Steroid-Refractory Chronic Graft-Versus-Host Disease: Treatment Options and Nursing Care.

BACKGROUND: Chronic graft-versus-host disease (cGVHD) is a significant complication for patients who receive allogeneic hematopoietic stem cell transplantation. This disease is further complicated for patients who are refractory to steroids. This article reviews emerging therapies and supportive care for patients with steroid-refractory cGVHD. OBJECTIVES: This article provides foundational knowledge on steroid-refractory cGVHD, emerging treatment options, and related supportive care. METHODS: Current research on emerging therapies for patients with steroid-refractory cGVHD is summarized along with supportive care recommendations and a review of related nursing considerations. FINDINGS: Emerging therapies for steroid-refractory cGVHD offer opportunities for improved clinical outcomes for these patients. Nursing knowledge of new therapies and supportive care for patients with steroid-refractory cGVHD supports the provision of optimal nursing care for a complex population of patients.

Treatment and Nursing for Steroid-Refractory Acute Graft-Versus-Host Disease.

BACKGROUND: Acute graft-versus-host disease (aGVHD) is a significant complication for patients who receive allogeneic stem cell transplantation. Patients whose aGVHD is refractory to corticosteroids face additional complications. OBJECTIVES: This article provides foundational knowledge on steroid-refractory (SR) aGVHD, current treatment options, and related supportive care. METHODS: Therapies for patients with SR aGVHD are summarized, along with supportive care recommendations and a review of related nursing considerations. FINDINGS: Current treatment and research on SR aGVHD offer opportunities for improved clinical outcomes for these patients. Nursing knowledge of the pathophysiology, treatment, and supportive care for patients with SR aGVHD is integral to the provision of optimal nursing care for a complex population of patients.

Medical Aid in Dying: An Overview of Care and Considerations for Patients With Cancer.

BACKGROUND: Medical aid in dying (MAID) is increasingly becoming a legal option for patients with terminal illness who desire greater control over how they end their life. The majority of patients who pursue this option are those with terminal cancer. OBJECTIVES:  This article provides foundational knowledge on MAID, including key considerations for nurses practicing in states where MAID is legalized. METHODS:  Available research and data on MAID are summarized, as well as clinical recommendations for patient education, counseling, and supportive care. A case study is included to illustrate relevant concepts. FINDINGS:  MAID is becoming an accepted practice for patients with terminal cancer through increasing legislation across the United States. Nursing knowledge of critical considerations for patients with terminal cancer who choose to pursue MAID is integral to the provision of optimal clinical oncology care at the end of life.

COVID-19 Vaccines and Immunosuppressed Patients With Cancer: Critical Considerations.

BACKGROUND:  Patients with cancer are highly vulnerable to COVID-19 because of immunosuppression from diseases and treatments. Emerging data characterize the impact of COVID-19 vaccines related to cancer malignancies and treatments. OBJECTIVES:  This article provides a clinical foundation on the immune response to the COVID-19 vaccine associated with the impact of cancer and its related treatments. It reviews strategies for vaccine scheduling, Centers for Disease Control and Prevention recommendations, and nursing considerations when administering the vaccine to immunosuppressed patients. METHODS:  Research studies about immune responses to COVID-19 vaccines among immunosuppressed patients with hematologic and solid tumor malignancies were summarized. FINDINGS:  Studies about the humoral immune responses of patients with cancer to COVID-19 vaccines help guide vaccination planning for this population. Critical nursing considerations for patients with cancer receiving COVID-19 vaccination are integral to the provision of optimal clinical oncology care during the pandemic.

Pilot Trial of Homebound Hematopoietic Cell Transplantation.

