Clinical Insights: December 2017


CE lesson worth 1.0 contact hour that is intended to advanced practice nurses, registered nurses, and other healthcare professionals who care for patients with cancer.

Release Date: December 22, 2017Expiration Date: December 22, 2018

This activity is provided free of charge.


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 healthcare professionals who care for cancer patients may articipate 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 patientswith cancer


Physicians’ Education Resource®, LLC is approved by the California Board of Registered Nursing,Provider #16669 for 0.75 Contact Hours.


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 relationships with any commercial interests pertaining to this activity.


  • Read the articles in this section in its entirety.
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  • Print your CE Certificate.


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 healthcare 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®.

Acute Myeloid Leukemia

Older Patients with AML Don’t Grasp Risks and Likely Outcomes of Treatment

Mindy Waizer

lder patients with acute myeloid leukemia (AML) often face a difficult choice: risky, intensive chemotherapy that offers a small chance of a cure versus nonintensive chemotherapy meant to improve physical comfort and quality of life.

Given the seriousness of the decision, it’s crucial that patients understand the implications of choosing one over the other, yet findings from a new study reveal that patients with AML aged 60 years and older have substantial misperceptions regarding treatment. Overall, compared with their oncologists’ estimates, they tend to overestimate both the risk of dying due to treatment and the likelihood of a cure.

Based on these findings, the investigators concluded that older adults with AML need to be better educated about their prognoses, treatment options, and likely outcomes so they can make more informed decisions about their care. Results of the study were presented at the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.

“A shared understanding of prognosis and treatment risks between clinicians and patients is crucial in informed consent, and this study adds to the literature on the deficiencies that exist in accurate knowledge on both sides of this interface,” said Andrew S. Epstein, MD, an expert representing the American Society of Clinical Oncology, a sponsor of the conference.

Of the 100 older adults with AML enrolled in the study, 50 were receiving intensive care, which typically meant hospitalization for 4 to 6 weeks, and 50 were receiving nonintensive care, often given as outpatient treatment. The median age was 71 years, 92% of patients were white, more than 50% had a college education, and most were from higher income brackets.

Within 3 days after starting treatment, both the patients and their physicians were given a questionnaire to assess how they perceived the likelihood of death from the treatment. One month later, they completed a follow-up questionnaire to assess perceptions of prognosis.

Responses showed that, regardless of whether they received intensive or nonintensive care, 63% of patients thought it was somewhat likely that they would die due to treatment, and 28% thought it was extremely likely. In contrast, 80% of the treating oncologists thought it was very unlikely that their patients would die due to treatment.

The largest gap in perception had to do with expected treatment outcomes. A month after beginning treatment, 90% of patients thought they were somewhat or very likely to be cured of AML. In contrast, 74% of the oncologists thought it was unlikely or very unlikely that their patients would be cured. The gap was most striking in cases involving nonintensive therapy—44% of those patients believed they would very likely be cured, while none of their oncologists considered that very likely.

Prior to the study, the authors looked at the level of understanding about treatment intentions and expected outcomes in people with other cancer types. The gaps in perception between those patients and their physicians were not as large as the gaps in the AML study. The researchers attribute this to higher levels of distress in people with AML due to the urgency of their treatment decisions.

“Patients with AML face very challenging treatment decisions that are often placed upon them within days after being diagnosed,” said senior study author Areej El-Jawahri, MD, an assistant professor of medicine at Massachusetts General Hospital in Boston. “Because they face a grave decision, they need to understand what the risks of treatment are versus the possibility of a cure.”

El-Jawahri and her colleagues have found that early consideration of palliative care in a treatment plan for patients with solid tumors improves patients’ understanding of their prognosis, and the investigators hope to study this in leukemia patients in the future. “We really do need interventions to facilitate communications and ensure accurate prognostic understanding in this patient population, where understanding the treatment risks and prognosis can have significant effects on their treatment choices,” she said. 


Nicholson S, Abel G, Fathi AT, et al. Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia (AML). Presented at: 2017 Palliative and Supportive Care in Oncology Symposium; October 27-28, 2017; San Diego, CA. Abstract 43. br />

Breast Cancer

Fears and Misconceptions of Radiation Therapy Better Than Expected in Patients With Breast Cancer

Katie Kosko

Everyone experiences fear. The emotion can stop anyone in their tracks.

And when it comes to cancer, fear can hit especially hard. Misconceptions about the disease and its treatment often leave patients frightened about what they might experience immediately and somewhere down the road.

