A retrospective cohort study describing chemotherapy-induced peripheral neuropathy in Non-Hodgkin lymphoma patients treated with EPOCH ± R: does HIV status matter?

The frontline immuno-chemotherapy regimen for HIV-associated non-Hodgkin Lymphoma is dose-adjusted EPOCH ± R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). Chemotherapy-induced peripheral neuropathy (CIPN), caused by vincristine, is a common adverse effect of EPOCH ± R, negatively impacting long-term patient outcomes. The primary objective of this study was to determine the incidence of CIPN, stratified by HIV status, in patients treated with EPOCH ± R. A retrospective cohort study at a tertiary referral comprehensive cancer center evaluated patients treated with EPOCH ± R from 2011 to 2018. The final sample included 27 patients with HIV compared to 279 without HIV (total n = 306). Overall, the incidence of CIPN was 29.4% (n = 90), including 5 with HIV (18.5%) and 85 without HIV (30.5%). Propensity scores were used to match patients by HIV status. Although no relationship was found between HIV status and neuropathy, CIPN affects too many undergoing treatments for lymphoma, supporting future investigations to minimize toxicities.

Stigma in Clinical Oncology.

BACKGROUND: Health-related stigma, including cancer-related stigma, can lead to discrimination that contributes to health inequities and poor health-related outcomes. OBJECTIVES: This article provides a scholarly foundation to acknowledge and address health-related stigma in clinical oncology care. METHODS: This comprehensive clinical literature review is based on peer-reviewed articles identified through targeted searches in CINAHL®, PubMed®, and Google Scholar™ databases. FINDINGS: This review provides an updated scholarly foundation about stigma in clinical oncology practice. The review highlights stigma in clinical oncology research, identifies a framework for examining multilevel health-related stigma and discrimination, examines stigma measurement instruments, and reviews stigma reduction interventions.

Stigma, Communication, and Clinical Oncology Care: Three Case Studies.

BACKGROUND: Health-related stigma can contribute to health inequities and poor outcomes. To address stigma-related issues in clinical oncology care, healthcare providers can identify stigma in clinical practice and apply strategies that reduce stigma. OBJECTIVES: The aim is to identify stigma-related issues experienced by patients with cancer and to present strategies that address stigma-associated barriers to quality clinical oncology care. METHODS: This article presents three case studies that illustrate stigma-associated issues and strategies to address those issues in clinical oncology care. FINDINGS: Identifying intersectional stigmas in clinical care, each case study includes the patient's background information, a social assessment, and a clinical update, as well as an example of dialogue between the nurse and patient. Each case study ends with commentary and questions to further illustrate stigma-related issues in clinical oncology care. Finally, supporting the case studies, the toolbox includes inclusive language; principles of universal precautions to apply to stigma in clinical oncology care; and communication components, strategies, and resources to reduce stigma in clinical oncology care.

Opioid Risk Mitigation Practices of Interprofessional Oncology Personnel: Results From a Cross-Sectional Survey.

BACKGROUND: This study explored the risk mitigation practices of multidisciplinary oncology health-care personnel for the nonmedical use of opioids in people with cancer. METHODS: An anonymous, cross-sectional descriptive survey was administered via email to eligible providers over 4 weeks at The Ohio State University's Arthur G. James Cancer Hospital. The survey asked about experiences and knowledge related to opioid use disorders. RESULTS: The final sample of 773 participants included 42 physicians, 213 advanced practice providers (APPs consisted of advanced practice nurses, physician assistants, and pharmacists), and 518 registered nurses. Approximately 40% of participants responded feeling "not confident" in addressing medication diversion. The most frequent risk reduction measure was "Checking the prescription drug monitoring program" when prescribing controlled medications, reported by physicians (n = 29, 78.4%) and APPs (n = 164, 88.6%). CONCLUSION: People with cancer are not exempt from the opioid epidemic and may be at risk for nonmedical opioid use (NMOU) and substance use disorders. Implementing risk reduction strategies with every patient, with a harm reduction versus abstinence focus, minimizes harmful consequences and improves. This study highlights risk mitigation approaches for NMOU, representing an opportunity to improve awareness among oncology health-care providers. Multidisciplinary oncology teams are ideally positioned to navigate patients through complex oncology and health-care journeys.

