inPractice Oncology Nursing

  • Editors in Chief: Dawn Camp-Sorrell, MSN, FNP, AOCN®, Rebecca Hawkins, MSN, ANP, AOCN®, ACHPN

  1. 1. Symptom Management

    1. 1-1

      Bone Marrow Suppression in Patients With Cancer

      • Authors: Colleen O'Leary, MSN, RN, AOCNS®; Lisa Blackburn, MS, RN, AOCNS®;

      • Last Reviewed: 10/12/2017

      • Abstract: Bone marrow suppression, also called myelosuppression, occurs when there is a ma... (more)

        Abstract: Bone marrow suppression, also called myelosuppression, occurs when there is a marked decrease in circulating blood cells (ie, erythrocytes, neutrophils, and platelets). Myelosuppression can be a life-threatening adverse effect of chemotherapy administration and often a dose-limiting toxicity. Cancer therapy, including chemotherapy, some immunotherapy and targeted therapy, and radiation therapy to the bone marrow, can not only destroy progenitor blood cells of the bone marrow but also affect mature circulating blood cells. The result is neutropenia, thrombocytopenia, and anemia. Nursing knowledge of the prevention and early recognition of complications secondary to bone marrow suppression is essential to improve outcomes in patients with cancer. Education relating to reducing risks and identifying alterations in the condition can provide patients with support to possibly reduce anxiety. In this module, Lisa Blackburn, MSN, RN, AOCNS®, and Colleen O’Leary, MSN, RN, AOCNS®, examine causes of bone marrow suppression and provide guidance for nurses managing these common complications. ( less )

    2. 1-2

      Cutaneous Complications in Patients With Cancer

      • Authors: Beth Eaby-Sandy, MSN, CRNP, OCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Cutaneous toxicities to oncologic therapies pose new and difficult challenges to... (more)

        Abstract: Cutaneous toxicities to oncologic therapies pose new and difficult challenges to patients and clinicians. Cutaneous alterations can be associated with chemotherapy as well as targeted agents and therapeutic radiation. There are a variety of cutaneous toxicities; this chapter focuses on rash, hand–foot syndrome (also called palmar–plantar erythrodysesthesia), alopecia, pruritus, nail changes, and radiodermatitis. These cutaneous toxicities are presented individually to highlight their unique presentations and distinguishing features. Viewing cutaneous symptoms from a comprehensive perspective can be helpful in approaching symptom assessment, management, and education. Prevention and management strategies are critical to helping patients with cancer remain on therapy and maintain an acceptable quality of life. In this module, Beth Eaby-Sandy, MSN, CRNP, OCN, discusses the pathophysiology and assessment of cutaneous toxicities as well as interventions for nurses to help their patients manage these toxicities. ( less )

    3. 1-3

      Female Sexuality and Reproduction in Patients With Cancer

      • Authors: Mary K. Hughes, RN, CNS, CT;

      • Last Reviewed: 4/1/2016

      • Abstract: Sexuality is an important quality-of-life issue for everyone, regardless of age ... (more)

        Abstract: Sexuality is an important quality-of-life issue for everyone, regardless of age or health status. All types of cancer can impact sexuality and intimacy. Cancer had not been considered a chronic illness until recently, so physicians and nurses did not usually address its impact on sexuality. Now that patients are living longer with cancer, it is essential that quality-of-life issues be addressed. As with other quality of life issues, sexuality is constantly susceptible to variation of highs and lows. Ironically, as cancer treatment and detection improve, there is a greater likelihood for compromised quality of life, such as with the impact of cancer on sexuality. Nurses and patients each falsely believe that if sexuality is an important issue, the other will bring it up. Nurses are in a unique position to address the issue with patients. This chapter will help nurses become aware of the sexuality and fertility changes that can occur as a result of cancer and/or its treatment, as well as the importance of sexuality to patients. This chapter also addresses the psychological, behavioral, and physiologic components of sexuality, and gives nurses information to address these issues. Using the PLISSIT model of sexual assessment developed by Jack Annon, nurses will learn how to assess patients’ sexual and fertility concerns and learn interventions to help alleviate these concerns. ( less )

    4. 1-4

      Anorexia, Cachexia, and Taste Alterations in Patients With Cancer

      • Authors: Beth Hall, RD, CSO, LN; Jeannine Brant, PhD, APRN, AOCN®, FAAN;

      • Last Reviewed: 5/9/2016

      • Abstract: Taste and smell alterations, anorexia, and cachexia are common in patients with ... (more)

        Abstract: Taste and smell alterations, anorexia, and cachexia are common in patients with cancer and contribute to morbidity, mortality, and compromised quality of life. Although the exact mechanisms associated with these phenomena are unknown, current research sheds insight on the assessment and management of these multifactorial cancer-related syndromes. Early assessment and detection of these problems is a primary nursing responsibility. When detected, nurses should work with other team members to provide holistic management that includes comprehensive assessment, patient and family education, nutritional counseling, and novel pharmacologic and nonpharmacologic strategies to increase appetite and energy and enhance quality of life. ( less )

    5. 1-5

      Constipation and Diarrhea Management for Patients With Cancer

      • Authors: Dawn Camp-Sorrell, MSN, FNP, AOCN®; Rebecca Hawkins, MSN, ANP, AOCN®, ACHPN;

      • Last Reviewed: 4/17/2017

      • Abstract: Bowel elimination problems, such as constipation and diarrhea, are commonly occu... (more)

        Abstract: Bowel elimination problems, such as constipation and diarrhea, are commonly occurring problems and can cause distress and discomfort for the patient with cancer. Despite the availability of treatment strategies, management of these symptoms can be challenging. The key to effective nursing management strategies for bowel elimination is prevention, which begins with an in-depth assessment of normal bowel patterns. Treatment plans must be changed based on continual assessment of the patient’s response to the plan and with the goal of improving the patient’s overall quality of life. ( less )

    6. 1-6

      Oral Mucositis, Esophagitis, Xerostomia, Dysphagia in Patients With Cancer

      • Authors: Vanna Dest, MSN, APRN, BC, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Oral and mucosal effects are common in the oncology patient and can occur as a r... (more)

        Abstract: Oral and mucosal effects are common in the oncology patient and can occur as a result of the cancer, cancer treatment, or from medications used to manage side effects or other comorbid conditions. Oral complications include mucositis, esophagitis, xerostomia, and dysphagia, which can cause distress and pain with significant impact on a patient’s quality of life. Pain can cause difficulty with eating, drinking, speaking, and oral care. These debilitating side effects can cause additional complications such as altered nutrition, dehydration, infection, airway obstruction, or aspiration pneumonia. The oncology nurse is on the front line for identifying patients at risk: providing early assessment, and management of oral complications and workings with other members of the multidisciplinary team to ensure the provision of quality care. Various interventions have been suggested for prevention and treatment of these complications, so nurses must be able to discern the level of evidence among recommended interventions to individual treatment plans. Vanna M. Dest, MSN, APRN, BC, AOCN®, discusses the best practices for assessment, management, and prevention of mucositis, esophagitis, xerostomia, and dysphagia. ( less )

    7. 1-7

      Nausea and Vomiting Management for Patients With Cancer

      • Authors: Rita Wickham, PhD, RN, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Despite advances in cancer therapies and antiemetics, nausea and vomiting (N&... (more)

