Nurse Navigator Responsibilities in Managing Care Transitions for the Patient With Acute Myeloid Leukemia.

Oncology nurse navigators (ONNs) help address barriers that would affect the patient's ability to receive timely and quality cancer care and bridge gaps from the ambulatory to acute settings by reinforcing the treatment pla.

Novel Therapies in Acute Myeloid Leukemia.

OBJECTIVE: To provide a comprehensive review of evidence-based data on the newly approved therapeutic agents in acute myeloid leukemia (AML) with regards to appropriate indications for use, efficacy, and safety. DATA SOURCES: Published clinical trials and observational studies. CONCLUSION: Optimal treatment decisions for AML should be personalized based on individual patients' performance status, disease risk as determined by mutational profile, response status, and prior therapies received. While the treatment options have expanded, several questions remain regarding appropriate patient selection, long-term efficacy and safety of these agents, and sequencing of therapies among available options. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be familiar with the peculiarities of the administration regimens of newer AML therapies, adopt formal monitoring strategies for side effects that are unique to these agents, and develop a framework to facilitate timeliness of follow-up and monitoring while on these therapies.

Midostaurin: Nursing Perspectives on Managing Treatment and Adverse Events in Patients With FLT3 Mutation-Positive Acute Myeloid Leukemia and Advanced Systemic Mastocytosis.

BACKGROUND: Acute myeloid leukemia (AML) and advanced systemic mastocytosis (SM) are clonal diseases of the blood. Prognoses for patients with FMS-like tyrosine kinase 3 (FLT3) mutation-positive AML and those with advanced SM are poor. In the United States, midostaurin was approved in 2017 in combination with standard chemotherapy in patients with newly diagnosed FLT3 mutation-positive AML and as a single agent in patients with advanced SM. OBJECTIVES: This article aims to improve oncology nurses' knowledge about the benefits and risks of midostaurin therapy and to provide guidance on the identification and management of eligible patients. METHODS: The clinical data that supported the U.S. Food and Drug Administration's approval of midostaurin are reviewed, and supporting safety and management considerations are provided based on the authors' experiences as nurses and advanced practice providers caring for patients who received midostaurin during these key clinical trials. FINDINGS: Nausea and vomiting are the most frequent nonhematologic adverse events reported with midostaurin; therefore, administer midostaurin with antiemetics, and recommend taking it with food. Care should be taken when midostaurin is coadministered with strong CYP3A4 inhibitors.

Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia.

OBJECTIVES: To describe the needs and formal assessment of family caregivers and ways to intervene to alleviate distress and enhance caregiving skills in the setting of adult and pediatric leukemia. DATA SOURCES: Literature review, clinical practice observations and experiences. CONCLUSION: While rapid treatment advances in leukemia are a welcome development, the reliance on complex care delivered by family members across settings continues to grow and, concomitantly, so does the risk of mental, physical, and economic burden. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses and other clinicians should systematically incorporate screening and assessment services so that educational and referral needs are identified and intervened upon.

Psychological and Financial Distress Management in Adults With Acute Leukemia.

OBJECTIVES: To review and summarize psychological and financial distress in adults with acute leukemia and provide evidence-based methods that nurses can apply to alleviate distress experienced by patients. DATA SOURCES: Oncology and palliative care literature published over the past decade. CONCLUSION: Current evidence supports the efficacy of psychosocial interventions to improve psychological well-being and reduce distress for adults undergoing treatment for leukemia. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role, not only in identifying patients who are experiencing impaired psychological well-being and high levels of distress, but also in providing prompt support to these patients.

Integration of Palliative Care into Acute Myeloid Leukemia Care.

