Forum Replies Created
-
Posts
-
Ok, now I have heartburn over Greg’s concern that it is a game of whack-a-mole to recommend interventions for our patients. I understand. Let me clarify friends. It is always tricky to pick just two articles for a journal club. I do not always get the chance to share all the good articles on non-pharmacologic interventions nurses can recommend to patients. In an article in a very fine journal, JCO, the authors summarized what we know to be effective for treating AIMSS. This article is available here: FW: https://youtu.be/BtmtwuJzVJ8?si=SpnIkGaAYD7PvS5f or look up: Gupta A, Henry NL, Loprinzi CL. Management of Aromatase Inhibitor-Induced Musculoskeletal Symptoms. JCO Oncol Pract. 2020;16(11):733-739. doi:10.1200/OP.20.00113.
What we know works much of the time: Exercise (and in particular moving in a warm water pool at the gym or YMCA), yoga, acupuncture, Duloxetine
Here is what might work: Switching to another AI, eating more fish rich in Omega 3 fatty acids (salmon, tuna, cod, mackeral, sardines, herring, lake trout)
Patti and Greg, thank you for joining us. Could you offer two risk factors that cancer patients can have for AIMSS?
It so great to learn about your response to these articles!
Hi Everyone,
Thank you for your thoughtful responses.
@Kristin Moore, Love your thoughts…keep pushing exerice and weight control. I think we need some good studies looking at a low inflammatory diet and its effect on arthralgias…Of course a low inflammatory diet is essentially a healthy, plant based diet…more fish, chicken, fruit, veggies and whole grains and less red meat, processed food and fried food.
Will you please think twice before advocating for patients to try tart cherry juice if there are scant research findings and no randomized controlled trials on this juice and it is expensive. 🙂@Jeff, since Vitamin D is a fat soluble vitamin and therefore can be damaging when taken in supplement levels, it is best practice to urge our patients to have their primary care physician or medical oncologist check a Vitamin D level before they take Vitamin D. AND it is really, really important to stress to patients that the best way to get the necessary vitamins and minerals is to eat sources of the requirements in regular amounts, rather than take supplements unless absolutely necessary. Jeff, there are some great resources at the James to encourage patients to exercise to control arthralgia. A referral to PT for the “James Cancer Exercise Program” can be made, you can print one of our super James patient education sheets on exercise and you can just ask your patients to start walking with their caregiver for 20 minutes a day just to control stress and bingo, their pain might get better. By the way, there is research to indicate that walking/swimming or exercising in a water water pool at McConnell Heart Health Center, a gym, or a YMCA is helpful.
I hear you Amy McHale! MAYBE everyone who has read these articles can ask for 5 minutes at a unit council meeting to talk to their colleagues about what they learned and what might they might be able to do to make patients more comfortable and more adherant with their medications.
@Reena, miss you girl. I hope you are enjoying Endo and they are appreciating you. Interesting you should mention the estrogen levels decreasing over time and level of arthralgia. After 40 years of working with breast cancer patients, it really seems to me anecdotally that younger patients (with higher levels of estrogen) seem to have more arthralgia on endocrine therapy.
May I ask all of you to consider to make sure you have read the super James patient education materials which address the use of supplements. A good place to start is to read the James patient ed sheet called Cancer: Precautions for Use of Dietary/Herbal Supplements.
Amber, love your thoughts about OT…I would say yes, a referral could help. And I absolutely agree that serologic markers would be a great thing to research. It would be so neat to have a blood test that would help us determine whether a patient will be at higher risk for arthralgia and then we can be proactive in recommending intervention.
Need more information about the James cancer exercise program? Ask Katie Ashworth, PT if a member of her team can send information to your clinic or do a quick presentation at a staff meeting. It is SO important.
Can’t wait to see more discussion.
Hello, My name is Lynne Brophy and I am the breast oncology clinical nurse specialist.
I chose these articles because arthralgia is a symptom found in cancer survivors who are receiving endocrine blocking therapy but also immunotherapy used for breast and other cancers. Arthralgia is one of the symptoms associated with cancer treatment that some patients can’t live with and ask for the therapy causing arthralgia to be stopped. Here is an example:
According to Bright (2023) and others, approximately 83% of breast cancer survivors have hormone receptor positive breast cancer and therefore are offered endocrine blocking therapy. Endocrine therapy in these patients decreases the risk of recurrence up to 50%. Good odds! This therapy can cause arthralgias at different rates of incidence, depending on the agent being used and other factors. Bright and others (2023) noted that up to 40% of breast cancer survivors do not finish the prescribed 5-10 years of endocrine blocking therapy and 30% of them do not take the therapy at the dose and or interval prescribed due to painful and debilitating arthralgias. These patterns of non-adherence are associated with a 49% increase of mortality from all causes in this population.