Naloxone Training: An Opportunity for Oncology Nurses to Save Lives.

Opioids are commonly prescribed for pain management in oncology; however, there is a growing concern for nonmedical opioid use in patients with cancer. The oncology practice can implement harm-reducing strategies such as prov.

Interprofessional Oncology Providers' Experiences and Knowledge of Opioid Use Disorders in Patients With Cancer.

OBJECTIVES: To determine oncology providers' experiences and knowledge of opioid use disorders (OUDs) in patients with cancer. SAMPLE & SETTING: The final sample of 773 participants included 42 physicians, 213 advanced practice providers (APPs), and 518 nurses at a large comprehensive cancer center. METHODS & VARIABLES: This study used a cross-sectional descriptive survey to describe providers' experiences and knowledge of OUDs. RESULTS: Nurses and APPs reported personal experiences with addiction and encountering issues with OUDs in patients more often compared to physicians. Knowledge deficits were identified regarding addiction, including evidence-based treatment for OUDs. Overall, OUDs are a topic of concern that the majority of oncology providers are interested in learning more about. IMPLICATIONS FOR NURSING: The opioid epidemic presents an opportunity to improve the knowledge of interprofessional oncology providers addressing OUDs. Nurses and APPs are ideally positioned for the prevention and early recognition of patients with an OUD and cancer.

Addiction in Patients With Cancer: Challenges and Opportunities.

Addiction is complex and multifactorial. Recognition provides the opportunity to provide potentially life-saving treatment. Oncology patients are not excluded from substance use disorders (SUDs) and the opioid epidemic. Patients with current or past SUDs may develop cancer, and an SUD may also develop during cancer treatment. Therefore, this unique subset of patients potentially has two fatal diseases: cancer and an SUD. Most oncology advanced practitioners (APs) are unprepared to care for SUDs in patients with cancer. Pain is one of the most common symptoms in the cancer population, and cancer-related pain is often treated with opioids. Opioid exposure increases the risk of developing an opioid use disorder (OUD). In addition, a cancer diagnosis can have a significant impact on mental health and wellness, and patients may use substances to cope with psychological distress. Drug and alcohol use exists on a continuum and while not all use is problematic, it may have adverse consequences. A cancer diagnosis provides another possibility for patients to engage in services and treatment for their unsafe use and/or addiction. The case study in this article of a patient with cancer and an SUD is an example of the challenges associated with the chronic and relapsing nature of addiction. Oncology advanced practitioners have the opportunity to positively influence outcomes through the assessment of substance use and adoption of harm reduction techniques in all patients with cancer.

Substance Use and Misuse: A Pilot Study to Improve Screening and Interventions at a Comprehensive Cancer Hospital.

Mounting evidence suggests patients diagnosed with cancer may be at increased risk for opioid misuse and diversion. Substance use disorders (SUDs), involving prescription medications and/or illegal substances, may significantly compromise the ability of healthcare professionals to deliver high-quality cancer care. A substance use screening pilot was conducted in ambulatory oncology clinics at a large cancer hospital in the midwestern United States. In this article, the authors present results from this quality improvement project. Future directions involve innovative methods to deliver addiction-specific knowledge to oncology healthcare providers and should focus on discussing screening results, as well as providing tailored recommendations using shared decision-making with patients and caregivers.

Implicit Bias Training: Improving Outcomes for Patients With Cancer Who Have Substance Use Disorders.

Being mindful of one's implicit bias in the treatment of patients with cancer who have substance use disorders is fundamental to quality of care and good patient outcomes. Implicit bias held by healthcare professionals could negatively affect patient assessment, diagnosis and treatment decisions, and follow-ups at discharge.

