identification of potentially problematic comorbidities and routine check-ins, nurse practitioners [can] ensure that patients do not discontinue lenvatinib prematurely.”

NP Suggestions for Managing Key Adverse Reactions

Jones highlighted sections of the poster featuring NP perspectives on how to manage hypertension, diarrhea, and fatigue—ARs that may negatively impact on quality of life and result in premature lenvatinib discontinuation. The recommendations for hypertension management included identifying patients with preexisting hypertension and making sure the condition was controlled before initiating lenvatinib.

Among strategies for fatigue management was a recommendation that preexisting fatigue due to a treatable cause should be addressed both before and during therapy. Moreover, NPs should be mindful that fatigue may be caused by a patient’s decreased appetite (which may be an effect of lenvatinib therapy). Lenvatinib-associated fatigue may be managed by treatment modification, which should depend on the severity of the patient’s fatigue.

Appropriate dosing of concomitant medications such as lactulose is critical for prevention of diarrhea. For patients who nonetheless experience this AR, NPs may suggest the “bananas, rice, apples, and toast (BRAT)” diet to solidify stools. Additionally, patients should be counseled on the importance of sufficient hydration to replenish electrolytes lost through diarrhea.

Because they are often the primary point of contact for patient education, NPs are well positioned to reassure patients that they will receive the best tolerated dose of lenvatinib. According to the investigators, this will help patients stay on treatment longer to derive the maximum therapeutic benefit.

A crucial aspect of patient education by NPs is discussing common ARs patients may experience and offering suggestions for managing them at home. It is also important for NPs to help patients identify situations that require a call or visit to the clinic or emergency services for symptom management.

“I hope this presentation will provide meaningful information to further advance your clinical practice and enhance patient understanding and adherence of lenvatinib treatment for uHCC,” concluded Jones.


Jones A, Moore A, Robbins C, Amaya-Chanaga C, Sung MW, Baron AD. Patient education and management of adverse reactions in patients with unresectable hepatocellular carcinoma (uHCC) treated with lenvatinib: nurse practitioners’ perspective. Presented at: 46th Annual Oncology Nursing Society Congress; April 20-29, 2021; Virtual. Abstract 9403. https://ons.confex.com/ons/2021/meetingapp.cgi/Paper/9403

Articles

CE lesson worth 1 contact hour that is intended to advanced practice nurses, registered nurses, and other healthcare professionals who care for patients with cancer.

Continuing Education: June 2021

No one deserves a cancer diagnosis, yet some patients feel stigmatized by their diagnosis, explained Lee Ann Johnson, PhD, RN, an assistant professor of nursing at the University of Virginia School of Nursing. Stigmas can be associated with a wide variety of cancer types including lung cancer and a possible association with smoking; human papilloma virus-related cancers such as oral, cervical, and anal cancers; male breast cancers; and male-specific cancers such as testicular, prostate, and penile cancer. 

Johnson understands these stigmas well. Her mother, who never smoked, died of lung cancer. Her grandfather, a former smoker, received a lung cancer diagnosis decades after quitting.“ 

In my family, we never made a big deal out of the smoking either way, but I have been to medical conferences and heard patients speak who often feel like their family blames them for getting the disease or their spouse...resents them for having to take care of them,” Johnson said. “Lung cancer is an awful disease with a high symptom burden; feeling stigmatized can add a layer of depression and anxiety.” 

Johnson and colleagues conducted a small study of patients with lung cancer to examine the influence of stigma on social support, symptom severity, and quality of life, among others.

 They found that about one-third of participants reported experiencing a high level of stigma, which was significantly related to a lower quality of life. There was higher symptom severity for feeling distressed, problems remembering things, and feeling sad. Greater symptom interference was reported related to mood, relations with others, and enjoyment of life. Cancer-associated stigma can come in other forms as well, according to Barbara A. Murphy, MD, director of the Head and Neck Oncology Program and director of the Pain and Symptom Management Program at Vanderbilt-Ingram Cancer Center. “Patients may have stigma associated with sequelae of their cancer,” Murphy said. “For example, a patient with head and neck cancer who has a large surgical procedure with visible scarring or disfigurement may have body image issues.” Such issues can profoundly affect emotions, result in depression, and decrease quality of life. There may also be less visible issues, she added. 

