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Stephanie,
I agree with you that patient reported fatigue and weakness could stem from a patient’s additional comorbidities, such as anemia. Cardiotoxicity doesn’t immediately come to my mind during these encounters. It makes me wonder how many patients who develop cardiotoxicity from ICI are missed at The James.Kasey,
I agree, I was not aware that “all patients” who receive ICIs undergo cardiac clearance as the journal article states. Given that cardiotoxicity can be life threatening for the patient, I think it would be more than reasonable to complete a cardiac screen on all patients at The James receiving ICI.Thank you, Maria Lowe, for presenting these interesting journal articles this month!
My name is Jessica Strohschein, and I am a nurse at the James Outpatient Care New Albany.
1. What was the knowledge gained from the article?
The knowledge I gained by reading these journal articles is that Immunotherapies are the standard of care for treatment of many cancer types. Cardiotoxicity is rare adverse event, which can present with non-organ specific symptoms and become life threatening to patients receiving ICI therapy. Immune-related adverse events secondary to ICI therapy can be reversible with the aid of glucocorticoids. However, there are patients who are resistant to steroid therapy and will need additional immunosuppressive treatment.
2. Will the research/information in this article change or influence your practice? If so, how?
Yes, I see bladder cancer patients on a weekly basis who receive Bacillus Calmette-Guerin (BCG) immunotherapy treatment. The information I gained from these journal articles will change my nursing practice, because I will have an increased awareness of cardiotoxicity presenting symptoms. I will collaborate these patient-reported symptoms with the multidisciplinary team to ensure the patient receives the best cancer treatment.
3. What other questions does the article raise about current practice?
The second article focused on response of glucocorticoids given to skin cancer patients only, I would like to know how the research and statistics for other cancer types, more specifically urology cancers (my nursing specialty), receiving glucocorticoids compare to the skin cancer patients?
4. Do you agree/disagree with the conclusions of the author, why?
I agree with the conclusions of the author because collaboration with a cardiologist and oncologist is an absolute necessity for patients receiving ICI therapy. Cardiotoxicity may present as non-organ specific symptoms, so it is important to have more than one set of eyes on the patient for evaluation and treatment. I agree that more research is needed to understand predisposing factors of cardiotoxicity and how to improve patient outcomes. Also, I agree that the frequency of immune-related adverse events may be underestimated and could skew the statistics.
Jeff- Thank you for sharing these articles with us for this month’s journal club. I have never heard of liquid biopsies before, and I am interested in showing these articles to the providers on my unit and gathering their thoughts. I too am intrigued on what type of research, equipment and costs it will take to increase the sensitivity and accuracy of liquid biopsies.
Stephanie-I agree with what you said about liquid biopsies not being readily accessible or a priority for patients, when tumor cells were being reported in the peripheral blood of patients since the 1860s. With the information I gathered from the two articles, I believe we will see a time when liquid biopsies are the standard practice.
1. What was the knowledge gained from the article?
I have honestly never heard of liquid biopsies before reading these journal articles. When I thought of “liquid biopsies” I also did not picture in my mind the procedure to be performed as it was described in the articles or the cancer types it could detect. I found these articles to be incredibly fascinating! As I began reading the articles my initial thoughts were, “Wait, why aren’t we doing these in clinic?” But after I finished reading, I learned that there is still much more that needs to be researched.
2. Will the research/information in this article change or influence your practice? If so how?
Liquid biopsies are not currently being performed for my department. With that being said, I would like to present these articles to the providers on my unit and gather their opinions on this biopsy. Currently, we use the standard practice of gathering biopsy cores from the bladder, kidney, and prostate. When I educate my patients on the biopsy procedure, some patients have turned away when they hear, “You will have blood in your urine, semen and stool for up to 30 days” and “you may also experience difficulty urinating and need a catheter placed after the procedure.” Liquid biopsies could be great minimally invasive option for patients to choose.
3. What other questions does the article raise about current practice?
Liquid Biopsy price? Currently, in the urology clinic we have a test called “4k score” which is a in depth predictor on the likelihood of developing a high-grade prostate cancer. The cost of the 4k score is $700 without insurance for one tube(5ml) of blood. With the liquid biopsies, I’m assuming it is affordable to only a select few of patients.
4. Do you agree/disagree with the conclusions of the author, why?
I agree with the authors on both articles that current practice is limited and advancement in technology is necessary for early detection and multi organ cancer involvement. Liquid biopsies could hold promise for patients in the future, but more research is needed.
