Loyda E. Braithwaite, MSN, RN, AGPCNP-BC, AOCNP, an oncology nurse practitioner at the University of Wisconsin Carbone Cancer Center, provides an overview of the evolving treatment landscape in hormone receptor–positive breast cancer. Braithwaite highlights the emerging role of selective estrogen receptor degraders, selective estrogen receptor modulators, and updates on aromatase inhibitors within the space. She also discusses the management of potential treatment-emergent toxicities and how recently approved agents might make active treatment more accessible for certain patient populations.

“Decision-making doesn’t happen spontaneously,” Braithwaite says. “[There] are strong data and scientific research that show new therapies are emerging. It is up to us, as advanced providers, or as nurses, to make sure that we provide that education and that support [to our patients], because the evidence is out there.”

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Loyda E. Braithwaite, MSN, RN, AGPCNP-BC, AOCNP, highlights nursing considerations in prescribing and administering endocrine therapy to patients with HR+ breast cancer. 

Loyda Braithwaite Discusses Evolving Treatment Options in HR+ Breast Cancer 

® spoke with Heidi Donovan, PhD, RN, professor of nursing and medicine, and co-director of the National Center on Family Support, at the University of Pittsburgh. Donovan recently co-led a study evaluating the utility of an online symptom management tool for women with recurrent ovarian cancer.

found that women who used the intervention experienced higher satisfaction with their symptom management.

“[In my opinion] some principles of our intervention are critical and actually overdue in clinical practice for ovarian cancer and other cancers,” she noted, emphasizing the importance of systematic symptom assessment in clinical settings, and enhancing women’s confidence in their ability to manage their symptoms, as well as their confidence communicating these symptoms to their healthcare providers.

“[By systematic] I mean [asking] the same questions repeatedly, over time, in order to pick up on changes that that are affecting patients and on symptoms that are affecting their quality of life, and their ability to function on a day-to-day basis,” she said. “The second principle was really enhancing women's confidence… A lot of what we did in this intervention was try to motivate women to recognize how much [of an] effect their symptoms were [causing] and build their confidence in their ability or their knowledge of things that they could try to get better management.”

Donovan HS, Sereika SM, Wenzel LB, et al. Effects of the WRITE symptoms interventions on symptoms and quality of life among patients with recurrent ovarian cancers: an NRG Oncology/GOG Study (GOG-0259). Published online ahead of print February 7, 2022. 

In this episode of “The Vitals,” Heidi Donovan, PhD, RN, discusses novel symptom management intervention for women with recurrent ovarian cancer.

Bringing a New Approach to Symptom Management in Ovarian Cancer

® spoke with Hamid Emamekhoo, MD, an assistant professor of the Division of Hematology, Medical Oncology and Palliative Care with the University of Wisconsin Carbone Cancer Center. Emamekhoo offers a snapshot of recent advances in kidney cancer treatments, an overview of caring for patients receiving immunotherapy and TKI combinations, and where future advances for kidney cancer research are headed.

“We have used high dose interleukin-2 for the treatment of kidney cancer since 1992—we have been doing immunotherapy for kidney cancer before immunotherapy was cool. But it was not the best treatment modality because it is a little hard to tolerate. It causes a lot of side effects because it mimics a severe sepsis and riles up the immune system,” explains Emamekhoo. “Of course, with the advancements in immunotherapy [and with] the approvals of [various] immune checkpoint inhibitors, that has changed significantly.”

Goodman VL, Rock EP, Dagher R, et al. Approval summary: sunitinib for the treatment of imatinib refractory or intolerant gastrointestinal stromal tumors and advanced renal cell carcinoma. 

. 2007;13(5):1367-1373. doi:10.1158/1078-0432.CCR-06-2328.

Fyfe G, Fisher RI, Rosenberg SA, et al. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. 

. 1995;13:688-696. doi:10.1200/JCO.1995.13.3.688.

