Redesigning and implementing a Canadian oncology nursing curriculum for an international partnership.

Cancer is one of the leading causes of death and disability globally. As a result, there is a need to provide specialized nursing care to the increasing number of complex oncology patients. Numerous healthcare centres do not have specialized oncology nursing education programs, creating an environment where oncology patients may be cared for by generalist nurses. To address this gap, advanced practice nurses in Princess Margaret Cancer Centre have redesigned a local program to provide specialized oncology education to nurses caring for oncology patients. The purpose of this article is to share the experience of redesigning and delivering a Canadian Specialized Oncology Nursing Education (SONE) program in the Middle East. The article describes learnings from an international collaborative project undertaken in Qatar.

Development of a Workshop for Malignant Hematology Nursing Education.

As part of a comprehensive orientation for nurses caring for patients with hematologic malignancies, nurses are expected to attend general corporate orientation immediately followed by hospital site-specific nursing orientation. The orientation is comprised of lectures, e-learning, and clinical observership, as well as clinical practice under supervision of a preceptor. Nurses also are expected to attend foundational courses. The goal of these courses is to consolidate practical and theoretical knowledge in a specific oncology nursing specialty. A workshop was developed that offers a unique vision by interweaving theory, practice, and patient voice.
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Tolerability of Vidaza (azacitidine) subcutaneous administration using a maximum volume of 3 ml per injection.

The azacitidine (Vidaza®) product monograph indicates that doses greater than 4 ml should be divided equally into two syringes and injected into different sites. Although 2 ml is a more commonly used maximum volume for subcutaneous injections, there is a lack of evidence to support the use of any given maximum volume with azacitidine. Applying the status quo of 2 ml to azacitidine results in patients receiving 3-4 injections per visit. This prospective study evaluated the frequency and type of injection site reactions when the maximum subcutaneous injection volume was increased from 2 to 3 ml per injection site. Among 30 patients, 309 doses were administered, and injection site reactions were noted in 92.9% of all doses, with the majority (82.2%) being grade 1; only 10.7% of doses resulted in grade 2 reactions, and there were no grade 3 or 4 reactions. There was no increase in frequency or severity of injection site reactions when the maximum volume was increased to 3 ml. The median number of injections that patients received per visit decreased from 3 to 2 after the volume was increased, and there was a statistically significant reduction in the incidence of pain. Decreasing the number of injections also facilitates ease of rotation of injection sites and decreases pharmacy preparation time. This is the first time that injection site reaction data relating to injection volume have been reported for azacitidine.

Tolerability of Velcade (Bortezomib) subcutaneous administration using a maximum volume of 3 mL per injection site.

Subcutaneous injection is now commonly used as a standard for bortezomib administration. The bortezomib (Velcade(®)) product monograph recommends that intravenous injections be prepared at a concentration of 1 mg/mL, while subcutaneous injections may be prepared at a concentration of 2.5 mg/mL. Many institutions and subcutaneous administration guidelines use 2 mL as the maximum volume for subcutaneous injection. Using 2 mL as the maximum volume for injection would mean that many patients receiving bortezomib will receive two injections during each visit with common dosing parameters. In this prospective study evaluating a change to subcutaneous administration, bortezomib 1 mg/mL was administered subcutaneously at a higher maximum of 3 mL per injection site. For 57 individual patients, 339 doses were administered. Skin reactions were noted in 42% with all reactions being Grade 1 or 2. Patients tolerated subcutaneous injections well and only four patients were switched back to intravenous route. This is the first time that subcutaneous bortezomib of a volume up to a maximum of 3 mL (bortezomib 3 mg) per injection site has been reported. This higher single dose is well tolerated with limited skin reactions, no significant hypotension and facilitates ease of administration with only 5 patients needing two injections per visit. If the maximum volume for injection was kept at 2 mL, a total of 46 patients would have received two injections per visit.