Oncology Nursing Society's Genomics and Precision Oncology Learning Library Resources for Nursing Practice.

Oncology nurses need an understanding of genomic science to provide optimal care, yet they may have limited background in how this science guides treatment. The Oncology Nursing Society (ONS) responded to this identified need.

Direct-to-Consumer Genomic Testing Through an Ethics Lens: Oncology Nursing Considerations.

BACKGROUND: The use of direct-to-consumer genomic testing (DTCGT) is increasing, but this testing may not be comprehensive and may lack clinical validity and utility. The ethical constructs of beneficence, nonmaleficence, justice, and autonomy provide a framework for coordinating the care of patients and their families. OBJECTIVES: This article provides an overview of the DTCGT process and reviews the ethical implications that affect clinical care. METHODS: A review of the literature was conducted using the following key words: genetics/genomics and direct-to-consumer testing. Common themes were identified, including test types, regulatory standards, marketing practices, ethics, privacy, and nursing implications. FINDINGS: An increased awareness of the clinical and ethical consequences of DTCGT is needed among healthcare providers and the general population. Oncology nurses can assist patients in navigating the field of genomics through consistent and comprehensive risk assessment, patient education about the risks and benefits of DTCGT, and referral to genomics professionals when appropriate.

Germline Cancer Genetic Counseling: Clinical Care for Transgender and Nonbinary Individuals.

Transgender and nonbinary (TG/NB) individuals may engage in cancer genetic counseling for a variety of reasons, including to assess risk and obtain recommendations for cancer prevention and early detection. Barriers to TG/NB.

PARP Inhibition: Genomics-Informed Care for Patients With Malignancies Driven by BRCA1/BRCA2 Pathogenic Variants.

BACKGROUND: Germline and somatic biomarker testing for BRCA1/2 pathogenic variants can provide important susceptibility, prognostic, and predictive information, guiding recommendations for care. OBJECTIVES: This article reviews BRCA1/2, DNA damage and repair mechanisms, prevention and screening guidelines for patients with germline pathogenic BRCA1/2 variants, indications for poly (ADP-ribose) polymerase (PARP) inhibitor therapy, associated side effects, tumor resistance, and implications for nurses. METHODS: A comprehensive review of the CINAHL®, MEDLINE®, and PubMed® databases was performed using the following search terms: BRCA1/2, PARP inhibitors, and genomic testing. FINDINGS: PARP inhibitors are indicated for select patients with malignancies associated with BRCA1/2 pathogenic variants. Awareness of PARP inhibitors, their mechanism of action, indications for use, and associated side effects helps oncology nurses guide patients and families in care recommendations, provide detailed patient education, effectively monitor for side effects, and promote adherence to therapy.

Response to "Treatment-Induced Ovarian Insufficiency and Early Menopause in Breast Cancer Survivors".

We thank Esch and Schadewald (2023) for their excellent article, "Treatment-Induced Ovarian Insufficiency and Early Menopause in Breast Cancer Survivors," which described the many symptoms that can occur subsequent to tre.

Response to "Knowledge and Practice of Breast Self-Examination: A Cross-Sectional Study of Women at Selected Health Centers in Oyo State, Nigeria".

I would like to thank Faleti et al. (2023) for describing the practice patterns of breast self-examination (BSE) in Nigeria. Early identification of the symptoms of breast cancer is important in the effort to improve quality.

How Did the Variant Get Its Name? Understanding Gene and Variant Nomenclature.

Genomics is foundational to precision oncology. Oncology nurses regularly review germline and somatic biomarker testing reports. The taxonomy and nomenclature of biomarker results have evolved. Accurate understanding and inte.

Laboratory Selection in Germline Genetic Testing: Laboratory Science Matters.

There are multiple laboratories that offer germline genetic testing, and it can be difficult to discern which one to use for testing. Some laboratories have more comprehensive analysis techniques and capability, which increases the accuracy of testing. The ordering provider has a responsibility to select the appropriate laboratory with technologic capability for the needed testing, inform the laboratory of prior testing results in the patient and family so known familial variants have targeted testing, and use appropriate terminology and nomenclature when communicating information to other healthcare professionals, patients, and families. This report presents a case illustrating the potential errors that can occur when a provider selects a laboratory that lacks the capacity to detect certain pathogenic variants, such as large deletions and duplications. False-negative germline testing results lead to missed opportunities in prevention and early detection for not only the patient but often multiple family members, which may lead to psychosocial distress and late-detected cancers. This case highlights the complexities of genetic care and why management by a genetics professional can facilitate more fiscally responsible care, appropriate genetic testing, and comprehensive care for all family members at risk.

