CREATING A SAFE SPACE: PROTECTING ONCOLOGY PATIENTS RECEIVING CANCER TREATMENT DURING A COVID-19 INFECTION

Coordination of Care Since the COVID-19 pandemic unfolded, strains on the healthcare system have been widespread and pervasive (Kumar & Dey, 2020). At times, this crisis has put the oncology patient in a particularly unique position. As oncology care is a time-sensitive endeavor, treatment delays are critical to mitigate against and understand (Du et al., 2022). Delays or interruptions in cancer treatment can lead to progressive symptoms and worsened survival (Kumar & Dey, 2020). In addition, psychological implications for cancer patients are prominent (Dermody & Shuman, 2022). In the beginning of the pandemic, oncology patients who tested positive for COVID-19 were admitted to a respiratory isolation area in the hospital system not specialized in oncology, to provide physical separation from other vulnerable oncology patients in the cancer hospital. As a result, specialized oncologic treatments were not always available, which caused potential delays in necessary interventions. The aim of this project was to create a safe space for oncology patients, with an active COVID-19 infection, who additionally required timely oncologic treatments requiring an inpatient admission (acute leukemia, CAR T-cell administration, stem cell transplant, surgical intervention). The cancer hospital designed a 9-bed HEPA-filtrated area, with five rooms capable of being converted into ICU rooms for critically-ill patients. This area was termed the "Respiratory Isolation Flex Unit (RIFU)." Nursing leadership developed guidelines and policies around its appropriate use to ensure patient safety. Not only was a physical space required to allow for these types of admissions, but appropriate nursing specialty was vital as well. Institutional processes were developed to allow for nursing staff who were specialty trained in chemotherapy, critical care, stem cell transplant, etc. to be available for these patients. Cancer patients with a positive COVID-19 test upon admission were appropriately assigned to the RIFU and able to receive timely treatment, education, and monitoring with specialty trained nursing staff. Nursing staff had positive experiences caring for this unique patient population and collaborated to ensure a consistent "patient first" mentality. These innovative solutions allowed the cancer hospital to rise to the occasion and provide essential oncology treatments during these unprecedented times to patients with active COVID-19 infections. By preventing delays in important treatments and allowing for continued specialized care, we strived to positively impact outcomes and patient experiences.

PHYSICAL ASSESSMENT OVER TELEMEDICINE

Oncology Nursing Practice The quick utilization of telemedicine services during the COVID-19 pandemic has resulted in a paradigm shift, where patients are now taking appointments from the comfort of their homes, instead of coming into clinic. With the chance of decreased infection, telemedicine is not only beneficial to people affected by cancer, but for other high-risk populations as well. To meet the demands of the rapidly increasing volume of virtual visits, nurses need to be provided with a standard of how to perform physical assessments over telemedicine. The aim of this clinical inquiry was to synthesize evidence and turn the findings into a guide for clinical staff. A systematic search was conducted using a PICOT question and MeSH terms. Databases, filtered to include publications in English, using humans and published within the past 5 years, included CINAHL, PubMed, SCOPUS, Web of Science, and Embase. Two hundred seventy-nine articles were identified. A three-member team critically appraised them, and 27 articles were identified as keepers. These included cohort studies, systematic reviews of qualitative studies, qualitative studies, expert opinions, and one systematic review of randomized controlled trials. Synthesis of the evidence found that the most suitable physical exams over telemedicine should include focused assessments of the head, eyes, and neck, musculoskeletal, cardiac, respiratory, neurology and integumentary systems. Detailed guidance for each system was summarized and will be presented. Guidance for patient set up prior to the telemedicine visit and various opportunities for leveraging home technology for assessment is described. Final presentation will describe each system and guidance on the completion of physical assessment over telemedicine as well as patient instructions for optimizing and preparing for the visit. With the expansion of telemedicine visits, the nurse plays a significant role in conducting virtual assessments with ambulatory patients. Not only does telemedicine offer a more personal connection than telephone visits, but it also allows for healthcare providers to perform some parts of a physical exam. With that, nurses need a guide for completing physical assessments over telemedicine to ensure that appointments are maximized to its full potential. By creating a guide, the nurse is further resourced to fulfill their scope of practice on how to deliver routine care to patients and support best patient care outcomes.

