Oncology Nursing News: The Vitals

In this special episode of The Vitals, we ring in the New Year 2024 by combing through 2023 FDA approvals. Listen as editor, Lindsay Fischer, recounts key approvals on a month-by-month basis. To read the full information surrounding the approvals, be sure to check out our news coverage below. 

As always, thank you for listening to The Vitals, and for all the engagement in 2023. We look forward to bringing you more oncology news in 2024.

In this episode of The Vitals, Beth Finley-Oliver, MSN, ARNP, AGNP-BC, a nurse practitioner who works in the outpatient hematology clinic at Moffitt Cancer Center, revisits her presentation from the 2023 JADPRO Live Annual Meeting and discusses the growing number of therapies for patients with relapsed or refractory multiple myeloma.

“A clinical trial upfront would be my first option. After that, I have to try and find something their myeloma hasn't seen yet.”

“With CAR T, the CRS incidence is higher, and I think we're doing better [at managing it] because we have multiple interventions. We see viral infections with [both] the CAR T and the bispecifics. We always have to kind of keep that in the back of our mind.”

“The more medications we have, the more this is turning into a chronic illness.”

 For More On Multiple Myeloma:

In May 2023, the FDA granted accelerated approval to epcoritamab-bysp (Epkinly) for the treatment of adult patients with relapsed/refractory (R/R) DLBCL, including DLBCL arising from indolent lymphoma, and high-grade B-cell lymphoma (HGBL), following 2 or more lines of systemic therapies. Shortly thereafter, in June 2023, the FDA granted accelerated approval to glofitamab-gxbm (Columvi) as a fixed duration treatment for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified or large B-cell lymphoma (LBCL) arising from follicular lymphoma, after 2 or more lines of systemic therapy. 

In this episode of The Vitals, Laura Zitella, MS, RN, ACNP-BC, AOCN, who is a hematology nurse practitioner in the Hematology, Blood, Marrow transplant, and Cellular Therapy (HBC) program at UCSF Health and associate clinical professor in the Department of Physiological Nursing at the University of California San Francisco, joins Oncology Nursing News to discuss how these newly approved bispecific antibodies are expanding third-line treatment options for patients with diffuse large B-cell lymphoma.  

“Bispecific antibodies are antibodies that generally have at least 2 antigen binding sites: 1 binding site is to the antigen of interest on the cancer cell, and in lymphoma, that's often CD19, or CD20. The other antigen binding site is to CD3, which is a T-cell marker.”

“Unfortunately, we do not cure all patients with second-line therapy [and] the bispecifics are used for third-line therapy, where we have historically had limited treatment options.”

“One of the big advantages of bispecific antibodies is that they are ‘off-the-shelf;’ they do not need to be manufactured, and they are available immediately."

“Epcoratimab is a subcutaneous [administration] bispecific antibody, whereas glofitamab is an intravenous [administration]. Both require step-up dosing, which means that you start with a small dose and then the subsequent doses are a little bit higher, and a little bit higher until you reach your treatment dose.”

In honor of lung cancer awareness month, for this episode of The Vitals, Nicole Gay, APRN-C, joins Oncology Nursing News to share how she counsels patients about lung cancer screening. 

Gay is a nurse practitioner at the University of Miami Sylvester Comprehensive Cancer Clinic, and a nurse navigator for the clinic’s lung cancer screening program. In the conversation, she shares how she addresses patient fears and concerns around screening, helping them feel comfortable and confident in navigating their health.

“Lung cancer screening, unfortunately, has a bit of a stigma around it. Part of my job is reducing that stigma, making patients feel comfortable and relaying how important screening for lung cancer really is.”

“This is a low-dose CT scan. The amount of radiation they are getting is reduced when you compare it to a normal CT scan.”

“We are very grateful for the change in the guidelines. It really widened the pool of patients that can be screened.”

In this episode of The Vitals, Holly Chitwood, DNP, FNP-C, AGACNP-BC, walks through a patient case with a 70-year-old male with metastatic colorectal cancer.1 His providers used circulating tumor DNA (ctDNA) testing to monitor his minimal residual disease (MRD) levels throughout active treatment. This approach, although not currently addressed in National Comprehensive Cancer Center Guidelines, allows patients and providers to have an idea of how the treatment is working earlier compared with what imaging can usually demonstrate, she explains.

