Journal of the advanced practitioner in oncology最新文献

{"title":"The Impact of the COVID-19 Pandemic on Work-Life Integration of Physician Assistants in Oncology.","authors":"Eric D Tetzlaff, Karen J Ruth, Heather M Hylton, Zachary Hasse","doi":"10.6004/jadpro.2025.16.7.2","DOIUrl":"10.6004/jadpro.2025.16.7.2","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic led to rapid changes in the delivery of oncology care. Studies examining the impact of the pandemic on the oncology workforce are largely limited to oncologists and nurses. This study was conducted to explore how the COVID-19 pandemic impacted the oncology physician assistant (PA).</p><p><strong>Methods: </strong>A survey of oncology PAs was conducted in the fall of 2020. Multiple choice items and two open-ended questions explored how the COVID-19 pandemic may have impacted clinical practice. Burnout was assessed using the Maslach Burnout Inventory.</p><p><strong>Results: </strong>Most participants worked in an academic center (63.7%), in medical oncology (73.3%), and in the outpatient setting (70.5%). Telemedicine was performed by 77.5% of PAs, and 34.7% of PAs reported being assigned to help cover other departments/specialties. Physician assistants performing telemedicine were found to have higher rates of burnout compared to those that did not perform telemedicine (47.3% vs. 15.6%; <i>p</i> = .0013). Surprisingly, burnout was significantly lower for PAs who were redeployed during the pandemic compared to those who were not (28.0% vs. 46.8%; <i>p</i> = .0285). There was no correlation in the rates of burnout based on changes in hours worked, base pay, bonus pay, continuing medical education funding, or working remotely.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic resulted in significant operational and workforce changes, which dramatically impacted the oncology PA. As the health-care landscape continues to adjust following the COVID-19 pandemic, future research should focus on the delivery of telemedicine to help identify opportunities to optimize this aspect of clinical practice and minimize the risk of burnout.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485127","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":"CAR T-Cell Therapy Unveiled: Navigating Beyond CRS and ICANS to Address Delayed Complications and Optimize Management Strategies.","authors":"Karla V Ow","doi":"10.6004/jadpro.2025.16.7.6","DOIUrl":"10.6004/jadpro.2025.16.7.6","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T-cell therapy has ushered in a transformative era in the management of relapsed/refractory hematologic malignancies. The extensive phase II trials targeting relapsed/refractory non-Hodgkin lymphoma, including diverse subtypes such as diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma, along with multiple myeloma and B-cell acute lymphoblastic leukemia, have culminated in the endorsement of various CAR T-cell products for these specific indications by the US Food and Drug Administration. Although CAR T-cell therapy has achieved remarkable success, it is important to recognize that this innovative approach often gives rise to notable toxicities and is frequently associated with a distinctive pattern of adverse effects. Advanced practice providers, including advanced practice nurses and physician associates, involved in the care of these patients should be able to recognize these toxicities and be versed in treatment strategies to mitigate their impact.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485113","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":"Implementation of a Malignant Hematology Education Intervention and its Impact on Hematology Nurse Practitioner Knowledge and Self-Efficacy to Practice.","authors":"Lauren Clermont, Mary Lewis, Su Yon Jung, Tia Wheatley, Wendie Robbins","doi":"10.6004/jadpro.2025.16.1.2","DOIUrl":"10.6004/jadpro.2025.16.1.2","url":null,"abstract":"<p><strong>Background: </strong>Nurse practitioners (NPs) entering the malignant hematology specialty often lack hematology-specific knowledge needed for practice; many have reported they want and need more hematology education. Deficiencies in hematology education stem from the minimal amount of hematology content included in NP programs and during job orientation. Knowledge deficits among NPs are associated with unpreparedness to practice and feelings of anxiety, insecurity, inadequacy, and guilt. Self-efficacy (SE) is a correlate to NP knowledge acquisition and competency development.</p><p><strong>Purpose: </strong>This was a process improvement effort to examine the impact of a malignant hematology education module on NP knowledge and SE to practice in malignant hematology.</p><p><strong>Methods: </strong>A convenience sample of 11 NP participants were recruited during onboarding to a hematology department in a tertiary care cancer hospital in Southern California. Participants completed an online learning module containing education about hematological malignancies. A pretest and posttest design using questionnaires was employed for data collection. Knowledge and SE scores obtained before and after the intervention were compared to assess for improvement.</p><p><strong>Results: </strong>Posttest NP knowledge scores increased by a mean of 2.4 points (20%; mean pretest: 7.1/12, posttest: 9.5/12), <i>p</i> < .05. Posttest scores for NP SE were similar to baseline (mean pretest: 32.6/40 points, posttest: 32.3/40), <i>p</i> > .05. Participants reported that the intervention was helpful in the onboarding process. Implications/Conclusion: The findings help establish the feasibility of a malignant hematology learning module in increasing knowledge for NPs during onboarding. Integrating an education module into NP job training may increase knowledge and preparedness to practice in malignant hematology.