For eligible patients with multiple myeloma (MM) and amyloid light chain (AL) amyloidosis, high-dose chemotherapy and autologous hematopoietic cell transplantation (HCT) is a standard and widely used consolidation therapy. Autologous HCT requires specialized care at a transplantation center and investment from patients and caregivers. We studied the safety and feasibility of delivering transplantation care in a homebound setting to decrease the burden of therapy and increase access to autologous HCT. Patients with MM and AL amyloidosis undergoing autologous HCT were eligible if they resided in designated ZIP codes and had a full-time caregiver, Wi-Fi connection, HCT Comorbidity Index ≤3, and Karnofsky Performance Status score ≥80. High-dose melphalan (on day -2) and hematopoietic cell reinfusion (day 0) were administered in the outpatient clinic. Protocol-specific home care was provided from day +1 through engraftment. Patients were assessed and blood was drawn daily by advanced practice providers. Interventions were delivered by registered nurses. Attending physicians communicated daily through telemedicine. Quality of life, patient and caregiver satisfaction, and fecal microbiota profiling data were collected. Fifteen patients were enrolled and received transplantation care at home starting on day +1 following hematopoietic cell infusion. Patients remained in the program for an average of 12 days and required an average of 2 outpatient visits while receiving home care. Seven of 15 patients were admitted for a median of 4 days (range, 3 to 10 days); admission occurred on day +7 in 5 patients, on day +8 in 1 patient, and on day +12 in 1 patient for neutropenic fever in 2 patients, fever attributed to engraftment syndrome in 2 patients, diarrhea in 2 patients, and dehydration in 1 patient. Only 1 patient had a documented infection (Clostridioides difficile). One patient admitted with neutropenic fever required intensive care unit admission for a gastrointestinal bleed. Forty-seven percent of the patients experienced a grade ≥3 nonhematologic toxicity. There were no deaths on the study. Patients and caregivers reported high satisfaction with care. Microbiota diversity patterns were similar to those of autologous HCT recipients who did not receive post-HCT care at home, although a subset of the cohort maintained microbiota diversity throughout. Homebound HCT in an urban setting is safe and feasible, with less than one-half of patients requiring inpatient admission. Despite increased patient and caregiver responsibility in the homebound setting compared with an inpatient setting, patient and caregiver satisfaction was high. These results support expansion of homebound transplantation care programs.

Mobile Health Interventions: Examining Medication Adherence Outcomes Among Patients With Cancer.

BACKGROUND: Treatment for cancer is trending toward oral therapies, which patients can self-manage from home. Proper adherence to oral therapy is vital to safe and optimal care in this setting. Mobile health interventions (i.e., text message reminders, mobile applications, and automated calls) are an evolving strategy aimed at improving medication adherence for patients on long-term oral therapies. OBJECTIVES: This review aims to provide an overview of research outcomes for the use of mobile health interventions among patients with cancer. METHODS: A comprehensive review of CINAHL®, MEDLINE®, and PubMed® was completed. Eleven articles were eligible for inclusion in this review. FINDINGS: Mobile health interventions are an acceptable approach among patients with cancer and may improve adherence outcomes for those at highest risk for suboptimal adherence.

Interprofessional Communication: Integrating Evidence to Enhance Systems During a Pandemic.

BACKGROUND: The COVID-19 pandemic placed challenges on interprofessional communication patterns among clinical care teams at a time when effective communication was greatly needed. The development of enhanced systems for communication that integrate the latest evidence and communication technologies can offer a solution to this crisis. OBJECTIVES: This article provides a framework for ways in which nursing teams can develop evidence-based enhanced interprofessional communication systems during a pandemic. METHODS: Based on communication models and related technologies, this article reviews strategies to enhance interprofessional communication. Two case studies are included that illustrate how nursing teams can enhance communication during a pandemic. FINDINGS: To improve communication during a pandemic, clinicians can incorporate interprofessional communication models in clinical practice and apply enhanced communication strategies.

A Survey of Clinicians Evaluating an Online Prelicensure Oncology Nursing Elective.

OBJECTIVES: Despite a growing population of individuals with cancer, there is limited oncology content in prelicensure nursing curricula. A distance learning oncology nursing elective course creates an option for integration into nursing programs. The purpose of this article is to describe curriculum development for an online oncology elective course using feedback and expertise from oncology nurses. DATA SOURCES: An online oncology course curriculum was developed and then shared with 70 oncology nurse experts to elicit feedback on course objectives, content, teaching strategies, and evaluation methods using a survey and open-ended questions. CONCLUSION: Experts agreed course objectives, content, teaching strategies, and evaluation methods were clear and comprehensive. Curriculum revisions were made based on recommendations from expert clinicians. A curriculum table for this proposed course is presented. NURSING IMPLICATIONS FOR PRACTICE: There is a need for oncology nursing curriculum in prelicensure programs. Educators should consider innovative ways of increasing academic-practice partnerships in curriculum development.

Social Isolation: Managing Psychological Distress in Hospitalized Patients During the COVID-19 Pandemic.

The COVID-19 pandemic caused many hospitals and treatment centers to temporarily restrict or prohibit visitors to control viral spread. This article presents a case study of a patient receiving a bone marrow transplantation who experienced psychological distress during hospitalization because of social isolation. The National Comprehensive Cancer Network guidelines for distress management are used as a framework to outline a nursing plan of care for managing social isolation-related psychological distress in patients who are hospitalized during a worldwide pandemic.