A study presented at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego, California, examined perception versus actual experience of patients with breast cancer who were treated with radiation therapy.

Investigators from David Geffen School of Medicine at the University of California, Los Angeles (UCLA) found that most patients’ experiences were better than what they expected. “When we see patients in our clinic, we generally sense a lot of initial fears and misunderstandings about radiation and how it works,” Narek Shaverdian, MD, radiation oncology resident and lead author of the study, said in an interview with Oncology Nursing News®. “It’s a scary word. It’s like a black box. People don’t know much about it unless, unfortunately, they have had family members or a friend go through a similar experience.”

Surveys were sent to 502 patients who received treatment for breast cancer at UCLA-affiliated multidisciplinary breast cancer clinics between 2012 and 2016. The 327 who responded ranged in age from 28 to 89 years, with a median age of 59. Eligible patients had 6 or more months of followup and were without tumor recurrence. Disease stage varied among the group, with 18% having stage 0 breast cancer; 38% stage I; 34%, stage II; and 9%, stage III.

Regarding treatment, 13% had axillary dissection, 37% received chemotherapy, and 70% received endocrine therapy; 82% underwent breast-conserving surgery. All patients received radiation therapy (RT), delivered as either standard whole-breast RT, (with or without regional nodal coverage), hypofractionated whole-breast RT, postmastectomy RT, or partial breast RT.

Patients were asked about their fears and beliefs regarding breast cancer treatment and adverse effects (AEs). They were also asked if the treatment experience and the short- and long-term AEs were as expected, worse than expected, or better than expected.

The survey was completed after radiation therapy over a median of 31 months. Nearly all women surveyed (94%) responded that they initially feared receiving radiation therapy. The most common concerns were about damage to internal organs (40%), skin burning (24%), and becoming radioactive (7%). However, 90% said they found breast radiation therapy “less scary” than anticipated.

In addition, short- and long-term AEs of radiation were better than or as expected for 83% and 84% of patients, respectively. They responded that AEs were less severe than or as expected for short-term breast pain (75%), skin changes (61%), and fatigue (78%), as well as for long-term appearance changes (85%), breast pain (79%), breast size changes (73%), and breast textural changes (70%).

In addition, 68% of patients reported that they had little to no prior knowledge of radiation therapy at the time of their diagnosis, and nearly half (47%) shared that they had previously read or heard “frightening” stories of serious AEs from radiation. Most patients said that their own treatment experiences did not confirm those negative stories, but 8 women (3%) found what they previously read to be true and 6 (2%) found what they heard from family and friends to be true.

“We were surprised by the findings because it is a large number of patients, and it goes to show how pervasive some of these fears are,” Shaverdian said. “Even in this cohort of patients, where large percentages of these women have 4-year college degrees, that there is still a significant amount of baseline misconceptions of radiation therapy.”

Nurses play an important role in reminding patients to ask any questions they have,” Shaverdian said. “Even if they think the question is insignificant, there is no wrong question,” he said. “We want patients to feel very comfortable with their treatment decision making and about their treatment options that are available to them.”

Shaverdian said that his next steps include making sure patients are more educated, figuring out how to proactively address some of the fears the investigators uncovered, and examining what healthcare providers can do to ensure a better treatment experience for all patients.


Shaverdian N, Wang X, et al. The patient’s perspective on breast radiation therapy: initial fears and expectations versus reality. In: Proceedings of the American Society for Radiation Oncology 59th Annual Meeting; September 24-27, 2017; San Diego, CA. Abstract 85.

Nurse Perspective

Pamela Ann Hall, BSN, RN OCN

Pamela Ann Hall, BSN, RN OCN

Pamela Ann Hall, BSN, RN OCNRadiation Oncology, Nurse/Patient Navigator, Welch Cancer Center, Sheridan, WY

Emotional complexities abound when a person hears they have cancer. Their world feels turned upside-down; the life they led before diagnosis feels gone. People live life differently as they begin to proceed on an unknown journey into the universe of cancer and treatment.

One of the strongest, most unpleasant emotions is fear. Accompanied almost always by stress, fear is very common and tends to undermine a person’s trust in the power of their soul and strength. Self-image and appearance changes in women also make them feel very anxious about radiation treatment.

Patients often have misconceptions (heightened by fear) about radiation therapy, making erroneous assumptions about what will happen to them when they undergo treatment. Radiation is in fact painless, but a common misconception is that it’s painful. Women also tend to believe myths that radiation causes terrible adverse effects, such as breast scarring from burns. The surveys returned by the 327 women post radiation indicated that they learned these pieces of misinformation were just that: myths.

