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Hello my name is Kelly Harms. I am a nurse in CTU.
1. The knowledge I gained from these articles was just the fact that these drugs cause this side effect in general, which happens in a big percentage of the patients that take them. In the first article, it stated 50% report a new onset or worsening of joint pain.
2. I can’t say it is going to change my practice in anyway as we don’t have many or any patients that are on these drugs. However, it will make more more aware if I do have someone on a AI to be more mindful in asking bout if they have joint pain present.
3. Both articles mentioned acupuncture was reported as helping arthralgia, which made me want to explore acupuncture more. I really don’t know much about it, of course I’ve heard about it helping different things, but don’t really know the mechanism as to why. Has anyone here every tried it for anything, just curious.
4. I did find the articles contradicting each other about Vitamin D supplement. The first articles stated there were benefits of this supplement while the second article stated there was no association with improvement of symptoms. Did anyone else notice this?
Lynne-I noticed you were asking about referring to PT for an exercise program. I think this would be a good route because I was thinking to myself it would be hard to motivate yourself to exercise if you are experience joint pain.
Greg-I agree with you on the interventions being mixed reviews on what works best to really help. Lynne, what ended up working best for your mom?
Michelle and Reena-
Reena, good question on why Benadryl wouldn’t help. Michelle, that is interesting background info from the GU dr RE: difference between Claritin and Benadryl.Trish-
That is a very good point about being careful with NSAIDS/Tylenol as we don’t want to mask a fever, esp when our patients are take G-CSF’s and have no white counts.Hello-
My name is Kelly Harms and I work in CTU.1. One thing that really stuck out to me was the why behind why neupogen causes bone pain, or at least the theories behind it. I knew of PIBP but didn’t understand the why. From these articles, it sounds like maybe we still aren’t totally sure, but the things described made sense to me.
2. We do not do a ton of G-CSF products in our clinic, but these articles are a good reminder that when we do get a patient taking one to make sure we are asking if they are having any issues with it, or prepping them of what to do if pain does become a problem for them.
3. I agree with the conclusions of each article in terms of there being several options to helping PIBP which include antihistamines, NSAIDS, or tylenol. With Claritin having minimal adverse side effects, I can see why this would be the first approach. When I worked in the float pool, I can’t remember which clinic it was, but Claritin was given in education with neupogen to help prevent the bone pain from occuring.
Hello, my name is Kelly. I am a nurse in CTU.
1. I found these articles extremely interesting as I often wonder if these alternatives are really that much better than smoking for people. In the second article I learned and found it alarming that it said e cigarettes emit formaldehyde which is 15 x’s greater health risks than prolonged smoking and they may also have a great pulmonary impact. I also find the statistic that 65% of patients continue to smoke after a cancer diagnosis.
3. These articles raised a lot of other questions for me, some of the same ones that were posed in both articles. Such as, should all ENDS be banned where smoking is banned? Was this just a way for nicotine companies to get their sales back up since there has been a down trend in actual smoking. I feel like they know these alternatives aren’t any better but need a way to up their sales. Especially if these get people hooked on ENDS and smoking which there is a large percentage of people that use both.
4. I agreed with the conclusion that e cigarettes should be taxed and regulated until benefits can be proven of helping people cease smoking. I also agree that the doses that are emitted should be standardized.
Jen Clark and Mindy-it is crazy that a cancer diagnosis isn’t enough to get people to stop. How many times have we heard “if I’m going to die anyway, I want to enjoy my life” when it comes to that.
Greg Goodman-you mentioned “even though I knew it was bad for me, I still smoked” The first article stated that ENDS use in the middle school and high school population increased threefold between 2013-2014. That is scary crazy to me. My daughter says she can’t go into the bathroom at school (high schooler) without someone vaping in there. Wondering if this younger generation is less aware of the dangers of smoking since the trend has kinda of slowed down?
Trish-
I agree with you that it would be nice to have the preventative measures for the high risk population on hand already rather than waiting and having to call in a prescription. Treat it almost like anticipating nausea and already having zofran/compazine etc at home.Jeff-
I agree with you and would love to know the reasoning of Benzydamine not being available in the United States.Hello, my name is Kelly Harms. I work in Clinical Treatment Unit (CTU). We do phase 1 clinical trials in the James.
1. I learned that targeted therapies can also cause OM as well as general chemo. I will admit, this is not on my radar with these therapies. With more and more treatments moving to these drugs, should this be more evaluated for these patients receiving this care?
2. I do feel like with what I have learned in above. Being more attentive and aware to any early mucosa issues with patients receiving would be important.
3. Another issue I thought of in regards to these articles, is should there be a nursing communication that automatically goes into the treatment plan when patients are receiving drugs that are common offenders of OM for cryotherapy? I might be wrong, but I don’t think there is a nursing communication. Recently, in clinical trials we had a study that included doxorubicin and given we don’t see standard of care often, it would have been helpful for the reminder for cryotherapy.
On a side note, when Stephanie Hsu replies on here…she had a specific study for prevention of OM come through CTU. I can’t remember all the specifics of it, but it was for head and neck patients receiving radiation daily.
Jeff-
I agree with you on being surprised there isn’t more cardiac clearance as well. I don’t feel like that’s even a thing with people with cardiac history, is it?Kasey-
I did not know that patient from last week was receiving an ICI. Very appropriate timing to read these articles!
Hello my name is Kelly and I work in CTU.
