Telemedicine in Community Cancer Care: How Technology Helps Patients With Cancer Navigate a Pandemic.

COVID-19 places unprecedented demands on the oncology ecosystem. The extensive pressure of managing health care during the pandemic establishes the need for rapid implementation of telemedicine. Across our large statewide practice of 640 practitioners at 221 sites of service, an aggressive multidisciplinary telemedicine strategy was implemented in March by coordinating and training many different parts of our healthcare delivery system. From March to September, telemedicine grew to serve 15%-20% of new patients and 20%-25% of established patients, permitting the practice to implement safety protocols and reduce volumes in clinic while continuing to manage the acute and chronic care needs of our patient population. We surveyed practice leaders, queried for qualitative feedback, and established 76% were satisfied with the platform. The common challenges for patients were the first-time use and technology function, and patients were, in general, grateful and happy to have the option to visit their clinicians on a telemedicine platform. In addition to conducting new and established visits remotely, telemedicine allows risk assessments, avoidance of hospitalization, family education, psychosocial care, and improved pharmacy support. The implementation has limitations including technical complexity; increased burden on patients and staff; and broadband access, particularly in rural communities. For telemedicine to improve as a solution to enhance the longitudinal care of patients with cancer, payment coverage policies need to continue after the pandemic, technologic adoption needs to be easy for patients, and broadband access in rural areas needs to be a policy priority. Further research to optimize the patient and clinician experience is required to continue to make progress.

Prevention and treatment of bone loss in patients with nonmetastatic breast or prostate cancer who receive hormonal ablation therapy.

Hormone ablation therapy is a mainstay in the treatment of breast and prostate cancers. However, aromatase inhibitors (AIs) used in postmenopausal women with breast cancer and androgen-deprivation therapy (ADT) used in men with prostate cancer contribute to substantial bone loss, thereby increasing the risk of osteoporotic fractures. Evidence-based guidelines, therefore, urge oncology practices to screen these patients for bone loss and, if needed, provide treatment to maintain bone health. In addition to lifestyle modification and calcium or vitamin D supplementation, bone protection strategies include treatment with bisphosphonates and denosumab, a monoclonal antibody against RANK ligand. Identification of patients at greater risk for bone loss and fracture and proper interventions can reduce fracture rates. Oncology nurses can play an important role in screening these patients. The purpose of this article is to inform oncology nurses about the effects of cancer treatment on bone health, review current prevention and treatment options for cancer treatment-induced bone loss, and discuss recommendations for identifying high-risk individuals.

Awareness, concern, and communication between physicians and patients on bone health in cancer.

PURPOSE: This study aims to explore physician-patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL). METHODS: The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them. RESULTS: Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients. CONCLUSIONS: Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients' perceptions, presenting a need for systematic awareness and education.

Molecular biology and immunology.

OBJECTIVES: To review basic molecular biology and immunology concepts to provide a foundation for the understanding of current and developing biological treatments for cancer. DATA SOURCES: Published scientific papers, review articles, and book chapters. CONCLUSION: Research into the structure, functions of the human cell, and development of molecular biology techniques, has increased the understanding of cancer pathophysiology. This research has assisted scientists to develop new cancer treatments, collectively called biotherapies. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are increasingly facing the administration of a variety of new biotherapies. Basic knowledge of molecular biology and immunology will assist the oncology nurse to understand the mechanisms of action of these therapies, leading to improved patient education and more vigilant surveillance of side effects during and after administration.

Breast-conserving therapy with adjuvant paclitaxel and radiation therapy: feasibility of concurrent treatment.