At our clinic, we take pride in fear-alleviating patient education. After patients have their consult and simulation, we immediately set up an education session, where we discuss all the potential adverse effects and late reactions of radiation. We also provide skin-care instructions and their cream on the day of consult, accompanied by a bag full of educational pamphlets, handouts, and contact information for resources and support groups. We introduce them to our team and give them a tour of the facility. We feel that the more education we offer, the more empowered the patient feels, leading to an overall more successful experience.

This UCLA study demonstrates the large and important role nurses play in educating patients, and in alleviating their fears and anxieties.

Lung Cancer

Frontline Pembrolizumab More Than Doubles Overall Survival in PD-L1+ NSCLC

Jason Harris

Two-year results from the phase III KEYNOTE-024 trial showed that frontline pembrolizumab (Keytruda) more than doubled median overall survival (OS) compared with standard chemotherapy in patients with high PD-L1— expressing non–small cell lung cancer (NSCLC).

The median OS with the PD-1 inhibitor was 30.2 months versus 14.2 months with chemotherapy, representing a 37% reduction in the risk of death (hazard ratio, 0.63; 95% CI, 0.47-0.86; P = .002). The findings, based on an additional 6 months of analysis from previous reporting, were presented at the International Association for the Study of Lung Cancer 18th World Conference on Lung Cancer (WCLC) in Yokohama, Japan.1

“As we continue to see updated findings from this study of patients with NSCLC in the first-line setting, practitioners are gaining valuable insights into the longer-term clinical benefit of Keytruda,” study author Martin Reck, MD, PhD, head of the Department of Thoracic Oncology at LungenClinic Grosshansdorf, in Germany, said in a press release. “The significant OS findings observed in KEYNOTE-024, which includes patients who have a poor prognosis, reinforce the use of Keytruda in appropriate patients in the first-line treatment of this disease.”

In the open-label trial, treatment-naïve patients with advanced NSCLC were randomly assigned to pembrolizumab monotherapy (n = 154) or standard of care platinum-based chemotherapy (n = 151). Eligible patients had not undergone systemic chemotherapy treatment for their advanced disease, had tumors without an EGFR sensitizing mutation or ALK translocation, and had tumors with high levels of PD-L1 expression, defined as a tumor proportion score ≥50%, as determined by a central laboratory FDA-approved test.

Pembrolizumab was administered as a 200-mg intravenous infusion on the first day of each 21-day cycle, to a maximum of 35 cycles or progressive disease. Patients assigned to chemotherapy received paclitaxel plus carboplatin, pemetrexed plus carboplatin, pemetrexed plus cisplatin, gemcitabine plus carboplatin, or gemcitabine plus cisplatin. Patients with nonsquamous NSCLC were allowed to take maintenance pemetrexed. The primary endpoint was progression-free survival, with secondary outcome measures including OS and objective response rate (ORR).

Data presented at WCLC were based on a median follow-up of 25.2 months and included findings from 82 patients who crossed over from the chemotherapy group to receive pembrolizumab and 12 patients who received anti—PD-1 therapy outside of study crossover.

The 24-month OS rate was 51.5% versus 34.5% favoring the pembrolizumab arm. At 12 months, the OS rate was 70.3% in the pembrolizumab arm compared with 54.8% in the chemotherapy group. The ORR was 45.5% (95% CI, 37.4%-53.7%) with pembrolizumab compared with 29.8% (95% CI, 22.6%-37.8%) in the chemotherapy group. Median duration of response was not reached in the pembrolizumab group (range, 1.8+ to 20.6+ months) compared with 7.1 months (range, 2.1+ to 18.1+ months) in the chemotherapy group. Safety results were consistent with outcomes in previous trials among patients with metastatic NSCLC. In the pembrolizumab group, 31.2% of patients experienced grade ≥3 treatment-related adverse events (TRAEs).

The most common TRAEs were diarrhea, fatigue, pyrexia, pruritus, nausea, decreased appetite, and rash. The most common immune-mediated adverse events in patients assigned to pembrolizumab were hypothyroidism, pneumonitis, hyperthyroidism, severe skin toxicity, and infusion reactions. There was 1 treatment-related death in the pembrolizumab group.