        Abstract: Despite advances in cancer therapies and antiemetics, nausea and vomiting (N&V) are still extremely problematic for many patients with cancer. N&V is often discussed as if it is a single problem, but uncontrolled nausea, rather than vomiting, is the larger problem in many instances. N&V is often thought to be a consequence of chemotherapy; however, it can occur with other cancer treatments including radiation therapy or surgery. Difficult-to-control nausea (and rarely intractable vomiting) that occurs with advanced cancer is often the most devastating symptom for patients. Understanding the complexity of N&V is necessary for oncology nurses to identify patients at risk and for consideration of appropriate options for individual patients. Oncology nurses need to have knowledge of both pharmacologic and nonpharmacologic interventions. Pivotal to improving the management of N&V is the education of patients and caregivers and discussion of available resources. Rita Wickham, PhD, RN, AOCN®, updates nurses on the latest evidence-based interventions to provide supportive care to patients with cancer experiencing N&V. ( less )

    8. 1-8

      Cancer-Related Genitourinary Complications

      • Authors: Gary Shelton, MSN, NP, ANP-BC, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: The genitourinary (GU) system is responsible for the creation of urine, a comple... (more)

        Abstract: The genitourinary (GU) system is responsible for the creation of urine, a complex filtration system that begins in the kidneys and is ultimately eliminated through the urethra. Mucosal surfaces and organs both directly and indirectly involved in urine passage can be affected by inflammation, irritation, and infectious processes. Symptoms and distress may promote one to seek healthcare that may lead to a diagnosis of cancer or for symptom relief that is secondary to cancer or its treatments. The key to management is prevention or early detection. An awareness of anticipated adverse effects from disease presentation, or likely sequelae of cancer treatment, leads the nurse to plan interventions for better outcomes. Although GU cancers and therapies greatly increase the risk of GU-related adverse effects, a diagnosis of any cancer and/or the implementation of any therapy/supportive care can have an impact on the GU system. Nurse assessment begins with a history and physical that can guide further assessment and query. The oncology nurse is a key participant in a patient’s care, able to educate and reassure patients that options exist for prevention and treatment, which are often successful in promoting good outcomes, better functioning, and quality of life. ( less )

    9. 1-9

      Male Sexuality and Reproduction in Patients With Cancer

      • Authors: Mary K. Hughes, RN, CNS, CT;

      • Last Reviewed: 4/1/2016

      • Abstract: Sexuality is an important quality-of-life issue for everyone, regardless of age ... (more)

        Abstract: Sexuality is an important quality-of-life issue for everyone, regardless of age or health status. All cancers can affect sexuality and intimacy, not just those affecting sexual organs. One of the reasons sexuality is not often addressed by physicians or nurses is that cancer has not been considered a chronic illness until recently. Now that patients are living longer with cancer, it is essential that quality-of-life issues be addressed. Both the nurse and the patient falsely believe that if sexuality is an important issue, the other will bring it up; nurses are in a unique position to address this with patients. This chapter will help the practitioner become aware of the sexual and fertility changes that can occur as a result of cancer and or its treatment as well as the importance of sexuality to men with cancer. It addresses the psychological and behavioral components of sexuality as well as the physiological components that give the nurse information needed to address these issues. Using Annon’s PLISSIT model of sexual assessment, the nurse can learn how to assess a patient’s sexual and fertility concerns and interventions that can alleviate these concerns. ( less )

    10. 1-10

      Metabolic Complications in Cancer Care

      • Authors: Barbara Holmes Gobel, RN, MS, AOCN®;

      • Last Reviewed: 5/9/2016

      • Abstract: Patients with cancer are at risk for developing numerous metabolic complications... (more)

        Abstract: Patients with cancer are at risk for developing numerous metabolic complications associated with cancer or its treatment. Dehydration in the patient with cancer can be caused by many factors, including nausea and vomiting, mucositis, and diarrhea. Flu-like syndrome is a constellation of symptoms that a patient may experience related to cancer treatment that mimics an influenza type of reaction. Electrolyte imbalances are common in cancer care and are often related to the administration of chemotherapy and targeted therapy or immunotherapy. Each of these problems faced by patients with cancer can affect quality of life and range from fatigue and weakness to organ damage and death. Nurses should be able to recognize these problems early to be able to intervene and better affect the outcomes for their patients. ( less )

    11. 1-11

      Cancer-Related Musculoskeletal Toxicities

      • Authors: Kathryn E. Post, APRN-BC; Loren Winters, MSN, ANP-BC, OCN®;

      • Last Reviewed: 5/10/2016

      • Abstract: Musculoskeletal complications are a common and often challenging problem in pati... (more)

        Abstract: Musculoskeletal complications are a common and often challenging problem in patients with cancer. The focus of this chapter will be on the assessment and management of arthralgia/myalgia, bone pain, fractures, osteonecrosis of the jaw, and hypercalcemia of malignancy. Musculoskeletal complications can be related to cancer treatment or to the disease. Symptoms may be acute or chronic and may vary in intensity and duration depending on the cause. If not recognized early and managed appropriately, musculoskeletal complications can lead to problems such as decreased adherence to cancer treatment, disability, decreased quality of life, and poor outcomes. An assessment for disease progression should be considered in any patient with new or severe musculoskeletal symptoms. The oncology nurse is often the first to recognize musculoskeletal complications and should be prepared to collaborate with other care team members such as the oncologist, rheumatologist, endocrinologist, orthopedic surgeon, or physical therapist for further assessment or management. The oncology nurse is in an ideal position to provide the support and education necessary to help patients with cancer manage musculoskeletal complications. ( less )

    12. 1-12

      Cancer-Related Cardiac Toxicity

      • Authors: Deborah Kirk Walker, DNP, CRNP, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Cancer patients are exposed to certain treatments including chemotherapies, targ... (more)

        Abstract: Cancer patients are exposed to certain treatments including chemotherapies, targeted therapies, and radiation to the left side of their chest that increase their risk for cardiac toxicity. Some of the more common of these toxicities include hypertension, left ventricular dysfunction, heart failure, and thromboembolic events. A patient with preexisting heart disease or other comorbid conditions are at increased risk for these cardiac effects. Initial screening and diagnostics can identify those at risk. A thorough assessment by the nurse and appropriate early intervention can help reduce the risk of cardiac toxicity or further damage to the heart. Deborah Kirk Walker, DNP, CRNP, AOCN®, describes the diagnosis and management of acute- and long-term cardiac toxicity in patients with cancer. ( less )

    13. 1-13

      Cancer-Related Hepatotoxicity

      • Authors: Marianne Davies, DNP, CNS, ACNP-BC, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: One of the most important functions of the liver is to metabolize toxic substanc... (more)

        Abstract: One of the most important functions of the liver is to metabolize toxic substances including medications. Damage can occur during this process and lead to significant hepatotoxicity. Drug-induced liver injury can be acute or chronic in nature and ranges from mild biochemical alterations to fulminant hepatic failure and death. Patients with cancer are at significant risk of hepatotoxicity and complications due to both their underlying disease state and treatment regimens, which include multiple potentially harmful drugs, irradiation, or transplant. Immunosuppression due to cancer or its treatment can also allow for reactivation of chronic viral infections, particularly hepatitis B and hepatitis C viruses, and increased risk of hepatic failure with newly acquired infections. Many herbal and dietary supplements may cause hepatotoxicity, and patients often are unaware of the risks or are reluctant to disclose the use of alternative therapies to their physicians. Oncology nursing staff is in a critical position to identify patients at risk of serious hepatotoxicity and drug-induced liver injury. ( less )

    14. 1-14

      Cancer-Related Nephrotoxicity

      • Authors: Marianne Davies, DNP, CNS, ACNP-BC, AOCNP®;