The current developments in oncology nursing: A review

Cancer has become one of the major causes of death in the growing world population, affecting people irrespective of their age, sex and culture. Cancer diagnosis and therapy is a distressing procedure and affects the physical, emotional and mental well-being of the patient. Many studies have reported that cancer has a long-term impact on patient's lives leading to mood dysfunction, heart problems and chemotherapy toxicity. Modern-day healthcare systems are moving towards a patient-oriented approach and are designed around the patient's well-being, needs and preferences. Oncology nurses form the fundamental part of this system and provide the patient with the much-needed care, support and hope for life. Oncology nursing has developed and evolved briefly in the recent few decades due to the advancement in treatment procedures. As cancer care continues to progress, nurses play a vital role in the field of oncology. Specialized oncology nurses are providing clinical care, or as nurse researchers leading revolutionary oncology research. The future of oncology nursing is optimistic. Nursing care for cancer patients not only requires guidance through medication and treatment, but also offers encouragement and motivation to the patients. The present review provides an insight into the nursing care of cancer patients, its brief history, advancements and the current practices of oncology nursing. Future prospects of oncology nursing have also been discussed in detail.Copyright © 2022, Kuwait Medical Association. All rights reserved.

EVUSHELD FOR THE IMMUNOSUPPRESSED: EFFICIENT ADMINISTRATION OF PREEXPOSURE PROPHYLAXIS FOR COVID IN THE OUTPATIENT ONCOLOGY SETTING

Providing immunocompromised patients, the best defense against being infected with COVID-19 is crucial. December 2021, the FDA gave emergency use authorization (EUA) of Evusheld, the only authorized pre-exposure prophylaxis available against COVID -19. Evusheld therapy is composed of two monoclonal antibodies tixagevimab and cilgavimab and patients are recommended to receive therapy every 6 months. Early January 2022 leadership began examining how to adapt and incorporate the growing demand of Evusheld administration in high volume outpatient area in a safe and efficient manner. The purpose was to provide pre-exposure prophylaxis for prevention of COVID-19 in the oncology patient population utilizing a streamlined and efficient process. Our Fast Track unit, where injections are given and blood specimens are obtained, was determined to best be able to administer this treatment while maintaining their existing volume/census. We educated clinical providers on inclusion and exclusion criteria as approved by the Food and Drug Administration (FDA). An ordering process within the electronic medical record was built, which then enabled the patient to self-schedule the injection appointment. The treating RNs were provided education and formal in-services regarding Evusheld, which was uploaded onto the OneDrive for future reference. Since these patients were coming from different office practices, on-site nurse practitioner coverage was identified as necessary on treatment days in case of a reaction. Since January 2021 our outpatient sites have safely and efficiently administered 506, with 5 adverse reactions (0.01%), doses of Evusheld in our Fast Track unit. Ensuring communication of administration clearance is communicated in a clear and concise manner within the interdisciplinary team. Additionally, verifying the Fast Track department could absorb the ever-growing volume while not interrupting operational efficiency within the Fast Track department.

RECRUITMENT AND RETENTION OF PATIENT-PARTNER DYADS FROM A CANCER REGISTRY FOR AN E-HEALTH INTERVENTION DELIVERED IN A RANDOMIZED CONTROLLED TRIAL

Healthcare Delivery Randomized clinical trials (RCT) that test the effects of dyadic interventions often face challenges in recruitment and retention. Because most cancer-focused RCTs recruit convenience samples from local cancer centers and hospitals, little is known about recruitment and retention using a population-based cancer cohort. This study describes the recruitment and retention of patient-partner dyads using a cancer registry to obtain participants for an RCT testing the efficacy of a dyadic, tailored eHealth intervention to improve quality of life in patients with prostate cancer and their partners. This study was a two-arm, parallel groups RCT. Men who recently completed treatment for localize prostate cancer were recruited from the North Carolina Central Cancer Registry Rapid Case Ascertainment (NCCCR RCA) from April 2018 to February 2021. Notably, recruitment coincided with the COVID-19 pandemic. After receiving a list of patients from the NCCCR RCA, we mailed patients' physicians an introductory letter that included the ability to opt out if they preferred that their patient(s) not participate. Next, introductory letters were mailed to patients, who were further screened for eligibility, invited to participate, and asked for permission to contact their partner. Using the same procedure, we obtained informed consent from the partners for their study participation. After baseline assessments, patient-partner dyads were randomly assigned to the intervention or control group. Dyads completed follow-up surveys 4-, 8-, and 12-month post-baseline. Data for this report were extracted from the research administrative log and analyzed using descriptive analyses. See the Consort Diagram (Fig.i) for participant flow through the study. Of 3,078 patients referred from RCA, 2,899 were contacted for screening;2,195 partners were approached after obtaining patients' permission;280 patient-partner dyads completed baseline assessments and were randomized (enrollment rate: 12.76%;95% CI (11.39%, 14.22%);and 221 dyads completed the 12-month follow-up (retention rate: 78.93%;95% CI (73.68%, 83.56%). Referral and recruitment were significantly affected by the pandemic. Conclusions: Despite the negative impacts of the COVID-19 pandemic, we used the NCCCR RCA to achieve a recruitment rate for patient-partner dyads that was equivalent to other epidemiologic cohort studies. Our retention rate was higher than the retention rates in most dyadic intervention studies (69%). A well-functioning research team and specific strategies (e.g. eHealth intervention, Internet phone, online surveys) facilitated recruitment and retention in this population-based, dyadic study with cancer patients and their partners.