In results published in 2016, grade ≥3 TRAEs were twice as common among patients in the chemotherapy group as in the pembrolizumab group (53.3% vs 26.6%).2 Incidence of serious TRAEs was similar between the 2 groups (21.4% for pembrolizumab vs 20.7% for chemotherapy). In the pembrolizumab group, 7.1% of patients discontinued treatment because of TRAEs compared with 10.7% of patients in the chemotherapy group. One patient in the pembrolizumab group died as a result of TRAEs on day 2. Three patients in the chemotherapy group died as a result of TRAEs (1 due to pulmonary sepsis on day 25, 1 due to pulmonary alveolar hemorrhage on day 112, and 1 due to unknown cause on day 8).


1. Brahmer JR, Rodríguez-Abreu D, Robinson AG, et al. Updated analysis of KEYNOTE-024: pembrolizumab vs platinum-based chemotherapy for advanced NSCLC with PD-L1 TPS ≥50%. Presented at: IASLC 18th World Conference on Lung Cancer; October 15-18, 2017; Yokohama, Japan. Abstract OA 17.06 (ID 9582).

2. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1—positive non–small-cell lung cancer. N Engl J Med. 2016;375(19):1823-1833. doi: 10.1056/NEJMoa1606774.

Nurse Perspective

Samantha Siegel, MSN, APN-C, OCN

Samantha Siegel, MSN, APN-C, OCN

Samantha Siegel, MSN, APN-C, OCNAdvanced Practice Nurse, John Theurer Cancer Center, Hackensack, NJ

As the immunotherapy world evolves, clinicians continue to gain insight on efficacy, toxicity, usage, and indications, as well as general knowledge. Metastatic lung cancer, long considered by the public and medical professionals as an imminently fatal diagnosis, has come to be viewed with a glimmer of hope. The fact that median overall survival in patients (with high PD-L1 expression) treated first line with pembrolizumab has demonstrated to be more than double that of patients receiving standard chemotherapy is exceptional. Not only has this treatment been shown to extend life expectancy, but it also provides the basis for hope and future breakthroughs in this field.

Although this article covers 1 study, immunotherapy is clearly not going away. The rapidly increasing FDA indications for numerous immunotherapies means increased usage and prevalence in the oncology community. If immunotherapy continues to show such exceptional survival benefits, more and more prescribers will be incorporating it into their wheelhouse of treatment options.

With that in mind, it is of the utmost importance that nurses are fully educated on treatment- related adverse effects and toxicities. Moreover, nurses need to be patient advocates and excellent educators in order to make their patients aware of all the different toxicities that can occur. For example, when a patient has a localized rash, said patient needs to know not to ignore it—rather, this rash should be reported to the clinical team and appropriately treated as a possible immunotherapy complication.

Immunotherapy administration is somewhat convenient for patients who want to maintain a work schedule or their basic lifestyle. Pembrolizumab specifically is administered just once every 3 weeks, significantly decreasing the number of clinical visits that a patient may require compared with conventional chemotherapy. The frequency of visits may change, of course, as toxicities develop. Additionally, it is important that the clinical team is using immunotherapy appropriately. To use pembrolizumab as first-line therapy for lung cancer, patients must have a high PD-L1 expression and not harbor an EGFR or ALK mutation. It is important to avoid any deviation from the National Comprehensive Cancer Network guidelines.

Psychosocial Issues

PRISM Intervention Helps Reduce Stress in AYA Patients

Katie Kosko

Targeted intervention can improve psychosocial stress experienced by many adolescent and young adult (AYA) patients with cancer, according to the results of a study presented during the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.

Using an intervention called Promoting Resilience in Stress Management (PRISM), investigators from Seattle Children’s Cancer and Blood Disorders Center and Research Institute conducted a pilot randomized controlled trial with 99 AYA patients who were diagnosed with new or newly recurrent disease for at least 2 weeks.

According to the study authors, PRISM uses 3 types of resources to help manage adversity: internal resources, such as stress management or mindfulness; community resources, such as social support; and existential resources, such as spirituality and the search for purpose.

“The experience of cancer is stressful in all realms, but we tend to focus more on physical symptoms than the equally important social and emotional challenges,” said Abby R. Rosenberg, MD, director of the Palliative Care and Resilience Research Program at the Research Institute and lead author of the study. “This is particularly true for AYAs who already struggle with normal developmental changes. When you throw cancer into the mix, it can become much harder.”

The patients, aged 12 to 25 years, received either PRISM or usual psychosocial care, which Rosenberg said at her center often includes a social worker, as well as additional resources such as professional psychology services if a referral is placed. All patients had access to standard psychosocial supportive care, including a social worker, psychologists, child-life specialists, and other experts in AYA oncology care, if needed.

