A scoping review on the nurse scientist role within healthcare systems.

BACKGROUND: The role of the nurse scientist in the clinical setting is not well defined, which contributes to variability in role implementation, scope, administration, funding, and affiliation across healthcare sites. AIMS: The aim of this scoping review was to identify attributes of the clinical nurse scientist role and its operationalization in the clinical setting through available evidence. METHODS: A comprehensive, computerized search of the literature in PubMed, Medline, and CINAHL was conducted in early May 2020 by a medical research librarian and repeated in July 2021 and April 2022. The 5-step framework described by Arskey and O'Malley guided the review methodology. Two reviewers conducted an independent screen of all articles, followed by a full-text review of eligible articles by two independent reviewers each using a standardized data extraction template. Themes were then organized and synthesized using descriptive content analysis from the included articles. RESULTS: A final sample of 55 full-text articles were included in the review. Overall, the findings suggest that the nurse scientist role in a clinical setting can be challenging to implement in complex healthcare environments. Successful models include the nurse scientist in a leadership role, alignment of research with institutional priorities, and strong support from senior leadership. LINKING EVIDENCE TO ACTION: Findings suggest that standardized guidelines are lacking to govern the implementation of the nurse scientist role in the clinical setting. To succeed, the nurse scientist role must be valued and supported by organizational leaders. Further, access to resources to build infrastructure must be provided. The magnitude and scope of individual organizational support can be tailored based on the resources of the institution; however, the foundation of having institutional leadership support is critical to role success of the clinical nurse researcher.

Cardio-Oncology Considerations in Oncologic Treatment Decisions.

At JADPRO Live Virtual 2021, presenter Anecita P. Fadol, PhD, FNP-BC, FAANP, FAAN, emphasized the critical role advanced practitioners play in the identification, monitoring, and management of the cardiac complications of cancer therapy. Dr. Fadol's presentation discussed identification of the most common cardiotoxicities associated with cancer therapy, clinical considerations related to common oncologic treatments with potential cardiotoxicity that may impact cancer treatment decisions, and the management of common cardiovascular issues in patients with cancer.

Cancer treatment-related cardiac dysfunction in breast cancer survivors: A retrospective descriptive study using electronic health records from a Korean tertiary hospital.

PURPOSE: The population overlap of breast cancer and cardiovascular diseases (CVDs) has increased due to early breast cancer detection and treatment and aging population trends. Moreover, breast cancer patients are at an increased risk for CVDs consequent to cancer treatments. We aimed to understand the characteristics of breast cancer patients with pre-existing CVDs and of those diagnosed with CVDs after receiving chemotherapy, and cancer treatment-related cardiac dysfunction's occurrence among Korean breast cancer patients with CVDs. METHODS: This retrospective descriptive study, which collected clinical data from electronic health records from a Korean tertiary hospital, included 1200 female breast cancer patients with CVDs, aged 15-75 years. RESULTS: A total of 45.7% had pre-existing CVDs, and 91.6% were classified as very high-risk for cardiotoxicity in the pre-existing CVDs group. Among the 1200 breast cancer patients with CVDs, only 439 patients had left ventricular ejection fraction (LVEF) data during their cancer treatment, and 121 received baseline assessment for LVEF. Of the 439 patients with LVEF data, 134 patients have been classified into cancer treatment-related cardiac dysfunction (CTRCD), and the median period from cancer diagnosis to CTRCD occurrence was 26.5 months. CONCLUSION: Despite the high cardiotoxicity risk of breast cancer patients with pre-existing CVDs, baseline studies of the risk assessment before chemotherapy were insufficient to support the prevention and early detection of cardiotoxicity. Therefore, it is paramount to consider how nurses focus on risk stratification before chemotherapy and support the regular monitoring of breast cancer survivors' cardiac functioning, to maintain optimal health status.

Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature.

BACKGROUND: Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. AIMS: To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. DESIGN: Systematic literature review on PC in patients with HF and in patients with cancer. DATA SOURCES: Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. RESULTS: Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. CONCLUSION: The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.

An overview of a different type of cardio-oncology gathering: summary of the COMP (cardio-oncology multidisciplinary practice) meeting held in Houston Texas, January 2020.

