Not only did ARO-HIF2, an investigational RNA interference (RNAi) therapy, reduce levels of hypoxia inducible factor-2 alpha (HIF2α) expression in patients with clear cell renal cell carcinoma (RCC), the agent was also found to have a manageable safety profile, according to data from the phase 1b AROHIF21001 trial (NCT04169711).

Findings from the trial, which were presented during the 2022 Genitourinary Cancers Symposium, showed that of 26 evaluable patients, 9 experienced a median reduction in HIF2α mRNA of 30% (range, -19% to -59%) by qPCR.

In the subset of patients who received ARO-HIF2 at 225 mg (n = 7) the median reduction in HIF2α mRNA was 46% (range, -22 to -47). In those who were administered 525 mg of ARO-HIF2 (n = 10), the median reduction in HIF2α mRNA was 27% (range, -19 to -39). In the subset of patients who were given 1050 mg of the agent (n = 9), the median reduction in HIF2α mRNA was 44% (range, -28 to -49).

Additionally, 14 patients achieved a median reduction in HIF2α protein of 26% (range, -1700 to -98) by immunohistochemistry (IHC). The HIF2α protein reduction rates in the 225-mg, 525-mg, and 1050-mg cohorts were 26% (range, -26 to -82), 47% (range, 0 to -90), and 0% (range, 1700 to -98), respectively.

“This ongoing phase 1 study provides initial proof of target engagement based on reductions in HIF2α expression, as well as an acceptable safety profile in response to escalating doses of ARO-HIF2,” lead study author James Brugarolas, MD, PhD, of UT Southwestern Medical Center, and colleagues, wrote in a poster on the findings.

HIF2α is usually expressed at low levels and targeted for degradation by the von Hippel-Lindau (VHL) tumor suppressor protein. However, VHL inactivation, which is a causative event of clear cell RCC, prompts tumorigenesis through uncontrolled HIF2α accumulation. The synthetic double-stranded RNAi trigger, ARO-HIF2, which includes an alpha-v beta3 targeting ligand, was developed to silence HIF2α expression.

The AROHIF21001 trial enrolled patients with advanced or metastatic clear cell RCC that progressed during or after at least 2 prior regimens which must have included a VEGF-targeted therapy and a checkpoint inhibitor therapy.

 To be eligible for participants, patients needed to be at least 18 years of age, have an ECOG performance status of 0 or 1, a life expectancy that was longer than 3 months, and organ function that was considered to be acceptable at the time of the screening.

Exclusion criteria included a history of untreated brain metastases, having received prior systematic therapy or radiation therapy within 2 weeks of the first dose of study treatment, or having previously undergone solid organ or stem cell transplantation. Moreover, patients could not be receiving current treatment with immune checkpoint inhibitors, nor could they have received prior HIF2 inhibitors within 6 months before their first dose of study treatment.

Intravenous ARO-HIF2 was administered weekly at 225 mg in cohort 1 (n = 7), 525 mg in cohort 2 (n = 10), and 1050 mg in cohort 3 (n = 9). Moreover, tumor growth was evaluated by biopsy at baseline and again at 2 weeks. Additionally, patients were evaluated for safety each week. Every 8 weeks, participants were examined for tumor response by RECIST criteria.

The primary end point of the study was to evaluate treatment-emergent adverse effects (TEAEs) associated with ARO-HIF2. Secondary end points included pharmacokinetics and preliminary efficacy per RECIST v1.1 criteria.

Exploratory end points included the assessment of post-dose tumoral expression of HIF genes in response to treatment with the agent, change in tumor integrin expression, correlation of integrin expression with changes in HIF gene expression, and the examination of serum biomarkers of agent activity. The correlation of disease-related gene expression to the activity of the agent is also under exploration. Plasma and urine metabolites will also be assessed.

Spanning cohorts, the mean age was 65.1 years (range, 44-87). Seventy-seven percent of patients were male. Regarding performance status, 42.3% of patients had an ECOG performance status of 0, and 57.7% had a status of 1. Most patients (53.8%) had intermediate-risk disease per International Metastatic RCC Database Consortium criteria; 23.1% had good-risk disease and 15.4% had poor-risk disease.