“Patients may have chronic fatigue and...no longer [be] able to maintain the same level of activity,” Murphy said. “They often feel a burden because they cannot work or fulfill their family roles in the same way as they used to. On the outside, people will look at them and say they look fine, but they do not feel fine.” 

Health care professionals and oncology nurses play an important role in reducing these stigmas and helping patients feel comfortable and welcome. For example, the results of a 2019 survey assessing lung cancer stigma showed that both doctors and nurses felt the most common way patients with lung cancer are treated differently was that they “received less sympathy from medical staff.”

According to Johnson, one of the best ways a nurse can have a positive effect is by asking the patient, perhaps even in the absence of their caregiver, about their experience. “Be upfront,” she said. “Ask them about how they are feeling and, if they are having issues, connect them to resources that could be helpful, such as therapy or social workers.” In fact, a study of prostate cancer stigma suggested that oncology nurses can improve patient experiences within the health care system and reduce stigmatization by improving psychosocial support. Nurses can improve communication between the patient and the physician and act as navigators to offer informational and emotional support.

Nurses may even have to look inward to assess their own conscious or unconscious bias toward patients whose diagnosis includes some of the more commonly stigmatized cancers. 

“As the whole field becomes more culturally sensitive and inclusive, I think we should also be developing programs that include stigma training,” Johnson said. “Addressing these possible biases would help us to provide the best care we possibly can to our patients.” 

Murphy agreed that oncology nurses have an important role to play.  

"Nurses are some of the most empathetic human beings I know, and there is a tremendous trust that patients place in nurses...more so than even in physicians,” she pointed out. “One of the important roles a nurse has is providing patients with the opportunity to ‘unload’ in a nonjudgmental environment.” 

Nurses can help to educate patients and their families and caregivers to address or reduce stigmas associated with certain cancers, Murphy continued. 

“We have to be champions of under-standing,” she said. “We have to constantly remind ourselves that patients are human beings and walk in their footsteps in order to effectively address their problems.”


1. Johnson LA, Schreier AM, Swanson M, Moye JP, Ridner S

. Stigma and quality of life in patients with advanced lung cancer.

2019;46(3):318-328. doi:10.1188/19.ONF.318-328

2. King JC, Rapsomaniki E, Rigney M, et al. Lung cancer stigma: a ten-year look at patient and oncology attitudes about lung cancer. 

2019;37(suppl 15):11619. doi:10.1200/JCO.2019.37.15_suppl.11619

3. Buote R, Cameron E, Collins R, McGowan E. Understanding men’s experiences with prostate cancer stigma: a qualitative study. 

2020;47(5):577-585. doi:10.1188/20.ONF.577-585

Feature Story

Some cancers carry stigma or cause people to feel guilty about their diagnosis. 

Cancer Stigmas Persist, But Nurses Can Help

In business, creative disruption (or innovative disruption) suggests that radical change in a marketplace is brought about by overturning existing conventions. Typically, some type of disturbance, expected or unexpected, occurs to alter the usual pattern of operating or doing business to create a new model.

In health care, a fitting example of this is reflected in how we have conversed with patients during the COVID-19 pandemic, which has migrated from calling to texting. Prior to the crisis, phone calls as the default mode of health care communication were already on the outs. Not surprisingly, only 18% of people say they listen to a voicemail from a number they don’t recognize.

 According to a recent survey of patients’ communication preferences before and during the pandemic, interest in phone calls had plummeted 14% in just a few months.

For providers and patients in a COVID-19 world, phone calls just weren’t getting the job done as well as they once had, for a variety of reasons. Seventy percent of people experienced longer call wait times than normal when trying to reach a business. Amid a health crisis, the last thing patients want is to be put on hold by their provider or interrupted by calls during the workday.

All told, things developed to a point where providers couldn’t effectively relay critical information about COVID-19, such as safety and protocols, park-and-wait instructions, and altered practice hours. Similarly, patients couldn’t quickly and easily get the information they needed when they needed it. Both parties were frustrated by the failure of phone calls to facilitate speedy interactions. As a result, it’s easy to see why patient satisfaction with health care communications during the pandemic fell by 7% compared with pre-pandemic figures, according to the communication preferences study.

