Skin toxicities and unmet supportive care needs of patients with cancer undergoing EGFR-inhibitor therapy / Toxische Hautreaktionen und Unterstützungsbedarf von KrebspatientInnen im Zuge einer EGFR-Antikörpertherapie. Eine deskriptive Studie

Background: Targeted therapies, such as the EGFR (epidermal growth factor receptor) inhibitor therapy, are being used to treat patients with various solid and metastatic tumours. Skin toxicities are a common side effect of this therapy. Aim: The aim of this study was to assess the effects of skin toxicities on quality of life of patients with cancer undergoing EGFR inhibitor therapy, as well as their unmet supportive care needs. Method: Embedded design. A standardised quantitative survey was administered and analysed. In addition, memos and audiotaped material of insightful conversations with the patients after survey administration were included in the analyses. Results: Among the three domains of the effects of skin toxicities on quality of life, physical symptoms (e. g. itching skin, rash) were most frequently reported to impair quality of life, while associated emotional and functional impairments were less frequently reported. Patients don't consider the management of skin toxicities to be a priority during their treatment, skin toxicities are rather perceived in context of the total symptom burden. Yet, we observed significant correlations between the assessed quality of life and unmet supportive care need domains, especially concerning physical and psychological needs. Conclusions: Although no clinically significant impairment of quality of life of patients undergoing EGFR inhibitor therapy was found, skin changes should be addressed in supportive interventions embedded in routine symptom management.

Nurses' practices in targeted therapies in Turkey.

PURPOSE: The number of targeted agents has increased over the last years. The aim of this study was to explore the current practice and knowledge of nurses about targeted therapies and to identify the gap in their management in Turkey. METHODS: Nurses who attended to the oncology nursing educational programs organised by the Turkish Oncology Nursing Association were invited to participate. A total of 187 nurses from 29 cities responded. Data were collected via a 30-item questionnaire on demographics and knowledge and practices on targeted therapies. Following this survey nurses were invited to participate in "target" courses. RESULTS: More than half of them (57.2%) stated they were willing to receive information on targeted therapies, mostly through in-service education (32.7%). Also, most of them were partly (67.3%) or not satisfied (24.3%) with their knowledge. Only few explained what targeted therapies are and how they work. While most of them responded correctly about how and where to store targeted drugs, few (1.8%) wrote that these agents should be stored in freezer. The majority stated that targeted agents should be prepared like the chemotherapy drugs. CONCLUSIONS: Lack of knowledge may cause errors and influence drug effectiveness. Nurses need to be supported with information. This survey revealed the needs in nursing practice over targeted therapies, side-effects and management.

Nursing implications of personalized and precision medicine.

OBJECTIVES: Identify and discuss the nursing implications of personalized and precision oncology care. DATA SOURCES: PubMed, CINAHL. CONCLUSION: The implications in personalized and precision cancer nursing care include interpretation and clinical use of novel and personalized information including genetic testing; patient advocacy and support throughout testing, anticipation of results and treatment; ongoing chronic monitoring; and support for patient decision-making. Attention must also be given to the family and ethical implications of a personalized approach to care. IMPLICATIONS FOR NURSING PRACTICE: Nurses face increasing challenges and opportunities in communication, support, and advocacy for patients given the availability of advanced testing, care and treatment in personalized and precision medicine. Nursing education and continuing education, clinical decision support, and health systems changes will be necessary to provide personalized multidisciplinary care to patients, in which nurses play a key role.

Information technology and precision medicine.

OBJECTIVES: To provide oncology nurses with an overview of clinical decision support (CDS) and explore opportunities for genomic CDS interventions. The nation's first personalized cancer decision support tool, My Cancer Genome, is presented as an exemplar of a novel CDS tool. DATA SOURCES: Published nursing and medical literature and the internet for an exemplar. CONCLUSION: CDS is a sophisticated health information technology that can translate and integrate genomic knowledge with patient information, providing recommendations at the point of care. IMPLICATIONS FOR NURSING PRACTICE: Nurses, as key stakeholders, must have an understanding of CDS interventions and their application to fully participate in all stages of CDS development and implementation.

Precision medicine for nurses: 101.

OBJECTIVES: To introduce the key concepts and terms associated with precision medicine and support understanding of future developments in the field by providing an overview and history of precision medicine, related ethical considerations, and nursing implications. DATA SOURCES: Current nursing, medical and basic science literature. CONCLUSION: Rapid progress in understanding the oncogenic drivers associated with cancer is leading to a shift toward precision medicine, where treatment is based on targeting specific genetic and epigenetic alterations associated with a particular cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses will need to embrace the paradigm shift to precision medicine, expend the effort necessary to learn the essential terminology, concepts and principles, and work collaboratively with physician colleagues to best position our patients to maximize the potential that precision medicine can offer.

Precision medicine clinical trials: defining new treatment strategies.

OBJECTIVES: To discuss the role of clinical trials in the changing landscape of cancer care resulting in individualized cancer treatment plans including a discussion of several innovative randomized studies designed to evaluate multiple targeted therapies in molecularly defined subsets of individuals. DATA SOURCES: Medical and nursing literature, research articles, and clinicaltrials.gov. CONCLUSION: Recent advancements in cancer biomarkers and biomedical technology have begun to transform fundamentals of cancer therapeutics and clinical trials through innovative adaptive trial designs. The goal of these studies is to learn not only if a drug is safe and effective but also how it is best delivered and who will derive the most benefit. IMPLICATIONS FOR NURSING PRACTICE: Implementation of clinical trials in the cancer biomarker era requires knowledge, skills, and expertise related to the use of biomarkers and molecularly defined processes underlying a malignancy, as well as an understanding of associated ethical, legal, and social issues to provide competent, safe, and effective health care and patient communication.

Precision medicine in oncology standard of care.

OBJECTIVES: To review the histologic subtypes and staging of non-small cell lung cancer and metastatic melanoma, as well as the molecular markers used to direct standard therapy. DATA SOURCES: Book chapters and journal articles from medical and nursing literature, as well as published clinical guidelines. CONCLUSION: Patients with metastatic non-small cell lung cancer and metastatic melanoma have had a paucity of treatment options, most fraught with toxicity with limited benefit. Increased understanding of tumor genetics and molecular markers has expanded the treatment options for these patients, often providing them with durable responses and improved quality of life. IMPLICATIONS FOR NURSING PRACTICE: To provide education and support to their patients, nurses caring for these patients need to understand the role that genetics and molecular markers play in directing these therapies.