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Kasey thanks for sharing that story regarding your CTU patient. Hearing how good the patient looked verses how sick she really was is an eye opener. I recently had a patient at the Breast Center that experienced pretty significant adrenal fatigue. The patient was refusing her immunotherapy and the team discussed with her that due to her severity of adrenal fatigue, she will live with adrenal fatigue for the rest of her life. The patient was refusing her immunotherapy but the team shared with her that the damage was already done and they encouraged her to continue with the treatment. Ultimately she refused.
@ Strickland- You mentioned oncology cardiac team. Hearing we added this clinic to The James several years ago made me really want to delve deeper into cardiac related issues in Oncology. Now after reading these journals I realize that there’s more to oncology cardiology than what I thought. I would love to spend a day in that clinic and pick their brains.
Hello! My name is Katie Conrad and I am a nurse in the JCRU. Wow! I found these journals interesting to read!
1. What was the knowledge gained from the article?
Both articles are very insightful. Generally, when administering an immunotherapy I assess for inflammatory symptoms or adrenal fatigue. Now I realized I shouldn’t limit my assessment to the typical thyroid, pneumonitis, or colitis. Cardio myocarditis should be a concern as well. I also learned that ICI-associated myocarditis frequently fails to respond to steroids and other immunosuppressants. Which is pretty frighting. More importantly I learned generally myocarditis from ICI generally occurs within the first 3 months of therapy initiation and most prominently 2-4 weeks after the start of therapy. Being primarily an oncology nurse, I sometimes forget how life altering other diseases like mycocarditis can be. Myocarditis can lead to cardiomyopathy, arrhythmias, heart blocks and much more.
2. Will the research/information in this article change or influence your practice? If so, how?
Yes, I will now be more mindful of toxicities related to immunotherapies. To be honest I generally feel like patient’s tolerate immunotherapies pretty well but what I am learning is that rarely when the treatment is not tolerated well it can be pretty life altering. An example of this is adrenal fatigue. I also learned that patients with autoimmune disorders are more at risk for developing adverse effects. Because of this I will be more aware during nursing check ins and notify providers when risk factors are present. Also, I will brush up on my knowledge regarding myocarditis and things I can look for to help patients who might be experiencing that.3. What other questions does the article raise about current practice?
I am more curious now about future research on immunotherapy and adverse effects. Could things that cause inflammation be avoided resulting in better tolerance of the treatments? Would an anti-inflammatory diet help decrease the chances of adverse problems?
4. Do you agree/disagree with the conclusions of the author, why?
I agree with the authors that more research is needed regarding toxicities related to immunotherapy. As with any new treatment time will tell what things we can expect regarding patients who are on these therapies for a longer period. Also, I agree cardiac clearance should be something considered especially with patients who has a history of autoimmune disorders.
Greg you mentioned saving our patient’s time and money with liquid biopsies. I found it interesting that certain mutations like KRAS was detected in patient’s sputum up to 2 years prior. With that in mind, could you imagine how much better early detection and prescreening could be with our patients?
Jeff thanks for leading this journal club and thanks for picking an interesting topic. I agree and am also looking forward to more research in this area. When discussing this with another nurse they mentioned a patient who was recently diagnosed with colon cancer after a home colon cancer screening. Although she still had to have a colonoscopy and biopsy, she was able to identify a problem earlier and in an less invasive way. I do not know if that kit is considered a liquid biopsy but it seems to correlate with how this article describes a liquid biopsy.
1. What information did I learn?
I have to admit the term liquid biopsy is new to me and pretty interesting. After reading this article I learned a liquid biopsy utilizes blood sampling to identify cancer cells from a tumor that are circulating in the blood or for pieces of DNA from tumor cells located in the blood.
2. How will the information gained change my practice?
It is clear after reading this article that liquid biopsies are continuing to improve in accuracy and have potential to help change diagnostic standards in testing . Going forward I will seek out new information regarding liquid biopsies to better my knowledge. More specific how are the providers at the James currently using this information towards treatment. I understand there are reliability concerns, as pointed out in the article, but the more information that is studied the more we are able to utilize these tests in a less invasive way to help our patients. In the future I would like to pay closer attention to the ” why” and “how” we are currently using the test results.
3. What questions does the article raise about current practice?
Currently we check CEA 19, 125 ect from my understanding to see response to treatments. I would like to know are these labs considered liquid biopsies? More so what labs am I already checking that are liquid biopsies?4. Do you agree or disagree with the conclusions of the author, why?
Considering I have limited knowledge (outside of what was gained through this journal club) regarding liquid biopsies, I would have to agree liquid biopsies will make future impact in the oncology world. Anytime we are able to study cell breakdowns in other areas of the body the more knowledge and better treatments we can offer to patients. This is one more tool to help.
Greg you bring up a good point when you mention you do not want to be a nurse unable to enjoy retirement because of the professions physical toll on the body. The first article brings that to life so much and makes me realize that my choices I make now have profound effects on my future. I was looking into the LSA account information and found this link https://yp4h.osu.edu/resources/get-active/fitness-discounts/ which is discounted health and wellness services OSU employees can use. Wanted to share just in case someone was interested in these services and wanted a discount.
Jeff- You bring up a good point with LSA. I am happy OSU is moving a positive direction with reimbursing employees for healthier lifestyle. When there is money to specifically spend towards something I am most likely to follow through. Have you seen the mindfulness studies? I received information on one study that is starting in the Spring and involved movement and moods.
Hello! I am Katie Conrad from ambulatory JCRU.