Creative disruption took place when health care providers realized they already had the solution to their communication ills at their disposal—text messaging. For starters, texting offers a range of advantages over calling.

On average, it takes 4 seconds to send a text message, but a corresponding phone call can last a minimum of 2 minutes, and often much longer. Similarly, the response rate for texts is 209% higher than it is for phone calls, and most text messages are read within 15 minutes.

By automating scheduling tasks such as text appointment reminders and COVID-19 education messages, providers can connect clearly and effectively with patients while increasing confirmations and decreasing no-shows. Through the use of group texts, providers can message large numbers of patients with important COVID-19 information, details about vaccinations, and the latest health advisories with the click of a button.

Yet health care organizations aren’t the only ones to gain from the transition of patient-provider communications from calls to texts. Patients themselves are fully on board with texting as the new normal. Eighty-one percent of Americans own a smartphone, and 97% send a text at least weekly.

 Clearly, texting has become the preferred way to communicate because it’s quick and convenient, and people can respond to messages. in their own time. And when it comes to patients, text messaging is surging. Nearly 80% of patients in the survey said they wanted to receive text messages from their provider. Another 84% said they preferred automated communication as a faster and more efficient

It’s not just text messaging that is changing the way providers interact with patients. Real- time, 2-way messaging adds a whole new dimension to patient engagement. Through 2-way texting, providers can answer patients’ questions, follow up on no-shows, and conduct a conversation with patients while not over- whelming staff with time-consuming phone calls. According to the patient survey, 73% of patients want to be able to text their medical provider. That communications compatibility is a win-win for health care organizations and those they serve.

Ultimately, the disruption caused by the COVID-19 pandemic has made providers and patients reexamine how they interact and communicate. Texting has become the new way of calling, and its flexibility and efficiency are helping to build upon and improve the patient-provider relationship. Patients feel as though providers are listening better and being more responsive to their needs and preferences. The end result is a better health care experience for patients and improved levels of satisfaction with their provider.

Vanderkam L. Are you still checking voicemail? 

 April 11, 2013. Accessed April 19, 2021. 

https://www.cbsnews.com/news/are-you-still-checking-voice-mail/

Patient communication preferences: the COVID-19 impact. SR Health. Accessed April 19, 2021. 

https://www.srhealth.com/resources/the-covid-19-impact

Schwab N. New report: COVID-19 reveals the importance of texting during global crises. Zipwhip

https://www.zipwhip.com/blog/coronavirus-business-and-consumer-trends/

Burke K. Is texting really 10 times more efficient than phone calls? Test Request. September 29, 2015. Accessed April 19, 2021. 

https://www.textrequest.com/blog/texting-more-efficient-than-phone-calls 

Pew Research Center. April 7, 2021. Accessed April 19, 2021. 

https://www.pewresearch.org/internet/fact-sheet/mobile/#:~:text=mobile%20revolution%20below.-,Mobile%20phone%20ownership%20over%20time,smartphone%20ownership%20conducted%20in%202011

Medical Economics

The last thing patients want is to be put on hold or interrupted by calls at work.

COVID-19 and the Rise of Texting in Health Care

In an age of information overload, it can be difficult for patients with cancer
to comprehend their diagnosis and navigate the associated health care
decisions. Even within the health care field, misconceptions and uncertainty
about the role of clinical trials often abound. It is imperative that nurses and
health care providers feel comfortable discussing with patients the part trials
play. Clinical trials are the vital bridge between research and a drug’s eventual availability to patients. The process comes to a halt if there is not enough
accrual for the study to take off, and poor enrollment is the predominant reason that clinical trials fail.

 Nurses can not only help to educate but also spread the word among their peers and patients. The more expeditiously trials can accrue, the faster drugs can get through the process and into the hands of clinics and patients.

Many barriers to clinical trial enrollment exist, including logistical concerns, assumed lack of access, and therapeutic concerns. Investigators in a number of studies evaluating these barriers have noted a lack of education regarding trials to be the most common barrier.

 When nurses have a firm grasp on the basics of clinical trials, including the different phases and how to explain them to patients, the conversation will be normalized. The more secure nurses are with this discussion, the more comfortable their patients will feel about bringing up the topic and keeping an open mind. For instance, it has long been a misconception that clinical trials are reserved for the time when standard- of-care options have failed. In fact, the National Comprehensive Cancer Network recommends clinical trials as the best option for any patient who receives a cancer diagnosis.

