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Reena, I would almost hate it if they studied the benadryl just because of all of the side effects. While PO form is not near as bad as IV, the side effects are too numerous. I would be afraid people would have a higher incidence of falls. With that being said, it does make you wonder. What about zyrtec or allegra?
Hey Patti, I didn’t realize the incidence of bone pain was that high either. Makes me feel like I should be really digging in and asking my patients how they are doing with their OBIs. Perfect time to remember would be when we are putting them on.
Hi All! My name is Holly and I work in OP JCRU. Thanks Trish for the articles! Good topic!
1. Knowledge gained? LOTS!!!
I was unaware that there were four separate theories about PIBP-expansion of bone marrow, inflammation/histamine release, afferent nerve stimulation, and osteoclast/osteoblast mediated bone resorption. They all make sense.
I was also unaware that taxane based chemotherapies could potentially cause increased pain if G-CFS received after. I wonder why?
I didn’t realize the reducing the dosage of G-CFS was an option and could potentially reduce or eliminate pain.
Finally, I also didn’t know famotidine along with loratidine was potentially more effective than loratidine alone.
2. How will this influence practice? I will definitely have patients talk to their providers about different options as to how to control this pain. I feel like it’s always just been loratidine for a few days before and a week after.
3. Other questions raised? LOTS!!!
We don’t usually recommend nsaids or acetominophen due to masking fever, but if they are effective, shouldn’t that be an option?
Why haven’t celebrex, gabapentin, pregabalin been studied for their effectiveness for this?Since this is such a prevalent issue with our patients receiving G-CFS, sounds like a lot more attention to doing research studies needs to occur.
Jeff-I went to an ASCOT review in 2023 and one of the thoracic docs was advocating for use of ENDS to stop smoking. It really surprised me since right about that time there was a big surge in adolescents ending up in ICU with severe lung issues from vaping.
Greg-I agree! It’s crazy that so many people are still using tobacco (and dying from it )after the clear link to cancers and breathing difficulties. Those companies are taking the same path with ENDS and probably will with whatever next new innovative nicotine delivery system they can come up with.
Hi All! My name is Holly Smith. I am in the outpatient float pool. Thanks Lindsay for leading the discussion!
1. Knowledge gained? I was surprised to learn that ENDS do not have to list the additive chemicals on the packaging and that they aren’t well-regulated by the FDA. Also, I wasn’t aware the Dept of Transportation banned e-cigarette use on airplanes, but allows passengers to carry them onto the plane. They also prohibit charging the batteries during flight. It seems bizarre to me that the DOT would allow this as we all know people love to break rules. Lastly, I was unaware there are so many variety of ENDS. Lastly, I know that tobacco products are big business, but it still boggles my mind that those companies are finding these new ways to get people hooked on something that is clearly bad for them. I remember my mother telling me that magazines in the 60s used to have ads stating “smoke cigarettes for your lung health”. This latest push to make E-cigs seem like they are a better alternative (without good research to back it up, I might add) is just another way to trick people into buying their products.
2. Will my practice change? I don’t believe it will. I advocate for “cold turkey” or weaning off smoking by decreasing the number of cigarettes over a period of time and having a plan in place prior to trying to stop.
3. What questions does this raise? Why aren’t ENDS more closely regulated? Are they more regulated in other countries? Why is benzene allowed to be in these when it is known to cause leukemias and other cancers?
4. Agree or disagree with authors? I agree that more research needs to be done and with as popular as ENDS are, it needs to be NOW. Especially since the tobacco companies seem to be targeting younger people.
Trish-I agree that sometimes the MMW is effective, if a patient can actually get it. Many pharmacies do not compound and I have had several instances where the patient could not get the prescription filled locally, which is a big issue when they live far away. It makes sense that OM is worsened if patients aren’t adherent to a good oral hygiene program but I could see it being a viscious cycle-pain making them not want to perform oral hygiene, esp if they don’t have access to MMW readily.
Jeff-I looked up the Benzydamine a little bit. It appears it has been used recreationally and in overdosages it acts as a deliriant and CNS stimulant. That would make sense why it wouldn’t be OTC, but it not being available in the US at all, seems silly since lots of medication in doses higher than intended can have similar side effects. Seems like some studies are warranted to determine efficacy, but unfortunately, they will have to be done outside of the US.