Additionally, 30.8% of patients received 2 prior lines of therapy, 30.8% received 3 prior lines, and 11.5% received 4 prior lines of therapy. Notably, 26,9% of patients received 5 or more prior lines of treatment. Prior treatment included anti-VEGF therapy (100%) and checkpoint inhibition (100%). Regarding 

 mutation status, 17.6% of patients had frame shift mutations, 29.4% had missense mutations, 5.9% had in frame deletion, 11.8% had no variant, and 35.3% did not have this information available.

Prior data from the trial showcased early signals of activity with ARO-HIF2 in the 225 mg and 525 mg cohorts.

 Specifically, 7 of 9 patients who had evaluable tumor samples and received treatment experienced reductions in HIF2α per IHC H-score. Notably, these reductions ranged from -9% to -82%, with a mean reduction of -48%.

Additional data presented during the 2022 Genitourinary Cancers Symposium showed that ARO-HIF2 elicited an objective response rate of 7.7% in all patients, with 2 patients experiencing a partial response. Furthermore, 30.8% of patients achieved stable disease and 50.0% experienced disease progression. One patient was not evaluable for response, and response data were missing for 2 patients. Overall, the disease control rate with the agent was 38.5%.

At least 1 TEAE of any grade occurred in 96.2% of patients. Specifically, 57.7% of patients experienced at least 1 grade 1 or 2 TEAE, 30.8% reported at grade 3 TEAE, 3.8% experienced a grade 4 TEAE, and 3.8% experienced a grade 5 TEAE. Serious TEAEs were reported in 34.6% of patients. Moreover, treatment-related AEs of any grade occurred in 65.4% of patients. One patient discontinued treatment due to TEAEs.

TEAEs of any grade that occurred in more than 4 patients included fatigue (50.0%), dizziness (26.9%), dyspnea (26.9%), nausea (23.1%), abdominal pain (23.1%), neuropathy (19.2%), and constipation (19.2%).

Enrollment for the phase 1 trial remains open and enrollment is ongoing.

Brugarolas J, Beckermann KE, Rini BI, et al. Initial results from the phase 1 study of ARO-HIF2 to silence HIF2-alpha in patients with advanced ccRCC (AROHIF21001). 

 2022;40(suppl 6):339. doi:10.1200/JCO.2022.40.6_suppl.339

Study of ARO-HIF2 in patients with advanced clear cell renal cell carcinoma. ClinicalTrials.gov. Updated April 19, 2021. Accessed May 3, 2022. 

https://clinicaltrials.gov/ct2/show/NCT04169711

Arrowhead announces positive interim results from phase 1b study of ARO-HIF2 for treatment of clear cell renal cell carcinoma. News release. Arrowhead Pharmaceuticals, Inc. July 6, 2021. Accessed May 3, 2022. 

This article was originally published on OncLive as “ARO-HIF2 Lowers HIF2α Expression and Demonstrates Favorable Safety Profile in Clear Cell RCC”

Articles

Patients with clear cell renal cell carcinoma experienced reduced levels of hypoxia inducible factor-2 alpha expression following treatment with ARO-HIF2. 

Investigational RNA Interference Therapy, ARO-HIF2, Yields Encouraging Phase 1 Results in Clear Cell RCC

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.

Videos

ONS Annual Congress

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

Oncology nurses can help reduce the number of central line-associated bloodstream infections (CLABSIs) in patients undergoing hematopoietic stem cell transplant (HSCT) by standardizing central venous catheter (CVC) blood draws and chlorhexidine gluconate (CHG) treatment usage, according to a presentation at the 2022 Transplantation & Cellular Therapy Meetings.

Following a peer-to-peer observation and validation process was implemented in June 2021, there was a 68% decrease in CLABSI incidences at NYU Presbyterian 10 West. The number of incidences improved from 2.82 events per 1000 central line days (pre-intervention January to May) to 0.90 events per 1000 central line days (June to August).