An innovative Cardio-Oncology meeting was held in Houston, Texas in January of 2020. This gathering was intended to broaden the scope of Cardio-Oncology to include major presentations by clinicians and researchers beyond physicians, as well as to provide comprehensive reviews by established experts aimed at a variety of levels of professional practitioners. The unique perspective of this meeting is presented in the overview that follows. This overview is intended to contribute to a broader view of Cardio-Oncology, and to provide perspective for the expanding group of providers relative to their individual areas of expertise. These perspectives can and should be incorporated in cardio-oncology centers.

Addressing the Symptom Management Gap in Patients With Cancer and Heart Failure Using the Interactive Voice Response System: A Pilot Study.

Patients with cancer and concurrent heart failure (HF) have severe symptoms that may adversely affect patients' quality of life in addition to limiting effective anticancer therapy. A system of frequent monitoring could alert clinicians, providing the opportunity for timely intervention before patients become severely ill and require hospitalization. The purpose of this pilot study was to evaluate if the MD Anderson Symptom Inventory-Heart Failure (MDASI-HF) instrument preprogrammed via the interactive voice response system (IVRS) can be used to collect symptom data that will generate symptom alerts to providers based on preset severity levels. Twenty-six patients were enrolled in the study. Symptoms were monitored using the MDASI-HF delivered via IVRS on a weekly basis for 3 months. When a participant's reported symptom(s) reached critical predetermined threshold levels, an alert prompted the nurse to triage the patient's response and initiate interventions per protocol. Descriptive statistics were used to describe the ratings of symptom severity and symptom interference with daily function. Demographic and disease characteristics were summarized using means, standard deviations, ranges, count, and proportions. Paired t-tests were used to examine symptom reduction from baseline to the end of 3 months. Fourteen (54%) participants completed the study with average IVRS usage rates of 84% at 1 month and 82% at 3 months. Over the course of the IVRS monitoring, 152 IVRS calls were completed and 107 critical threshold alerts were generated, prompting physician notification, medication titration, and non-routine clinic visits. Most of these alerts were managed by telephone, particularly those related to diuretic titration, and prevented hospital readmission. Symptom monitoring via the IVRS can potentially bridge the gap in symptom management to improve clinical outcomes in patients with cancer and HF. The IVRS can be of benefit in the symptom management of patients, especially those constrained by geographic location. This can potentially improve the quality of care, patient satisfaction, and quality of life of these patients.

Management of Chemotherapy-Induced Left Ventricular Dysfunction and Heart Failure in Patients With Cancer While Undergoing Cancer Treatment: The MD Anderson Practice.

Chemotherapy-induced cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact morbidity and mortality. With a high prevalence of cardiovascular disease in cancer patients, the risk of developing HF is significantly increased. A new discipline of Onco-Cardiology has evolved to address the cardiovascular needs of patients with cancer, however, there is limited evidence-based data to guide clinical decision-making in the management of the cardiovascular complications of cancer therapy. The department of cardiology at MD Anderson Cancer Center initiated the MD Anderson Practice (MAP) project and developed algorithms to guide the management of the cardiovascular complications of cancer therapy. For chemotherapy-induced HF, we initiated the Heart Success Program (HSP), a patient-centered program that promotes interdisciplinary collaboration for the management of concurrent HF resulting from chemotherapy-induced cardiotoxicity. After one year of HSP implementation, compliance with the Center for Medicare and Medicaid Services HF core measures has significantly improved. The measurement of LVEF and initiation of recommended pharmacologic therapy for HF (angiotensin converting enzyme inhibitor [ACE-I] or angiotensin receptor blocker for ACE-I intolerant patients) has improved to 100%; provision of discharge instruction has improved from 50 to 94%; and the 30-day hospital readmission rate decreased from 40 to 27%. This article will describe the MD Anderson Practice in the management of chemotherapy-induced cardiomyopathy and HF in cancer patients through the HSP. The novelty of the HSP has raised clinician's awareness of the magnitude of the clinical problem of HF in cancer and the.

The Use of Cardiac Resynchronization Therapy in Cancer Patients with Heart Failure.