      • Last Reviewed: 4/12/2016

      • Abstract: Several cancer therapies, comorbid medical conditions, and treatments can lead t... (more)

        Abstract: Several cancer therapies, comorbid medical conditions, and treatments can lead to altered kidney functioning in patients with cancer. Acute renal injury can be life-threatening. The key to ensuring adequate kidney functioning is the prevention of injury. This begins with a thorough assessment of patients’ comorbid medical conditions, medications, and dietary history. Cancer treatment regimens must be adjusted if patients have risk factors that increase their risk of renal injury. The oncology nurse is in a critical position to educate patients about the importance of adhering to hydration and medication regimens, as well as reporting any signs and symptoms that may be of concern. ( less )

    15. 1-15

      Cancer-Related Neurological Toxicity

      • Authors: Julie Walker, MSN, RN, FNP-C;

      • Last Reviewed: 4/1/2016

      • Abstract: Neurologic complications of cancer are a major cause of morbidity in oncology pa... (more)

        Abstract: Neurologic complications of cancer are a major cause of morbidity in oncology patients and can be either acute or chronic in nature. Neurologic complications from chemotherapy and radiation therapy have been well described, but newer targeted therapy agents may also cause complications. Thus, nurses who care for patients with cancer should be alert for potential neurologic complications. The signs of neurologic compromise are often subtle and if not recognized, may lead to irreversible neurologic damage or life-threatening events. Oncology nurses are often in more frequent contact with cancer patients and may be first to be alerted to new neurologic symptoms. Oncology nurses are also critical for providing patient education about the safety and management of chronic neurologic complications of cancer. By recognizing potential hazards to patient well-being, oncology nurses provide a critical service in helping a patient to preserve and maintain optimal quality of life. Julie Walker, MSN, RN, FNP-C, provides information on common presentation and management strategies of cancer- or cancer treatment–related neurological complications: cognitive changes, peripheral neuropathy, cerebellar dysfunction, and seizures. ( less )

    16. 1-16

      Cancer-Related Pulmonary Toxicity

      • Authors: Wendy H. Vogel, MSN, FNP, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: Patients with cancer may develop pulmonary toxicity, which refers to damage of t... (more)

        Abstract: Patients with cancer may develop pulmonary toxicity, which refers to damage of the parenchymal lung. Pulmonary damage may be caused by cancer or by treatments for cancer such as surgery, radiation therapy, chemotherapy, immunotherapy, or targeted therapy. Treatment type, dose, frequency, and route can all increase a patient’s risk for pulmonary toxicity. Pulmonary toxicity may occur acutely or as a later effect, often years after cancer therapy. Complications include pneumonitis, pulmonary fibrosis, and changes in lung function. Symptoms to note include cough, wheezing, and dyspnea. Management of pulmonary symptoms is a critical aspect to improving quality of life in a patient with cancer, but the underlying cause must be addressed while alleviating symptoms. Several strategies are available to nurses for management of pulmonary toxicity, including respiratory exercises and physical aids. In this module, Wendy H. Vogel, MSN, FNP, AOCNP®, describes optimal nursing practices for assessment, intervention, and management of pulmonary toxicity in patients with cancer. ( less )

    17. 1-17

      Cancer-Related Fatigue

      • Authors: Karen Overmeyer, MSN, RN, APRN;

      • Last Reviewed: 4/1/2016

      • Abstract: Cancer-related fatigue (CRF) is among the most common and most distressing side ... (more)

        Abstract: Cancer-related fatigue (CRF) is among the most common and most distressing side effects of cancer treatment. Although some patients initially have fatigue as a part of the disease process, CRF can develop at any stage of treatment. Generally, symptoms improve after the completion of therapy, but CRF has been known to persist for months and even years beyond the end of treatment. Unlike normal tired states, CRF is persistent and can be unrelenting in its profound impact on quality of life, impairing physical performance and cognitive, psychosocial, and emotional well-being. Yet, CRF is underdiagnosed, undertreated, and generally underrecognized. Nurses are in a unique position to advocate for the use of evidence-based guidelines and valid assessment tools for timely screening, documentation, and ongoing monitoring to improve the quality of life of patients with cancer. ( less )

    18. 1-18

      Pain Management for Patients With Cancer

      • Authors: Beth Faiman, PhD, MSN, APN-BC, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Pain and the associated limitations on physical function are perhaps the most fe... (more)

        Abstract: Pain and the associated limitations on physical function are perhaps the most feared and incapacitating aspects of the cancer experience. The word “pain” comes from the Greek language and the word poinē, which means penalty or a consequence of symptoms. Many patients with cancer experience pain at some point during the course of their disease, as a result of the diagnosis or the treatment itself. Despite the knowledge of wide-ranging fear about pain among patients with cancer, physical and emotional pain remains underdiagnosed and is often not treated appropriately in patients with cancer. Undertreated pain has several consequences related to quality of life. Barriers posed by healthcare professionals themselves, the patient, and the healthcare system or organization may prevent effective pain management in patients with cancer. Nurses have an important role in recognizing and managing cancer pain. This module will highlight important components in the nursing diagnosis and management of pain as the fifth vital sign in cancer care. ( less )

    19. 1-19

      Sleep Disturbances in Patients With Cancer

      • Authors: Karen Overmeyer, MSN, RN, APRN;

      • Last Reviewed: 4/1/2016

      • Abstract: Sleep disturbances are at epidemic levels in the United States, with 30% to 33% ... (more)

        Abstract: Sleep disturbances are at epidemic levels in the United States, with 30% to 33% of persons in the general population experiencing some aspect of disrupted sleep (insomnia) or daytime sleepiness. A myriad of psychological symptoms have been associated with poor sleep, including depression, a decrease in quality of life, reduced productivity in the workplace, greater risk of accidental injuries, increased risk of diabetes and obesity, and an overall increased use of healthcare services. Among cancer patients, whose disease and treatments are associated with a host of symptomatology and side effects, sleep difficulties can compound issues that affect quality of life and further compromise daily functioning. Nurses and clinicians can positively influence these situations by routinely screening and assessing for the presence of sleep disturbances and helping to direct interventions toward improving sleep. ( less )

  2. 2. Oncologic Emergencies

    1. 2-1

      Cancer-Related Cardiac Tamponade

      • Authors: Roberta Kaplow, RN, PhD, AOCNS®, CCNS, CCRN;

      • Last Reviewed: 4/1/2016

      • Abstract: Cardiac tamponade is a life-threatening oncologic emergency characterized by a p... (more)

        Abstract: Cardiac tamponade is a life-threatening oncologic emergency characterized by a pericardial effusion that has caused hemodynamic compromise. Diagnosis of a patient with this condition can be challenging, as symptoms can be nonspecific or may not be evident until the patient has progressed from having a pericardial effusion to a cardiac tamponade. The patient’s clinical status must be assessed on a frequent basis to determine if decompensation is occurring, if the patient is responding to therapy, and if re-accumulation of pericardial fluid is taking place. Several clinical approaches are available to manage cardiac tamponade based on the patient’s clinical status and the underlying cause of the effusion. In this comprehensive point-of-care resource, Roberta Kaplow, RN, PhD, AOCNS®, CCNS, CCRN, provides insight on the cause, diagnosis, and management of cardiac tamponade in patients with cancer. ( less )

    2. 2-2

      Carotid Artery Rupture

      • Authors: Linda Schiech, RN, MSN, AOCN®, LNC;

      • Last Reviewed: 5/16/2016

      • Abstract: Carotid artery rupture is a life-threatening situation for patients with a histo... (more)

