Journal of the advanced practitioner in oncology最新文献

{"title":"Integrating a Rare Disease into Practice: Development of a Toolkit for Systemic Mastocytosis.","authors":"Sandra Kurtin, Cem Akin, Tracey I George, Edward Pearson","doi":"10.6004/jadpro.2025.16.7.17","DOIUrl":"10.6004/jadpro.2025.16.7.17","url":null,"abstract":"<p><p>Systemic mastocytosis (SM) exemplifies the diagnostic and management challenges associated with rare diseases, which often involve prolonged time to diagnosis, limited access to clinical experts, and persistent symptom burden. Advanced practitioners (APs) are increasingly responsible for the care of patients with rare and classical hematologic disorders. The Advanced Practitioner Society for Hematology and Oncology (APSHO) convened a multidisciplinary, AP-led steering committee to evaluate the AP role in managing SM, develop an online toolkit, and design surveys to identify best practices, unmet needs, and practical strategies for improving care for patients living with indolent systemic mastocytosis (ISM). The toolkit emphasizes early symptom recognition, integration of validated patient-reported outcome measures, and incorporation of disease-specific tools into clinical workflows and electronic medical records (EMRs). The emergence of targeted therapies, such as avapritinib for both advanced and indolent SM, has further highlighted the need for AP education on novel disease mechanisms and treatment strategies. This project demonstrates a replicable model for developing educational and clinical resources to support APs in managing rare diseases and improving patient-centered care.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Multifocal Leukoencephalopathy in Chimeric Antigen Receptor T-Cell Therapy Recipients: A Case Study.","authors":"Michelly Abreu, Chirag B Patel, Krina Patel, Fareed Khawaja, Sudhakar Tummala","doi":"10.6004/jadpro.2025.16.7.16","DOIUrl":"10.6004/jadpro.2025.16.7.16","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T-cell therapy is a novel immunotherapy modality that has shown remarkable response rates in refractory hematologic malignancies, including multiple myeloma (MM). Cytokine release syndrome (CRS) and neurotoxicity are well-described side effects of this therapy. CAR T-cell therapy recipients are also at increased risk for infections due to immune dysfunction, history of multiple lines of therapy, history of lymphodepleting chemotherapy prior to cell infusion, and prolonged B-cell aplasia. Progressive multifocal leukoencephalopathy (PML) is an opportunistic disease of the central nervous system caused by the reactivation of JC virus (JCV) in the setting of immunosuppression, which leads to increased morbidity and mortality. Here, we present a patient treated with ciltacabtagene autoleucel for refractory MM who presented with PML around 2 months after receiving CAR T-cell therapy. This case emphasizes the risks for the development of PML in immunocompromised patients potentially related to persistent B-cell aplasia, hypogammaglobulinemia, and prolonged immunosuppression and discusses treatment approaches. Treatments for PML are mostly focused on reconstituting immunity. However, no adequate treatment strategy for PML has yet been established and further research is needed.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Patients With Relapsed/Refractory Multiple Myeloma Treated With Talquetamab: Highlights From Pharmacists' Perspectives.","authors":"Tyler Sandahl, Mohammad A Rattu, Grace Jiang, R Donald Harvey, Kendra Yum, Kathleen Gray, Thomas Renaud, Jaszianne Tolbert, Scott A Soefje","doi":"10.6004/jadpro.2025.16.7.15","DOIUrl":"10.6004/jadpro.2025.16.7.15","url":null,"abstract":"<p><p>Talquetamab is a first-in-class G protein-coupled receptor family C group 5 member D (GPRC5D) and CD3-targeting bispecific antibody with > 71% overall response in patients with relapsed or refractory multiple myeloma who have progressed on three other drug classes. GPRC5D is highly expressed on myeloma cells, along with some expression in normal hair follicles, skin, and tongue. Its unique expression on these normal tissues results in a distinct pattern of adverse events (AEs), as observed in the phase I/II MonumenTAL-1 trial. GPRC5D-related AEs included oral side effects (e.g., dysgeusia, dysphagia, xerostomia) and dermatologic toxicities (e.g., skin, nail). These AEs can be managed by dose modifications, emollients, and/or topical or oral corticosteroids. Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome were consistent with the T-cell redirection mechanism of talquetamab and can be managed consistent with other trials of T-cell redirection therapies. Infection rates were mostly grades 1 or 2, and grade ≥ 3 infection rates were lower than B-cell maturation antigen-targeting bispecific antibodies; infections were treated with anti-infective agents. Adverse events were manageable and led to few treatment discontinuations. This review reports on talquetamab safety in MonumenTAL-1, with an additional pharmacy focus on strategies related to drug dispensing and clinical management.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Poverty, Rural Location, and Racial Segregation Are Factors in Colorectal Cancer Screening in Low-Income and Uninsured Populations.","authors":"Wen Hsin Chen, Rosaleen D Bloom, Arica Brandford, Gang Han, Scott Horel, Marivel Sanchez, Jason Mcknight, Jane L Bolin","doi":"10.6004/jadpro.2025.16.7.14","DOIUrl":"10.6004/jadpro.2025.16.7.14","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the correlation between geographical factors, including rurality, persistent poverty counties, racial residential segregation, and adherence to colorectal cancer (CRC) screening among low-income uninsured and underinsured individuals in Texas.</p><p><strong>Methods: </strong>Utilizing retrospective survey data collected by the A&M Texas Cancer Screening program from 2011 to 2022, linear mixed-effects models were employed. The models examined CRC screening adherence within the recommended time frame as the primary outcome, with geographical county-level characteristics (rurality, racial residential segregation, and persistent poverty) as the main predictors, controlling for other sociodemographic variables.</p><p><strong>Findings: </strong>The linear mixed-effects analysis revealed that individuals residing in counties characterized by high racial residential segregation (OR = 0.54, 95% CI = 0.36-0.79) or persistent poverty (OR = 0.65, 95% CI = 0.45-0.92) were less likely to self-report having undergone any type of CRC screening within the recommended time frame compared to those in counties with lower racial residential segregation and non-persistent poverty. Conversely, residents of rural counties were more likely to report being up to date with CRC screening compared to their urban counterparts (OR = 1.8, 95% CI = 1.27-2.55).</p><p><strong>Conclusions: </strong>The findings underscore the need for more targeted CRC screening promotion strategies tailored to low-income, uninsured populations residing in disadvantaged areas such as rural and persistent poverty counties, as well as those characterized by high racial residential segregation.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Advanced Practitioner Perspectives on Symptom Burden and Symptom Management in Indolent Systemic Mastocytosis.","authors":"Sandra Kurtin, Susan Woodward, Erin Kolb, Shonna Snyder, Shawna Hull","doi":"10.6004/jadpro.2025.16.7.13","DOIUrl":"10.6004/jadpro.2025.16.7.13","url":null,"abstract":"<p><strong>Background: </strong>Symptom burden is the primary driver for patients with indolent systemic mastocytosis (ISM) to seek medical care, whether or not they are diagnosed.</p><p><strong>Purpose: </strong>This descriptive study aimed to describe the advanced practitioner (AP) and ISM patient perspective relative to the symptom burden of ISM, multidisciplinary diagnosis and management of ISM, barriers to symptom management, strategies for collaborative management of ISM, and communicative health literacy in patients with ISM.</p><p><strong>Methods: </strong>An ISM patient survey and AP survey were developed by an AP-led steering committee incorporating validated tools to measure symptom burden, symptom burden impact, barriers, and strategies for improving symptom burden. Surveys were embedded in Qualtrics and were deployed by Conexiant to a convenience sample of AP members of the Advanced Practitioner Society for Hematology/Oncology (APSHO), AP members of the American Initiative in Mast Cell Diseases, and patients affiliated with The Mast Cell Disease Society between December 22, 2024, and February 3, 2025.</p><p><strong>Findings: </strong>50 APs and 53 ISM patients completed 100% of the questions on the corresponding surveys. The symptom burden described using the Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF) to identify the symptoms that are most common, most challenging, and have the greatest impact on quality of life aligns with published data for patients in this survey. Only 24% (<i>n</i> = 13) of ISM patients indicated their disease was well controlled, while 76% of APs indicated greater than 50% of their ISM patients had well-controlled disease (<i>n</i> = 38). Most APs (68%) in the survey indicated they saw one to five ISM patients per year but were comfortable with managing ISM-related symptoms (54%, <i>n</i> = 27). Practice patterns for triage, multidisciplinary management, and shared decision-making are described.