“Oncology nurses play a primary role in implementing strategies to help reducing preventable CLABSI,” Thanyanee McNinney, BSN, RN, OCN, of the New-York Presbyterian Department of Nursing, said in a poster presentation of the findings.

CLABSIs represent a significant mortality risk to patients and are also linked with financial toxicities; one case of CLABSI can cost around $40,000.

Furthermore,factors including long term central line placement and usage, high-dose chemotherapy, prolonged immunosuppression, and the possibility of posttransplant complications such as graft-vs-host-disease (GVHD) mean that patients undergoing HSCT are especially vulnerable to CLASBI. However, research has demonstrated that proper insertion techniques and central line management can help prevent CLABSI.

In 2020, there were 0.51 CLABSIs per 1000 central line days at the investigator’s institution; by the second quarter of 2021, there were 2.82 CLABSIs per 1000 central line days.

Therefore, investigators sought to increase competency and reduce the incidence at their institution. Their objective was to reduce incidence by 20% within 3 months on a 16-bed HSCT inpatient unit in an academic medical center.

Investigators collaborated with the Hospital Acquired Infection (HAI) champions and nursing leadership teams to develop an action plan. This plan consisted of a thorough root to cause analysis of incidences, interdisciplinary huddles, standardized validation tools to allow peer-to-peer observation and validation during blood culture and blood specimen collection via central lines and CHG use.

The CVL peer feedback tool assessed whether observed staff performed proper hand hygiene when indicated, needle endcaps were clean, CVC ports/lines not being used had an alcohol impregnated endcap in place, all intravenous (IV) tubing not being used had a red cap, that no IV tubing were expired and had adequate labels indicating last line change, and that the CVC dressings were clean, intact, and not reinforced.

Following peer-to-peer observation and validation, it was revealed that 35% of nurses did not adhere to NYP policy when collecting blood cultures or drawing blood via a central line. Furthermore, 66% of nurses did not know how to perform CHG treatments correctly.

In addition, the study revealed multiple opportunities for growth. Among some of the registered nurses, peers observed the donning of gloves without performing hand hygiene, opening equipment without proper aseptic technique; insufficient scrubbing of the hub, failure to replace new Q-site prior to drawing blood cultures, drawing blood cultures directly through the lumen without a new Q-site placement, and a failure to flush with required amount of normal saline post-blood draw and performing push-pause technique when flushing.

Ultimately, nurses can be pivotal in reducing CLABSIs by educating staff members on proper CHG wipe usage and standardizing central line blood draws. These efforts are consistent with the “zero harm” initiative adopted at various institutions and represents a commitment to providing a safe and caring environment for patients and staff by eliminating all preventable patient injuries and infections.

McNinney T, Roselli T, Miner D. Reducing central line-associated bloodstream infections (CLABSI) through standardizing central venous catheter (CVC) blood draws and chlorhexidine gluconate (CHG) treatment usage. Presented at: 2022 Tandem Meetings Transplantation & Cellular Therapy Meetings of ACTCT and CIBMTR; April 23-26, 2022; Salt Lake City, UT. Abstract 612. 

Oncology nurses at the 2022 ASTCT Meeting shared how a peer-to-peer observation and validation tool helped decrease central line-associated bloodstream infections by 68%.



Oncology Nurses Drastically Reduce Central Line Infection Incidences Through Peer-to-Peer Observation Strategy

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.

Study Seeks to Identify Connection Between Cognitive function and Anxiety In Patients Receiving Chemotherapy 

In the age of cyberattacks, establishing and practicing a downtime procedure is crucial to safeguard patient care, according to Kelli-Ann Mancini, MSN, RN, OCN.

Mancini, an oncology nurse at Yale New Haven Health Smilow Cancer Hospital, recently co-authored a study focused on maintaining patient care in downtime conditions, which was presented at the 47th Annual Oncology Nursing Society Congress. In her presentation, she demonstrated that preparedness is imperative to successful patient care.

