Journal of the Advanced Practitioner in Oncology最新文献

{"title":"Maintaining Survival While Improving Quality of Life: An Advanced Practitioner–Led Pilot Feasibility Study to Reduce Radiation Dose in Children With Brain Tumors","authors":"Jennifer L. Raybin, PhD, RN, CPNP, Andrew Donson, Nicholas K. Foreman, MRCP, Rajeev Vibhakar, MD, Michael H. Handler, MD, Arthur K. Liu, MD, PhD","doi":"10.6004/jadpro.2024.15.1.3","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.3","url":null,"abstract":"Purpose: Oncology advanced practitioners (APs) are on the front line in treating adverse effects. Among children with brain tumors, treatments such as craniospinal irradiation (CSI) cause neurocognitive injury, endocrinopathies, and ototoxicity. High-dose CSI with concurrent chemotherapy allows high-risk embryonal tumors (non-anaplastic) good survival (70%), but significant distressing effects are commonly treated by APs in multidisciplinary long-term follow-up. The aim of this study was to test feasibility of reducing radiation dose with an AP-led protocol. Methods: An interdisciplinary team developed this pilot study with the primary outcome of fewer than two deaths in 10 patients (80% survival). Secondary outcomes were feasibility of an AP-led treatment protocol and acute/late effects of treatment. The AP held a pioneering role as principal investigator of a tumor treatment study. Exclusion criteria included age less than 3 years and anaplasia. The CSI was reduced from 36 to 24 Gy. All other treatment was standard. Results: Survival rate exceeded the primary outcome threshold (88%); the accrual rate (80%) and follow-up neurocognitive testing rate (75%) were acceptable. Eight children ages 3 to 19 years (M = 8) with tumors of varied molecular subtyping were enrolled. The single death occurred 2.5 years from diagnosis of multiorgan failure (without evidence of tumor). The mean survival is 11 years, with two college and one graduate degrees. Acute and late effects were decreased compared with the higher-dose CSI. Conclusion: APs who treat cancer adverse effects can also conduct clinical prospective studies to maintain survival rates and improve quality-of life-outcomes.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"148 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139819454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Practice Providers’ Role in Intimacy in Advanced Cancer Patients","authors":"Anna Poullard, DNP, MSN, APRN-BC, Sheena Charles, MS, FNP-BC","doi":"10.6004/jadpro.2024.15.1.6","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.6","url":null,"abstract":"The primary objectives of early phase clinical trials are to determine the safety, tolerability, and recommended doses of an investigational agent for patients with advanced cancer. Although these advances in cancer treatment have resulted in patients living longer, patients often experience psychological side effects that may affect sexual health and intimacy. It is estimated that cancer and its subsequent treatments affect the sexual health and intimacy of 40% to 100% of this patient population. Patients with advanced cancer who have undergone numerous treatments may be impacted negatively, not only physically (such as being disfigured by surgical resection) but also emotionally in relationship aspects with their intimate partners. Health-care providers who treat patients with advanced cancer enrolled in early phase clinical trials tend to focus primarily on treatment, physical side effects, and symptom management. Advanced practice providers (APPs) are accustomed to performing comprehensive physical examinations on patients; however, research indicates that intimacy and sexuality are most often excluded in discussions with patients with advanced cancer. The purpose of the article is to increase awareness of the need to address intimacy and sexuality in this patient population and to encourage APPs to make this a part of their everyday practice.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"139 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139827695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Posters From JADPRO Live 2023","authors":"","doi":"10.6004/jadpro.2024.15.1.8","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.8","url":null,"abstract":"Thirty-three clinical posters focused on the role of the advanced practitioner were presented at JADPRO Live this past November 9 to 12, 2023, in Orlando, Florida.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"87 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cost of Care: Financial and Social Factors in Cancer Management","authors":"Beth Faiman, PhD, MSN, APRN-BC, AOCN, BMTCN, FAAN, FAPO","doi":"10.6004/jadpro.2024.15.1.1","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.1","url":null,"abstract":"It is known among clinicians, including advanced practitioners (APs), that non-medical factors will influence health outcomes and contribute to health disparities. Factors such as socioeconomic position, access to health-care and education systems, and living conditions impact whether a patient will be provided similar treatment, care, or resources as others with the same condition. These are referred to as social determinants of health (SDOHs), and negative social factors lead to patients experiencing deleterious outcomes (Pinheiro et al., 2022).","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"15 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139888308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Posters From JADPRO Live 2023","authors":"","doi":"10.6004/jadpro.2024.15.1.8","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.8","url":null,"abstract":"Thirty-three clinical posters focused on the role of the advanced practitioner were presented at JADPRO Live this past November 9 to 12, 2023, in Orlando, Florida.