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Accreditation/Credit Designation

Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC, designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physicians' Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669, for 1.5 Contact Hours.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AstraZeneca, Celgene Corporation, and Helsinn Therapeutics (US), Inc.

Community Practice Connections™: 2nd Annual School of Nursing Oncology™


Release Date: September 28, 2018
Expiration Date: September 28, 2019
Media: Internet - based

Activity Overview

The 2nd Annual School of Nursing Oncology™ was developed to provide the latest information on key topics in oncology that can readily be applied to nursing clinical practice in a variety of settings. This enduring activity features faculty video commentary on key topics presented at the live meeting, including strategies to help optimize patient management and insights into the evolving treatment landscape for a variety of commonly encountered malignancies. This activity will also address such topics as landmark and recent key trials in oncology, and the clinical implications of their results.

Acknowledgement of Commercial Support

This activity is supported by educational grants from AstraZeneca, Celgene Corporation, and Helsinn Therapeutics (US), Inc.

 

Instructions for This Activity and Receiving Credit

  • You will need to login to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video files” will be available for your reference.
  • In order to receive a CME certificate, participants must complete the activity.
  • Complete the posttest and pass with a score of 70% or higher, complete the evaluation and then click on request for credit. Participants may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational program is directed toward nurses interested in the management of patients with cancer. Other healthcare professionals interested in the management of patients with cancer are also invited to attend.

Learning Objectives

  • Identify recent advancements in the management of solid and hematologic malignancies
  • Describe current and emerging roles for tumor testing to guide treatment selection for patients with cancer
  • Recognize treatment-related adverse events for different malignancies
  • Apply best practices to manage and counsel patients concerning adverse events associated with therapies they receive to treat their cancer
  • Develop evidence-based supportive care strategies for patients undergoing treatment for cancer
  • Outline important disparities in care among patients with cancer

At the conclusion of this activity, you should be better prepared to:

Faculty, Staff, and Planners' Disclosures

Faculty

Grace Cherry, RN, MSN, NP
Oncology Nurse Practitioner
UCLA Melanoma Program
Los Angeles, CA
 
 

Disclosure: Consultant: Array; Speaker: Merck, Novartis

Beth Eaby-Sandy, MSN, CRNP, OCN
Thoracic Oncology Nurse Practitioner
Abramson Cancer Center
Hospital of the University of Pennsylvania
Philadelphia, PA
 

Disclosure: Consultant: AbbVie; Speaker: Takeda, AstraZeneca, Helsinn, Merck

Laura S. Wood, RN, MSN, OCN
Renal Cancer Research Coordinator
Cleveland Clinic Taussig Cancer Center
Cleveland, OH
 
 

Disclosure: Speaker: Bristol-Myers Squibb, Merck, Pfizer

The staff of Physicians' Education Resource®, LLC, (PER®) have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.
 

PER Pulse™ Recap

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PER Pulse™ Recap

KEY POINTS IN GENITOURINARY MALIGNANCIES

For patients with prostate cancer, hormone therapy may be administered, resulting in a variety of different adverse events (AEs), including diarrhea, gynecomastia, cognitive impairment, hot flashes, peripheral edema, and cardiac AEs.1 For patients with prostate or bladder cancer, the use of chemotherapy may also result in a variety of AEs, including anorexia, diarrhea, fatigue, mucositis, myelosuppression, and peripheral neuropathy. Patients with urothelial cancers should be particularly mindful of the risk for recurrent infection and special care that may be required during urinary diversion.2 For those patients who are candidates for tyrosine kinase inhibitors, potential treatment-associated AEs include anorexia, hypertension, fatigue, hypothyroidism, mucositis, elevation in liver enzyme values, diarrhea, hand-foot syndrome, arthralgia, and myelosuppression.3 Checkpoint inhibitors can also affect multiple organs and systems.4

Immunotherapy-related AEs may become severe and even life-threatening if diagnosis and appropriate treatment are delayed.5 Toxicity management is multidimensional. Patients should receive education before initiation of immunotherapy on multiple topics, including the treatment plan, the mechanism of action of immunotherapy (how it is different from chemotherapy), and potential AEs. AEs may be subtle and can develop at any time, and early communication with the oncology team is important. It is also important for nurses to be aware that the toxicity profile for the same medication may vary among different disease states. AEs such as dermatitis may also persist beyond immunotherapy treatment interruption. Genitourinary (GU) immune-related AEs include hematuria, nephritis, acute kidney injury, and chronic kidney disease. Concomitant medications should be reviewed, and any nephrotoxic agents should be changed.