PRISM was delivered in 4 half-hour to hourlong sessions with a trained research associate, followed by a family meeting that allowed AYA patients to share what was helpful to them. All but 4 patients who received PRISM participated in the family meeting.

Patients were asked to complete the surveys at enrollment and at 2, 4, and 6 months (for the final outcomes).

The investigators found that for most patients, the intervention improved resilience and quality of life, increased hope, and lowered distress. In addition, the incidence of depression was much lower—6% in the intervention group compared with 21% in the usual care group.

“Cancer is a daunting disease regardless of a person’s age,” said Andrew S. Epstein, MD, an expert with the American Society of Clinical Oncology. “AYAs with cancer face an especially unique and challenging experience, as they deal with the physical and emotional difficulties of cancer treatment at the same time they are coping with the normal stresses of adolescence and entering adulthood.”

Future studies must include a larger cultural demographic, Rosenberg said. She and the team hope to test PRISM in patients with advanced cancers, as well as other diseases. “Brief, developmentally targeted psychosocial interventions are feasible and promising with this population of AYAs with cancer,” she said. 


Rosenberg A, Bradford M, Klein V, et al. The “promoting resilience in stress management” (PRISM) intervention for adolescents and young adults: A pilot randomized controlled trial. Presented at: 2017 Palliative and Supportive Care in Oncology Symposium; October 27-28; San Diego, CA. Abstract 176.

Nurse Perspective

Jennifer Brown, BSN, RN, CPN, CPHON

Jennifer Brown, BSN, RN, CPN, CPHON

Jennifer Brown, BSN, RN, CPN, CPHONChildhood Cancer Survivorship Nurse, 24 Hours in the Canyon Cancer Survivorship Center, Amarillo, TX

An often overlooked and underaddressed adverse effect of cancer is the psychosocial stress our patients experience, which has been proven to affect their physical well-being. It’s a rare occurrence if an individual reaches the end of treatment unscathed in some way, regardless of age. However, adolescents and young adults (AYAs) are in a particularly difficult situation. They are already experiencing the challenges of developing their identity, becoming more independent, building more meaningful and lasting relationships, and starting to make plans for the future. AYAs must learn to cope with their new “normal” while also continuing to navigate this critical stage in their development toward becoming an adult.

In the study that used the Promoting Resilience in Stress Management (PRISM) intervention, researchers discovered that it “improved resilience and quality of life, increased hope and lowered distress in the majority of patients.” So, how do we put this intervention into practice?

First, we can teach our patients some of the following stress management skills, to hopefully reduce the negative effect cancer has on them:

1. Have patients practice mindfulness, focusing only on what is happening at that exact moment.

2. Promote the use of relaxation exercises like abdominal breathing.

3. Improve pain and fatigue, the physical manifestations of stress, through movements and controlled breathing practiced in yoga, which have been shown to reduce stress.

4. Encourage them to do what they enjoy, like listening to music, drawing, writing, or reading.

Next, a cancer diagnosis for an AYA patient often means putting plans on hold; some even convince themselves that their previous goals are now unattainable. Nurses can encourage short-term goal-setting versus long-term. If a patient focuses on long-term goals such as getting married, bearing children, and having a career, they can become discouraged. More realistic goals would be:

1. “I will get out of my hospital room at least once a day and try to meet other kids like me.”

2. “I still want to attend prom even though I don’t feel attractive since I lost my hair.”

3. “I want to make it through this next round of chemo without vomiting. I will advocate for myself and ask for medicine if I’m feeling nauseated.”

An essential aspect of goal-setting, though, is teaching them how to deal with unmet goals. Encourage them to advocate for themselves and interact with their doctor. On the other end of the spectrum, when a patient achieves a goal, celebrate that victory, no matter how small.

Last, help a patient find meaning in their cancer experience. For patients in this age group,—especially adolescents,—this can be difficult, as they are still learning how to process their thoughts and emotions. Teach them how to identify negative self-talk and unrealistic thoughts/feelings. What we shouldn’t do is insist that good things are going to come from them having cancer, because we don’t want to offer false hope. Each person has a different cancer experience, and not all will view it as positive. Therefore, we can teach them the skills necessary to navigate their cancer journey in the healthiest way possible.

Complementary Therapy

Yoga Improves Quality of Life in Patients With Lung Cancer

Brielle Urciuoli

People with advanced lung cancer, as well as their caregivers, can benefit from yoga, according to a study presented at the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.