Tung I, Sahu A. Immune checkpoint inhibitor in first-line treatment of metastatic renal cell carcinoma: a review of current evidence and future directions. 

 2021(11):707214. doi:10.3389/fonc.2021.707214.

FDA approves nivolumab plus ipilimumab combination for intermediate or poor-risk advanced renal cell carcinoma. FDA. News release. April 16, 2018. Accessed March 23, 2022. https://bit.ly/37Wi3Uz

FDA approves Merck’s Keytruda (pembrolizumab) in combination with Inlyta (axitinib) as first-line treatment for patients with advanced renal cell carcinoma (RCC). Merck. April 22, 2019. Accessed April 22, 2019. https://bit.ly/2IKrjMM

FDA approves nivolumab plus cabozantinib for advanced renal cell carcinoma. FDA. News release. January 1, 2021. Accessed March 23, 2022. 

FDA approves KEYTRUDA (pembrolizumab) plus LENVIMA (lenvatinib) combination for first-line treatment of adult patients with advanced renal cell carcinoma (RCC). News release. Merck. August 11, 2021. Accessed March 23, 2022. 

AVEO Oncology Announces U.S. FDA Approval of FOTIVDA® (tivozanib) for the Treatment of Adult Patients with Relapsed or Refractory Advanced Renal Cell Carcinoma. AVEO Oncology. News release. March 10, 2021. Accessed March 10, 2021. 

FDA approves pembrolizumab for adjuvant treatment of renal cell carcinoma. FDA. News release. November 17, 2021. Accessed March 23, 2022. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-adjuvant-treatment-renal-cell-carcinoma

Choueiri TK, Escudier B, Powles T, et al. Cabozantinib versus everolimus in advanced renal-cell carcinoma. 

Cella D, Choueiri TK, Hamilton M, et al. Health-related quality of life (HRQoL) in previously untreated patients with advanced renal cell carcinoma (aRCC) in CheckMate 214: five-year follow-up results. 

. 2022;40(suppl 6):307. doi:10.1200/JCO.2022.40.6_suppl.307

Choi WSW, Boland J, Lin J. Hypoxia-Inducible Factor-2α as a Novel Target in Renal Cell Carcinoma. 

. 2021;8(2):1-7. doi:10.15586/jkcvhl.v8i1.170

FDA approves belzutifan for cancers associated with von Hippel-Lindau disease. FDA. News release. Accessed August 13, 2021. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-belzutifan-cancers-associated-von-hippel-lindau-disease?utm_medium=email&utm_source=govdelivery

In this episode of “The Vitals,” Hamid Emamekhoo, MD, discusses the evolving treatment landscape of kidney cancer. 

Carbone Cancer Center Expert Shares Biggest Updates in Kidney Cancer Treatment

In this episode of “The Vitals,” we spoke with Caitlin Benda, MBA, MS, RD, CSO, LDN

 a clinical oncology nutritionist supervisor at American Oncology Network, about dietary strategies to support patients undergoing curative cancer therapies.

Throughout our conversation, Benda discussed how nurses can help change a patient’s approach to diet in order to combat complications brought about by nausea and appetite loss. In addition, she highlights the importance of allowing patients some autonomy in their diet, common gastrointestinal—related side effects with different cancer treatments, and the importance of nutrition screening tools in increasing necessary referrals.

“Oncology nurses, especially infusion nurses, are spending a lot of time around patients, gathering information from these patients that maybe the patient did not have time to communicate in the same amount of detail to the physician or to whoever they were seeing in the office,” notes Benda. “Using that information and sending referrals to dieticians early on in the process [is vital]. We know that malnutrition is a very significant problem among individuals going through cancer treatments, and it is much easier to prevent malnutrition than it is to treat malnutrition.”

In this episode of “The Vitals,” Caitlin Benda, MBA, MS, RD, CSO, LDN, discusses important dietary considerations for patients with cancer.

