Flexibility, adaptation, and roles of patient navigators in oncology during COVID-19.

BACKGROUND: The impact of COVID-19 on cancer care during the first 6 months of the pandemic has been significant. The National Navigation Roundtable Workforce Development Task Group conducted a national survey to highlight the role of patient navigators (PNs). METHODS: An anonymous online survey captured how cancer care navigation changed during 2 phases: 1) March 13 to May 31, 2020; and 2) June 1 to September 4, 2020. Differences between the 2 time periods for categorical variables were assessed using χ2 tests, and 1-way analyses of variance were used for ordinal variables. RESULTS: Almost one-half of PNs expected changes in duties (49%) during phase 1. By phase 2, PNs showed greater confidence in retaining PN work (P < .001) and reduced changes to duties (P < .01). PNs reported new training on COVID-19 and telehealth during phase 1 (64% and 27%, respectively) and phase 2 (54% and 19%, respectively). Significant decreases in service delays were identified by phase 2 for cancer screening (P < .001), preventive care (P < .001), medical treatment (P < .01), cancer treatment (P < .001), and cancer survivorship services (P < .01). PNs reported that the top patient issues were COVID-19 concerns, medical care disruptions, and finances, and there were decreases in medical care disruptions (P < .01) during phase 2. PNs addressed myths related to mask use, COVID-19 spread, disbelief, risk, clinical changes, transmission prevention, and finances/politics. CONCLUSIONS: The PN role demonstrated resiliency and adaptability. Both clinical and nonclinical oncology PNs identified key patient needs and can provide connections with patient populations that have been economically and socially marginalized, which is necessary to build trust throughout the pandemic.

Oncology Nursing Symptom Science: Overview of the NINR, ONS, and NCI Symptom Science Colloquium.

This article provides an overview of the process, development, and evaluation of the Symptom Science Colloquium sponsored by the National Institute of Nursing Research, Oncology Nursing Society (ONS), and National Cancer Institute. This colloquium was the first of its kind to leverage the common goals of these institutes to advance oncology symptom science. Specifically, this article will identify the goals of the agencies involved and synergy in forming this collaboration, review the ONS Research Agenda that provided the blueprint for the colloquium, and offer insights and lessons learned to be used for future planning. The colloquium engaged roughly 500 participants from all levels of clinical (RNs, advanced practice nurses), educational (undergraduate, master's, doctorate), and research (students, faculty, scientists) expertise. Six featured expert speakers and 115 poster presentations focused on the latest research in symptom science, cancer survivorship, palliative and end-of-life care, and hot topics (COVID-19, health disparities). Fourteen networking sessions fostered opportunities to engage with international experts. Special awards emphasized mentee-mentor relationships and exemplary midcareer faculty. Based on this emphasis, the authors provide themes from the successful award applications as exemplars. A summary of participant satisfaction and recommendations for future collaborations to enhance and advance oncology symptom science are provided.

Update on the Role of Research in the Oncology Nursing Society.

Changes are underway at the Oncology Nursing Society to align resources so that scientists have the support needed to generate new knowledge and clinicians have access to tools needed to use evidence-based interventions that can speed the translation of research to transform cancer care.

Novice Oncology Nurse Navigator: Core Elements in Establishing Training Needs and Building on Competencies.

BACKGROUND: Oncology nurse navigation opportunities are rapidly expanding as the value of the role is recognized. However, there is a lack of training opportunities focusing on the unique needs of the oncology nurse navigator (ONN). Most navigator training programs provide only general oncology navigation content. OBJECTIVES: The purpose of this article is to evaluate the current state of training for the novice ONN and begin to identify core elements to inform development of a standardized training program. METHODS: Navigator training programs and literature related to the role and development needs of the novice ONN were reviewed. FINDINGS: Training of the novice ONN varies widely, with little evaluation of the most effective way to prepare for the role. It is clear that the learning needs of the ONN are different than those of other types of navigators and oncology nurses.

Oncology Nurse Practitioner Role: Recommendations From the Oncology Nursing Society's Nurse Practitioner Summit.