Chitwood is an assistant professor in the College of Nursing at the University of Kentucky, as well as a practicing oncology APRN who primarily cares for patients with gastrointestinal, hepatic-biliary, and sarcoma tumors in her clinic. To read the full case study, please check out our show notes below.

“This is a new technology that we have. It is basically looking at what is in your blood to see how much circulating tumor DNA is floating around.”

“In this case, and in a lot of my patients, you will see ctDNA is about, you know, anywhere from 2 to 3 months [ahead], predating what you will see on imaging.”

“You have to be very judicious in explaining the results, especially if you have a positive result, and the patient should be included in the decision making.”

In this episode of The Vitals, Patricia Jakel, RN, MN, AOCN, co–editor-in-chief with Oncology Nursing News, sits down with Quanna Batiste-Brown, DNP, RN, NEA-BC, FAAN, to discuss the reality of racism in nursing. Batiste-Brown is an adjunct associate professor and Chief Nursing Officer at UCLA health.

The pair discuss the implications of the National Commission to Address Racism in Nursing, which, in 2021, published survey findings from 5,623 nurses. The findings showed that 50% of nurses feel that there is “a lot” of racism in nursing; that 63% of nurses have personally experienced racism in the workplace; and that 56% of nurses say that racism has impacted their mental health in the workplace. 

 Moreover, although 3 out of 4 nurses have witnessed racism in the workplace, 64% of those who actively challenged racism or stood up for their colleagues said their actions effected no change.

 Batiste-Brown, who is part of California ANA and helped created a workforce in her group that led to the larger ANA’s commission on nursing report, discussed the implications of racism in nursing, and offered insight in how to talk to administration and coworkers about creating an inclusive community that protects employees and promotes better patient care. 

 Episode Highlights

 “Nurses across the state were really upset and tired and wanted to do something about their own lived experiences, [and the] experiences of their patients. [They] wanted to talk about what nurses could do to affect change in racism and health equity, or the care that they are delivering and what their patients were experiencing.”

 “There is opportunity for everyone to come together to have honest conversations about how we move change forward.”

 “Be mindful of someone's mental health and be sure that they're not keeping that information inside of them, because it can be detrimental to your health to be going through something as severe as racism and not tell anyone about it.”

 Podcast Episodes

1. Our Racial Reckoning Statement. American Nurses Association. Accessed October 11, 2023. https://www.nursingworld.org/practice-policy/workforce/racism-in-nursing/RacialReckoningStatement/ 

2. National Commission to Address Racism in Nursing. Accessed October 11, 2023. https://www.nursingworld.org/practice-policy/workforce/racism-in-nursing/national-commission-to-address-racism-in-nursing/ 

In this episode of The Vitals, Ryan Tamargo, NP, AONCP, a nurse practitioner with the inflammatory breast cancer (IBC) program at the Dana-Farber Cancer Institute, talks about IBC and why it is often misdiagnosed. She discusses the launch of an online IBC Scoring System tool, which was developed through Susan G Komen, the Milburn Foundation, and the Inflammatory Breast Cancer Research Foundation. According to Tamargo, this tool may prove helpful in raising awareness about this rare form of breast cancer and make it easier for primary care providers to recognize the symptoms and make the correct diagnosis. 

Inflammatory Breast Cancer (IBC) Scoring System online tool

“What can be tricky about [IBC] is that there is sometimes no mass. The symptoms can be very progressive that it can look like an infection to primary care providers or providers in the community.” Time stamp (TS) 1:48

“The tool can be really helpful in going step-by-step [through] what you're actually seeing, and then will give you a score at the end." TS 4:00

“The best thing to prevent this [from] becoming metastatic is going to be treatment with chemotherapy as soon as possible.” TS 9:30

Jagsi R, Mason G, Overmoyer BA, et al. Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research. Breast Cancer Res Treat. 2022;192(2):235-243. doi:10.1007/s10549-021-06434-x

In this episode of The Vitals, Heather Santone, an oncology nurse navigator with Allegheny Health Network, shares which unique challenges nurse navigators face when caring for geriatric patients. She points out that many of these patients have difficulty securing transportation to and from their appointments, or struggle to navigate online applications or internet services. Luckily, nurse navigators can play a large role in helping patients overcome these obstacles and ensuring that patients do not fall through the system’s cracks.