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 1","pages":"15-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434792","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":"Abdominal Bloating Following a Diagnosis of Aplastic Anemia: Correlation or Red Herring?","authors":"Alexis C Geppner","doi":"10.6004/jadpro.2025.16.1.4","DOIUrl":"10.6004/jadpro.2025.16.1.4","url":null,"abstract":"<p><p>Aplastic anemia (AA) is a bone marrow failure disorder resulting in peripheral pancytopenia and marrow hypoplasia. An alternative diagnosis of hypoplastic myelodysplastic syndrome (MDS) can overlap this diagnosis but is differentiated by the presence of dysplastic progenitor cells. Since AA can be characterized as an autoimmune disease directed against hematopoietic stem cells, its presence can potentially increase susceptibility to alternate malignancies. Hypoplastic MDS, however, can present itself in an extramedullary fashion solely or as a relapse of acute myeloid leukemia resulting in symptoms similar to those described in this case study. Solid tumor malignancies may also result in abnormal blood counts, creating a wide differential diagnosis. This manuscript presents a case of untreated AA in a patient presenting later with severe abdominal bloating.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 1","pages":"30-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434779","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":"Navigating Complex Cases With Empathetic Communication.","authors":"Beth Faiman","doi":"10.6004/jadpro.2025.16.1.1","DOIUrl":"10.6004/jadpro.2025.16.1.1","url":null,"abstract":"","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 1","pages":"9-10"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434796","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":"High-Risk Breast Clinic.","authors":"Erica S Doubleday, Peggy Jo Alker","doi":"10.6004/jadpro.2025.16.1.3","DOIUrl":"10.6004/jadpro.2025.16.1.3","url":null,"abstract":"<p><p>Individuals who are at a high risk for breast cancer are a unique population. These women and men may be eligible for additional screenings for breast cancer and require education that can help reduce the risk of breast cancer. There are several risk factors, such as smoking and obesity, that can be modifiable to help reduce the risk for developing breast cancer. Currently, there are limited data on the number of high-risk programs that provide additional screening recommendations and education to patients in this population, across the country. The need to create a thorough and inclusive program that includes education for providers and patients, the latest technology in mammography, and other breast screening techniques and routine clinic visits for high-risk breast cancer patients was recognized at a cancer center in southeast Louisiana. The creation of the high-risk breast (HRB) clinic has helped ensure patients are receiving the standard of care, ensure providers are up to date on the latest guidelines, and has improved patient satisfaction across this population. The creation of this clinic has evolved over the past 3 years, including a standardization model for this population, an increase in weight loss referrals prompting interest in a weight loss clinic within the HRB clinic, and multidisciplinary monthly team meetings.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"16 1","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434786","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":"Safety in Subsequent Lines of Therapy in Patients With Relapsed/Refractory Follicular Lymphoma.","authors":"Tajuana Bradley, Mark Davis, Julie Martin, Susan Woodward","doi":"10.6004/jadpro.2024.15.8.21","DOIUrl":"10.6004/jadpro.2024.15.8.21","url":null,"abstract":"<p><p>Follicular lymphoma (FL) is a disease often characterized by chronic and successive relapses after first-line chemoimmunotherapy. Although chemoimmunotherapy and combination therapy, such as lenalidomide with rituximab, are well established in the treatment sequence of FL, there is a need to streamline treatment options and determine placement of novel agents, such as chimeric antigen receptor T-cell therapy, an enhancer of zeste homolog 2 inhibitor, or a phosphoinositide 3 kinase inhibitor, into the treatment landscape. As such, the purpose of this review is to compare the safety profiles of approved agents in subsequent lines of therapy for relapsed or refractory FL and to assess how the management of adverse events may impact treatment choice.