BACKGROUND: Oncology nurse practitioners (ONPs) are advanced practice RNs prepared at the graduate level with high-level knowledge and skills in oncology. Because of challenges in educational programs and variability in the scope of practice at the state and institutional level, many ONPs are challenged to practice to the full extent of their education, certification, and licensure. OBJECTIVES: The purpose of this article is to review issues affecting the education and practice patterns of ONPs and to identify solutions to address the challenges that exist for ONPs. METHODS: Members of the Oncology Nursing Society's Nurse Practitioner Summit summarized the challenges faced by ONPs related to education, training, practice, and professional development. FINDINGS: Efforts to promote ONP practice at the fullest extent of licensure and across various settings should be prioritized. Resources must be devoted to education, onboarding, and retention to integrate and retain ONPs as leaders of the interprofessional team.

Cannabis Guidelines
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Cannabis has been used for centuries in the treatment of medical conditions. Cannabis has been recommended for appetite, anxiety, depression, sleep, and migraines. However, the stigma associated with cannabis as a recreational drug has created challenges to the legitimacy and social acceptance of cannabis for medical purposes in the United States.

The Need for Identification Cards in Immuno-Oncology 
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Oncology nurses have worked within the three pillars of cancer care-surgery, chemotherapy, and radiation therapy -for decades. Now, immuno-oncologic (I-O) therapy agents are a new paradigm in cancer treatment. On March 28, 2017, an I-O think tank was held at the Oncology Nursing Society (ONS) in Pittsburgh, PA. This think tank was organized in response to the rapid changes in cancer treatment with the advent of I-O therapies. The think tank appraised the needs of patients receiving these agents and the oncology nurses and healthcare providers caring for them. Seventeen nurse experts from around the country joined seven ONS staff members to discuss the challenges faced by patients receiving these therapies and the nurses who administer the treatments and coordinate the care. 
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The Intersection of Palliative Care and Survivorship.

People who are diagnosed with cancer become our patients, but, by some definitions, they also qualify as cancer survivors and people who may need palliative care. This may be confusing for patients with cancer and for those who define care by oncology setting or specialty. It may be helpful to test these concepts using case studies.

A Multiorganization Approach to Improving Palliative Care in Honduras.

Since 2011, oncology nurses and physicians in the United States have been volunteering in Honduras with the International Cancer Corps (ICC), organized by the American Society of Clinical Oncology (ASCO), in partnership with Health Volunteers Overseas (HVO). In this article, the authors will summarize the work of the ASCO/HVO ICC teams that developed educational programs with local partners to improve cancer and palliative care in Honduras.

Oncology Nurses and the Cancer Moonshot 2020.

When Vice President Joe Biden's son, Beau, died of a brain tumor in May 2015, the Vice President's grief was profound. Yet, his grief generated an idea, a big idea: Let's collaborate and focus the talent and resources in our country to eliminate cancer as we know it. When Vice President Biden shared his idea with President Barack Obama in the fall of 2015, not only did President Obama endorse the idea, he announced the National Cancer Moonshot Initiative during his January 2016 State of the Union Address. The goal is to double progress against cancer and break down silos that prevent science and industry from working together. The initiative centers around the development and implementation of new vaccine-based immunotherapies to target individual tumors based on their genomic signature.

2016: Creating a Culture of Safety in Oncology.

Nurses play vital roles in preventing errors and improving the quality of care for patients. However, in the breakthrough Institute of Medicine (IOM) reports, To Err Is Human: Building a Safer Health System (IOM, 1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), it was estimated that about 44,000-98,000 Americans die each year as a result of medical errors. Gibson and Singh's (2003) book, Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans, shared real-life stories of medical mistakes to help raise awareness and create a sense of urgency for the issues surrounding healthcare errors. Gibson and Singh (2003) also included aspects of the human side of errors-the perceptions of the healthcare providers regarding their errors and the responses of patients who had been harmed. 
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The Missing Piece of Survivorship: Cancer Prevention.

The patient, R.C., finished her chemotherapy for breast cancer on June 4, 2007. At 58, she was ready for a better year, putting cancer treatment behind her and beginning her new life after cancer. In 2014, I was surprised to see R.C. on the schedule for chemotherapy education for FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin). Colorectal cancer had been discovered during a routine colonoscopy. When I met with her, she was obviously shaken and asked, "What happened? I thought I was done with cancer."
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After the Bell: Lifestyle Transformation After Cancer Treatment.

