Oncology Nursing News Top Stories: February 2023

Data presented at the 64th American Society of Hematology (ASH) Annual Meeting and Exposition continued to grab the attention of our readers in February as our coverage expanded to include expert recaps and features on abstracts that warranted extra attention.

Below, we feature a piece which piggybacks off data presented at the ASH meeting to argue for the liberalization of patient diets in comprehensive cancer centers. Additionally, Nilesh Kalariya, PhD, AGPCNP-BC, AOCNP; and Laura J. Zitella, MS, RN, ACNP-BC, AOCN joined Oncology Nursing News® for an interview highlighting key takeaways from the meeting for nurses and advanced practitioner.

Data from the 2022 San Antonio Breast Cancer Symposium (SABCS) also captured renewed attention in the oncology nursing space, in particular with the results of the TAM-01 trial (NCT01357772). Many women with estrogen receptor–positive ductal intraepithelial neoplasia of the breast will receive adjuvant tamoxifen as part of their treatment course; however, for many, the standard 20-mg dose is intolerable, and can interfere with adherence. At the symposium, investigators presented data from TAM-01, which showed that tamoxifen, at a dose of 5 mg daily (babytam), continued to show a benefit over placebo in reducing the risk of recurrence from invasive breast cancers and ductal carcinoma in situ (DCIS) in women with breast intraepithelial neoplasia in a 10-year follow-up. These data represent “promising results for those concerned about tamoxifen [adverse] effects,” Lea Ann Biafora, MS, RN, OCN, CCM, ONN-CG, an SABCS attendee, commented in an email interview with Oncology Nursing News®.

Lastly, find articles highlighting some of the less clinical considerations of oncology nursing, including a feature article from the Carla Schaefer, DNP, RN, OCN, CENP, associate chief Nursing officer of solid tumors at Rutgers Cancer Institute of New Jersey highlighting nursing education considerations, as well as an interview with Anna Skwira-Brown, APRN, AOCNP, who offers a perspective on how nurses can work on building their communication in a heavy emotional conversation.

5. A Plea to Let Patients With Cancer “Just Eat”

High-dose chemotherapy is an effective treatment strategy for many patients with cancer; however, this treatment is also associated with prolonged pancytopenia, which can elevate an individual’s risk of an opportunistic infection. Chemotherapy is also liked to mucositis, which can increase the risk of bacteria translocation between the gut and the bloodstream.

Many comprehensive cancer centers therefore practice restricted diets for patients. The thinking behind this is to restrict the introduction of bacteria through food. With this diet, the intake of fresh fruits, vegetables, dairy products, and raw or undercooked meats are prohibited. However, this diet has been controversial for many years, as it has never been found to reduce the risk of gastrointestinal infections.

In the February print edition’s Nurse’s Note, Stephanie Jackson, DNP, MSN, RN, AOCNS, BMTCN, makes an argument against these diets, asserting that preventing malnutrition and nutritional deficiencies are equally as important in cancer treatment, and that there are better ways to prevent the contamination of the gastrointestinal tract.

4. ASH Data Offer Treatment Direction for Oncology Nursing Professionals

Following the 2022 ASH Annual Meeting and Exposition, 2 experienced nurse practitioners spoke with Oncology Nursing News® to offer their opinions and insights to some of the data presented. Listen to Nilesh Kalariya, PhD, AGPCNP-BC, AOCNP; and Laura J. Zitella, MS, RN, ACNP-BC, AOCN, discuss which abstracts they believe have the greatest potential to change oncology nursing practice.

“If I have to pinpoint one thing [of interest], it’s the results of KarMMa-2 [NCT03601078] cohort 2c which allowed patients to use maintenance therapy after CAR T-cell therapy,” says Kalariya.

“We have [seen] remission lasting for up to 2 years based on published data, but we have patients at [The University of Texas] MD Anderson [Cancer Center], who are more than 3 years [posttreatment] and they are still in stringent complete remission. More data will come in near future, but from what we see now, CAR T-cell therapy, followed by maintenance therapy, might be a key in frontline settings to have a longer duration of response for patients with relapsed and refractory multiple myeloma.”

3. Low-Dose Tamoxifen Shows Continued Efficacy in Adjuvant Setting at 10-Year Follow-Up

Tamoxifen, at a dose of 5 mg daily (babytam), continued to show a benefit over placebo in reducing the risk of recurrence from invasive breast cancers and DCIS in women with breast intraepithelial neoplasia in a 10-year follow-up of the TAM-01 trial. According to investigators, the low risk of death observed with a lower dose support treatment de-escalation in DCIS for women who are intolerant to the standard dose (20 to 40 mg/daily) in the adjuvant setting.

An analysis of the data was presented at the 2022 SABCS. At a median follow-up of 9.7 years (range, 8.3-10.9), the survival curves showed a 42% reduction in overall breast events (breast cancer or DCIS) with babytam compared with placebo (HR, 0.58; 95% CI, 0.35-0.95; P = .028).

2. Nursing Education Can Be a Lifelong Marathon. Are You Ready for the Race?

There can be a lot of pressure for nurses to stay-up to date with the evolving field of medicine, writes Carla Schaefer, DNP, RN, OCN, CENP. For many nurses, learning is a continuous process, and should be viewed as more of a marathon than as a sprint. There are many different paths to continuing education, so the question can become: how to get started?

In this feature piece, Schaefer outlines key considerations that nurses may find useful when planning to work towards a second degree—such as degree requirements, time commitments, and financial, all while encouraging nurses to take their time. As she writes “Sometimes the hare wins the race, but often, the tortoise, with its a slow and steady pace, is the victor. Only you can decide whether you will be the tortoise or the hare.”

1. Nurse Perspectives on Difficult Conversations: How Do I Tell My Kids That I Am Dying?

Oncology nurses may frequently find themselves in emotional conversations with their patients within a moment’s notice, which can be overwhelming at times. However, learning to take a pause before responding, showing a willingness to understand, and trying to make the patient feel supported are the best steps a nurse can take in any situation, according to Anna Skwira-Brown, APRN, AOCNP.

Brown, a nurse practitioner at Essentia Health Duluth Clinic in Minnesota, recently co-authored an article in the Clinical Journal of Oncology Nursing about best practices in palliative and end-of-life nursing conversations. In an interview with Oncology Nursing News®, Brown discussed the lessons she learned in a personal experience, when a patient turned to her and asked, “How do I tell my kids that I am dying?”

“I had 2 young kids at home [at the time] and the first thing I thought of [was] that would be the most awful thing in the whole wide world,” Brown told Oncology Nursing News®, “but that’s not what this patient needed to hear.”

Interested in joining the conversation? Reach out to lfischer@mjhlifesciences to learn about opportunities for oncology nurses today!