A daunting challenge that we face as oncology nurses is the need to stay current with relevant new information, technologies, and trends in cancer care. Given the existence of more than 100 types of cancer, generalists (those of us who work in clinic, office-based, or inpatient settings within surgical, radiation, and medical oncology practices) have a particularly difficult time keeping up-to-date, compared with nurses who subspecialize in individual malignancies.
One of my key roles as an Oncology Clinical Nurse Specialist is to help bedside staff remain apprised of evolving approaches within cancer care. For this reason, I plan to periodically share interesting clinical pearls with other members of TheONC. I will provide a brief synopsis of selected studies published in the medical literature, along with reference citations for quick access of more detailed information on the subject. The only caveat is that the information I share will most likely be reflective of my personal bias as to what news is valuable and intriguing. I hope that you will find these “Five Interesting Facts” helpful in your daily practice.
Measuring Tobacco Consumption
Plasma cotinine, the major circulating metabolite of nicotine, is proportional to the level of tobacco smoke exposure and is detectable for up to 1 week following tobacco use. Cotinine can be identified in urine, saliva, and blood to distinguish active smokers from nonsmokers. In a recent study, higher cotinine levels (used to stratify patients as nonsmokers, light smokers, or heavy smokers) were predictive of reduced survival among multiple prospective US cohorts with pancreatic cancer.1 Could this marker be used as an outcome measure of nurse-directed smoking-cessation interventions?
Dr. Otis Brawley, Chief Medical and Scientific Officer for the American Cancer Society, makes the case for a larger societal and governmental role in cancer prevention.2 In highlighting selected successful initiatives from other nations, he identifies possible approaches to restricting tobacco access; expanding public health education programs; lowering alcohol consumption; reducing carcinogen exposure; promoting healthy eating, physical activity, and obesity control; and implementing clinical preventive interventions (ie, use of vaccines to counter infectious etiologies of certain malignancies). Dr. Brawley lobbies for greater use of advertising, social marketing, education, and regulation to improve the overall health of the US population.
Evaluating Cancer Patients’ Care Experience
A review of progress in addressing the cancer survivorship goals identified in the Institute of Medicine’s and National Research Council’s seminal 2006 publication, From Cancer Patient to Cancer Survivor: Lost in Transition, revealed that the quality of life during the cancer survivorship period still has not been adequately studied.3 In their review, the authors identified the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Cancer Care Survey, a collaborative effort between the National Cancer Institute and the Agency for Healthcare Research and Quality, as the gold standard for measuring cancer patients’ well being and quality of life.4,5
Using Herbs to Manage Oral Mucositis
A broad range of treatment modalities have been employed to manage oral mucositis. These include preventive strategies; and techniques to debride and disinfect mucosal tissue, control bleeding, and reduce pain (with the latter achieved by topical and systemic analgesics). The use of certain herbal medicines to manage these sequelae, while less studied, has potential efficacy due to their antioxidant and anti-inflammatory properties. A recent review of this topic discusses the promise of selected herbal agents as suggested by results from in vitro, in vivo, and clinical trials.6
Assessing Financial Toxicity
With 12% to 80% of patients in the United States experiencing financial hardship, which is projected to increase in the future, insurance and financial concerns contribute to cancer-related stress. While this issue is identified as a measure of distress in common patient evaluation tools like the National Comprehensive Cancer Network Distress Thermometer and Problem List, the most appropriate way to address these concerns has not been established. Clinicians at Memorial Sloan Kettering Cancer Center recently described their implementation of a clinic-based financial distress screening instrument for routine evaluation of financial toxicity related to cancer care.7
1. Yuan C, Morales-Oyarvide V, Babic A, et al. Cigarette smoking and pancreatic cancer survival. J Clin Oncol. 2017;35:1822-8.
2. Brawley OW. The role of government and regulation in cancer prevention. Lancet Oncol. 2017;18:e483-e493.
3. Nekhlyudov L, Ganz PA, Arora NK, Rowland JH. Going beyond being lost in translation: a decade of progress in cancer survivorship. J Clin Oncol. 2017;35:1978-82.
4. National Cancer Institute. SEER-CAHPS linked data resource. https://healthcaredelivery.cancer.gov/seer-cahps/. Accessed September 13, 2017.
5. Agency for Healthcare Research and Quality (AHRQ): CAHPS surveys and guidance. https://www.ahrq.gov/cahps/surveys-guidance/index.html. Accessed September 13, 2017.
6. Baharvand M, Jafari S, Mortazavi H. Herbs in oral mucositis. J Clin Diag Res. 2017;11:ZE05-ZE11.
7. Khera N, Holland JC, Griffin JM. Setting the stage for universal financial distress screening in routine cancer care. Cancer. 2017 Aug 17. [Epub ahead of print]