With respect to other supportive and palliative care challenges, it is important for nurses to be aware that urinary tract infections may be more frequent and may require courses of antibiotics. Bisphosphonate therapy may be used in patients with prostate cancer and renal cancer, which may increase risk for osteonecrosis of the jaw. Early involvement of palliative care services should be considered, possibly even before initiation of systemic therapy. For those patients who develop brain metastases from GU cancers, treatments such as steroids may help to decrease edema and improve symptoms such as headaches, nausea, and ataxia. Stereotactic radiosurgery may also help, as well as whole-brain radiation therapy. Bone metastases may be quite painful and can be treated with tumor embolization and surgery. Bone health may be optimized for some patients with GU malignancies through use of zoledronic acid and denosumab to prevent skeletal-related events. Supplementation with calcium and vitamin D may be considered.
 

  • The emergence of new therapies for patients with GU malignancies has contributed to the complexity of patient management, and nurses should be prepared to counsel their patients on potential treatment-related AEs and address other supportive care challenges.
  • For more information on recent developments in treatment options and the management of patients with cancer, please go to: gotoper.com/online-cme-activities/cpc/cpc-sono18.

References:

    1. Hormone therapy for prostate cancer. American Cancer Society website. www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html. Revised July 18, 2018. Accessed September 10, 2018.
    2. Clifford TG, Katebian B, Van Horn CM, et al. Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients. World J Urol. 2018;36(5):775-781. doi: 10.1007/s00345-018-2181-2.
    3. Schwandt A, Wood LS, Rini B, Dreicer R. Management of side effects associated with sunitinib therapy for patients with renal cell carcinoma. Onco Targets Ther. 2009;2:51-61.
    4. Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med. 2018;378(2):158-168. doi: 10.1056/NEJMra1703481.
    5. Fecher LA, Agarwala SS, Hodi FS, Weber JS. Ipilimumab and its toxicities: a multidisciplinary approach. Oncologist. 2013;18(6):733-743. doi: 10.1634/theoncologist.2012-0483. 

 
 
2 of 3
PER Pulse™ Recap

KEY POINTS IN MELANOMA

Many patients with metastatic melanoma have BRAF mutations, and BRAF inhibitors have demonstrated clinical efficacy in melanoma with BRAF V600 mutations. These medications are often used in combination with MEK inhibitors in the care of patients with BRAF-mutated advanced melanoma. BRAF inhibitors, such as vemurafenib and dabrafenib, have been studied as monotherapy, and although patients often respond to these therapies, relapses often occur because of the emergence of drug resistance.1 The combination of encorafenib and binimetinib has recently been added to National Comprehensive Cancer Network guidelines for patients with BRAF V600-activating mutations.1

With respect to immunotherapy, therapeutic options in the adjuvant setting and for patients with metastatic or unresectable melanoma have emerged. Nivolumab and ipilimumab have been approved as adjuvant therapy, while pembrolizumab, nivolumab, ipilimumab, the combination of nivolumab and ipilimumab, and talimogene laherparepvec are all approved treatment options for patients with metastatic or unresectable melanoma.1,2

Talimogene laherparepvec is an intratumoral injection; it is an oncolytic viral therapy indicated for local treatment of unresectable cutaneous, subcutaneous, and nodal lesions in patients with melanoma following initial surgery. In a study comparing talimogene laherparepvec and GM-CSF in the treatment of patients with melanoma, the durable response rate was 16.3% in the arm treated with talimogene laherparepvec, and 2.1% in the arm treated with GM-CSF.3 In another study addressing the combination of talimogene laherparepvec and pembrolizumab, patients treated with the combination had a 62% objective response rate, as well as a 33% complete response rate.4  
 

  • Numerous treatment options for patients with advanced melanoma have demonstrated efficacy and have recently been incorporated into treatment guidelines for these patients.
  • For more information on recent developments in treatment options and the management of patients with cancer, please go to: gotoper.com/online-cme-activities/cpc/cpc-sono18.