As commonly used, adjuvant paclitaxel after doxorubicin in high-risk breast cancer patients results in a prolonged delay of the onset of radiation therapy after breast-conserving surgery. Concurrent delivery of breast irradiation with paclitaxel would allow for earlier initiation of radiation. We report on the toxicity of concurrent paclitaxel and breast irradiation after doxorubicin and cyclophosphamide. Twenty-four patients were treated with concurrent breast radiation and paclitaxel. All patients received four cycles of doxorubicin and cyclophosphamide followed by four cycles of paclitaxel, 175 mg/m2 every 3 weeks. The radiation therapy started after the first cycle in 3 patients, after the second cycle in 16, and after the third in 5. The breast received 4680-5040 cGy external beam irradiation, followed by a boost of 1000-2000 cGy. Fifteen patients received supraclavicular irradiation, and a posterior axillary supplement was used in five patients. Median follow-up after completion of irradiation was 11.5 months (range 2-29 months) with 21 patients followed >or=6 months, 12 followed >or=12 months, and 7 followed >or=18 months. Using Radiation Therapy Oncology Group (RTOG) acute toxicity scoring criteria, 7 patients experienced grade 1 skin and/or soft tissue reactions and 17 patients had grade 2 reactions. The average total duration of radiation treatment was 49 days (range 41-57 days). Only eight patients had radiation therapy interruptions for a median of 3.5 days (range 2-8 days): two more than 5 days. None had a chemotherapy dose reduction. One patient discontinued paclitaxel after the third cycle due to bilateral upper extremity neuropathy. No cases of pneumonitis or brachial plexopathy were seen. Concurrent treatment with every 3-week paclitaxel and breast irradiation was well tolerated. Additional study is needed to determine optimal timing, long-term toxicity, and potential benefits of concurrent radiation therapy and paclitaxel.

The role of licensed nursing personnel in radiation oncology part a: results of a descriptive study.

PURPOSE/OBJECTIVES: To identify the specific administrative, clerical, patient care, patient education, and research responsibilities that licensed nursing personnel perform in the field of radiation oncology. DESIGN: Descriptive. SAMPLE: 281 licensed nursing personnel employed in the field of radiation oncology in North America. METHODS: Subjects completed a six-page, self-administered questionnaire comprised of fixed-choice and open-ended questions. MAIN RESEARCH VARIABLES: Demographics, employment settings, and administrative, clerical, patient care, patient education, and research responsibilities. FINDINGS: Nurses in radiation oncology tend to be older (41-60 years of age) and considerably well educated, with many years of experience in this field. Nurses are responsible for a wide variety of tasks. The study found a strong demonstration of the role of nurse educator among radiation oncology nurses. IMPLICATIONS FOR NURSING: Radiation oncology nursing is a subspecialty in evolution. The data should provide support for further exploration of how patient education and support influence patient outcomes in radiation oncology.

The role of licensed nursing personnel in radiation oncology part B: integrating the ambulatory care nursing conceptual framework.

PURPOSE/OBJECTIVES: To describe the professional opportunities for licensed nursing personnel in radiation oncology within the conceptual framework developed for ambulatory care nurses by the American Academy of Ambulatory Care Nursing (AAACN). DATA SOURCES: Published articles and books. DATA SYNTHESIS: Using AAACN's framework, the researchers identified three roles that are part of every ambulatory care nurse's practice and can be readily customized to radiation oncology: an organizational/systems role, a professional role, and a clinical nursing role. Incorporating the described framework into a radiation oncology nurse's job description can lead to maximizing the use of the professional staff member within the radiation oncology department. This level of professional utilization and validation of the radiation oncology nurse will lead not only to improved patient outcomes but also to greater professional satisfaction, resulting in improved retention. CONCLUSIONS: The complexity of oncology therapies demands expert oncology nurses. This clearly is recognized in medical oncology, and patients with cancer who are being treated with radiation are no less important. To optimize patient care and therapeutic outcomes, the integration of nursing in all aspects of the radiation treatment continuum is essential. IMPLICATIONS FOR NURSING: Radiation oncology nursing is an evolving subspecialty. Nurses can use the information in this article to evaluate their current roles and individual potential for further professional growth.