Food for Thought: Nutrition Considerations for Patients With Cancer

® met with Matt Iwaniec, PsyD, a licensed clinical health psychologist with the stem cell transplant and CAR-T therapy program at Allegheny Health Network, to discuss fully integrated behavioral services as it relates to oncology.

In our discussion, Iwaniec highlights the mechanisms behind psychosocial treatments like cognitive behavior therapy (CBT) and acceptance and concomitance therapy (ACT), discusses recent advances in the behavioral health space, and underscores the need to normalize behavioral therapy for patients facing a cancer diagnosis.

“Psychologists and behavioral health professionals have a unique skill set that we can bring to the practice of oncology to help patients, families, clinicians, doctors, nurses, teaching assistants, nurse practitioners, etc deal with the stress of cancer—because it is not just stressful on the patient. It is stressful on the whole family, and it is stressful on the teams that are treating them, too.”

Iwaniec expresses that he believes integrated behavioral health care is the “way to go” for the future and should become a standard part of cancer care treatment. However, there still are a lot of unmet needs that need to be addressed, he says.

“There is still a big gap between availability of mental health care and the need for mental health care. It is a problem that is endemic everywherethroughout through all our systems. We are on this path to better integration of mental health care from start to finish with the patient. There are examples of places where that is happening, but often, behavioral health care is not fully integrated [although it] needs to be. The 2 biggest impediments to that are having the [proper] staff, but also getting the general patient population to acknowledge that mental health care is a part of cancer health care.”

In this episode of “The Vitals,” Matt Iwaniec, PsyD, discusses the value of integrated behavioral health programs in cancer care. 

Behind Integrated Behavioral Health Services 

® met with Mark Honor, PA-C, Department of Malignant Hematology, Moffitt Cancer Center, to discuss managing adverse events (AEs) related to cancer therapies. In our conversation, we discuss the different mechanisms of action of today’s most popular therapeutic options, and best principles for responding to adverse events in patients receiving combination or immunotherapies.

“I went to school to be a medical provider; they didn't go to school to be a patient. They're not going to walk up to me and say, ‘Mark, I think I had gastroparesis, can you prescribe me some metoclopramide?’ They're not going to do that. The thing is, we can be ignorant of the facts if we don't ask the right questions. You must ask the right questions.”

“[If you are] the triage nurse, or the primary nurse, you have to be invasive,” he added. “Once a patient tells you they're having a problem, you need to know what they ate last night, and what they have been eating recently. Because a lot of times by asking all those questions, the nurse can [actually] solve a lot of these problems.”

In this episode of “The Vitals,” Mark Honor, PA-C, discusses adverse event management in patients receiving different therapeutic options. 

Ask The Right Questions: Clinical Pearls of AE Management

In this special episode of “The Vitals,” 

® Magazine met with Janice Post-White, PhD, RN, FAAN, to discuss her recently published book, “Standing at Water’s Edge.”

Post-White was an oncology nurse when her 4-year-old son, Brennan, was diagnosed with B-cell acute lymphoblastic leukemia. Throughout our discussion, she reflects on the intersections of her professional and personal life, the lessons she learned, and offers advice for those processing their own grief in the wake of cancer.

“I remember saying to one student, ‘You know, I really need to know more about pediatric oncology.’ And, that year, my son was diagnosed... I guess you have to be careful what you wish for. But what I also learned is that [although] I had a PhD in nursing, and I had a [cancer] background, with a minor in immunology, pathobiology, I was interested in psycho-neuro-immunology, or how the mind and the body communicate. All of my research focused in that area, but none of what I did prepared me to be a cancer mom.”

“I did immune assays in the lab and I studied imagery and massage and mindfulness meditation, healing touch therapies, and everything I [thought] I knew about cancer. I thought I knew what it was. But it was when my son was diagnosed that I learned, I really don't know how to be a [caregiver]. There's a lot more than just knowing and the knowledge; it's really the emotional realm.”