</p><p><strong>Conclusions: </strong>This is the first ISM symptom burden-focused survey to provide a direct comparison of patient responses to those of APs in hematology/oncology and allergy and immunology. Indolent systemic mastocytosis symptom burden measurement and symptom burden reduction remain challenging, with several barriers and gaps identified in this study. The APSHO Toolkit for Systemic Mastocytosis, developed in parallel to this study, provides an AP-focused resource for overcoming some of the barriers and gaps identified in this study.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility Testing of an APRN-Led Model of Care for Transition of Patients After Completion of Phase I Trials.","authors":"Betty R Ferrell, Tami Borneman, Finly Zachariah, Virginia Sun, Nathaniel Co, Vincent Chung","doi":"10.6004/jadpro.2025.16.7.12","DOIUrl":"10.6004/jadpro.2025.16.7.12","url":null,"abstract":"<p><strong>Background: </strong>Patients on clinical trials experience numerous quality of life (QOL) concerns, including those associated with advancing disease. This pilot project tested the feasibility and initial outcomes of an advanced practice registered nurse (APRN)-led intervention for patients with gastrointestinal (GI) tumors transitioning after completing a phase I trial.</p><p><strong>Objectives: </strong>The objectives were to (1) Develop the \"Transitions\" care plan intervention based on prior research to support patient QOL including symptom management, psychosocial and spiritual support, and care after trial completion; (2) Test the feasibility of the intervention in a sample of patients with GI tumors; and (3) Evaluate the impact of the Transitions care plan intervention on improved care and QOL.</p><p><strong>Methods: </strong>A single-group, convenience sample of patients with GI tumors completing phase I clinical trials was accrued at a National Cancer Institute-designated Comprehensive Cancer Center in the western US. Patients completed questionnaires at baseline, 3 months, and 6 months. Interviews were conducted at 3 months for further understanding of patient needs. A Transitions care plan for the patient was developed by the APRN in collaboration with the patient and medical oncologist. Chart audits were conducted to capture supportive services referrals and completions. Key variables included domains of QOL, distress, and use of supportive care services.</p><p><strong>Results: </strong>Patients (<i>N</i> = 37) had significant needs for support across all QOL domains. The Transitions care plan model was valuable in assessing QOL needs, facilitating patients' understanding of disease status, and providing access to supportive care services.</p><p><strong>Implications: </strong>APRNs can develop a model of care to support patients completing clinical trials.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Program Implementing an Evidence-Based Walking Plan to Improve Cancer-Related Fatigue in Adult Patients on Oral Cancer Treatments.","authors":"Jennifer D Bernt, Rita Million, Nicole S Pham","doi":"10.6004/jadpro.2025.16.3.2","DOIUrl":"10.6004/jadpro.2025.16.3.2","url":null,"abstract":"<p><strong>Background: </strong>Fatigue is a prevalent symptom among cancer patients, even after completing treatment. The National Comprehensive Cancer Network Guidelines recommend incorporating physical activity as a strategy to combat cancer-related fatigue.</p><p><strong>Objectives: </strong>The goal was to develop and implement an evidence-based translational research quality improvement project to improve fatigue in patients starting oral cancer treatment.</p><p><strong>Methods: </strong>Outpatient oncology nurses (registered nurses and licensed practical nurses) responsible for educating patients starting treatment for cancer were provided education about the walking program. The information was incorporated into education for patients starting oral chemotherapy. Nursing knowledge, beliefs, and attitudes were evaluated before and after the subject-intensive education. Patient study participants were provided with pedometers and completed the Brief Fatigue Inventory and a survey about their beliefs and attitudes before and after implementing the walking program.</p><p><strong>Outcomes: </strong>Fatigue scores showed a slight decrease post intervention but not a statistically significant difference. Advanced-stage cancer showed a near-significant relationship with increased fatigue levels. Nursing knowledge improved by 13%, and nurses reported increased confidence in six of nine topics. Nursing barriers to education shifted from personal comprehension to a need for resources.