When Germline Genetic Testing Results Are Unclear: Highlighting Variants of Uncertain Significance.

With the advent of high-throughput next-generation sequencing (NGS) and multigene panel testing, genetic testing and interpretations have become increasingly complex. Specifically, reports demonstrating "variant of uncertain significance" (VUS) present interpretative challenges. Misinterpretation of a VUS may result in clinical harm, emotional distress for patients and family members, and potential health-care provider liability. The following article and deidentified case study illustrate how a lack of health-care provider and patient understanding of a germline VUS resulted in a negative patient outcome and unnecessary surgery.

Oncology Nurse Practitioners in Genetics: Examining Scope of Practice and Competence.

Genomic science is rapidly evolving, and ordering germline testing requires appropriate and comprehensive assessment of a patient's personal and family history, as well as the knowledge base to facilitate selection of the best test or panel of tests, provision of pretest counseling for informed consent, interpretation of test results, post-test recommendations, and coordination of care for other at-risk family members. Prior to ordering germline genetic testing, an advanced practice RN's scope of practice accountability includes consideration of competence in the provision of genomic care. This article provides a case study to illustrate the complexities of issues related to competence when ordering germline genetic testing.

Breast Cancer: Survivorship Care Case Study, Care Plan, and Commentaries.

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Colon Cancer: Survivorship Care Case Study, Care Plan, and Commentaries.

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Hematologic Malignancy: Survivorship Care Case Study, Care Plan, and Commentaries.

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Prostate Cancer: Survivorship Care Case Study, Care Plan, and Commentaries.

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Survivorship Care: More Than Checking a Box.

In 1987, the 12th Annual Oncology Nursing Society (ONS) Congress® held in Denver, Colorado, featured a session moderated by Deborah A. Boyle, MSN, RN, AOCNS®, FAAN, with Fitzhugh Mullan, MD, and Susie Leigh, BSN, RN, cofounders of the National Coalition for Cancer Survivorship, titled "The Seasons of Survival," which was one of the earliest presentations to oncology nurses that proposed cancer was not necessarily a deadly disease and that nurses could address the needs of survivors. As an advanced practice nurse (APN) in oncology hearing this presentation, I began to look at long-term needs of survivors who had advanced beyond acute care and benefited from effective treatments. Cancer survivorship now is a priority in oncology clinical practice.

Cognitive Dysfunction: Common Side Effect.

For cognitive dysfunction, standards of care are based on established evidence-based practice. Cognitive dysfunction is the decline in function in one or more cognitive domains, including attention and concentration, executive function, information processing speed, language, visuospatial skill, psychomotor ability, and/or learning and memory. Cognitive dysfunction occurs in 80% of patients with brain tumors, 40% of patients with acute myeloid leukemia, and as many as 75% of patients with breast cancer.

Constipation: Common Side Effect.

For constipation, standards of care are based on established evidence-based practice. Constipation is the decreased passage of stool characterized by infrequent bowel movements, hard stool, a sensation of abdominal bloating or cramping, straining with bowel movements, and the feeling of incomplete evacuation. Constipation occurs in 43%-58% of people with a diagnosis of cancer.

Distress: Common Side Effect.

For distress, standards of care are based on established evidence-based practice. Distress is a multifactorial and unpleasant emotional experience of a psychological (e.g., cognitive, behavioral, emotional), social, and/or spiritual nature that can interfere with the ability to effectively cope with a cancer diagnosis, physical symptoms and treatment, and long-term consequences of treatment. All patients are expected to experience some level of distress at some point in the cancer trajectory.

Fatigue/Lack of Endurance: Common Side Effect.

For fatigue/lack of endurance, standards of care are based on established evidence-based practice. Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to the activity and interferes with usual function. Lack of endurance refers to limited physical capability to sustain an exercise or activity for an extended period of time. From 80% to 100% of patients with cancer report experiencing fatigue. It can be isolated or occur within a symptom cluster with pain, depression, dyspnea, anorexia, and sleep disturbance.

Genitourinary Distress: Common Side Effect.

For genitourinary distress, standards of care are based on established evidence-based practice. Genitourinary distress is accidental urine leakage that can dampen underwear or saturate clothes. It is a sense of urgency, frequent urination, and/or pain or discomfort when urinating. Genitourinary distress is found in 35%-75% of patients with prostate cancer.