®, Mancini discusses the intervention that her institution implemented to combat this potential threat, why they felt it was necessary, and the broader implications of caring for patients with cancer in an increasingly digital age.

Please discuss the potential threat that a cyberattack poses to patient outcomes, and the importance of preparing a healthcare system to be able to combat this possibility.

With a potential cyberattack, patient care in its entirety can be significantly delayed or essentially halted. Many of our lines of communication rely heavily upon our electronical system. In terms of technology, [this includes] our epic patient records, communication via our mobile devices, scans, admissions, and more—all of which could really be delayed.

We had downtime procedures in place. Ultimately, the downtime processes that we had already would not have [easily] expanded for the length of time that a cyberattack could really endure—days, weeks, months even, in terms of how long it could potentially take to even have that [problem] rectified. This could have a huge impact on patient care, given how we currently rely so heavily on technology.

What is the process map that your team developed? How does it work?

At Smilow, we have 4 inpatient units: surgical oncology, women’s oncology, solid tumor inpatient oncology, and our hematology oncology units. Our surgical oncology and our women's gynecologic oncology take a lot of admissions straight from the post-anesthesia care unit (PACU). A lot of that handoff is done via an electronical medical record system.

Before our reliance on electronical medical records, it was all verbal handoff or nurse to nurse communication. Currently, we rely heavily on notes and flow sheets. The PACU admission process was important to look at because they needed [clear] outlines in terms of what do to if our electronical medical record isn't available. Our teams process maps not only outline what to do, but [includes] every single flow sheet on paper that you would need to complete a patient chart in its entirety.

What is important about these process maps is that they're interdisciplinary. They don't only include what nursing needs; it also includes what would it look like if we had chemotherapy being ordered for a new patient. [Imagine] a patient is coming in for chemotherapy:

How do those orders get placed [if we] don't have an electronical medical record? What does it look like on paper? How does that translate to pharmacy? How does that translate to the pharmacy mixing room? How does that get back to nursing in a flow that doesn't create a lot of confusion, and potential safety risks for patients? Ultimately, this process map is step-by-step instructions across multiple domains.

[Furthermore,] not only do we have the process maps outline, but we also did roleplay. We were able to take those process maps and roleplay and look at what it would look like if a patient had to go to scan for MRI. How are those results translated to nursing, to physicians, and to providers?

We looked at this as everything went down—which means everything from computer systems to fax machines. We asked: Who would be responsible for taking those results? What does that look like? Who brings those results to the nurse so that they could be reviewed? It is the same thing with high-risk chemotherapy—essentially, what does that look like? Who hand delivers that patient chart from area to area [in the clinic]?

We even outlined in the process map where those charts are kept so that in all inpatient units within Smilow, we would have a standard location and there wouldn't be confusion if a patient was on a different unit. For example, if we did not have beds on the hematology unit, and there was a patient who would need to be on a solid tumor unit, those providers would know exactly where to go.

In your opinion, what are the necessary tools that frontline workers will need in order to provide seamless patient care in the event of this type of emergency?

Overall, that priority would be ensuring that we have continuous checks of the actual downtime forms to ensure that things get updated very frequently. We must ensure that if there's an upgrade to our computer or electronic medical record, in those flow sheets, that actual upgrade translates to paper documentation. We need those checks and balances completed, and [we need to] ensure that we actually have a ready number available in the unit if there were a downtime.

Finally, it is crucial to ensure that those dry runs are periodically done—even if it's just annually. However, I would encourage it to be done more frequently than annually.

Henderson C, Mancini KA. Maintaining patient care in the age of cyberattacks. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P209.

Established Downtime Procedures Protect Patient Outcomes Against Cyber Attacks

Older men with prostate cancer who have received androgen-deprivation therapy (ADT) may be at an increased risk of major averse cardiovascular events, including myocardial infractions, stroke, or death from any cause, according to data presented at the 47th Annual Oncology Nursing Congress.