DYNAMIC, NOT PANIC: COPING WITH THE DECLINING PATIENT IN RADIATION ONCOLOGY

Professional Development Emergency situations are a part of medicine, but their unexpected nature adds to staff and patient anxiety. Cancer patients undergoing radiation alone or in combination with chemotherapy are at risk for complex adverse effects. Staff need to recognize that emergencies can present in different ways and intervene quickly and knowledgably to avoid mortality and morbidities. Evidence shows that a multidisciplinary approach is more effective in addressing these situations and critical thinking provided through simulation training is evidence-based. Although simulation shows an increase in confidence and ability to critically think during emergencies, very little information exists in the literature on the use of simulations training for oncological emergencies. When a declining patient is identified, it is essential for staff to act as a team to avert more complications and possible death. Because of this need for collaboration and to incorporate appropriate PPE due to COVID-19, simulation training and mock codes were critical components of the educational program. To improve emergency management of declining patients, a standardized educational program, including simulation training was provided to a multidisciplinary staff within the radiation oncology unit. Pre-assessment questionnaires were sent to all radiation oncology staff who cared for patients at risk for declining conditions. The training sessions were intentionally kept small to promote hands-on learning and open dialogue. Staff then had "hands on" education with simulation that included how to use, connect, and prepare emergency equipment;inventory supplies in each drawer of the "crash" carts, including medications;and understanding of roles and responsibilities. The exercise ended with all staff working together as a team to complete patient scenarios. Post-assessment questionnaires were sent to participants which confirmed an increase in confidence, critical thinking, and an increased feeling of teamwork during an emergency. Because of the small group sessions, staff reported that they felt comfortable asking specific questions and were not afraid to make mistakes. Implementation of the standardized simulation educational program proved to be effective at increasing staff confidence and teamwork during oncologic emergencies. Analysis of the data suggests that staff appreciated the opportunity to be part of the simulation experience and declining patient situations have become a team effort with delineated roles and responsibilities to ensure safe patient care.

Influence of the COVID-19 Pandemic on Adherence to Orally Administered Antineoplastics.

BACKGROUND: Several factors can influence adherence to orally administered antineoplastics, including fear or anxiety resulting from situations such as the COVID-19 pandemic. The aim of this study was to analyse the influence of these patients' experiences on adherence to orally administered antineoplastics. METHODS: Cross-sectional study in four hospitals including >18 year old cancer patients receiving orally administered antineoplastics during the first half of 2021. Data were collected from medical records and through telephone interviews. Adherence was assessed through the prescription refill records and pill counts. Patients' fear resulting from the pandemic was assessed by means of a structured questionnaire using a 5-point Likert-type scale. RESULTS: Our sample compr BARCELONAised 268 patients (54% men) with a mean age of 64 years (SD 12). More than 15% had experienced afraid and 5% had experienced a dangerous situation when attending hospital, 17% felt they had received less care, and 30% preferred telepharmacy. Adherence measured by pill count was 69.3% and 95.5% according to prescription refill records. Patients who had experienced fear or anxiety when attending hospital were less adherent (aOR 0.47, 95% CI 0.23-0.96, p = 0.039). CONCLUSION: The fear experienced by some patients has affected adherence to treatment.

Impact on the Nutritional Status and Inflammation of Patients with Cancer Hospitalized after the SARS-CoV-2 Lockdown.

Many studies have demonstrated that malnutrition has a negative impact on quality of life and mortality in patients with cancer. During the SARS-CoV-2 lockdown, dietary intake changes were detected in the Spanish population, reflecting an increase in the consumption of fruit, bread, flours, and eggs. The present study analyzed the nutritional status of 728 patients with cancer admitted once the SARS-CoV-2 lockdown finished, comparing it with the previous year as well as with mortality rates. The Malnutrition Universal Screening Tool (MUST) was applied in the first 24 h after admission. Age, gender, days of stay, circulating concentrations of albumin, cholesterol, C-reactive protein (CRP), lymphocytes, prealbumin, and mortality data were analyzed. Patients with cancer admitted between June and December of 2020 exhibited no statistical differences in BMI, age, or gender as compared to patients admitted in 2019. Statistically significant differences in nutritional status (p < 0.05), albumin (p < 0.001), and CRP (p = 0.005) levels regarding lockdown were observed in relation with a small non-significant reduction in mortality. In conclusion, following the SARS-CoV-2 lockdown, an improved nutritional status in cancer patients at admission was observed with a decrease in the percentage of weight loss and CRP levels together with an increase in albumin levels compared to oncological patients admitted the previous year.