Who better to coach a patient through addressing side effects and the importance of adherence than an oncology nurse? Let’s look at what we have learned from these articles. Here are my questions for you.
1. When assessing a patient with joint pain, what is the difference you look for to tell if the patient has potential arthritis pain in a joint or joints vs. arthralgia?
2. Tell me what patient population you work with. What risk factors for arthralgias does your patient population possess? Maybe share 2-3?
3. Name a pharmacologic intervention that has not been effective for arthralgia.
4. Name two non-pharmacologic interventions which might be effective for arthralgia.
5. Could working toward a healthy weight be helpful in arthralgia management? (By the way, working toward a healthy weight can reduce risk of cancer in the first place but can also reduce the risk of recurrence of certain cancers.)
6. What is the role of physical activity in arthralgia treatment?
7. Have you ever asked the treatment team for a referral to the James cancer exercise program (which is a PT referral with “James cancer exercise program” in the comments.FYI: Dr. Alexa Meara is a rheumatologist who is part of the division of medical oncology at The James. She is eager to see patients who are experiencing various rheumatoid like side effects such as arthralgias in our cancer survivors. Does your team know about her? Are they writing referrals to her to help our patients cope with side effects?
Looking forward to hearing from you. Lynne
Hello, my name is Lynne Brophy and I am the breast cancer clinical nurse specialist and unfortunately, related to three people who vape and have serious, chronic mental illness.
What was the knowledge gained from the article? I absolutely loved reading the article by Essenmacher, et al. the psychiatric clinical nurse specialists! Even though it made me more nervous about my relatives, I thought the tips they offered about how to speak to patients about ENDs in table 3 was great. I was not surprised about the statistics regarding people with serious mental illness/ substance use disorder who use ENDS. I have seen this. I believe it.
How will this change my practice? My patients at risk for breast cancer or with breast cancer and a risk of relapse/recurrence need to quit smoking to decrease cancer risk but also to decrease the risk of cardiovascular disease after breast cancer treatment (chemotherapy and radiation therapy, especially on the left side). I would like to try inviting our team to think about using the wording in table 3 to talk to patients. Our revised clinical practice guideline on breast surgery will ask patients to abstain from tobacco use and vaping for four weeks before surgery…so I hope this will encourage us to use our nursing expertise to encourage patients to stop using ENDS (and tobacco).
What other questions does the article raise about current practice? Per Jeff’s comments, these articles have reminded me that it is CRITICAL for James nurses to get involved in some way with legislation regarding tobacco and END use. An easy way to do that is to go to The American Cancer Society’s Cancer Action Network, here: https://www.fightcancer.org/ Sign up to get more information. Then, if you wish you can provide lobbying via phone call, email or letters to legislators OR you can join us when we travel the Ohio State house next year in person for a few hours to educate and lobby with state legislators about cancer related topics. This year, we discussed the need to ban flavorings in ENDS in Ohio to decrease the risk of young people getting interested in using an END because they taste good and are more easy to conceal at home and school.
Do you agree/disagree with the conclusions of the author, why? I agree with the authors that ENDS have not been supported as methods to stop using tobacco and therefore should not be recommended as such. I think that nurses have the opportunity to provide brief tobacco/END cessation counseling to patients and remind them of the benefits of quitting even if they already have cancer. There is plenty of data that their pulmonary health will improve at least some if they quit, in addition to many other positive effects. We just need to remember that tobacco is harder to quit than cocaine so our patients MUST be referred to the tobacco cessation clinic for support. (It would be so nice if nurses worked in this clinic as tobacco cessation counselors.).
Per Kelly’s comment about banning ENDS where tobacco is banned, I believe the James has done this. But I am not sure everyone knows that noone should be vaping in a public place. Maybe more education is needed for employees at OSU? Wondering?
Lindsey and Renee, thank you SO MUCH for sponsoring this journal club. I really appreciate it and LOVE reading my colleague’s viewpoints.