OBJECTIVE: To provide an overview of the past, present, and future of the integration of palliative care services for patients with hematologic malignancies, such as acute myeloid leukemia (AML). DATA SOURCES: Published literature as indexed in Medline, relevant guideline documents, textbooks, and clinical experience. CONCLUSION: Patients with acute leukemias have substantial palliative care needs that often go unmet with standard oncology care. Evidence shows that the early integration of specialist palliative care into standard oncology care improves patient-centered outcomes among those with advanced solid tumors. Emerging evidence supports similar benefits among hospitalized patients with hematologic malignancies undergoing stem cell transplantation, and additional trials are underway to further test palliative care interventions in patients with AML. IMPLICATIONS FOR NURSING PRACTICE: By better understanding the palliative care needs of patients with AML and the evidence of integration with standard oncologic care, patients with leukemias may be more likely to receive early integrated palliative care.

Interdisciplinary Management of Acute Leukemia Across the Continuum of Care.

OBJECTIVE: To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE: Literature review and experiential knowledge. CONCLUSION: Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.

Psychosocial Experiences of Young Adults Diagnosed With Acute Leukemia During Hospitalization for Induction Chemotherapy Treatment.

The diagnosis of cancer for anyone is a time of fear and uncertainty. For young adults (YAs) diagnosed with acute leukemia (AL), there are the additional challenges related to lengthy aggressive in-hospital treatment, multiple concurrent symptoms, and decreased well-being. The purpose of this study was to explore the experiences of YAs with AL undergoing induction chemotherapy. This study used a nested qualitative longitudinal design with a convenience sample. Qualitative data were collected using semistructured interviews, and participants were invited to maintain journals. The semistructured interviews were audiotaped, transcribed, and loaded into Atlas.ti for analysis. Common themes and categories were verified and used to disseminate the findings. Seven YAs, mean age 32 (SD, 4) years, participated in this study. Three thematic classifications emerged: getting through, supported yet isolated, and information exchange preferences, which detail how these YAs processed and coped during treatment. The findings from this study provide important insights for nurses regarding coping mechanisms that YAs apply, which included relying on technology and social media platforms. Additionally, the YAs in this study discussed their need for information. The findings from this study may provide insights for clinicians currently caring for YAs with AL, while also directing future palliative care research endeavors.

"I would like to tatoo the illness on my arm". The Integrated Personalized Nursing Diagnosis (IPND).

BACKGROUND AND AIM: The nursing diagnosis can based on two different approaches: the standard diagnosis, searching for regularities that can fall within pre-existing categories identified by the nurse, as the expert of the disease; the narrative diagnosis, based on personal meaning attributed to the illness, of which only the patient is the expert. The aim of this work is to underline the usefulness of integration between standard diagnosis and narrative diagnosis, through the Integrated Personalized Nursing Diagnosis (IPND). METHODS: A 31 years old man, suffering from leukaemia, is welcomed at an Italian Oncological Day Hospital, by a nurse trained in the IPND approach. She used the Gordon functional models on objective data, and collected a narration about patient's experience, which has been analyzed with a Grounded Theory methodology. RESULTS: The narrative revealed critical issues and the priorities that patient assigns, which would not have been obtained from a standard diagnosis. From the standard diagnosis, however, emerge several aspects that the patient has neglected to narrate and that does not directly address in his story. The diagnostic integration allowed the nurse to define a conceptual map of problems and resources in a personalized manner. CONCLUSION: The IPND not only gives importance to the priorities of the patient, but also underlines the dynamic path, in which not only the static analysis of needs becomes significant, but also the changes that occur in attributing new meanings to the life experience, as well as the evolution of the person him/herself in this process.

Access to Palliative Care Consultation and Advance Care Planning for Adults with High-Risk Leukemia.