1. What was the knowledge gained from the article?
As mentioned from several above, we work with these drugs on such a common day to day basis, even in the CTU trial world. I too learned that cardiac toxicities are more common than I was aware for these class of drugs.
2. Will the research/information in this article change or influence your practice? If so, how?
I do feel like this will make me more aware if a patient were to mention symptoms that in the past seemed a little more benign, especially if there is cardiac history, needs reported immediately.
3. What other questions does the article raise about current practice?
One question that I thought of is -How much depth is reviewed with patients prior to start treatment about long term use of steroids if that needs to be the treatment if there are side effects? Although, with the conclusion of the second article being there need to be bigger studies done to gain more data on this topic, maybe it isn’t at forefront of mind prior to starting ICI.
Jeff- The statistic of the amount of nurses retiring by 2030 is crazy to me as well, kind of scary. I feel as though with all the negative around nursing right now, it makes me wonder, are there going to be enough new nurses that want to come into this profession to help close the gap?
Katie-You brought up a very interesting point of whether resiliency programs help or is an answer to the problem. It made me think even is it a bridge in between the two almost until staffing, etc gets better.
Hello, my name is Kelly. I am a nurse in CTU on 5 James.
1. In the article written by our own fabulous James RN’s, I found the topic of ageism interesting. I do remember when EPIC became a thing a few nurses who were close to retiring just decided to do so rather than go through the hassle of EPIC. I also can recall some nurses making comments to the effect of feeling less than. On the reverse side of the coin from ageism, I do know of experiences where the older nurses tended to “eat their prey,” when it came to the younger nurses coming into the job. It just sparked for me the idea of coming off both ends of the spectrum and looking out for each other and teamwork definitely would help both ends!
2. The article will definitely influence me on a personal level to keep taking self care important. “Nurses have a higher than average percentage of obesity, sleep problems, untreated depression, anxiety, and chronic pain….and an estimated loss of approx 5 years of life” WHAT??!! 5 years….that’s a lot. Self care is so important.
4. I agree with the conclusion of the 2nd article’s conclusion of healthcare systems should invest in the well-being of their clinicians. I am very appreciative of the hospital’s extension of the $125 lifestyle spending account. I think this is a step in the right direction to make employees feel appreciated and splurge maybe on things they wouldn’t normally like getting a massage, etc.
I forgot to say this in my first response. My name is Kelly and I work in CTU.
Michelle- I agree with you on the no standards for cooling caps. It almost seemed like patient preference on how long before and after when I would work at Mill Run, or maybe I just didn’t know enough about the process.
Greg- That’s funny you mentioned trying essential oils for your headache and it worked like magic. I guess maybe I’ve always been skeptical because it’s usually someone trying to sell me on them. But, you got to try it money-pressure free and it worked!
1. I had no idea that Martha Morehouse did a research project and published their findings! That is awesome. I will be completely honest, I’ve always been skeptical of essential oils and if they actually work. It was very interesting to see the conclusion that ginger did indeed have a positive impact for fatigue and anxiety. I also liked how they included and gave credit to the standard of care methods in this article as well.
2. A question I had from the scalp cooling article, if scalp cooling has been used since the 1970’s, how have there not been more well-designed trials by now? I found that really unbelievable.
3. Unfortunately, my unit would not come across an opportunity to use the scalp cooling caps, so I won’t be changing my practice based on the article. Working in clinical trials, which can be very specific, it would be interesting to see if any of the sponsors have any issues with using essential oils. I have never heard of it being contraindicated, but it’s not something we necessarily have thought about here.
Jeff- When you mention you would love to see hospitals more accommodating, do you have specifics in mind? Your mention of that intrigued me.
Michelle-I agree with you that the pandemic changed the lens of home life being a more team effort. Luke is now does our laundry…woohoo! But in all seriousness, what I find interesting now, is at his job, the employer is mandating people come in 2-3 x’s a week. Luke said they had the highest grossing two years during the pandemic on his team, and they were all working from home. So, as an employer, how do you not see that and re-evaluate? I think a lot of it must have to do with the fact that they are paying for office space, so it needs to be used?
Hello, Kelly here, a RN in CTU.
Will the research/information in this article change or influence your practice? If so how?
I really enjoyed the article “Work-Life Balance Is a Cycle, Not an Achievement.” I enjoyed the step by step approach it took to boil the stress down one might be feeling. I recently did this approach myself when I left the float pool (love you all still!!) I had always worked 3 days a week since graduating nursing school, and working the 4th day as silly as it sounds, seemed like a lot more. I felt more tired and more crunched for time to keep up with home things and even though for my family schedule being done at 4 was probably a little easier, mentally it wasn’t better for me.What other questions does the article raise about current practice?
As mentioned above by others, these articles aren’t geared towards the healthcare working force. I actually feel like the opposite actually happened to healthcare workers in general during the pandemic. I feel like work-life balance, probably as a whole probably was worse. Short staffing, sick staff, people working in covid units or ED’s that would isolate once they got home from their families to keep them healthy, you heard of all of that during the pandemic.Do I agree or disagree with the authors?
I found the point about the specific ages of children at home being a factor very telling. My husband had a couple of coworkers whose kids are in that lower age range, and they both definitely felt more stressed trying to work from home than his coworkers with older kids. The coworkers with the younger kids were so ready to get back to the office, even if it is only 2-3 days a week now.