Managing Addiction: Guidelines for Patients With Cancer.

Addiction in patients with cancer is not well described. Patients with substance use disorders (SUDs) and cancer experience worse outcomes; however, no guidelines exist for identifying and successfully managing these issues in oncology. With the goal to improve patient safety and outcomes, an interprofessional work group at a major academic cancer hospital initiated a trial screening process for identifying substance abuse issues in an oncology population. Simultaneously, guidelines for patients with cancer and SUDs were created.

HIV and Cancer: An Overview of AIDS-Defining and Non-AIDS-Defining Cancers in Patients With HIV.

People living with HIV are at an increased risk of cancer and often face worse outcomes because of treatment disparities, including increased mortality. When the immune system is severely compromised from HIV infection, AIDS can develop and result in an even greater risk for life-threatening disease or cancer. In addition, patients with HIV receiving cancer treatment require close monitoring for potential drug interactions and toxicities, particularly related to preventing opportunistic infections. Oncology nurses are ideal patient advocates to promote cancer prevention and screening strategies among this population. This article reviews associated risk factors for AIDS-defining and non-AIDS-defining cancers in patients with HIV.

Clinical Trial Amendments: Development of a Process for Consistent Implementation
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Clinical trials are responsible for the advancements made in cancer care. An interdepartmental work group at a major academic cancer hospital developed a process for the consistent communication and implementation of clinical trial amendments. This process ensures improved patient safety, as well as high-quality research. 
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The evolution of a malignant hematology nurse practitioner service.

Nurse practitioners (NPs) have been suggested as one possible solution to the predicted oncologist shortage. Although NPs are in a unique position to positively affect the care of patients with hematologic malignancies who are hospitalized, little information exists regarding the inpatient role of the NP in hematology and oncology. The purpose of this article is to describe the successful implementation and evolution of a highly functioning inpatient malignant hematology NP service.

B-cell lymphoma, unclassifiable: a review of the literature.

B-cell lymphoma, unclassifiable, (BCLU) is a subtype of lymphoma first recognized by the World Health Organization in 2008. Patients with this lymphoma have a very poor prognosis, with a rapidly progressive and refractory clinical course despite intensive therapy. Clinical data remain sparse, and no established therapeutic approach exists for the treatment of BCLU. Although BCLU may currently be under-recognized, its incidence is expected to increase with improved detection. Diagnostic accuracy is critical to prevent under- or overtreatment of patients. Treatments may need to be more intensive and include central nervous system prophylaxis. Development of clinical trials evaluating immunochemotherapy is recommended for this challenging lymphoma subtype. Nurses play a critical role in providing disease and treatment education and assessment, monitoring during therapy, and managing treatment-related side effects. Nurses need to emphasize prevention of chemotherapy complications and timely communication with the oncology healthcare team.

Nursing research in tobacco use and special populations.

Smoking is responsible for approximately one in five deaths in the United States per year. The Surgeon General's 1964 report first linked smoking as a cause of cancer. Since then cigarette smoking has had a steady decline to its current estimate of 19.8%. There are, however, some special populations where smoking continues to occur at a higher prevalence than the general population. This chapter discusses tobacco dependence among the following special populations: low socioeconomic status including Medicaid, hard-core smokers, rural, and homeless; immigrants; and persons living with HIV. For each population, there is an overview of the disparities in tobacco use, special challenges unique to that population, and exploration of current research on tailoring of tobacco dependence treatment. Each of the special populations discussed present unique challenges with tobacco dependence treatment that will require careful examination before disparities will ultimately decrease. Eliminating disparities has been marked as an important research agenda item as noted in Healthy People 2010. Nurse researchers are well positioned to combine their clinical expertise and knowledge of patient psychosocial needs with investigation of patient-focused research questions in each of these special populations.