In this episode of “The Vitals,” Dr. Janice Post-White discusses how she balanced working as an oncology nurse through her child’s cancer diagnosis, and the lessons she learned from the experience. 

When an Oncology Nurse Becomes a Cancer Mom: How One Nurse Navigated Her Child’s Leukemia Diagnosis 

For this episode of “The Vitals,” we spoke with Patricia Jakel, MN, RN, AOCN, University of California Los Angeles Health, and Elspeth Knill-Selby, a nurse practitioner in breast surgery at Yale Cancer Center. The 2 experts discuss the rewards of mentorship—from both a providing and receiving perspective, as well as the importance of nurturing young nurses as they transition to acute care.

“I think to be a well-rounded mentor, you have to have a good sense of self and understand yourself—and be able to articulate your feelings in a positive way.”

“I think I look at mentorship as kind of nurturing somebody along the way, and hopefully contributing to their success in what it is that they choose to do. In nursing, sometimes, and in medicine as well, people can kind of ‘eat their young’, so to speak. Therefore, I would look at it as nurturing and trying to create an environment that's not threatening—because certainly when you go in to nursing, and when you go into [an] advanced practice role, it's scary.”

In this episode of “The Vitals,” 2 veteran oncology nurses discuss the value of mentorship—particularly for novice nurses. 

The Value of Nurse Mentorship in Oncology

For this episode of “The Vitals,” we spoke with Nikki Urban, a registered nurse and practice manager at Allegheny Health Network, about the implementation of a successful phone triage program at the oncology institution.

Urban discusses why the program came about, some of its successes, and how a phone triage program can bring value to an oncology center.

“The phone triage process is a patient-centered initiative that really has patient access in mind,” Urban explains. “The initiative has provided the opportunity for patients to call in and have their concerns addressed in a real-time fashion with an oncology-trained nurse.”

Urban added, “I know sometimes patients will call in [and say] ‘Oh, my goodness, I have a real person that I'm speaking to.’ Patients have been excited about it, and the oncology triage team is able to immediately address symptoms, assess patients, and decide if a patient needs a same-day visit or [if] they need to come into our infusion office for supportive care. They can schedule those appointments right at the point of the call.”

In this episode of “The Vitals,” Nikki Urban, RN, discusses the successful implementation of a phone triage program at Allegheny Health Network.

Access-Focused Care: The 4-1-1 on Oncology Phone Triage Programs

Cisplatin is a life-saving drug, says Bruce Carleton, PharmD, FCP, FISPE. However, although the drug has lifesaving benefits, it also causes some degree of hearing loss in about 60% of children who receive this therapy. Furthermore, about 40% of children who receive cisplatin require hearing aids for the rest of their lives as a result of treatment.

In this episode of “The Vitals,” Carleton, of the Department of Pediatrics, Division of Translational Therapeutics, at the University of British Columbia, spoke with 

® about balancing the beneficial effects of cisplatin with it’s potential to cause permanent hearing loss, in children with solid tumors. He discusses a study he recently co-authored, whose findings indicate that children under the age of 5 years are at an increased risk of developing hearing loss because of this treatment, compared with children older than the age of 5, as well as comments on how genetics may one day play a role in reducing the risk of hearing loss in this patient population.

The study assessed 368 pediatric patients with cancer by conducting over 2000 audiological assessments before, during, and after receiving cisplatin treatment. Three years after starting therapy, 75% of patients aged 5 years and younger, and 48% of patients aged older than 5 years had experienced cisplatin-induced hearing loss. According to Carleton, these findings demonstrate a need for routine audiological assessments for children who receive this treatment.

“At the end of every cycle, we should [conduct] a hearing assessment, and we should follow the toxic course of this drug,” he says. “The legitimate concern among some clinicians is that if patients or parents know that their child is developing hearing loss, they're more likely to say, ‘Do we really have to give them this cisplatin?’”

On this episode of “The Vitals,” an expert in genetics discusses ongoing research to address cisplatin-induced hearing loss in pediatric patients with cancer.