        Abstract: Carotid artery rupture is a life-threatening situation for patients with a history of head and neck cancer. Major risk factors include past treatment modalities, such as external beam radiation to the neck and surgery via a neck dissection, which can cause weakening of the artery and eventual rupture. Over the years, prevention and treatment strategies have improved, resulting in better clinical outcomes and survival rates; however, mortality remains high, and patients who survive frequently experience significant morbidity. Carotid artery rupture is a particularly important topic for oncology nurses, because they are the healthcare professionals who are typically at the bedside when rupture occurs. As a result, nurses need to recognize the risk factors and warning signs for carotid artery rupture, be prepared to act emergently to obtain treatment, and provide support to patients and their families during and after these frightening events. ( less )

    3. 2-3

      Disseminated Intravascular Coagulation

      • Authors: Carol Viele, RN, MS, OCN; Theresa A. Moran, RN, MS, FNP-C, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: Disseminated intravascular coagulation (DIC) is always caused by an underlying i... (more)

        Abstract: Disseminated intravascular coagulation (DIC) is always caused by an underlying illness. It manifests as a systemic process that results in both clotting (thrombosis) and bleeding (hemorrhage), often simultaneously. Initiating factors include exposure of blood to procoagulants such as tissue factor and cancer procoagulant; the watershed effect includes fibrin formation within the circulation, fibrinolysis, depletion of clotting factors, and end-organ damage. The treatment goal is twofold: first is the symptomatic treatment of the thrombosis and hemorrhaging, and second is the treatment of the underlying disease. Regardless of treatment, DIC is associated with high mortality, which may be attributed, in part, to the underlying disease. ( less )

    4. 2-4

      Hypercalcemia of Malignancy

      • Authors: Marcelle Kaplan, MS, RN, AOCN®, CBCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Hypercalcemia is the most common metabolic complication in patients with cancer.... (more)

        Abstract: Hypercalcemia is the most common metabolic complication in patients with cancer. It often reflects advanced disease and portends a limited life span. Recognition and timely treatment of hypercalcemia may be delayed because clinical manifestations are nonspecific and vague. Therapy is individualized based on the extent of serum calcium elevation and focuses on rehydration and inhibition of bone resorption. The oncology nurse has a key role in assessing for and managing organ system changes and in implementing treatments. In this chapter, Marcelle Kaplan, MS, RN, AOCN®, CBCN®, provides evidence-based resources for managing hypercalcemia, instituting pain relief and comfort measures, and providing emotional support to patients and caregivers. ( less )

    5. 2-5

      Hypersensitivity and Anaphylaxis

      • Authors: Marlene SanFilippo, MSN, ARNP, FNP-C, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: Drug therapies for cancer sometimes result in hypersensitivity or infusion react... (more)

        Abstract: Drug therapies for cancer sometimes result in hypersensitivity or infusion reactions that can be serious and even life threatening. As oncology nurses are the providers who most often administer antineoplastic agents, they must be prepared to promptly recognize and manage these reactions. Identifying patients who are more likely to experience hypersensitivity or infusion reactions is the first step. Reactions are not always preventable, but the effects of reactions may be minimized with premedications. Some reactions are controlled solely by interrupting the infusion, but some patients will require further interventions. Having a protocol or plan in place to assess and treat hypersensitivity and infusion reactions is essential to successful management. ( less )

    6. 2-6

      Cancer-Related Sepsis

      • Authors: Deena Damsky Dell, RN-BC, MSN, AOCN®, LNC;

      • Last Reviewed: 4/1/2016

      • Abstract: Sepsis is an important issue for oncology nurses: the diagnosis of cancer means ... (more)

        Abstract: Sepsis is an important issue for oncology nurses: the diagnosis of cancer means that immune surveillance has failed and that patients are more vulnerable to infection. Although most infections can be adequately treated, a massive overwhelming infection can cause sepsis progressing to severe sepsis, septic shock, and eventually multiple organ dysfunction syndrome. The resulting mortality from sepsis is greater than that of breast, lung, and colon cancer combined. The fact that the severity of sepsis can progress within 24 hours means that the problem is not one just for intensive care nurses. Any nurse caring for patients with cancer needs to be able to recognize the signs and symptoms of sepsis quickly and to initiate early treatment regardless of the setting in which care is being delivered. Aggressive treatment in the first 6 hours can lower mortality from sepsis. Patients who survive an episode of sepsis are at increased risk of developing organ damage, disability, and possibly cognitive impairment. Hence, primary prophylaxis remains very important. ( less )

    7. 2-7

      Spinal Cord Compression

      • Authors: Anne Marie Flaherty, MSN, APNc, AOCNS®;

      • Last Reviewed: 5/18/2016

      • Abstract: Malignant spinal cord compression (MSCC) affects up to 14% of patients with canc... (more)

        Abstract: Malignant spinal cord compression (MSCC) affects up to 14% of patients with cancer each year in the United States with global reports estimated as high as 20%. Behind brain metastasis, it is the second most common neurologic complication. It is considered a significant oncologic emergency and can have a dramatic impact on quality of life for patients. Compression of the spinal cord and nerve roots affects neurologic function, impairing sensation, mobility, and bowel and bladder control. The most prevalent symptom experienced by patients with MSCC is back pain, occurring in 95% of cases. The earlier MSCC is identified, the better the outcomes for the patient regarding neurologic function and ambulation. Nurses are vital in the early recognition and treatment of MSCC. Coordination of multiple disciplines is necessary to provide optimal care and prevent complications that can have life-altering effects for the patient with metastatic cancer. ( less )

    8. 2-8

      Superior Vena Cava Syndrome

      • Authors: Andrea Moran, APRN;

      • Last Reviewed: 4/1/2016

      • Abstract: Superior vena cava syndrome (SVCS) is rare but potentially life-threatening comp... (more)

        Abstract: Superior vena cava syndrome (SVCS) is rare but potentially life-threatening complication that may arise in association with certain cancers, indwelling vascular devices, infections, and radiation damage. Prompt identification and intervention can improve outcomes for patients at risk for SVCS or with impending or worsening symptoms of SVCS. In this chapter, Andrea Moran, APRN, provides clinical insights to help oncology nurses identify patients at highest risk for developing SVCS, recognize the signs and symptoms of SVCS, and provide the necessary supportive care to help manage patients with SVCS. ( less )

    9. 2-9

      Syndrome of Inappropriate Antidiuretic Hormone Secretion

      • Authors: Sandra E. Kurtin, RN, MS, AOCN®, ANP-C;

      • Last Reviewed: 4/2/2016

      • Abstract: Syndrome of inappropriate antidiuretic hormone secretion (SIADH; also known as s... (more)

        Abstract: Syndrome of inappropriate antidiuretic hormone secretion (SIADH; also known as syndrome of inappropriate antidiuresis) can occur in patients with cancer, particularly those with small-cell lung cancer and head and neck cancers. SIADH, one of the most common causes of hyponatremia in the absence of renal disease, can be life threatening. The nurse’s role is to carefully monitor for and report patients’ signs and symptoms of the condition, as well as to educate patients on fluid balance and sodium intake. In hospitalized patients with SIADH, the nurse must be vigilant in monitoring clinical and laboratory indicators of emergent SIADH to prevent short- and long-term complications. In this chapter, Sandra E. Kurtin, RN, MS, AOCN®, ANP-C, provides key insights into pathophysiology, causes, clinical and laboratory assessment, interventions, complications, and patient education for cancer patients with SIADH. ( less )