1. Will the research/information in this article change or influence your practice? If so how?
It is a no brainer that stress is bad for one’s overall health. As pointed out in the article “Dying to retire or living to work: Challenges facing aging nurses”, stress can lead to poor immune responses, cardiovascular disease, body injuries and much more. I for one am not immune to this and am starting see very unhealthy results from adverse effects of stress on myself. I have made this my number one priority this year and both articles are strong reminders that if I would like to have a long healthy future I need to take initiative. One thing that I have looked into is joining the mindfulness study through OSU. This study involves individualized data obtained through the Oura Ring.
2. What other questions does the article raise about current practice?
Currently OSU has some supportive and resiliency programs, and I can remember going through a program called Heart Math at an outside hospital. I also can remember participating in programs here at OSU and the OSH and still struggling with resiliency. My question is does facilities look at these programs as a tool to help with resiliency or does it look at it as an answer? I say this because it seems staffing issues and higher demand for the profession contributes the most to loss of resiliency and stress.
3. What was the knowledge gained from the article?
I found a lot of information from both articles interesting specifically regarding agism. I found it interesting that the first article points out that nurses who have longer years of service can be excluded from valuable education. Perhaps managers feel that more experienced nurses are already knowledgeable in a certain subject matter and won’t benefit quit as much as an inexperienced RN. This doesn’t make sense as we all know there are new things to learn every day and expanding everyone’s knowledge should be fair and equal. I can’t say that I am shocked that more nurses will be retiring earlier. In fact, I am a little jealous. I do hope we as professionals can have open conversations regarding agism and take away all around understanding.
Lee Ann you mentioned assessing patient’s stress levels and including discussion of work-life balance. This is interesting because oftentimes I am always considering my own work-life balancing and fail to check in on my patient’s well being when it comes to work-life balance. As other’s have mentioned in this thread, people often make their identity reflective on their profession and how much work they put into their career. Oftentimes our oncology patient’s lose that sense and have very time consuming medical appointments.
Greg: I agree with your comment that work life balance looks different during different parts of our life. COVID showcased that in many circumstances. During the initial start when my son was home with me I noticed my schedule would change more towards me working weekends but quickly I felt the strain on working more during my family’s “off” time. I do feel lucky in some stance that as a nurse my schedule during that time was flexible. However, my work stress was quickly spilling over into my home life at the time and I eventually switched into a role that my schedule could be more consistent.
Hello my name is Katie Conrad and I am from the float pool.
Knowledge gained:
I gained a sense of ownership over work life balance from these articles. Lupa and Rulz-Castro’s article discusses steps to help find better work life balance. One advice that is given is self reflections and acknowledgement of issues at hand. I have found many times in my nursing career and home life where I over extend myself. The pendulum swings from one side to other making either home duties or work duties exhausting. Taking ownership over things I can control and learning from mistakes allows me to move on to a solution. In my nursing career solutions have ranged from changing schedules to changing departments. At home I have learned that it takes a village and when that village isn’t available than it is time to cut back.What other questions does the article raise about current practice?
COVID is a tricky illness that we are still learning about. I don’t know how many times I have seen isolation/quarantine changes since the start of the pandemic. One thing that I feel is straining at this time is the amount of sick time that families have had to go through. Having a daughter in daycare myself, I have felt this burden. Schools and daycares continue to require doctor’s notes for children to return making one ill call turn into multiple days. My sick bank has decreased significantly to where I have reconsidered certain vacation days which isn’t good work/life balance practices. I would like to see a COVID sick bank return.Will the research/information in this article change or influence your practice? If so how?
Yes, as someone who thrives when those around me thrive. I realize balancing work life benefits myself, my family and coworkers. This article encourages me to take it a step further and look into how balanced am I personally. Am I guilty of over extending myself in one area over the other? Of course I am but the articles also encourages me that knowing I realize this means I already on the road to fixing it.Wine.40 I didn’t realize there was a CBL for TLS. Going to look for it today. I think TLS is complex in general but to monitor for it in outpatient setting seems complicated. Michelle you bring up a good point. CTU has very rigorous scheduling that allows monitoring for such issues but what sticks after the drugs and regimens are approved?
Holly you bring up a good point. How far do we screen for TLS in outpatient setting. I was in the CTU the other day and a good bit of their patient were being screened (unsure of the med) but not so much for 5th floor chemo. Sometimes I get so used to looking for the hold parameters labs that maybe my practice should include looking at the uric acid levels more in the outpatient setting.
What was the knowledge gained from the article?
TLS has always been interesting to me. I am familiar with administering rasburicase for high uric acid but I had no idea a side effect of rasburicase was methemoglobinemia. I’ve seen methemoglobeinemia as a result from other medications like dapsone but never rasburicase. I also did not know rasburicase can cause mucositis and other side effects like nausea and neutropenia. After reading this article I sent it to a few inpatient oncology nurses I am friends with and all of us had no idea methomglobiemia was a side effect from rasburicase. I also did not know that patient with African and Mediterranean decent had a high risk to rasburicase complications.
What other questions does the article raise about current practice?
I feel currently I glance through labs and really pay attention to treatment hold labs. Example if hold for plt <100,000 than I will make sure I note the plate number. Now after reading the second article, I realize I need to be paying closer attention to uric acid levels and creatine trends.
Do you agree/disagree with the conclusions of the author, why?
I agree that tumor lysis needs monitored closely in inpatient and outpatient settings. There are many treatment plans that are switching outpatient. An example of this is HIDAC. As more and more patients are being treated outpatient, we as nurses are seeing more complex scenarios that require closer monitoring. One of them being tumor lysis and early hydration and interventions help prevent patients from poor outcomes.