To give a snapshot, the FDA approved 92 novel cancer drugs for 100 indications based on data from 127 clinical trials.

These are therapies that went through the rigorous process to approval and are now additional treatment options for patients who may currently be receiving treatment in your clinic. But for patients, reinforcing that safety is clinical trials’ primary focus is paramount, and engrained by strict training requirements, detailed reporting systems, and strict protocols for which adherence is non-negotiable.

Many resources are available for additional information on clinical trial options. These include the physicians or advanced practice providers at your practice, oncology-focused conferences, and the clinicaltrials.gov website, to name a few. Empowering our colleagues to stay well informed and feel comfortable talking to patients about clinical trials can have a long-lasting impact on trial enrollment and advancement and, most importantly, on patients’ comfort and understanding. It is time to normalize the conversation for science, the continued growth of nurses, and the overall survival of our patients.

Unger, J. M., Cook, E., Tai, E., & Bleyer, A. (2016). The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies. 

American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting

Ford, J.G., Howerton, M.W., Lai, G.Y., Gary, T.L., Bolen, S., Gibbons, M.C., Tilburt, J., Baffi, C., Tanpitukpongse, T.P., Wilson, R.F., Powe, N.R. and Bass, E.B. (2008), Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review. Cancer, 112: 228-242. 

National Comprehensive Cancer Network. NCCN Guidelines Version 2.2021-Pancreatic Adenocarcinoma.https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. May 10, 2021.

Ladanie A, Schmitt AM, Speich B, et al. Clinical Trial Evidence Supporting US Food and Drug Administration Approval of Novel Cancer Therapies Between 2000 and 2016. 

Partner Perspectives

"Clinical trials are the vital bridge between research and a drug’s eventual availability to patients.The process comes to a halt if there is not enough accrual for the study to take off. This is where nurses can not only help to educate but also spread the word among their peers and patients."
—Megan Price, MSN, APRN, FNP-C

Normalize the Clinical Trial Conversation

CURE Media Group recognized Maria Lim, BSN, RN, OCN, BMTCN, as the winner of its 2021 Extraordinary Healer® Award for Oncology Nursing, which honors the expertise, compassion, and helpfulness of nurses in the cancer community. 

In addition, Jennifer E. Giovanni, PhD, MSN, MPH, RN, received the Finest Hour Award, which recognizes the self- less achievements of a nurse caring for patients during the COVID-19 pandemic.

Essays were submitted by colleagues, patients, and family members that identified Lim, 2 finalists, and nearly 100 other Extraordinary Healer® nominees, all detailing the noble acts of oncology nurses. These ranged from providing a shoulder to cry on or a blanket to keep warm to making accommodations above and beyond the call of duty so that patients’ experiences during cancer treatment are a little more tolerable. Both awards were presented on April 29 during a virtual celebration held in conjunction with the 46th Annual Oncology Nursing Society Congress.

Lim, a nurse since 1993, moved from the Philippines to the United States and serves as a hematology/oncology/infusion clinic nurse at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois. She was nominated by one of her patients, who considers her the modern-day “angel of the battlefield.” Lim aims to be not only a nurse but a support system for all her patients, some of whom have battles beyond cancer, with posttraumatic stress disorder, for example.

Giovanni, who was previously a travel nurse, started her life of serving others in 1995 when volunteering with the Peace Corps. Since then, she has worked for several agencies, including the Centers for Disease Control and Prevention and the US Air Force. Most recently, she has worked in New York and New Jersey as a crisis response critical care nurse in areas severely affected by the COVID-19 pandemic.

Finalists for the Extraordinary Healer® award included Jessica Ellison, MSN, BA, RN, a transplant coordinator at Rush University Medical Center in Chicago, Illinois, and Katherine Gacek, BSN, RN, OCN, a nurse navigator from the University of Chicago Medicine in Illinois.

Mike Hennessy Jr, president and CEO of MJH Life SciencesTM, the parent company of CURE Media Group, mentioned that he had directly experienced the impact oncology nurses have. His mother, Patti Hennessy, died in January 2020 after living with breast and ovarian cancers for 9 years.