ADT is often used as a treatment for patients with advanced prostate cancer. Nurses caring for patients receiving ADT may be aware to look out for a list of adverse events (AEs), including hot flashes, cognitive impairment, muscle wasting, and anemia. However, in recent years, providers have also begun to turn their attention to 

cardiac complications associated with this treatmen

Previous literature has demonstrated an association between the treatment and cardiovascular risk; however, there is still debate on whether ADT causes that risk or if it is other comorbidities, said Deborah Boldt-Houle, an author on the study and senior director of medical affairs at TOLMAR Pharmaceuticals, which manufactures the ADT therapy Eligard (leuprolide acetate), during the presentation.

This study, which included the medical records of 44,339 patients, evaluated the relationship between risk of major cardiovascular events and age in patients with prostate cancer on ADT. Patients included in the study were divided into age group: younger than 60 (6%); 60 to 70 years old (24%); 70 to 80 years old (39%); or 80 years or older (31%).

In the overall population, major averse cardiovascular events risk was between 2% and 6% one year after ADT initiation, and 12% and 31% four years after.

Additionally, risk of major adverse cardiovascular events was more common in older patients compared to younger patients in the first seven years after ADT.

Boldt-Houle added that these results are significant and a possible explanation for this is because older patients tend to have more comorbidities that could cause cardiovascular issues, such as diabetes, obesity and frailty, she explained.

The results highlight that a patient’s care team should be cognizant of their age and risk for major averse cardiovascular events prior to starting treatment with ADT. Future studies are needed to evaluate the role comorbidities play in cardiovascular problems during ADT.

Vandross J, Atkinson S, Boldt-Houle D. Risk of major adverse cardiovascular events after initiation of androgen deprivation therapy is higher for older patients.

Older men who have received androgen-deprivation therapy are an increased risk of heart issues, however, the root of the risk is still not well understood. 

Following ADT, Older Patients With Prostate Cancer Are at an Increased Risk of Cardiac Complications

Non-drug therapies such as cognitive therapies may be useful for cancer survivors experiencing insomnia. However, more research is needed to determine benefit in patients with advanced-stage cancer and those undergoing active treatment, according to results of a study presented at the 47th Annual Oncology Nursing Society Congress.

Eugenie Spiguel, a nurse practitioner in integrative medicine at Memorial Sloan Kettering Cancer Center in New York, explained that patients with cancer often experience insomnia at a rate of two or three times higher than the general population. And it is often treated with medication, which is not always suitable for patients who do not want an added mediation and the potential side effects that come along with it.

The American College of Physicians recommends cognitive behavioral therapy as first-line treatment for insomnia, and Spiguel sought to evaluate if this was an effective treatment option for patients with cancer based on previous studies.

cognitive behavioral therapy for insomnia

. The studies included methods such as group therapy, telemedicine and shortened versions of the typical visits for cognitive behavioral therapy (from six visits to two).

“By and large the findings were overwhelmingly positive, so there was an improvement in many insomnia parameters,” Spiguel said during the presentation. Improvements were observed in the time it took to fall asleep, the ability to stay asleep and waking up early.

 and not patients currently undergoing treatment.

“And that is unfortunate only in that we already know that it’s effective in the general population, (and) the survivorship population coincides with that,” she said. Spiguel hopes that patients undergoing active treatment can be included in future studies.

“I would love to see more research done on patients who are undergoing treatment or in the advanced cancer (stage) population,” she added.

She concluded in saying that treating insomnia in patients with cancer is easy to implement into daily practice and is rewarding.

“If we find that patients are having insomnia, we can easily intervene with a non-drug therapy. I do this myself in my own clinic and it is extremely rewarding to see somebody improve, to see their insomnia really get better,” Spiguel concluded.

Spiguel E. Cognitive behavioral therapy for insomnia comorbid with cancer. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P313.

Cognitive therapies were found to be effective for helping cancer survivors with insomnia, but more research is needed for patients actively receiving treatment. 