I also like the cryotherapy being built in to the plans. I have seen a few where it is built in, but not many.Hello all! My name is Holly Smith from ambulatory JCRU. Thanks Trish for hosting this month’s journal club!
1. Knowledge gained: I, too, was surprised that some immunotherapies such as cetuximab and pantumumab can cause OM. I guess it makes sense since they can also cause pneumonitis, colitis, etc. I personally haven’t seen it, yet. I also found it interesting that women seem to be a higher risk for OM. I also hadn’t considered that bolus chemotherapy vs. infusions over a period of time would have a better response to cryotherapy. It was also notable that there didn’t seem to be a difference in efficacy for those using cryotherapy for 2 hours vs. 6 hours, which is nice for the patient. There was a lot of really interesting little tidbits of knowledge in these articles.
2. Change or influence practice: I think that it will likely change my practice in the way that I approach teaching with my patients with regard to cryotherapy and even oral hygiene. I know that I likely stress this more when I am caring for the head and neck population, but should focus on other disease lines since this can be a bigger issue than I previously understood.
3. Questions raised: I don’t recall reading much about the prevalence and prevention of thrush in these populations, as we know it can exacerbate pain and thus interfere with nutrition, and even oral hygiene adeherence.
4. Agree or disagree: I agree with the authors that OM is a huge issue overall and more studies and better teaching would benefit patients greatly.Jeff, I totally agree. We need more education and so do our patients, especially since so many have comorbidities coinciding with their cancer which can predispose them to adverse events/reactions.
Maria! Thanks for leading this journal club!
I totally agree with you that more research is needed and why hasn’t it been done? It does make you wonder if there just hasn’t been time since there are new ones every time you turn around.Hi All! My name is Holly Smith. I also work in the outpatient JCRU.
1. What was the knowledge gained?
I feel like these articles were very eye opening and I learned a lot.
First, I did not realize that cardiac toxicities could be an issue with ICIs with the exception of a few that require ECGs or echos as listed in the plan, and that the risk increases with combination therapy.
Second, I was surprised to learn myocarditis is the most common cardiotoxicity.
Third, I was even more surprised to find out that glucocorticoid refractory events are treated with other mabs or mycophenolate.
2. Will this information change my practice?
Yes, absolutely. Many of my patients complain of fatigue or shortness of breath or maybe even have a somewhat elevated heart rate that can easily be attributed to they type/location of cancer they have, if they are retaining fluid (lung/abdominal), or if they are dehydrated because they were nauseated and/or vomiting. I will be more cognizant about taking a deeper look, rather than just assuming it is disease related or the normal side effects of therapy.
3. What other questions are raised?
As some of the others have mentioned, why isn’t cardiac clearance or cardiac “checks” more common, especially with combo therapy?Greg-We draw a lot of genetics labs at various clinics (Ambry, to name one). I too have filled out paperwork for NavDx. I wonder if some of those are just for RNA and DNA or if they are looking for liquid tumors too. Clearly a good topic to look in to. I feel like this is a big black void in my nursing knowledge.
Katie- I am questioning like you…what are we doing in our practice that may involve liquid biopsies? We draw a lot of labs that I have no idea what they are. It would be nice to clarify if the CA 125 etc are considered liquid biopsies.
Thanks Jeff for the interesting articles!
1. Knowledge gained: I too was unfamiliar with liquid biopsies. I am definitely interested in learning more about them, but must admit it reads to be pretty complicated. Seems like this could be the future of cancer screeing and I had no idea how many different methods that can be used.
2. Influence on practice: I can’t see it infuencing my practice currently (with the exception of drawing labs such as CA 125 and the like- From the “Next generation” article, I interpreted those assays as being liquid biopsies, but maybe not?), although I can envision a future where we, as nurses, could be involved in collecting liquid tumor samples as this becomes more streamline.
3. Questions raised: How involved is the James in researching this? I realize that there can be a great expense (example dPCR) with liquid biopsies, but would using liquid biopsies be cheaper in the long run if you are detecting cancer earlier and preventing multiple surgeries etc? As Katie mentioned, are we already drawing blood for liquid biopsies and dont’ even know it?
4. Agree/disagree with authors: I agree that great strides have been made with liquid biopsies and they will definitely be impactful once some of the kinks can be worked out, such as sensitivity, specificity, and expense to name a few. It could be a game changer once figured out.