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974135","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":"Improving Depression Screening in Adult Patients With Cancer.","authors":"Madison L Krekel, Dorothie Durosier Mertilus","doi":"10.6004/jadpro.2024.15.8.20","DOIUrl":"10.6004/jadpro.2024.15.8.20","url":null,"abstract":"<p><p>Depression in adult patients with cancer may lead to decreased treatment adherence, decreased quality of life, and possible suicidal ideation. Adequate screening can promote timely diagnosis and treatment of depression. A quality improvement project was implemented at a cancer center in which adult patients are diagnosed with and treated for cancer. A paper version of the 9-item Patient Health Questionnaire (PHQ-9), a validated tool to screen for depression, was provided to patients during their scheduled appointment. A two-sample test of proportions was used to compare the proportion of patients screened before project implementation to the proportion of patients screened after project implementation. Depression screening rates increased from 2% before to 12% after project implementation. Frequent screening with the PHQ-9 should occur in adult patients with cancer to adequately identify depressive symptoms. Adequate screening will provide the necessary information for providers to make referrals to mental health services and allow patients to adhere to their treatment plans, improving their quality of life.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974133","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":"Sharing Genomic Tumor Sequencing Results With Patients: Experiences of Advanced Practice Oncology Providers.","authors":"Lisa Stewart, Anne Floyd Koci, Tracy Brock Lowe, Wesley G Patterson, Christopher L Farrell, Janice S Withycombe","doi":"10.6004/jadpro.2024.15.8.17","DOIUrl":"10.6004/jadpro.2024.15.8.17","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer routinely undergo genomic tumor sequencing, a component of molecular profiling (MP), to better characterize their cancer and identify potential targetable alterations. Targeted treatments potentially confer higher response rates and better efficacy. With increasing complexity, patients may require detailed explanations of MP results. Patient understanding of MP results increases the likelihood that eligible patients receive targeted treatment. Advanced practice providers (APPs), defined as nurse practitioners, physician assistants, and pharmacists, frequently review and discuss MP results with patients. Purpose: The aim of this study is to understand APP experiences discussing MP results with adult cancer patients.</p><p><strong>Methods: </strong>A qualitative study was conducted through virtual semi-structured interviews with APPs recruited via study invitation shared through the Advanced Practitioner Society for Hematology and Oncology (APSHO). Eligibility criteria included APPs with > 1 year of oncology experience and involvement in discussing MP results. Data were analyzed utilizing a constant comparative analysis and coded in three stages: open, axial, and selective.</p><p><strong>Results: </strong>Thirteen participants were enrolled from across the United States. Participants discussed learning to understand and explain MP findings primarily through on-the-job experiences. Barriers to patient education were also described. Initially coded participant statements (open codes) produced six themes (axial codes).</p><p><strong>Conclusions: </strong>With MP now standard practice in oncology, APPs frequently discuss these results with patients. This study highlights that additional and continuing education related to MP is needed in communicating complex results. Patient educational tools, specific to patients' MP findings and tailored to their preferences and literacy levels, are critically needed.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974137","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":"Effects of a Revision to the Standard Admission Order Set on Laxative Prescribing for Opioid-Induced Constipation.","authors":"Shila Pandey, Jessica I Goldberg, Kelly Haviland","doi":"10.6004/jadpro.2024.15.8.18","DOIUrl":"10.6004/jadpro.2024.15.8.18","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid-induced constipation (OIC) is highly prevalent in patients with cancer-related pain on opioid analgesics and has negative consequences on physical and psychological well-being and quality of life. Oncology clinical practice guidelines recommend the use of osmotic and stimulant laxatives for the prevention and management of opioid-induced constipation, not stool softeners such as docusate sodium. Prescribing practices continue to fall behind these recommendations.</p><p><strong>Methods: </strong>This quality improvement project revised the laxative options available in the standard admission order set in the electronic medical record. Specifically, docusate sodium was removed and replaced with senna and polyethylene glycol 3350.</p><p><strong>Results: </strong>A total of 2,742 patient admissions preintervention were compared to 2,752 admissions postintervention. The number of orders for docusate (<i>p</i> < .001) and docusate-senna (<i>p</i> = .002) orders decreased significantly after the intervention, in addition to the number of OIC diagnoses (<i>p</i> < .001). However, the number of orders for polyethylene glycol (<i>p</i> = .559), senna (<i>p</i> = .582), other laxatives (<i>p</i> = .245), or functional bowel disorder medications (<i>p</i> = .533) did not change significantly. No significant differences were observed in the frequency of laxative orders placed within 24 hours of an opioid order, number of laxatives prescribed at discharge, admissions related to bowel-related complications, or length of stay.</p><p><strong>Conclusions: </strong>Interventions utilizing the electronic medical record can facilitate evidence-based management of OIC. Development of clinical practice guidelines and tailoring these interventions further is needed to adapt this approach at other institutions and sustain practice change.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974128","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}