Genetic cancer risk assessment for PA practice.

ABSTRACT: The roles of cancer genetics and risk assessment as areas of medicine are rapidly evolving. Genetic cancer risk assessment (GCRA) has begun to penetrate patient care for providers in all specialties and areas of expertise. To provide comprehensive patient care and thorough risk evaluation, physician associates/assistants (PAs) should have a fundamental understanding of the role of GCRA as it pertains to their patients' overall health and medical management. This article highlights the importance of GCRA services, outlines resources for PAs to gain proficiency in GCRA, and provides a walkthrough of GCRA practice development and maintenance.

Bosutinib treatment for Philadelphia chromosome-positive leukemias.

The SRC-ABL inhibitor bosutinib is one of the five tyrosine kinase inhibitors currently approved for the treatment of Philadelphia chromosome-positive leukemias. Bosutinib has shown activity against all phases of resistant chronic myeloid leukemia that do not harbor the T315I or V299L ABL kinase domain mutations. Bosutinib is overall well tolerated; transient diarrhea is the most common side effect. This article summarizes the pharmacokinetics, pharmacodynamics, safety and efficacy of bosutinib for the treatment of Philadelphia chromosome-positive leukemias.

Development of a Standardized Bone Marrow Procedure Training and Competency Toolkit for Advanced Practice Providers in a Large Community Oncology Practice.

Bone marrow procedures are a common diagnostic tool utilized in hematology/oncology and can be completed in the office by trained clinicians. Currently, there are limited guidelines for appropriate training and competency for bone marrow procedures performed by advanced practice providers (APPs) in a community oncology practice setting. The need to create a standardized training and competency protocol for APPs in this setting was recognized. A comprehensive, standardized educational and procedural toolkit was created. The creation of a comprehensive training toolkit for APPs in the community oncology practice setting helps to ensure a high standard of procedural proficiency and consistency among individual providers and practices. The creation of such an extensive toolkit is time consuming. By adopting and standardizing toolkits such as this one, community hematology/oncology practices can ensure the delivery of high-quality patient care by highly trained and proficient APPs.

Tools to optimize the functionality of a leukemia clinical trial team.

A multidisciplinary approach offers efficiency and quality care by delegating tasks according to individuals' expertise. However, increasingly stringent regulatory requirements, albeit essential for successful conduct of clinical trials, have magnified the workload of research teams. We describe tools that have efficiently addressed regulatory requirements and facilitated the conduct of clinical trials. The research team consisted of a merge of healthcare providers and research staff. Each individual team consisted of a hematologist, a physician assistant and a nurse coordinator, supported by a shared group of clinical research coordinators, an investigational drug pharmacist, a regulatory associate and a data manager. Technology tools, complemented by operational reorganization, optimized knowledge, documentation and communication, and allowed high volume enrollment with consistent regulatory compliance. We conclude that technology combined with a coordinated team care approach can facilitate the integration of trials in clinical practice.

Managing chronic myeloid leukemia: a coordinated team care perspective.

Treatment of chronic myeloid leukemia (CML) has seen dramatic progress in recent years with the development of tyrosine kinase inhibitors (TKIs). To take maximum advantage of therapy with TKIs, compliance and good understanding of monitoring response to therapy are essential. We established a team that included a hematologist, a physician assistant (PA), and a nurse who work closely with a social worker, a pharmacist, and a research coordinator to assist patients throughout their journey with CML. The patient and the referring community oncologist were incorporated into this team. This coordinated team care approach takes advantage of each member's specific skills to provide patients with education about CML, encourage patients' strong involvement in tracking/monitoring results/response to therapy, and support patients with issues that arise throughout the long course of the disease. A low rate of noncompliance with clinic visits (3%) was an indirect measure of the impact of this approach. The inclusion of the referring oncologist in the team extended the tracking of monitoring results to the community practice. We conclude that a coordinated team care approach is feasible in the management of patients with CML. This approach provided patients with education and a good understanding of response to therapy and improved relations with the health care team.