    10. 2-10

      Tumor Lysis Syndrome

      • Authors: Jeanne Held-Warmkessel, MSN, RN, AOCN®, ACNS-BC;

      • Last Reviewed: 12/27/2013

      • Abstract: Tumor lysis syndrome (TLS) is a potentially life-threatening complication of ant... (more)

        Abstract: Tumor lysis syndrome (TLS) is a potentially life-threatening complication of antineoplastic therapy. When cancer cells die, the intracellular contents are released into the bloodstream. The rapid influx of potassium and phosphorus, in addition to purines that are converted to uric acid, can overwhelm the renal excretory system resulting in hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia. The nurse plays a critical role in the assessment, management, and treatment of patients at risk of developing TLS. Ongoing monitoring of the cardiac, renal, and nervous systems for signs and symptoms of TLS is required. Understanding and following the treatment guidelines for the prophylaxis of patients at increased risk of TLS is crucial for minimizing potential morbidity and mortality associated with this serious complication. In this comprehensive educational resource for nurses, Jeanne Held-Warmkessel, MSN, RN, AOCN®, ACNS-BC, reviews important practice concepts on the diagnosis, prevention, and management of TLS. ( less )

  3. 3. Serious Manifestations of Cancer

    1. 3-1

      Ascites and Effusions

      • Authors: Kelley Mayden, MSN, FNP, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: The collection of fluid into tissue or a body cavity is commonly referred to as ... (more)

        Abstract: The collection of fluid into tissue or a body cavity is commonly referred to as an effusion. When fluid accumulation is due to an underlying neoplastic process, it is termed a malignant effusion. Malignancy-related effusions convey a poor prognosis and are associated with increased morbidity and mortality in patients with cancer. Common malignancy-related effusions include those of the pleural, pericardial, and peritoneal cavities. Effusion-related signs and symptoms are site-dependent and range from mild to life threatening, such as cardiac tamponade. Treatment focuses on symptom relief, palliation, and treatment of the underlying malignancy. Core nursing responsibilities in the management of patients with malignancy-related effusions include patient assessment, assistance with therapeutic procedures, patient monitoring, and patient education. In this chapter, Kelley Mayden, MSN, FNP, AOCNP®, discusses the management of pleural, pericardial, and peritoneal effusions. ( less )

    2. 3-2

      Metastases

      • Authors: Miriam P. Rogers, EdD, APRN, AOCN®, CNS;

      • Last Reviewed: 5/9/2016

      • Abstract: Metastases at diagnosis or the development of metastases later in the disease is... (more)

        Abstract: Metastases at diagnosis or the development of metastases later in the disease is an ominous sign for patients with cancer. Although there are opportunities to cure some cancers in the metastatic setting (eg, testicular cancer), most patients with metastatic cancers will not be cured. Even with the burden of metastasis, prolonged survival and improved quality of life is possible for many patients. For others whose disease cannot be slowed, the focus is on palliation of the symptoms caused by the presence of metastatic tumors in organ systems. Metastatic disease fundamentally changes the discussion of prognosis with a patient because it places the patient in stage IV disease regardless of the stage at diagnosis. Nurses have multiple roles in this setting by providing education, guidance, treatment, and care to patients and caregivers. In this module, Miriam P. Rogers, EdD, APRN, AOCN®, CNS, describes the factors that contribute to metastases as well as how to manage different types of metastases (eg, skeletal, visceral, central nervous system, cutaneous, and miscellaneous). ( less )

    3. 3-3

      Paraneoplastic Syndromes

      • Authors: Anne Zobec, MS, ANP-BC, AOCNP®;

      • Last Reviewed: 5/2/2017

      • Abstract: Paraneoplastic syndromes are rare disorders that arise from an altered immune re... (more)

        Abstract: Paraneoplastic syndromes are rare disorders that arise from an altered immune response to the presence of a malignancy. Symptoms can result from tumor secretion of hormones, peptides, or cytokines or an immune cross-reactivity between malignant and normal tissues, which can create an array of symptoms not caused by direct tumor invasion, compression, or metastasis. Tumor secretions, referred to as mediators, can have effects at remote or distant target organs. Mediators interfere with communication between cells in the body which results in abnormal or increased activity of the normal function of cells.

        Paraneoplastic syndromes may affect diverse organ systems, most notably the neurologic, endocrine, cutaneous, and rheumatologic systems. These disorders are complex and present both medical and nursing challenges. Increased awareness could lead to earlier recognition and diagnosis. Because paraneoplastic syndromes often cause considerable morbidity, nurses need to be aware of effective treatment that not only can prolong survival but also can improve patient quality of life. ( less )

  4. 4. Cancer Treatments

    1. 4-1

      Chemotherapy Principles

      • Authors: Nancy Jo Bush, RN, MN, MA, AOCN®, FAAN;

      • Last Reviewed: 12/8/2016

      • Abstract: Cancer is the uncontrolled growth of cells, combined with the malignant behavior... (more)

        Abstract: Cancer is the uncontrolled growth of cells, combined with the malignant behavior, invasion, and metastasis of these cells. Chemotherapy is the administration of drugs aimed at killing rapidly dividing cells such as cancer cells and is one of the 5 main cancer treatment modalities: surgery, radiation, chemotherapy, immunotherapy, and targeted therapy. Chemotherapeutic agents disrupt cancer cells at different points in the cell cycle to cause apoptosis. There are several classifications of chemotherapy agents with different mechanisms of action to eradicate cancer cells, thereby leading to various side effects and toxicity profiles. The nurse caring for the patient with cancer must understand how chemotherapy works to anticipate these toxicities and side effects. The nurse must also be familiar with and understand the different dosing principles of chemotherapy to ensure patient safety. This module will cover the dynamics of each chemotherapy agent, from the mechanism of action to the impact on normal tissues of the body, dosing principles of chemotherapy, and the benefits and use of concurrent therapy. ( less )

    2. 4-2

      Chemotherapy Side Effects and Adherence

      • Authors: Nancy Jo Bush, RN, MN, MA, AOCN®, FAAN;

      • Last Reviewed: 9/28/2016

      • Abstract: Education by the oncology nurse regarding the safe and efficacious use of chemot... (more)

        Abstract: Education by the oncology nurse regarding the safe and efficacious use of chemotherapy in cancer is paramount to optimal patient care. There are many drug interactions (drug–food, drug–complementary and alternative medicines, drug–drug) that can occur with chemotherapy treatment, and the nurse must understand and know when to discuss these potential interactions. Since chemotherapy is a systemic treatment that exposes rapidly proliferating normal cells to the cytotoxic effects of the drugs, patients receiving chemotherapy will experience side effects from treatment. Symptom management is critically important to keep patients on treatment and therefore achieve the best overall results of therapy. If chemotherapy toxicities are not managed appropriately, this, among other things, can lead to nonadherence. The oncology nurse has a vital role in recognizing and managing symptoms and side effects but also ensuring adherence to therapy. ( less )

    3. 4-3

      Immunotherapy in Cancer Treatment

      • Authors: Gail Wilkes, RNC, ANP-BC, MS, AOCN®;

      • Last Reviewed: 6/6/2017

      • Abstract: A rapid expansion in immunotherapy cancer research has occurred in the last 5 ye... (more)

