Journal of the advanced practitioner in oncology最新文献

{"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}

{"title":"Evaluating the Impact of a Clinical Pharmacist in Patients Receiving New Chemotherapy for Breast Cancer: Analysis of a Pilot Study.","authors":"Carissa Joelle Ganihong, Anshika Singh, Roseanne Dimarco","doi":"10.6004/jadpro.2024.15.8.19","DOIUrl":"10.6004/jadpro.2024.15.8.19","url":null,"abstract":"<p><strong>Purpose: </strong>Breast cancer treatment may include chemotherapy, which is associated with significant toxicities. At the Sidney Kimmel Cancer Center at Jefferson Health, a pilot program was developed to add an oncology clinical pharmacist to the breast cancer clinic. The purpose of this study is to identify the impact of the clinical pharmacist in supportive care management, add to existing literature discussing the impact of the clinical pharmacist in ambulatory oncology settings, and justify future, permanent ambulatory oncology pharmacist positions within the institution.</p><p><strong>Methods: </strong>This single-center retrospective chart review assesses interventions made by the clinical pharmacist in patients with any stage of breast cancer who presented to the breast clinic for new chemotherapy treatment between September 1, 2020, and February 28, 2021. The primary outcome was to describe clinical pharmacist interventions at the first follow-up encounter after chemotherapy initiation. Secondary outcomes included classifying and quantifying total interventions and comparing intervention details between total and included patients within the 6-month timeframe.</p><p><strong>Results: </strong>Of 44 included patients, 29 had a follow-up encounter. The clinical pharmacist directly managed 33% of the 58 patient-reported adverse drug effects. In 6 months, the clinical pharmacist made 1,068 interventions spanning 189.6 documented hours. The most common interventions were coordination of care, education, and supportive care pharmacotherapy interventions.</p><p><strong>Conclusion: </strong>This study identified the pharmacist's role in supportive care management and reports the successful integration of a clinical pharmacist into a breast cancer clinic. Future directions include conducting prospective studies to further explore the impact of the clinical pharmacist on treatment outcomes.</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/PMC11715395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974129","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":"Medullary Renal Cell Carcinoma: A Case Study.","authors":"Kate Townsend","doi":"10.6004/jadpro.2024.15.7.4","DOIUrl":"10.6004/jadpro.2024.15.7.4","url":null,"abstract":"<p><p>Medullary renal cell carcinomas are exceedingly rare and essentially uniformly and rapidly fatal. Expeditious diagnosis is crucial. Immediate treatment with a clinical trial or platinum-based chemotherapy is needed for metastatic disease given the aggressive nature of medullary renal cell carcinomas. In this article, we discuss a 24-year-old man with no known significant past medical history who presented with a progressive cough and shortness of breath. After evaluation at an urgent care and four evaluations in the emergency department, the patient was admitted and ultimately diagnosed with metastatic medullary renal cell carcinoma. This case highlights the characteristics, presentation, rarity, and aggressiveness of medullary renal cell carcinoma.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"15 7","pages":"451-456"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018973","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":"Obinutuzumab Infusion-Related Reactions: Multicenter Retrospective Evaluation of Incidence, Severity, and Risk Factors.","authors":"Erin Hickey Zacholski, Sarah Rugh, Jenna Marshall, Pramit Nadpara, Donald Moore","doi":"10.6004/jadpro.2024.15.7.2","DOIUrl":"10.6004/jadpro.2024.15.7.2","url":null,"abstract":"<p><strong>Introduction: </strong>Despite standard prevention strategies, obinutuzumab carries a significant risk of infusion-related reactions (IRRs) for patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Reported rates of IRRs vary in phase III clinical trials evaluating obinutuzumab-containing regimens. Although obinutuzumab has a higher rate of severe (grade 3 and higher) IRRs than rituximab, clinical risk factors predicting IRR have not been identified, and therefore strata informing patient-specific risk of IRR have not been applied in practice.</p><p><strong>Methods: </strong>This multicenter, retrospective evaluation of patients with CLL/SLL estimated the incidence of obinutuzumab-related IRRs and evaluated risk factors for the development of IRR in a real-world population.</p><p><strong>Results: </strong>68 patients with untreated or previously treated CLL/SLL were included in the analysis, with the majority being older adult (median age = 70) males (61.8%) with Rai stage III and IV CLL. All-grade IRRs occurred in 25% of patients, and severe IRRs occurred in 1.5% of patients. Of the variables evaluated, absolute lymphocyte count was a significant predictor (<i>p</i> ≤ .05) of the odds of experiencing an IRR in patients receiving obinutuzumab.</p><p><strong>Conclusion: </strong>Obinutuzumab IRR rates in a real-world population were comparable to most phase III clinical trial results succeeding implementation of split dosing and standard premedication. Absolute lymphocyte count is a statistically significant predictor for increased odds of experiencing an IRR. Future research evaluating risk-adapted obinutuzumab administration strategies is needed to recommend a specific approach.</p>","PeriodicalId":94110,"journal":{"name":"Journal of the advanced practitioner in oncology","volume":"15 7","pages":"437-443"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018976","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}