</p><p><strong>Recommendations: </strong>Patients diagnosed with advanced-stage cancer should receive timely fatigue prevention and management education. In addition, educating nurses to address this knowledge deficit is imperative. The information gathered from this project presents an opportunity for further research using a walking plan and nursing education to improve current interventions used to reduce cancer-related fatigue.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 3","pages":"95-103"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Diseases and Educational Tools for Advanced Practitioners.","authors":"Beth Faiman","doi":"10.6004/jadpro.2025.16.3.1","DOIUrl":"10.6004/jadpro.2025.16.3.1","url":null,"abstract":"","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 3","pages":"86-87"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ductal Carcinoma In Situ: Non-Mass Enhancement on MRI 10 Years Before Mammographic Microcalcifications.","authors":"Nancy W Stead, Andria P Caton","doi":"10.6004/jadpro.2025.16.3.3","DOIUrl":"10.6004/jadpro.2025.16.3.3","url":null,"abstract":"<p><p>In developed countries, the lifetime risk of developing breast cancer among women is 11%. Therefore, screening asymptomatic women for breast cancer is widely accepted as preventive health care. Mammography is the primary imaging modality for the detection of breast abnormalities. Digital breast imaging detects 90% of symptomatic or asymptomatic cancers. The sensitivity, specificity, and negative predictive values of this modality are each about 90%. As a standard of care, the Breast Imaging Reporting and Data System (BI-RADS) is used to quantify increasing degrees of positive predictive values in mammography. This can help clinicians identify abnormalities that may need additional imaging studies or biopsies. To reduce false-negative breast cancer screening results, efforts have focused on increasing the sensitivity of mammography or supplementing it with ultrasound or MRI. Advanced practitioners are strategically positioned to detect incongruities between imaging techniques and physical assessments. With increased knowledge, advanced practitioners are better prepared for shared decision-making discussions regarding follow-up imaging procedures. The case report in this article describes a 10-year discordance of imaging that proved to be high-grade ductal carcinoma in situ (DCIS) and offers a hypothesis of the physiology to explain this discordance. A better understanding of breast imaging will enable the advanced practitioner to recommend the most appropriate follow-up study for patients.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 3","pages":"105-112"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor-Infiltrating Lymphocyte Cell Therapy for the Treatment of Advanced Melanoma: From Patient Identification to Posttreatment Management.","authors":"Lisa Kottschade, Emily Webb Rodriguez, Susan Harding, Smita Ranjan, Lori Mcintyre, Peter A Prieto, Lissa Gray, Jannakie Joseph, Jennifer Swank","doi":"10.6004/jadpro.2025.16.7.8","DOIUrl":"https://doi.org/10.6004/jadpro.2025.16.7.8","url":null,"abstract":"<p><p>Adoptive cell therapy with tumor-infiltrating lymphocytes (TILs) was recently approved for patients with advanced melanoma (metastatic or unresectable) previously treated with immune checkpoint inhibitors and BRAF/MEK targeted therapies (where appropriate). Tumor-infiltrating lymphocytes isolated from patient-derived tumor tissues enter the tumor microenvironment and recognize tumor-specific antigens, leading to the destruction of tumor cells. The multistep TIL cell therapy journey is led by a multidisciplinary health care team. Patients selected for TIL cell therapy undergo tumor tissue procurement for TIL generation, followed by preparative lymphodepletion before receiving a single-dose infusion of TIL and a short course of high-dose interleukin-2. Successful implementation of TIL cell therapy requires well-established procedures and workflows to select and screen patients, procure tumor tissue, administer TIL cell therapy, and monitor patients during treatment and after discharge. The advanced practice provider plays a central role in a patient's TIL treatment journey by planning and coordinating care across the health-care system, educating patients and staff, and providing direct and supportive patient care. Here, we review the treatment landscape for advanced melanoma and clinical data supporting TIL cell therapy. We also provide guidance related to patient selection, tumor tissue procurement, TIL cell therapy regimen, safety monitoring, symptom management, and post-discharge follow-up.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}