There are many traditions on the last day of chemotherapy. It is often a happy time when patients have pictures taken with their oncology nurses and ring the bell as they leave the infusion area. For many, the bell is symbolic of the completion of cancer treatment and the beginning of the rest of their lives as cancer survivors. After the bell, survivors often go home wondering what they can do to be healthier and reduce their risk of recurrence.


Oncology Nursing Is Evidence-Based Care.

This issue of the Clinical Journal of Oncology Nursing (CJON) will be the final time that you will see the Evidence-Based Practice (EBP) feature column. Why? Because we have seen oncology nursing evolve in the past 20 years and EBP is everywhere! We use it in our clinics and hospital units, incorporate it into decisions about symptom management, and use evidence to develop survivorship guidelines. We discuss EBP in journal clubs and use applications on mobile devices to find the best interventions for our patients. We have oncology nurses sitting on committees to develop guidelines based on the best evidence and expert opinion. We have come a long way and it is our belief that EBP is included in almost every article in CJON and, therefore, a need no longer exists for an individual column about EBP. 
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Providing Culturally Appropriate Care to American Muslims With Cancer.

Worldwide, Islam is the second most populous religion and, in many countries in the Middle East, South and Southeast Asia, and Africa, it is the predominant religion. The population of Muslims in the United States is projected to dramatically increase in the next few decades. Understanding the role of Islam for people who believe in and follow Islam-Muslims-will provide nurses with important perspectives that affect health behaviors, cancer screening, treatment decision-making, and end-of-life care.
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Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon.

BACKGROUND: In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC). METHODS: We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women's Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC). RESULTS: Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000. CONCLUSIONS: High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.

Communication in oncology care: the effectiveness of skills training workshops for healthcare providers.

Communication skills are the cornerstone of the patient-provider relationship in cancer care. Lack of these skills can diminish patient disclosure, increase patient anxiety, and decrease satisfaction with care. The purpose of this article is to evaluate the literature regarding the efficacy and outcomes of communication skills training programs for healthcare providers in oncology. Using four databases, the author found 21 research articles about communication skills training programs for healthcare providers in oncology. The majority of published studies involved training programs for experienced clinicians (i.e., physicians, nurses, nurse practitioners, physician assistants) in oncology care. Programs varied in length from 18-105 hours and evaluated communication skills, patient satisfaction and anxiety, and provider confidence and perceived stress. Specific communication skills and provider confidence were statistically improved in 19 of 21 studies. Follow-up data showed maintenance of some skills and attrition of others. Longer programs with consolidation workshops are seen as more effective.

The Power of 2.5 Million Words.

Today, I am writing for the first time as the new editor of the Clinical Journal of Oncology Nursing (CJON). It is my honor to assume this role from my colleague and mentor, Deborah K. Mayer, PhD, RN, AOCN, FAAN. For eight years, Deb served as the editor of one of the most widely read journals in oncology nursing, CJON. 
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Breast Cancer Survivors and Sexuality: A Review of the Literature Concerning Sexual Functioning, Assessment Tools, and Evidence-Based Interventions.

BACKGROUND: Most breast cancer survivors (BCSs) experience sexual dysfunction from treatment-induced hormonal changes, making sexual assessment an important component of survivorship care. However, because many oncology healthcare providers do not perform such assessment, a number of BCSs endure unidentified sexual dysfunction. Barriers to assessment faced by providers must be identified, and further research should examine the perspectives of BCSs and their partners regarding preferences for sexual assessment and interventions. OBJECTIVES: The purpose of this literature review was to explore tools used to assess sexual functioning and evidence-based interventions used to treat sexual dysfunction in BCSs. METHODS: Articles published from 2003-2013 that reported on the effects of breast cancer and its treatment on sexual functioning in BCSs and located through online database searches (PubMed, the Cochrane Library, MEDLINE, CINAHL) were reviewed. FINDINGS: Sexual dysfunction is a common problem among BCSs. Using various assessment tools, providers should regularly assess sexual functioning in BCSs during and after treatment to improve quality of life for BCSs and their partners.