In previous studies, following an exercise program reduced symptom burden among patients with breast cancer. Investigators at the University of Texas MD Anderson Cancer Center wanted to find out if a lower-impact exercise, such as yoga, would have the same effect on patients with lung cancer. These patients typically have more symptoms, including difficulty breathing, depression, and fatigue.

Led by Kathrin Milbury, PhD, an assistant professor of cancer medicine in the Department of Palliative Care and Rehabilitation Medicine, the study enrolled 26 pairs of patients with advanced lung cancer and their caregivers in 15 hour-long yoga sessions. On average, each pair attended 12 sessions. The control group consisted of patients who were told that they were on a waiting list for yoga classes.

Each patient participating had advanced lung cancer that could not be removed surgically and was receiving chest radiation. Most also were undergoing chemotherapy.

The yoga therapy involved physical exercises, breathing exercises, and meditation/guided imagery. According to Milbury, yoga could be a beneficial intervention for patients with cancer because it is not only gentle but also easily modified for individual needs and abilities. Because yoga emphasizes that participants focus on their breath, it can be especially beneficial for people with lung cancer, who often experience breathing problems.

The study results revealed that the yoga pairs showed more improvement compared with the control wait-list pairs. “The patients who practiced yoga had significantly better physical function as assessed by the 6-minute walking test...better stamina to perform work or daily activities, and improved mental health, while the caregivers who received yoga instruction had improvements in fatigue and stamina while working,” wrote the investigators.

Results of the walking test, which measured how many meters participants could cover in 6 minutes, showed that patients involved in the yoga intervention improved their distance or plateaued over time, whereas, on average, those in the control group saw declines in how far they could walk in the allotted time.

Not only did the yoga program improve quality of life for both patients and caregivers, but it also proved to be something that many of them looked forward to doing. “The participants enjoyed the intervention, as it gave them a time away from cancer,” Milbury said.

While Milbury noted that this feasibility study provides grounds for larger studies to examine yoga’s potential benefits for patients with lung cancer—it is now proven that patients with advanced disease are not too sick to participate in a yoga program. “Overall, we were encouraged by the results,” she said.


Milbury K, Mallaiah S, Liao ZX, et al. Randomized controlled trial (RCT) of a dyadic yoga program for lung cancer patients undergoing radiotherapy and their family caregivers. Presented at: 2017 Palliative and Supportive Care in Oncology Symposium; October 27-28; San Diego, CA. Abstract 125.

Adverse Effects

Interventions are Needed to Prevent CINV-Related Hospitalizations

Brielle Urciuoli

Chemotherapy-induced nausea and vomiting (CINV) is a common—and often costly— problem among patients with cancer. In fact, insurers pay, on average, more than $15,000 for each CINV-related hospitalization, according to the results of a study presented at the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.

Researchers examined 37,730 reports of hospitalization due to nausea and vomiting that occurred during 2014. The average amount that the hospital charged the insurance company was $26,603; after adjustments, the average amount paid out was $11,232. Factoring in physicians’ fees, the total average cost came to $14,197. Taking inflation into account, that equals $15,120 in 2016. Thankfully, strides have been made to prevent these incidents, but many patients still end up in the hospital for nausea and vomiting.

“This economic impact, in addition to the consequences for patients’ quality of life, suggests the need for continued advances in preventing CINV and optimizing compliance with national antiemetic guidelines, particularly for chemotherapy with high emetogenic potential,” wrote the authors.

Further, lead study author Eric Roeland, MD, a medical oncologist and palliative care specialist at UC San Diego Health, mentioned that healthcare organizations might not always follow protocol that could help decrease the risk of CINV. “Surprisingly, the adherence to evidence-based guidelines is poor, with approximately half of institutions not implementing the proper CINV prophylactic strategies,” he said. “Consequently, CINV is still a major concern for patients with cancer. If patients do not receive proper CINV prophylaxis, I would estimate that more than half of patients suffer from CINV. With the proper CINV prophylaxis, it is about 25% of patients who still have persistent symptoms of nausea and vomiting, especially in the breast cancer patient population.”

Roeland hopes that research will continue to advance in the field of CINV, particularly in assessing who might be at a higher risk, as well as implementing and standardizing treatment protocols so that people have not simply less nausea and vomiting but none at all.


Roeland E, Ma J, Binder G, et al. Hospitalization costs for nausea and vomiting: a savings opportunity. Presented at: 2017 Palliative and Supportive Care in Oncology Symposium; October 27-28, 2017; San Diego, CA. Abstract 155.

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