I live in Erie; we are a smaller city. A lot of our testing has to be done in Pittsburgh. Time stamp (TS) 5:56

Transportation is a large barrier to care for older people because [oftentimes] they have stopped driving, and they may not have the transportation. TS 7:28

Technology is huge, because a lot of our services, like American Cancer Society’s great Road-to-Recovery program, is on an App—they give us [a 1-800] number so we can call in, but a lot of things, like Lyft goes back to an app or a computer system. TS7:37

The nice thing about navigation is the that we are there to help prevent the gaps. For the most part, we do a really good job of keeping those gaps very small, to make sure we are trying to follow [patients] all the way through treatment so that they are not lost.” TS 10:07

In this episode of The Vitals, Shawna Douglas, BSN, RN, a head and neck oncology nurse navigator with Allegheny Health Network, highlights the unique challenges that this population faces, including access to proper dental care, nutrition specialists, and postsurgery speech and swallow therapy. She draws from personal experience to share a story of how she used the resources available at her institution to help a patient find transportation to and from her appointment—highlighting the value that nurse navigators can provide their patients. 

 Episode Highlights

 “My role as their oncology navigator is to help be that one point of contact and to guide them through their cancer journey. I provide additional information resources, referrals, and support.” Time stamp (TS) 1:49

 “They always need a dietician to follow them, [they may have] possible feeding tube considerations, [and] they always need to see a dentist regardless of treatment options. Patients also need that dental clearance if they are going to be receiving radiation to the head and neck. Stemming from the dental evaluation, a lot of our patients need to see an oral surgeon for some extractions.” TS 3:41

 

“There are sometimes issues with noncompliance because there are so many appointments that need to be scheduled. They get very overwhelmed. That's where I come in.” TS 4:37

In this episode of The Vitals, Oncology Nursing News® spoke with Linda Bloom, MPA, RN, OCN, about strategies to improve communication among patients with limited English proficiency who are admitted to surgical oncology. Bloom, who is a clinical nurse IV at Memorial Sloan Kettering Cancer Center, presented on this topic during the 48th Annual Oncology Nursing Society Meeting, and the findings have been published in the Clinical Journal of Oncology Nursing.

 As Bloom explains in the discussion, perianesthesia nurses and language assistance staff joined forces to improve communication for patients with limited English proficiency, including those with hearing, speech, or visual impairments. Nurses were provided with tablets embedded with 2 video interpreter applications, as well as smart phones and wearable communication devices with audio interpreter options. American Sign Language interpreters were available through the video interpreter tablets so that nurses could communicate with hearing impaired patients, and clear masks were distributed so that these patients could lip read. White boards were provided to help communication with non-verbal patients, and magnifiers and voice recorders were used to help improve communication with visually impaired patients. 

 Overall, the introduction of these devices allowed patients have a voice during their presurgical assessment and ensured that the information being discussed was accurate and clear. Moreover, by leveraging trained medical interpreters who understand medical terminology, nurses and health care staff could ensure that patients were fully informed of the procedures they would need to have. 

 “Patient safety should always be the priority,” Bloom told Oncology Nursing News.  “Accurate and precise communication ensures that patient safety is prioritized to the highest degree.”

 Episode Highlights:

 “When the patient had to go to the room for the procedure, she clutched the amplifier and earpiece and tried to grab the mic. [She] said, ‘You can't take this away—I haven't been able to hear since I [got] here.’” Time stamp (TS) 7:33

“The Creole language speaking assistant heard him before the interpreter had [time] to tell me and texted his daughter. I immediately knew we had to get a social worker involved.” TS 10:22

“Some of [this technology] is very low tech: a whiteboard for a patient who is nonverbal. They love it… people don't realize it's easier than pen and paper because you can erase it; you can write more.” TS 12:33

1.     Bloom L. Nurses take on language access. Presented at 48th Annual Oncology Nursing Society Congress. April 25-30, 2023; San Antonio, TX. Accessed June 15, 2023.https://ons.confex.com/ons/2023/qi/eposterview.cgi?eposterid=2528 

2.     Bloom L. Improving communication for surgical patients with cancer with limited English proficiency. Clin J Oncol Nurse. 2023;27(4):359-363. doi: 10.1188/23.CJON.359-363