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"27 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral T-Cell Lymphoma, Not Otherwise Specified: Diagnosis and Therapeutic Approaches for the Advanced Practice Provider","authors":"Karla V. Ow, MSN, APRN, AOCNP, Ann Vo, MSN, APRN, FNP, Jonathan Cunningham, MPAS, PA-C","doi":"10.6004/jadpro.2024.15.8.3","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.8.3","url":null,"abstract":"T-cell lymphomas (TCLs) have a unique pathobiology, clinically aggressive course, and poor prognosis. Recently, there have been significant advances in understanding the molecular genetic alterations of TCLs through next-generation sequencing. This has led to the development of specific therapeutic molecules. This review aims to provide an up-to-date overview of the current therapeutic approaches for the subtype peripheral T-cell lymphoma, not otherwise specified.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"963 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Use of Intratumoral Injections in Solid Tumor Malignancies Improve Outcomes and Reduce Adverse Events? An Integrative Review","authors":"Maggie Matyola, APRN, FNP-C, Ashley Martinez, DNP, APRN, FNP-BC, Joyce Dains, DrPH, JD, APRN, FNP-BC, FNAP, FAANP, FAAN","doi":"10.6004/jadpro.2024.15.1.4","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.4","url":null,"abstract":"The purpose of this review is to assess the efficacy and adverse events associated with intratumoral injection in the treatment of solid tumor malignancies. A literature review was conducted using PubMed, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus databases from 2009 to 2022. A total of 588 articles were retrieved, with five selected based on inclusion and exclusion criteria. Inclusion criteria specified English language publications, in human trials, and use of intratumoral anticancer agents. The findings from this integrative review demonstrate treatment efficacy as measured by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with increased stable disease and partial response in patients as well as a prolonged survival period. Additionally, findings show that this therapy is associated with predominantly mild adverse events.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"183 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139824401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guess What Is in My Brain","authors":"Catherine Joseph, MSN, APN, AGACNP-BC","doi":"10.6004/jadpro.2024.15.1.7","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.7","url":null,"abstract":"Magnetic resonance imaging (MRI) of the brain is an important diagnostic tool used by neurologists. This article explores the workup and management for a patient with a brain lesion and highlights the importance of neuroimaging. Similarities and differences in MRI findings for meningioma, central nervous system lymphoma, and glioblastomas are discussed, along with common MRI sequences and their utility.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"56 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139827454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Financial Toxicity Screening and Care Coordination Quality Improvement Program in a Gynecology Oncology Urban Practice","authors":"Tina Harris, DNP, NP-C, AOCNP, Julie Brinzo, DNP, APRN, MBA, FNP-C, Christopher Pell, PhD","doi":"10.6004/jadpro.2024.15.1.2","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.1.2","url":null,"abstract":"Background: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"41 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139891143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering Oral Chemotherapy Understanding and Safety (FOCUS) Project: Interventions for Improving Knowledge and Compliance With National Safety Standards","authors":"Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP, Rita D'Aoust, PhD, MS, RN, Deborah Baker, DNP, CRNP, NEA-BC, Ginger Hanson, PhD, MS, Lauren Gjolaj, RN, MBA, Lawrence Negret, MD, Daniel O'Neil, MD","doi":"10.6004/jadpro.2024.15.8.1","DOIUrl":"https://doi.org/10.6004/jadpro.2024.15.8.1","url":null,"abstract":"Background: Oral chemotherapy drug development and use has increased, and evidence in the literature suggests variability in practices nationally. Thus, there is a need for continuous review of the process of oral chemotherapy administration that focuses on improving adherence to national standards. Objectives: This quality improvement project evaluated provider and staff general knowledge on oral chemotherapy and national safety standards and the implementation and ease of use of an electronic medical record (EMR)-integrated chemotherapy documentation template geared toward improving compliance with national chemotherapy administration standards. Methods: This project utilized a pre-test and post-test design comparing provider and staff knowledge as well as the intervention of a chemotherapy documentation template to assess compliance with national chemotherapy administration safety standards in an academic medical center. Through chart review, 24 national safety standards relevant to oral chemotherapy administration were used to assess compliance prior to and following the introduction of the intervention. Additionally, feasibility, accessibility, and usability of the intervention were evaluated through a validated questionnaire. Findings: Knowledge gained from pre-test to post-test improved (p value of < .001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of < .001). The participants (n = 29) scored the documentation template as above average, indicating overall ease of use and feasibility for continued use.","PeriodicalId":17176,"journal":{"name":"Journal of the Advanced Practitioner in Oncology","volume":"13 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139687596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}