“The nominations come from your patients, your coworkers, and loved ones, and it’s just utterly remarkable,” Hennessy said. “After reading through the different essays we received and seeing firsthand the care that my mother received during her battles with cancer, it is clear that oncology nurses are the most selfless, caring, and truly inspiring individuals that you can be around. The way that you’re all able to comfort patients in what is probably the most traumatic time of their lives is galvanizing.”


Keynote speaker and award-winning actor and producer Sterling K. Brown, who is known for his role as Randall Pearson on the TV show This Is Us, among others, delved deeper into his role as a cancer advocate, which stemmed from his experience of losing his uncle to cancer.

During his keynote lecture, he showed his appreciation of oncology nurses, who often lean into the stressful, emotional situation rather than step away from it.

Maria Lim was nominated by her patient Bradford Evans, whom she has known for nearly 5 years. In his interview, Evans said he can’t imagine working with any other attending nurse and calls her the “helping hands” of the infusion unit.

“Myself or any of the other patients, we don’t know what tomorrow is going to hold,” Evans said. “It’s by the grace of God that we’re here. Ms Maria, through her helping hands, she’s the emissary of God, [who] keeps us alive and keeps us kicking. I will forever be indebted to her for her kindness, her professionalism. She listens to us, and not only me, but she listens to all the patients.”

Lim had an important role in his life the moment Evans received his cancer diagnosis. “As soon as he said, ‘[I’m referring you to] oncology,’ my world stopped, and she brought the world back around,” he said.

Lim aims to make chemotherapy a “somewhat enjoyable event,” by cheering patients up, Evans said. She greets them with a warm smile and even places patients near each other so they can share stories about their active duty days.

Lim has always recognized the importance of patients with cancer, especially those who are on active duty or are veterans. “When they’re diagnosed, it’s really like, OK, they’re veterans, they have this experience,” she said. “Some of them have PTSD, they have psych issues... and now they’re diagnosed with cancer. It’s like another battle for them.”

Jennifer E. Giovanni was nominated by her aunt, Pam Malone, RN, APRN, who quoted a previous writing by Giovanni in her nominating essay and interview. Malone mentioned how, from the start, Giovanni’s life has been one of serving others.

“Jennifer is someone who has done in her life all the things I wish I could have done,” Malone said. "From the get-go, even before she became a nurse, hers was a life of service and trying to help others, starting out in the Peace Corps and progressing from there. Most recently with [COVID-19], she has been on those front lines on more than 1 occasion. And I don’t know how she does it, but she did, and her experiences really meant a lot to her.”

During the interview, Giovanni described a time she was there for a patient who had stage 4 lung cancer with metastases to his brain and liver before he was intubated, which required “one final call” with his wife and children. With an iPad in hand, Giovanni brought his family to his bedside virtually. The patient’s family comforted him, saying “Don’t worry” and “We’ll see you in a little bit,” although he understood his outcome. The patient’s son came to visit the day before his father died.

“I was in there cleaning the room and doing those herculean nursing tasks that we all have to do somehow in 14 hours,” Giovanni said. “The son was outside the room, and I just thought what it must be like to stand there and look at your father intubated, clearly in a bad way, and not be able to touch [him]...That was a heavy day, but that was also a heavy phone call, but also one that I walked away from with gratitude because I was that presence at that sacred space.”

Giovanni took the opportunity to thank everyone for the award not only for herself, but also on behalf of all nurses on the front lines. “There’s something very special about the nurses that came forward to take care of patients with severe COVID-19, and also those that keep doing it day after day after day,” she said. “The trauma of it is profound, and it doesn’t come upon [us] until one steps away, and then it is overwhelming. I worry about the nurses that are out there doing this day in and day out. They are the true heroes.”

Jessica Ellison was nominated by Paul Kent, MD, from Rush University Medical Center, who credits her for establishing their institution as a national leader for patients with fibrolamellar carcinoma, a liver cancer that typically affects healthy adolescents and young adults.

“We have 2 of the best surgeons you could ever want, the best interventional radiologist you ever want, but not a single part of this, not from day 1 and not until today, would have been possible without Jessica,” Kent said during the interview.