BACKGROUND: Although strong evidence supports early palliative care (PC) and consistent advance care planning (ACP) for patients with poor-prognosis Stage IV solid tumors, best practice standards have not been established for hematologic malignancies. Our primary objective was to describe current access to specialty PC consultation and ACP for inpatients with high-risk leukemia. Secondary objectives were to describe components of ACP and PC practices. METHODS: We enrolled all patients with high-risk leukemia (acute leukemia ≥65 years or relapsed leukemia >18 years) admitted to the University of North Carolina Cancer Hospital from October 1, 2015, to August 1, 2016. Structured chart reviews provided data on demographics, disease characteristics, PC consultation, frequency and components of documented ACP, and quality measures for PC practices. RESULTS: Of 50 high-risk leukemia patients, 52% were 65 years of age or older with a new diagnosis of acute leukemia and 48% were under the age of 65 with relapsed leukemia. Most patients (64%) reported pain on admission. Twenty-two percent of patients died within 3 months of hospitalization. Sixteen percent of patients received PC consultation and 24% had complete ACP, with an identified surrogate decision-maker documented treatment preferences. CONCLUSIONS: In this descriptive study of inpatients with high-risk leukemia, we found that despite a poor prognosis and high symptom burden, the frequency of PC consultation and ACP documentation was low. Findings suggest missed opportunities to provide PC to a high-risk subset of hematologic malignancies, and may help to target future interventions.

Leukostasis: Management to Prevent Crisis in Acute Leukemia
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BACKGROUND: Hyperleukocytosis, a peripheral white blood cell count greater than 100,000/mm3,is most commonly seen in patients with newly diagnosed or relapsed acute lymphoblastic leukemia and acute myeloid leukemia. Leukostasis is a reduction in blood flow related to hyperviscosity. Hyperleukocytosis, causing leukostasis, is an oncologic emergency and requires an exacting assessment and rapid response with appropriate intervention to prevent morbidity and mortality in the first week after diagnosis. OBJECTIVES: The objectives of this article are to equip oncology nurse to identify patients with hyperleukocytosis and to provide nursing interventions that will ensure safe, quality care. METHODS: A case study is used to demonstrate key concepts that are critical in early assessment, identification, and treatment of patients with leukostasis.
. FINDINGS: Oncology nurses well versed in the pathophysiology, clinical presentation, and management of leukostasis can make a significant contribution to the safe management of patients with cancer.

Integrated narrative assessment exemplification: a leukaemia case history.

BACKGROUND AND AIM: In the Integrated Narrative Nursing Assessment (INNA), the Evidence-Based Nursing Model is integrated with the Narrative-Based Nursing Model. The INNA makes use of quantitative instruments, arising from the natural sciences as well as of qualitative ones, arising from the human achieving results of standardization and reproducibility, as well as of customization and uniqueness. Accordingly, the purpose of this work is to exemplify the thinking process of and the method adopted by a nurse adopting an integrated narrative assessment in the evaluation of a patient. METHOD: The patient suffered from acute myeloid leukaemia, treated with chemotherapy. Her nurse worked in a haematology ward in a North Italy Hospital. The nurse had previous experience in conducting the assessment according to INNA. Based on patient's characteristics, the nurse chose to use the narration (to explore needs from their subjective perception) and the scales (to measure them objectively) among the various assessment instruments provided by the INNA. RESULTS: The resultant integrated outcomes helped the nurse to have a comprehensive overview of the person's health-care needs and their connections. These outcomes derive from the integration of narrative information with those obtained from the scales, which in this paper have shown consistent results. CONCLUSION: It is very difficult to reach this complexity by considering qualitative and quantitative assessment strategies as mutually foreclosing, given that both emerged as being very useful in identifying, understanding and measuring the needs of the assisted person. Then they both could be used to design a customized intervention, encouraging new connections between disease, illness, sickness and everyday life.

Hearing loss in palliative care.

BACKGROUND: Age-related hearing loss is remarkably common, affecting more than 60% of adults over the age of 75. Moreover, hearing loss has detrimental effects on quality of life and communication, outcomes that are central to palliative care. Despite its high prevalence, there is remarkably little written on the impact of hearing loss in the palliative care literature. OBJECTIVE: The objective was to emphasize its importance and the need for further study. We use a case as a springboard for discussing what is known and unknown about the epidemiology, presentation, screening methodologies, and treatment strategies for age-related hearing loss in palliative care. DISCUSSION: The case describes a 65-year-old man with acute myelogenous leukemia (AML) that has progressed despite treatment. No concerns are raised about communication challenges during conversations between the palliative care team and the patient in his quiet room. However, in the midst of a family meeting, shortly after discussing prognosis, the patient reports that he cannot hear what anyone is saying. CONCLUSION: We describe simple methods of screening patients for hearing loss, and suggest that practical approaches should be used universally in patient encounters. These include facing the patient, pitching one's voice low, using a pocket talker, and creating a hearing-friendly environment when planning a family or group meeting.