References:

    1. Melanoma guidelines. Version 3. National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf. Published July 12, 2018. Accessed      September 7, 2018.
    2. Imlygic (talimogene laherparepvec) [prescribing information]. Thousand Oaks, CA: Amgen, Inc; 2015.  https://pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/imlygic/imlygic_pi.pdf. Accessed September 10, 2018.
    3. Andtbacka RH, Kaufman HL, Collichio F, et al. Talimogene laherparepvec improves durable response rate in patients with advanced melanoma. J Clin Oncol. 2015;33(25):2780-2788. doi: 10.1200/JCO.2014.58.3377.
    4. Ribas A, Dummer R, Puzanov I, et al. Oncolytic virotherapy promotes intratumoral T cell infiltration and improves anti-PD-1 immunotherapy [Erratum in Cell. 2018;174(4):1031-1032. doi: 10.1016/j.cell.2018.07.035]. Cell. 2017;170(6):1109-1119.e10. doi: 10.1016/j.cell.2017.08.027.

 

3 of 3
PER Pulse™ Recap

KEY POINTS IN LUNG CANCER

The majority of patients with lung cancer are diagnosed at an advanced stage of the disease and may face significant physical challenges. Chronic respiratory conditions can lead to an increase in ventilatory requirements, with muscle fatigue, reduced exercise capacity, and impaired pulmonary function. Breathlessness can also affect patient quality of life. In addition, patients with lung cancer often experience greater levels of emotional distress than those seen with other malignancies. Lung cancer is a more stigmatized disease, with association between lung cancer and smoking, and the belief that the disease is self-inflicted.1 This stigma may result in patients delaying reporting of symptoms, delayed diagnosis, poor patient-clinician communication, poor quality of life, and patient psychosocial distress, including depression and anxiety.1 Early and effective supportive and palliative care are essential to improve patient outcomes.

Prehabilitation programs may be useful in improving surgical outcomes for patients with lung cancer. Preoperatively, they are designed to enhance pulmonary function, as well as patient exercise and functional capacity. Postoperatively, they may help shorten the duration of hospitalization and reduce hospitalization costs and the incidence and severity of postoperative complications, and improve patient quality of life.2-5

The management of chemotherapy-induced nausea and vomiting (CINV) remains an item of critical importance in optimizing patient outcomes. Inadequate management of CINV leads to higher health care costs and reduction in patient quality of life. Physicians and nurses alike tend to underestimate the incidence of this adverse event. New medications and combinations of therapies have been developed to help manage CINV, and these have been incorporated into NCCN guidelines for patients receiving highly emetogenic chemotherapy and moderately emetogenic chemotherapy.6 Both patient- and chemotherapy-related risk factors may increase the risk for development of CINV, and patients must be educated regarding their individual levels of risk and how to best manage it.
Epidermal growth factor receptor inhibitors are commonly used in the treatment of patients with lung cancer, and these medications are usually well tolerated. But patients treated with these agents are susceptible to dermatologic toxicities such as papulopustular eruption, xerosis, pruritus, and paronychia, as well as mucosal and hair abnormalities.7 These are generally mild to moderate in nature, and can be managed with supportive interventions; however, dose reductions or interruptions may be required.7

  • There have been multiple recent advancements in the management of patients with lung cancer, and nurses can do a great deal to optimize patient quality of life.
  • For more information on recent developments in treatment options and the management of patients with cancer, please go to: gotoper.com/online-cme-activities/cpc/cpc-sono18.

References:

    1. Shen MJ, Hamann HA, Thomas AJ, Ostroff JS. Association between patient-provider communication and lung cancer stigma. Support Care Cancer. 2016;24(5):2093-2099. doi: 10.1007/s00520-015-3014-0.
    2. Boujibar F, Bonnevie T, Debeaumont D, et al. Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study. J Thorac Dis. 2018:10(4):2240-2248. doi: 10.21037/jtd.2018.03.161.
    3. Sebio García R, Yáñez-Brage MI, Giménez Moolhuyzen E, Salorio Riobo M, Lista Paz A, Borro Mate JM. Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial. Clin Rehabil. 2017;31(8):1057-1067. doi: 10.1177/0269215516684179.
    4. Driessen EJ, Peeters ME, Bongers BC, et al. Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: a systematic review. Crit Rev Oncol Hematol. 2017;114:63-76. doi: 10.1016/j.critrevonc.2017.03.031.
    5. Rivas-Perez H, Nana-Sinkam P. Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: a review. Respir Med. 2015;109(4):437-442. doi: 10.1016/j.rmed.2015.01.001.
    6. Guidelines for antiemesis. National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf.  Published June 11, 2018. Accessed September 11, 2018.
    7. Lacouture ME, Anadkat MJ, Bensadoun RJ, et al.; for the MASCC Skin Toxicity Study Group. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011;19(8):1079-1095. doi: 10.1007/s00520-011-1197-6.

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