OBJECTIVES: Investigate the use of cardiac resynchronization therapy (CRT) in cancer patients with heart failure (HF); assess factors associated with ischemic and non-ischemic HF. BACKGROUND: Many newer cancer therapies are cardiotoxic; thus, the incidence of HF has been increasing in this high-risk patient population. CRT has beneficial effects on morbidity, mortality, and left ventricular function in patients with non-ischemic cardiomyopathy, yet cancer patients and survivors who develop severe HF and are eligible for CRT often do not receive it. METHODS: Review of 2 years of echocardiography and electrocardiography data from cancer patients. RESULTS: Of 272 patients meeting inclusion criteria for CRT placement (LVEF ≤35%, QRS duration ≥120 ms), 131 (48.2%) had HF with ischemic etiology and 141 (51.8%) had HF with non-ischemic etiology. Most patients had solid tumors, including breast, lung, sarcoma, and lymphoma (73.2%, n=199). Only 21.3% (58/272; 27 ischemic; 31 non-ischemic) underwent CRT placement, who were mostly women and those with solid tumors. Non-ischemic HF was significantly associated with younger age (<65 years) (OR=0.91; 95% CI=0.87-0.95) and female sex (OR=2.5; 95% CI=1.1-6.0). As expected, ischemic HF was significantly associated with history of myocardial infarction, diabetes, and cardiovascular disease. CONCLUSIONS: CRT is underutilized in cancer patients with HF. Most of the cancer patients who did not receive CRT had non-ischemic HF secondary to chemotherapy. CRT may be less utilized in those patients due to shortened life expectancy, yet evidence suggests that CRT has beneficial effects on morbidity, mortality, and left ventricular function. Its use may improve patient quality of life and allow oncologists to continue cancer treatments that could prolong survival.

Pregnancy in a patient with cancer and heart failure: challenges and complexities.

A 24-year-old African American female (L.R.) with a history of smoking and gestational diabetes was diagnosed with Hodgkin lymphoma. She received multiple chemotherapies, including six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), followed by radiation therapy to left inguinal areas for a total of 30.6 Gy in 17 fractions; she obtained complete remission. Two years later, L.R. had disease relapse in the mediastinum and received two cycles of ESHAP (etoposide, methylprednisolone, high-dose cytarabine, cisplatin) followed by etoposide and ifosfamide. She then received BEAM (carmustine, etoposide, cytarabine, and melphalan) as a conditioning regimen and underwent autologous bone marrow transplant. Her post-transplant course was complicated by cytomegalovirus antigenemia, aspergillus pneumonia, and congestive heart failure with left ventricular ejection fraction (LVEF) of 20%-25%. She was treated with an ACE inhibitor (lisinopril) and a beta-blocker (carvedilol) with improvement of her LVEF to 30%-35%. A follow-up chest x-ray showed an increase in the size of the anterior mediastinal adenopathy suspicious for relapse of lymphoma, and at the same time she was also found to be 5 weeks pregnant. Given her cardiomyopathy, significant obesity, poorly controlled diabetes, and cancer recurrence, L.R. was advised by her gynecologist that the pregnancy was very high risk and might not be viable. The oncologists advised her to terminate the pregnancy within the first trimester, as she needed salvage radiotherapy treatment to the mediastinum and chemotherapy treatments that might endanger the fetus. However, the patient decided to continue with the pregnancy. A multidisciplinary team-which included a cardiologist, oncologist, high-risk obstetrician, pharmacist, and nurse practitioner-was then involved to provide care during the pregnancy. A social worker was also solicited to help with home and financial issues because L.R. was a single mother with a 2-year-old son. L.R. was treated with carvedilol and furosemide, with monthly cardiology clinical follow-up during the first and second trimesters, then every 2 weeks starting with the 28th week, and weekly thereafter until delivery. Between visits, she notified the clinic for symptoms of heart failure exacerbation and was seen as necessary. The possible in utero effects of both medications were discussed with the patient. L.R. had a normal uncomplicated pregnancy and delivered a 6-pound, 10-ounce healthy boy at 39 weeks via vaginal delivery and was discharged home 2 days later. A week after delivery, L.R. presented to the cardiology clinic in good spirits and was excited to show pictures of her newborn baby. She had no cardiac complaints and the repeat echocardiogram showed an unchanged LVEF of 30%-35%.