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I found this patient population had a higher likelihood of gaining weight despite exercising and diet modifications.
I didn’t see many patients on glucosamine sulfate or chondroitin sulfate when I worked with the breast cancer population. I would be curious to know if the providers don’t find the evidence to be convincing. I did see duloxetine prescribed at times.
Hello, my name is Patti, and I just started working on the James After Hour nurse line.
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? Arthritis is joint pain with inflammation so I would say it would be pain that last longer. Arthralgia is joint pain. Arthritis seems to be more than one joint in my experience.
2. Tell me what patient population you work with. What risk factors for arthralgias does your patient population possess? Maybe share 2-3? I cover all James patients including Breast Cancer patients.
3. Name a pharmacologic intervention that has not been effective for arthralgia.
Vitamin d 600 IU showed no significant difference according to the article Current and future advances in practice: aromatase inhibitor induced arthralgia.
4. Name two non-pharmacologic interventions which might be effective for arthralgia. Yoga, exercise and tai chi.
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.)
A healthy weight would be helpful when managing arthritis.
6. What is the role of physical activity in arthralgia treatment?
Physical therapy greatly decreases joint pain.
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. I have never asked for this referral. I have however asked for PT referral. This information will be useful going forward in my clinical practice.I know that tylenol and ibuprofen have a risk of masking a fever but directing the patient to take their temperature prior to taking these antipyretics would help decrease that risk.
Moore, D. C., & Pellegrino, A. E. (2017) mention that a dose reduction of pegfilgrastim can be an option to reducing the adverse side effect of bone pain. It was discussed that the risk of Febrile Neutropenia was higher for those who received the lower dose of pegfilgrastim.
Does neupogen the short acting growth factor have a lower incidence of bone pain? You may adjust dose easier with the short acting drug.Hello my name is Patti and I currently work at SSBC infusion. My breast cancer patients often receive pegfilgrastim with their chemotherapy regimens.
What was the knowledge gained from the article?
The articles provided a great review on the drug mechanism. I didn’t realize that bone pain was as prevalent as 45%. I wasn’t aware of providers suggesting famotidine as a treatment option. The breast cancer providers often recommend claritin.Will the research/information in this article change or influence your practice? If so how? I will continue to encourage the patient to use antihistamines. I will let patients know that they can use both claritin and famotidine so that bot histamine 1 and 2 receptors are blocked.
What other questions does the article raise about current practice?
I think another journal participant brought this up but What non-pharmacological methods could be used for pain management?
The SSCBC infusion patients received reiki during their infusion prior to COVID. I witnessed the benefit this had on many patients and their pain, fatigue, and anxiety.I see the providers at Sscbc using dexamethasone suspension with the severe cases. I can’t speak to whether or not patients are on chemotherapy or immune therapy. In the literature it states it would be used for immune-related mucosal toxicity.
I also found it interesting that honey made the list for management of oral mucositis.
The morphine suspension is an interesting treatment option. In my experience providers are very hesitant to prescribe any narcotics.
Hello my name is Patti (infusion nurse at SSCBC)
What was the knowledge gained from the article?
Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis provided me with a good refresher oral mucositis. I had forgotten oral mucositis causes atrophy and destruction of the mucosal lining of the mouth leading to ulcer.
Targeted and immune therapies have shown to also cause mouth sores.
Will the research/information in this article change or influence your practice? If so how?
I will assess my targeted and immune therapies for mouth sores.
Do you agree/disagree with the conclusions of the author, why?
I do agree cryotherapy helps prevent mouth sores when receiving bolus IV chemos. We recommend all of our Adriamycin patients use cryotherapy while their adria is being administered.
These articles reinforced the importance of not underestimating the potential of severe adverse side effects from receiving checkpoint inhibitors.
Kasey thank you for sharing a specific patient scenario. It truly reiterated the topics in these journal articles.
What was the knowledge gained from reading these articles?
I was unaware of the potential of cardiac toxicities with patients receiving immune checkpoint inhibitors.
I also was unaware of treatments steroid-refractory immune-related side effects from checkpoint inhibitors.
Will the research in this article change your practice? These articles reiterated the importance of a thorough assessment by the nurse and keeping providers informed of changes.
What other questions does the articles raise?
Like others have mentioned should there be any additional testing for those patients prior to initiating treatment.
I’ve seen provider obtain thyroid labs prior to starting treatment but haven’t seen any cardiac clearance. I know with trastuzumab echocardiograms are required every 3 months.I too have unfortunately witnessed ageism amongst my colleagues. After participating in this journal club I am going to be more aware of my own behavior. I will stand up for my colleagues when I witness such behavior.
I too am excited for the LSA program. I’m blessed to be in the financial position that I can use this additional money to pay for something to improve my overall health. Unfortunately, due to inflation some lower paying positions well have to use this money for cost of living, utilities.
I worry about the Patient Care Assistance that I’ve encounter in this healthcare system and whether or not they make enough to pay for their basic needs.Patti at SSCBC
1. What was the knowledge gained from the article?
It made me nervous that the average age of a nurse is in their 50’s. Does this mean we haven’t hit the bottom when it comes to the staffing shortage?
2. How will the research in the articles change current practice?
These articles have reinforced the importance of selfcare. I’ve been in this profession for almost 20 years and I have found myself setting boundaries with my employer. I work the hours I am scheduled and give my employer 110% and the rest of the week is for my family and I. I also have found leaving the unit during my lunch. When I leave and eat and take a walk it helps me to to refocus and I feel more refreshed.
3. Do you agree/disagree with the authors.
I agree with the article that healthcare is extremely stressful which in returns leads to several health issues. How often have you been given cookies or pizza as an appreciation for working hard? For nursing I’ve seen nurses over and over work 12 hours with out taking a 30 minute uninterrupted break. I challenge a healthcare system to invest in their employees and ensure they all get a 30 minute uninterrupted break and let that be their study.