        Abstract: A rapid expansion in immunotherapy cancer research has occurred in the last 5 years, with more than 900 clinical trials on clinicaltrials.gov in various phases for different tumor types, both solid tumors and hematologic malignancies. Significant strides in cancer immunology have been made in translating knowledge of tumor biology and immunology from the bench to the bedside for patient care. With an improved understanding of the immune system, newer strategies have been approved, such as therapeutic vaccines (eg, sipuleucel-T) and immune checkpoint inhibitors. Immunotherapy, also called biotherapy or therapy with biologic agents, can be categorized into 5 main types: (1) cytokines, (2) monoclonal antibodies, (3) vaccines, (4) immunomodulatory agents, including checkpoint inhibitors, and (5) gene therapy. The oncology nurse must understand the basics of the immune system and how immunotherapy agents work in order to educate patients on the rationale for use, efficiently incorporate these agents into the patient care armamentarium, and understand new developments that are studied and approved. Many side effects can potentially occur once the patient is at home, so patients and families also need education that is easily understandable, relevant, and engaging to promote effective, safe care. In this module, Gail Wilkes, MS, RN, RNC, ANP-BC, MS, AOCN®, provides an overview of the unique mechanisms of action of various immune-based therapies currently used to treat patients with cancer, as well as detailed descriptions of the known treatment-related toxicities of each therapy. ( less )

    4. 4-4

      Targeted Therapies

      • Authors: Gail Wilkes, RNC, ANP-BC, MS, AOCN®;

      • Last Reviewed: 7/9/2018

      • Abstract: The development of targeted therapies represents an initial step in realizing th... (more)

        Abstract: The development of targeted therapies represents an initial step in realizing the goal of individualized cancer treatment. Yet this therapy brings challenges to nurses, patients, and caregivers in terms of understanding the drugs and mechanisms of action, cost of treatment, and management of side effects. The field of targeted therapy is rapidly changing, complex, and demands that nurses understand fundamental concepts of molecular functioning in cancer to stay abreast of advances. Targeted molecular cancer therapies can interfere with cell growth signaling or tumor blood vessel development, promote the death of specific cancer cells, or interrupt the cell’s metabolism to kill cancer cells. Agents can be categorized based on the target or communication pathway blocked. The oncology nurse must understand the basics of how cancer develops (oncogenesis) and how targeted therapies block malignant pathways in order to educate patients on the rationale for use and to efficiently incorporate these agents into the patient care armamentarium. Because many potential side effects can occur once the patient is at home, patients and families also need education that is easily understandable, relevant, and engaging to promote effective, safe care. Targeted therapies are expensive, so patients should be made aware of available resources to defray costs to allow continuation with treatment or to make choices in treatment. In this module, Gail Wilkes, RNC, ANP-BC, MS, AOCN®, provides an overview of the unique mechanisms of action of the targeted therapies currently used to treat patients with cancer as well as detailed descriptions of the known treatment-related toxicities of each agent and the nurse’s role in the management of side effects. ( less )

    5. 4-5

      Radiation Therapy

      • Authors: Susan Weiss Behrend, RN, MSN, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Radiation therapy is a local/regional treatment modality that uses high specific... (more)

        Abstract: Radiation therapy is a local/regional treatment modality that uses high specificity to target the tumor, and in some cases surrounding anatomic organs at risk, while sparing normal tissue; it is used as definitive treatment or as neoadjuvant, adjuvant, or prophylactic therapy. The treatment goals of radiation include cancer cure, control, palliation, and anticipatory palliation. Simulation using 3-dimensional imaging generates complete conformal and virtual treatment planning to determine treatment and target volume. Several modalities administer external beam radiation therapy; these include intensity-modulating radiation therapy, image-guided radiation therapy, stereotactic surgery, brachytherapy, and radioimmunotherapy. Susan Weiss Behrend, RN, MSN, AOCN®, reviews multiple facets of radiation therapy to assist nurses in the management of cancer patients receiving radiation treatments. ( less )

    6. 4-6

      Hematopoietic Cell Transplantation

      • Authors: Kim Schmit-Pokorny, RN, MSN, OCN®, BMTCN;

      • Last Reviewed: 4/18/2017

      • Abstract: Hematopoietic cell transplantation (HCT) is used as a therapeutic intervention f... (more)

        Abstract: Hematopoietic cell transplantation (HCT) is used as a therapeutic intervention for many malignant and nonmalignant diseases. Stem cells are collected from bone marrow, peripheral blood, or umbilical cord blood. Patients undergo an extensive evaluation to determine eligibility for transplant. The hematopoietic cells may be harvested or collected from the patient or a relative, such as a sibling, or from an unrelated donor identified through a donor registry. Patients receive a myeloablative or nonmyeloablative conditioning regimen to eradicate the malignancy and suppress the immune system. The stem cells are infused after the conditioning regimen. Recovery and transplant side effects vary according to the source of stem cells infused and by type of donor. Nurses are essential to providing quality patient care during the entire transplant process, including long-term care of the transplant survivor. ( less )

    7. 4-7

      Surgery in Cancer Treatment

      • Authors: Joanne Lester, PhD, CRNP, AOCN®;

      • Last Reviewed: 4/12/2016

      • Abstract: Surgery is an essential component of adult oncology care. It is used as a primar... (more)

        Abstract: Surgery is an essential component of adult oncology care. It is used as a primary treatment in solid tumors, as supportive treatment in hematologic malignancies, as a strategy in cancer prevention, and as a palliative measure in later stages of disease. The history of surgery has evolved from radical surgeries with large incisions to minimally invasive surgical techniques. Minimally invasive tools include laparoscopic, computer-based, and robotic instrumentation that promote small incisions, same-day ambulation, and early discharge to home. Patients with cancer are frequently offered multiple treatment options, which include neoadjuvant chemotherapy (ie, before surgery) to shrink the tumor for less invasive surgery or removal of the related organ with reconstructive surgery for restoration when appropriate. As major caregivers to surgical patients, nurses are ideally situated to assist patients throughout the perioperative continuum—from preoperative assessment and patient education to monitoring, risk reduction, and management of surgical complications. ( less )

    8. 4-8

      Cancer-Related Complementary and Alternative Medicine

      • Authors: Georgia M. Decker, MS, RN, ANP-BC, AOCN®, FAAN;

      • Last Reviewed: 4/1/2016

      • Abstract: Patients with cancer show a sustained interest in using complementary and altern... (more)

        Abstract: Patients with cancer show a sustained interest in using complementary and alternative medicines (CAM). Various US surveys report that 50% to 83% of patients with cancer use CAM. Cancer patients use CAM for a variety of reasons, including symptom management and use of less toxic, more natural approaches. However, incorporating CAM into cancer care can make patient care more difficult. Often patients lack in-depth knowledge of CAM and believe that because a technique or preparation is natural, it must be safe to use. Research on CAM is steadily emerging, providing evidence regarding the benefits and risks of such therapies. This chapter reviews several CAM topics, including its use among cancer patients in the United States, the 8 National Cancer Institute Office of Cancer Complementary and Alternative Medicine domains for CAM and common therapies that fall within these domains, and how to assess cancer patients for their use of CAM in a nonjudgmental manner. Nurses providing care for patients with cancer should be aware of the reliable resources and practice issues associated with CAM that are detailed in this chapter. ( less )

    9. 4-9

      Clinical Trials in Oncology

      • Authors: Giselle J. Moore-Higgs, PhD, ARNP, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Clinical trials represent the primary approach for translating novel cancer trea... (more)

        Abstract: Clinical trials represent the primary approach for translating novel cancer treatments into clinical practice. Patient participation in cancer clinical trials is crucial to the advancement of cancer treatment. As care providers who interact frequently with patients, nurses play an important role in offering patients the opportunity to learn more about clinical trials. This chapter provides nurses with an overview of the clinical trial process and the roles and responsibilities of nurses caring for patients participating in a cancer clinical trial. ( less )