Incidental radiological findings suggestive of COVID-19 in asymptomatic patients.

Despite routine screening of patients for coronavirus disease 2019 (COVID-19) symptoms and signs at hospital entrances, patients may slip between the cracks and be incidentally discovered to have lung findings that could indicate COVID-19 infection on imaging obtained for other reasons. Multiple case reports and case series have been published to identify the pattern of this highly infectious disease. This article addresses the radiographic findings in different imaging modalities that may be incidentally seen in asymptomatic patients who carry COVID-19. In general, findings of COVID-19 infection may appear in computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, ultrasound, or plain X-rays that show lung or only apical or basal cuts. The identification of these characteristics by radiologists and clinicians is crucial because this would help in the early recognition of cases so that a rapid treatment protocol can be established, the immediate isolation to reduce community transmission, and the organization of close monitoring. Thus, it is important to both the patient and the physician that these findings are highlighted and reported.

Impact of the COVID-19 Pandemic on Oncology Patients' Mental Health and Treatment Plans.

The COVID-19 pandemic has disrupted cancer care to a certain degree. There is objective evidence that COVID-19 outbreaks are causing substantial emotional distress among cancer patients regardless of their disease severity. This study aims to measure the levels of psychological distress, depression, and pandemic anxiety among cancer patients in Saudi Arabia during the outbreak of COVID-19 and their impact on patients' cancer treatment plans. Methods: This was a cross-sectional study conducted among oncology patients in Saudi Arabia in November of 2020. The levels of stress, depression, and anxiety symptoms during the COVID-19 outbreak were measured using the Questionnaire for Depression and Anxiety (PHQ-4), and patients were classified as depressed/distressed if the total score was 6 and above and classified as not depressed/distressed if they scored less than 6. Results: Among the sampled population, anxiety symptoms and depression were detected in 61.5% and 70.2%, respectively. Statistical analyses revealed that feeling more isolated was significant for anxiety symptoms (p = 0.005), while patients who used institutions as a source of COVID-19 information had significant depression (p = 0.010) compared to patients who accessed information from other sources. In the binary regression model, feeling more isolated than before was 3.208 times more likely to be associated with anxiety symptoms (OR = 3.208; 95% CI = 1.391-7.396; p = 0.006), while those patients who had a support institution as a source of COVID-19 information were 4.2 times more likely to be associated with depression (OR = 4.200; 95% CI = 1.328-13.280; p = 0.015). Conclusion: The COVID-19 pandemic has added to the burden on cancer patients. The increased risk of anxiety symptoms and depression was clearly demonstrated in this study. Feeling isolated had a greater impact on anxiety symptoms, while obtaining COVID-19 information from a patient support institution negatively affected depression.

A study to assess the psychosocial aspects of care for cancer patients with COVID-19 at Tata Memorial Hospital, Mumbai, India.

COVID-19 has more impact on cancer patients due to their immune compromised status. In this study, we tried to understand the impact of cancer patients afflicted with COVID-19 in the physical, emotional, vocational, financial and social domains. The patient caregivers' problems were also assessed. The investigator tailored the tool and content validity was done by the experts. Total samples were 50 and convenient sampling was used. Descriptive statistics were used and the Shapiro-Wilk's test was used for normalcy of the variables. The major findings were that the majority belonged to male population with an average annual salary. The diagnosis was hematolymphoid as the main focus compared to breast, bone, gynaecological, gastrointestinal, genitourinary and others. Patients who were receiving chemotherapy were in the majority when compared to radiation, Palliation and surgery. In the physical domain, patients experienced fatigue as a major problem most probably due to the treatment of chemotherapy. The other major problems were loss of smell, breathlessness and loss of appetite. Skin pigmentations were not experienced. In the emotional domain, the major problem was the depression they experienced during COVID-19. In the social domain, financial problems was the most important aspect and access to medication acquirement and transport during the pandemic and job securities were the other problems. Care givers felt social distancing to be a major aspect while looking after patients. They were very uncertain about the prognosis of COVID-19. The Middle age group had more emotional problems.

COVID-19 and ART: the view of the Italian Society of Fertility and Sterility and Reproductive Medicine.

The COVID-19 pandemic is an unprecedented global situation. As assisted reproductive technology (ART) specialists, we should be cautious, carefully monitoring the situation while contributing by sharing novel evidence to counsel our patients, both pregnant women and would-be mothers. Time to egg collection and drop-out rates are critical parameters for scheduling treatments once the curve of infections has peaked and plateaued in each country. In order to reduce the values for these two parameters, infertile patients now require even more support from their IVF team: urgent oocyte collection for oncology patients must be guaranteed, and oocyte retrievals for women of advanced maternal age and/or reduced ovarian reserve cannot be postponed indefinitely. This document represents the position of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) in outlining ART priorities during and after this emergency.