Ellison mentioned that she was at first caught off guard when she received a
phone call saying she was a finalist for the Extraordinary Healer®, but then realized that Kent must have nominated her for it. “It has been a lot of work,” she said about establishing the program at her institution. “There’s been a lot of...tears from my eyes, tears from the patients’ eyes. It’s been a long journey for all of us, but in the end, I know that some of the work or all of the work that I have done has helped several patients, families, and their caregivers.”

Katherine Gacek was nominated by Rose Conti, MSN, RN, CNM, who described in her essay and interview about a time the nurse navigator made a storyboard to detail every treatment step for a nonverbal patient with autism who was being treated for Hodgkin lymphoma. The patient, who at first had disruptive behavior because he did not under- stand the severity of disease, was put at ease through Gacek’s efforts.

“She does this for all of her patients, but this patient in particular was [one] who stood out,” Conti said in the interview. “Her extra steps to care for this patient and make him feel comfortable did just so. It was a world of difference [between] what we saw in his actions and how he actually took his care while he was with us.”

“I could not believe that it worked so well,” Gacek said. “And I just feel like I had such a small piece of the puzzle to get this done, but I think it just showed that sometimes we have to think outside of the box. That was one of those cases, and nurses are doing all these things all the time. We’re being very inventive, and it’s not always straightforward, but we just have to find a way to get things done.”

Gacek noted how recognition, such as being an Extraordinary Healer® finalist, is a humbling experience.

“I’m just so, so thankful that nurses are being recognized, because there are times
that we are the unsung heroes,” she said. “Especially in oncology, we wear so many hats, and along with helping patients get through their treatment, that means so many things. That could mean helping with side effects or helping someone get to and from their appointments or helping a mom explain to their school-aged child what it means to go through chemotherapy and what that is going to mean for them. It’s just such a rewarding experience already, [and I feel] so appreciated to get recognized.”

Kristie L. Kahl, vice president of content at MJH Life Sciences

, the parent company of CURE Media Group, hosted the virtual event. She took the opportunity to thank the nurses and doctors who have worked tirelessly throughout the COVID-19 pandemic.

“I would like to thank all the front-line nurses and doctors who have not skipped a beat,” she said. “Over the last year plus, you’ve put your health and the health of your family members at risk, all to ensure that your patients can continue their treatments and now get vaccinated against this virus that has turned our worlds upside down. Your dedication has not gone unnoticed. Your patients thank you, we thank you, and we hope everyone continues to stay safe.”

Bristol Myers Squibb and Janssen Oncology sponsored the event. Jana Low, regional business director Bristol Myers Squibb, experienced the selflessness of oncology nurses when she herself received a diagnosis of melanoma.

“On behalf of everyone at Bristol Myers Squibb, I thank you for your compassion,
your dedication, and for being there every day for each of us. No matter what nurse hat you’re wearing, you are critical in our fight. Each battle is unique to that [patient] and their family, and through your work, continue giving patients and their loved ones the strength when they need it most,” Low said.

Pearl Pugh, vice president of sales and marketing in hematology at the Janssen Pharmaceutical Companies of Johnson & Johnson, said the COVID-19 pandemic has been a challenge for everyone but especially front-line workers, who dedicate their lives to others despite the circumstances.

“During the pandemic, when patients have not been able to have their loved ones or care- givers by their sides in the hospital or at treatment clinics, you’ve helped to fill the void by offering hope and support,” Pugh said.

Laura Leonetti, director of marketing (brand lead) of hematology and oncology at Janssen Oncology, echoed Pugh’s admiration of front- line workers during the COVID-19 pandemic.

“The COVID-19 pandemic has put the role of front-line health care workers, including nurses like yourselves, in the well-deserved spotlight,” Leonetti said. “For over a year now, you have overcome tremendous challenges and worked tirelessly during an unprecedented health care crisis. The world has seen first- hand the skill, determination, and heart it takes to serve as a nurse on the front lines. You are truly bright and brave heroes, not only to cancer patients but to all of us.”

Cover Story

CURE Media Group also recognized Jennifer E. Giovanni, PhD, MSN, MPH, RN, as winner of the Finest Hour Award, which highlights the dedi- cation and selflessness exhibited in frontline workers during the COVID-19 pandemic.

June 2021

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Maria Lim, BSN, RN, OCN, BMTCN, Wins CURE's 2021 Extraordinary Healer for Oncology Nursing