Cancer Survivors Struggling With Insomnia May Benefit from Cognitive Therapy 

A new education intervention for oncology nurses resulted in one-third of ultrasound-guided peripheral IV (PIV) insertions being conducted by the oncology nurses themselves, thus reducing the team’s dependency on the vascular access team and decreasing peripheral access wait times for patients, according to results of a study presented at the 47th Annual ONS Congress.

Between August 2021 and February 2022, oncology nurses were responsible for 250 PIV insertions; 42 insertions were conducted in August, 33 in September, 48 in October, 30 in November, 33 in December, 25 in January, and 39 in February.

“Currently, we have 19 ultrasound-guided PIV trained oncology nurses in the [intensive care units; ICU], [and] we have had no documented complications, although the numbers of missed attempts are rarely recorded,” Stacy Artrip, MSN, APRN-CNS, OCN®, of The Ohio State University Wexner Medical Center—James, said in a poster presentation of the findings. “This project has helped our nurses grow in their practice by building clinical skills, confidence, interdisciplinary communication, and consideration [of] non-central line alternatives.”

Critically ill patients with cancer present unique challenges to vascular access; however, a comprehensive literature review revealed that there is currently insufficient research regarding the vascular access needs of this patient population. Investigators sought to address this care gap by developing and implementing an oncology nurse–led ultrasound guided peripheral access program. Ultimately, investigators hope that the nurses in their institution will be competent enough in PIV insertion that they will not need to rely on the vascular access team to care for their patients.

Investigators consulted a table of experts for insights regarding their intervention plan. This team included the vascular access team, the medical librarian, the local DNP, a representative from the Ultrasound company, and the ICU nurse managers. Their literature review yielded 14 articles, which were combined in an evidence and synthesis table to further guide their approach.

The proposed ultrasound-guided PIV intervention outline included a 2-hour class comprised of both a lecture and hands-on component, accompanied by 4 hours of clinical experience with a PIV team member to become proctored in insertion.

The lecture would cover the principles of ultrasonography, including related equipment, and insertion techniques, assessing difficult IV access, vascular anatomy of upper extremities, vein selection, catheter gauge and length, infection prevention, complications, and procedure documentation. For the hands-on component of the class, trainees learned how to navigate the ultrasound machine and practice placements on a phantom arm.



Clinical competency would be measured by the trainee’s ability to successfully insert 5 placements on live patients in the 4 hours of their clinical practice. To maintain their clinical competency, nurses needed to successfully place at least 7 PIVs annually.

Ultimately, the investigators conducted a 4-hour class for oncology nurses to teach the fundamental of PIV insertions. This class was accompanied by 12 hours of clinical practice. These longer classes and clinical experiences were based on recommendations buy the local experts. Investigators sought to allow adequate time for skill development to help build a solid foundation.

In addition, the investigators implemented a live tracking tool which collects monthly data. They measured competency by the following metrics: 2 ultrasound-guided PIV insertions per month with an 85% success rate. The local experts supported a yearly competency with rigorous competency requisites.

The investigators’ ultimate goal is to create nurse self-reliance and have the nursing team become responsible for almost all PIV insertions. However, to meet this objective, nursing teams may need a drastic change in culture, the study authors noted.

“This [number] only represents approximately one third of the total ultrasound guided PIVs places, while the other 2 thirds are still being placed by the vascular access team,” Artip concluded. “The biggest barrier right now is changing culture. Our culture prior to this implementation was to utilize the vascular access team. Most trained nurses only place them when it is their own patients rather than seeking out other patients who need access.”

“Part of this is advertisement—not everyone knows who is trained and thus don’t seek help from their trained peers,” she explained. “Part of this is also lack of desire or also not actively looking for opportunities to practice this skill and become proficient.”

Moving forward, the team will assess which nurses have remained proficient and offer those who have not a choice: they may either take another class or they may step down and step down from using the skill. The team plans on hosting a second class in the summer of 2022.

Artrip S, Weber ML. Evidence into practice: developing an ultrasound guided PIV insertion program for critically ill oncology patients. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P13.