    10. 4-10

      Palliative Care and Hospice Care for Patients With Cancer

      • Authors: Joan Panke, MA, NP, ACHPN; Sarah Bayne, MSN, FNP-BC, ACHPN;

      • Last Reviewed: 4/1/2016

      • Abstract: Palliative care is the medical specialty devoted to the relief of patient and fa... (more)

        Abstract: Palliative care is the medical specialty devoted to the relief of patient and family suffering throughout the course of a serious illness. Palliative care includes nonhospice palliative care and hospice care. Although specific criteria limit access to hospice for some patients, nonhospice palliative care is available to patients from the time of diagnosis and throughout the disease trajectory. Many professional oncology organizations formally recognize the importance of concurrent palliative and oncology care, as well as early access to hospice care. This module will provide oncology nurses with an overview of palliative and hospice care by reviewing the 8 domains that describe the specialty: 1) structure and processes of palliative care; 2) physical aspects of care; 3) psychological, emotional, and psychiatric aspects of care; 4) social aspects of care; 5) existential, spiritual, and religious aspects of care; 6) cultural aspects of care; 7) care of the patient at the end of life, and 8) the ethical and legal aspects of care. Joan T. Panke, MA, RN, ACHPN, and Sarah Bayne, MSN, FNP-BC, ACHPN, provide nurses with an in-depth review of these 8 domains that comprise quality palliative and hospice care, along with a discussion of family-specific issues, caregiver concerns, and suggestions for improved care throughout the cancer experience. ( less )

    11. 4-11

      Considerations in the Treatment of the Older Adult with Cancer

      • Authors: Diane Cope, PhD, ARNP-BC, AOCNP®;

      • Last Reviewed: 4/1/2016

      • Abstract: The number of adults 65 years of age and older is expected to increase by 40% by... (more)

        Abstract: The number of adults 65 years of age and older is expected to increase by 40% by 2030 and double by 2050. The dramatic growth is due in part to the aging baby boomer generation and the increase in life expectancy. The older adult population has a higher incidence of cancer than any other age group. In addition, the older adult with cancer experiences age-related physiologic decline and often has other comorbidities. The oncology nurse requires specialized knowledge of both gerontology and oncology to provide care that addresses the complex needs for this unique individual and ensures quality care and positive patient outcomes. In this module, Diane G. Cope, PhD, ARNP-BC, AOCNP, describes considerations for older adult patients receiving cancer treatment. ( less )

  5. 5. Treatment Delivery Considerations

    1. 5-1

      Extravasation Management

      • Authors: Gail Wilkes, RNC, ANP-BC, MS, AOCN®;

      • Last Reviewed: 4/1/2016

      • Abstract: Vesicant extravasation is a dreaded and potentially serious complication of chem... (more)

        Abstract: Vesicant extravasation is a dreaded and potentially serious complication of chemotherapy administration. Extravasation is defined as the leakage of a drug, called a vesicant, from a vein into surrounding tissue, where it can cause necrosis. In many cases, extravasation can be prevented, but if it does occur the consequences can be minimized. The nurse’s role in extravasation includes prevention, management, and documentation. Prevention involves teaching patients about how to reduce risk and identify symptoms early, as well as how to work with nurses in the event that extravasation occurs. Management involves the implementation of appropriate measures to reduce patient, nurse, and device risks. Documentation includes a careful recording of the details of the extravasation and how it was managed. Several organizations provide guidelines and recommendations for the nursing prevention, management, and documentation of extravasation; these include: the Oncology Nursing Society, the European Oncology Nursing Society/European Society of Medical Oncologists, the American Society of Clinical Oncology, and the Intravenous Nurses Society. The Oncology Nursing Society and the American Society of Clinical Oncology collaborate to continually update safety standards for chemotherapy administration. Because tissue necrosis from extravasation can cause significant patient distress and disability, nurses who negligently administer chemotherapy are at risk for legal action. In this chapter, Gail Wilkes, RNC, MS, ANP-BC, AOCN, provides an update on the prevention, management, and consequences of extravasation as well as how documentation can protect your practice. ( less )

    2. 5-2

      Professional Standards, Quality, and Evidence-Based Practice in Oncology Nursing: Focus on Legal Implications

      • Authors: Margaret Barton-Burke , PhD, RN, FAAN;

      • Last Reviewed: 4/1/2016

      • Abstract: Oncology nursing practice demands adherence to a standard of care both legally a... (more)

        Abstract: Oncology nursing practice demands adherence to a standard of care both legally and qualitatively. Maintaining a standard of care requires knowledge of practice standards, ongoing education, quality initiatives, and, most importantly, proper documentation. Standards and quality initiatives help the staff nurse understand how nursing care affects patient outcomes. Documentation should provide evidence that patient care was provided according to the standard, and when performed accurately, can minimize legal actions against the nurse in a malpractice claim. The nurse is challenged with keeping abreast of the changes within the healthcare system that affect oncology nursing practice, especially as they relate to administration of chemotherapy and biotherapy. ( less )

    3. 5-3

      Venous Access Devices

      • Authors: Kerry Hennessy, MSN, RN, AOCN®; Susanne Conley, RN, MSN, CPON®, AOCNS®;

      • Last Reviewed: 4/1/2016

      • Abstract: Care of the patient with cancer requires reliable venous access for cancer treat... (more)

        Abstract: Care of the patient with cancer requires reliable venous access for cancer treatment and symptom management. New technology continues to evolve with venous access devices (VAD), which are considered some of the most important advances in the treatment and supportive care of patients with cancer and are integral to managing cancer patients’ care. VADs are used to access the venous system to give medications, blood products, nutrition, and to obtain blood products. VADs are available in an assortment of device designs for short-term and long-term use within the peripheral and central venous system. Short-term catheters are inserted for up to 6 weeks, which includes peripheral, midline, and nontunneled catheters. Long-term catheters are inserted for a time period greater than 6 months and are located with the tip of the catheter in the superior vena cava including peripherally inserted central catheters, tunneled catheters, and implantable ports. The oncology nurse practice must be grounded in knowledge of this expansive technology and guided by recognized professional standards of care and guidelines related to venous access. In order to minimize and prevent complications, meticulous care of VADs is required. The oncology nurse is positioned to actively participate in and influence decisions concerning patient access, promote evidence-based approaches to care, and optimize patient outcomes. In this chapter, Kerry Hennessy, RN, MSN, AOCN®, and Susanne Conley, RN, MSN, CPON®, AOCNS®, provide evidence-based recommendations for nursing care and review current standards for VADs. ( less )

  6. 6. Cancer Psychosocial Care

    1. 6-1

      Anxiety in Patients With Cancer

      • Authors: Lauren Gurschick, MSN, AGNP-BC, OCN®, CHPN;

      • Last Reviewed: 4/2/2016

      • Abstract: Anxiety is a common experience for patients with cancer, caregivers, and oncolog... (more)

        Abstract: Anxiety is a common experience for patients with cancer, caregivers, and oncology nurses. Signs and symptoms include difficulty concentrating, unrelenting worry, heart palpitations, diaphoresis, restlessness, and agitation. However, because anxiety is largely subjective, some patients may be asymptomatic. Several well-validated screening tools are available to screen for anxiety; which should be used at the time of cancer diagnosis to have a baseline measure. Additional frequent screening by interdisciplinary team members throughout the illness, during survivorship, and at the end of life is essential for optimal management of anxiety. Psychoeducation is the most effective treatment and has evidence and research to support its use. Several complementary therapies have also demonstrated a likely effect on decreasing anxiety. Nurses have frequent interaction with patients with cancer and their caregivers, so they are uniquely positioned and qualified to educate, review, and reinforce the use of pharmacologic and nonpharmacologic strategies to manage anxiety. In this module, Lauren Gurschick, MSN, AGNP-BC, OCN®, CHPN, discusses the causes, assessment, and management of anxiety. ( less )