Patient-reported symptoms and quality of life in adults with acute leukemia: a systematic review.

PURPOSE/OBJECTIVES: Systematically summarize findings from research conducted on adult acute leukemia survivors as they relate to symptoms and quality of life (QOL). 
 DATA SOURCES: Systematic review of the literature from 1990­2013 found in the PubMed, PsycINFO®, EMBASE, and CINAHL® databases, as well as manual searches. 
 DATA SYNTHESIS: The review identified 16 quantitative studies and 1 qualitative study published from 1990­2013 that used a self-reported QOL or symptom questionnaire. Fatigue was the most commonly assessed and reported symptom, followed by depression. 
 CONCLUSIONS: Acute leukemia and its treatment have a significant impact in all QOL domains. Future studies should include longitudinal research, more than one recruitment site, increased minority representation, and home-based exercise interventions as ways to improve all domains of QOL. 
 IMPLICATIONS FOR NURSING: This review increases awareness of commonly reported symptoms faced by adults with acute leukemia. Oncology nurses are central in monitoring and reporting symptoms to the interdisciplinary team that may contribute to changes in function, with the overall goal of optimizing QOL over time. 


Effect of art making on cancer-related symptoms of blood and marrow transplantation recipients.

PURPOSE/OBJECTIVES: To examine whether a one-hour art-making session during blood and marrow transplantation (BMT) treatment significantly affects therapy-related symptoms, state anxiety, and stress. DESIGN: A pre- and post-test crossover design. SETTING: An urban outpatient cancer center in the midwestern United States. SAMPLE: A convenience sample of 20 patients, aged 20-68 years (X = 38.5), receiving treatment at a BMT clinic. METHODS: Participants completed a demographic questionnaire, the Therapy-Related Symptom Checklist, and the Spielberger State-Trait Anxiety Index, and provided salivary cortisol samples. After pretesting, individuals were assigned to either a wait list or intervention. Individuals in the wait-list group received the usual treatment before completing the post-test measures. Individuals in the intervention group participated in a one-hour art-making session, after which they completed post-test measures. Participants then crossed over to the other group. MAIN RESEARCH VARIABLES: Art making, stress, state anxiety, and therapy-related symptoms. FINDINGS: Therapy-related symptom concerns for the intervention group at post-test were significantly lower than at pretest; no change ocurred in the control group. The salivary cortisol levels were significantly lower at post-test in the intervention and control groups. No change occurred in the anxiety levels of participants in the intervention and control groups. The study hypothesis was partially supported. CONCLUSIONS: Art making decreased therapy-related symptoms (e.g., feeling sluggish, difficulty concentrating). Use of more physiologic indices to measure stress and replication on a larger sample are suggested. IMPLICATIONS FOR NURSING: Individuals receiving BMT may benefit from participation in art-making interventions. Art making is easy to implement in a clinic setting and allows for positive interactions between nurses and patients.

Acute leukaemia: making sense of a complex blood cancer.

Acute leukaemia represents a diverse group of blood cancers that affect both children and adults. Treatment schedules for these haematology cancers are often prolonged, with many associated side effects and complications. Nurses caring for patients with acute leukaemia require an anticipatory approach, where care is aimed at minimizing the side effects of treatment and being constantly vigilant for any impending adverse effects. Moreover, patients require support for the psychosocial issues that can arise for patients during their illness. This article provides an overview of acute lymphoblastic leukaemia and acute myeloid leukaemia. Nursing considerations in the care of patients being treated for acute leukaemia are also explored.