Oncology nurses may be able decrease peripheral access wait times for patients, however, a change in culture may be necessary to see full results.

Patient Wait Times Reduced by Teaching Oncology Nurses to Insert Ultrasound-Guided Peripheral IV 

Jessica MacIntyre, ARNP, NP-C, AOCNP, executive director of Clinical Operations for Sylvester Comprehensive Cancer Center, discusses a nurse-led program designed to initiate early referrals of patients with cancer to nutrition services.

MacIntyre oversees various programs including oncology social work, cancer support services, nurse navigation, cancer survivorship, cancer prevention, and phase I clinical research operations. She recently presented at the 47th Annual Oncology Nursing Society Congress about a navigation nurse-driven protocol, which resulted in early referral and intervention to nutrition services.

Timely referral to support is linked to better outcomes; however, nutrition referrals are not typically made prior to the first appointment with the oncology team. This protocol, MacIntyre explains, sought to overcome that barrier by empowering nurse navigators to make referrals based on specific criteria, including a diagnosis of head and neck, thyroid, or pancreatic cancer, verbalize an interest in a nutrition consult, receiving total parenteral nutrition or enteral nutrition, and/or report unintentional weight loss of: 1% to 2% total body weight in 1 week, 5% of total body weight in 1 month, or at least 7.5% body weight in 3 months.

MacIntyre J, Lovan P, Torrents S. Integrating early referrals to oncology nutrition services through the cancer navigation program: the experience at Sylvester Comprehensive Cancer Center (SCCC). Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P360.

Jessica MacIntyre, ARNP, NP-C, AOCNP, discusses empowering oncology nurse navigators to refer patients undergoing chemotherapy or radiation therapy to nutrition services. 

Jessica MacIntyre on Utilizing Nurse Navigators to Connect Patients to Nutrition Services

Single nucleotide polymorphism (SNP) genotyping could be used to predict radiation dermatitis in patients with breast cancer, according to findings that were presented during the 47th Annual Oncology Nursing Society (ONS) Congress.

Through an evaluation of 16 cohort studies, 13 of which had a low risk of bias, the following 7 genotypes were found to be associated with severe radiation dermatitis: 

Lower radiation dermatitis was found in those with 

“[This association] can be used to contribute to planning of radiation therapy as well as improve the nursing follow-up of patients most likely to develop severe radiation dermatitis, based on clinical and genetic assessment,” lead study author Beatriz Aguiar, of the University of Brasilia in Brazil, said in a virtual presentation of the data.

Radiation dermatitis, which occurs in an estimated 95% of patients with breast cancer who are undergoing radiation, typically has an impact on the continuity of treatment for patients with breast cancer, along with their quality of life and their body image.

Prior radiogenomic studies have evaluated the potential of SNPs to predict the risk of severe radiation dermatitis, the authors noted in their poster.

In the analysis presented at the ONS Congress, investigators sought to identify whether SNPs are associated with the rate of severe radiation dermatitis with the use of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. The authors also performed the search at CINAHL, Cochrane CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science in the gray literature and in a reference list of articles.

Additionally, the Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies tool was utilized to assess the risk of bias from the individual studies. Investigators conducted a meta-analysis of 16 cohort studies to evaluate the association between SNPs and severe radiation dermatitis. Grading of Recommendation, Assessment, Development, and Evaluation was also utilized to assess evidence.

Further findings showed that there was a low certainty of evidence for association with severe radiation dermatitis in the 

 gene – SNP rs3957356 – CT genotype (odds ratio [OR]: 5.57; 95% CI, 1.73-17.87; 

 = .004). This was also the case in the GG genotype with the 

 gene – SNP rs2282367 (OR, 2.03; 95% CI, 1.18-3.48; 

Aguiar B, Normando AG, Guerra E, et al. Association of single nucleotide polymorphisms with severity of acute radiation dermatitis in breast cancer patients: systematic review and meta-analysis. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P7.

Single nucleotide polymorphism (SNP) genotyping could be used to predict radiation dermatitis in patients with breast cancer.

Latest Conference Articles