    2. 6-2

      Caregiver Issues in Cancer

      • Authors: Kellyann Jeffries, NP;

      • Last Reviewed: 4/1/2016

      • Abstract: Caregivers are family members, friends, or community individuals who voluntarily... (more)

        Abstract: Caregivers are family members, friends, or community individuals who voluntarily provide unpaid care and support for individuals living with cancer. In doing so, they form an essential part of the patients’ network of support. Caregiving comes with many benefits, but there can also be burdens that cause strain. Nurses are experts in assessing and caring for their patients. Equally important are understanding, assessing, and providing interventions for the caregivers of oncology patients. A nurse is a primary pillar of support for caregivers of patients with cancer. Awareness of the caregiver’s coping presents opportunities to respond to anxiety, alleviate stress, and offer suggestions, thereby promoting wellness for the caregiver, and, ultimately, the patient. Assessment tools and exploring questions can help nurses identify situations in which support, education, or other resources may be needed. Resources for caregivers of patients with cancer have expanded beyond the traditional medical and social community support groups. There are now a host of online interactive sites, apps, and social media supports. Kellyann Jeffries, NP, presents practical information on caregiver strain and burden, including caregiver assessment tools and interventions to provide caregiver support. ( less )

    3. 6-3

      Depression in Patients With Cancer

      • Authors: Erika M. Rosato, RN, OCN®, MHA;

      • Last Reviewed: 4/1/2016

      • Abstract: Patients with cancer are more likely than the general population to become depre... (more)

        Abstract: Patients with cancer are more likely than the general population to become depressed and suicidal. Many factors contribute to the prevalence of depression including type of cancer, age of the patient, stage at diagnosis, as well as the patient’s personal risk factors. Depression is often undetected or undertreated because many providers and patients believe that it is a natural reaction to the diagnosis of cancer. Screening tools for depression and suicide can assist the oncology nurse in planning patient care and evaluating outcomes. Interventions including psychotherapy, medications, education, and self-care can promote recovery for the patient with cancer. Collaboration with the multidisciplinary team and family will facilitate access to resources and referrals that can assist the patient diagnosed with depression. Including patients in the planning of their care gives them an opportunity for “feeling in control” of the treatment and decision making process. The oncology nurse has an integral role in the care of the patients with cancer. Oncology nurses need to be able to accurately identify patients at risk for depression and suicide. Equally important, nurses must explore their own attitudes and beliefs regarding depression, suicide, and mortality. In this module, Erika M. Rosato, RN, OCN®, MHA, describes best nursing practices in the assessment and management of patients with depression. ( less )

    4. 6-4

      Loss and Grief

      • Authors: Susan Finn, MSN, RN, AOCNS®;

      • Last Reviewed: 4/1/2016

      • Abstract: Grief and loss is inherent in oncology due to the nature of the disease. The dia... (more)

        Abstract: Grief and loss is inherent in oncology due to the nature of the disease. The diagnosis of cancer represents physical as well as psychosocial loss. Oncology nurses consistently encounter individuals facing the prospect of loss, grief, bereavement, and mourning. The experience of grieving is uniquely individual and varies widely based on cultural, spiritual, and situational factors. The expression of grief, mourning, and bereavement includes cognitive–behavioral features as well as physiological symptoms. An understanding of these factors places the oncology staff nurse in a position to support patients, families, and multidisciplinary colleagues in this important work. ( less )

    5. 6-5

      Spirituality

      • Authors: Jen Brock, BA Psych, RN, BSN, OCN®, RYT;

      • Last Reviewed: 5/12/2016

      • Abstract: Spirituality can be considered a “vital sign” of care of a patient w... (more)

        Abstract: Spirituality can be considered a “vital sign” of care of a patient with cancer. Research is accumulating that indicates patients prefer healthcare providers ask about their spiritual or religious beliefs because they would influence the medical decisions patients would make if they became gravely ill. Conversely, patients with cancer who did not receive spiritual care become distressed, leading to depression, feelings of isolation, and decreased quality of life. Consequently, nurses should be alert for opportunities for spiritual assessment and be aware of indicators of spiritual distress. Nurses are in a unique position to encourage collaboration with multidisciplinary teams that can foster incorporation of the patient’s spiritual needs and beliefs into a holistic approach to cancer care. In this chapter, Jen Brock, BA Psych, RN/BSN-OCN, RYT, describes best practices for the identification, assessment, and management of spiritual distress to improve the quality of life of patients with cancer. ( less )

  7. 7. Survivorship Issues

    1. 7-1

      Psychosocial Issues of Cancer Survivors

      • Authors: Joni Watson, MBA, MSN, RN, OCN®;

      • Last Reviewed: 5/12/2016

      • Abstract: Given the 13.7 million US cancer survivors alive today and the expected 18 milli... (more)

        Abstract: Given the 13.7 million US cancer survivors alive today and the expected 18 million US cancer survivors by 2022, nurses in all fields of practice need to be aware of the unique physical, emotional, and practical concerns of long-term cancer survivors. Psychosocial issues experienced by cancer survivors encompass emotional and practical realms. For most survivors, distress declines throughout cancer survivorship, but some survivors do experience increased distress as a result of initial cancer treatment and various ongoing issues. In this chapter, Joni Watson, MBA, MSN, RN, OCN®, provides a comprehensive review of nursing strategies for ongoing assessment and implementation of current evidence-based guideline interventions to help ease cancer survivors’ long-term psychosocial issues. ( less )

    2. 7-2

      Health Promotion for Cancer Survivors

      • Authors: Carol Cannon, MSN, AGACNP-BC, CHPN;

      • Last Reviewed: 4/1/2016

      • Abstract: The diagnosis of cancer and its treatment can lead to many physical and psycholo... (more)

        Abstract: The diagnosis of cancer and its treatment can lead to many physical and psychological sequelae, and put patients at increased risk for poor health outcomes. As patients are living longer after a cancer diagnosis, preventing further complications and promoting wellness becomes a priority for this population. Oncology nurses are positioned to promote a healthy lifestyle to minimize complications and comorbidities in cancer survivorship. Carol Cannon, MSN, AGACNP-BC, CHPN, discusses recommendations for sun safety, tobacco cessation, diet and exercise, vaccine schedule, as well as cancer screening for cancer survivors. ( less )

    3. 7-3

      Long-term Complications of Cancer Treatment

      • Authors: Carol Cannon, MSN, AGACNP-BC, CHPN;

      • Last Reviewed: 4/1/2016

      • Abstract: Cancer treatment can lead to many physical and psychological sequelae that can o... (more)

        Abstract: Cancer treatment can lead to many physical and psychological sequelae that can occur or persist for months or years after treatment completion. More patients are living longer after a cancer diagnosis and returning to community health practices for care, so managing these symptoms poses a challenge to nurses in all fields of practice. Oncology nurses are positioned to identify possible long-term issues for patients undergoing cancer treatment. Oncology nurses are also positioned to assist in creating an accurate and comprehensive care plan for each survivor, detailing the treatment received as well as the plan for management and prevention of any health problems caused by the treatment. ( less )