The Integration of Survivorship Care Planning at a Comprehensive Cancer Center.

Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have better coordinated follow-up care, higher overall satisfaction, and report significantly fewer posttreatment emotional concerns. The Commission on Cancer, a program of the American College of Surgeons, has developed a standard of care in which 100% of eligible patients are to receive an SCP by the end of 2019. Nurse practitioners at a National Cancer Institute (NCI)-designated academic medical center worked to develop a standardized process to deliver SCPs to all eligible patients. The primary objective of the project was to standardize how SCPs were completed and embed them into the electronic medical record (EMR) using a templated note created for the EMR. Through an interdisciplinary steering committee, survivorship priorities were established and aligned with LIVESTRONG and American Society of Clinical Oncology guidelines. In addition, survivorship care planning was identified as an essential service to be provided by all cancer disease management groups (DMG) at the cancer center. A cancer SCP subcommittee was formed to explore methods to expand the delivery of SCPs and standardize the SCP process. Prior to this project, SCPs were being done by less than 10% of the providers and only for a few diagnoses, and no standardized method of documentation existed prior to this quality improvement initiative. The standardization of the SCP has increased both participation of other DMGs as well as increased the rate of completion to 34%. We believe that continuous reassessment and process improvement will help us reach the Commission on Cancer goal of providing SCPs to all eligible patients.

A pilot study of activity engagement in the first six months after stem cell transplantation.

UNLABELLED: PRPOSE/OBJECTIVES: to describe the natural pace and pattern of activity resumption in the first six months after stem cell transplantation (SCT). DESIGN: longitudinal, descriptive survey. SETTING: bone marrow transplantation program of a National Cancer Institute-designated comprehensive cancer center in the northeastern United States. SAMPLE: 18 men and 18 women who underwent either autologous (83%) or allogeneic (17%) transplantation. METHODS: participants were surveyed 30 days, 100 days, and six months after SCT. Descriptive statistics were followed by exploratory linear mixed modeling with factors of time, gender, and the interaction between time and gender. MAIN RESEARCH VARIABLES: a modified checklist version of the Activity Card Sort was used to measure activity retention. FINDINGS: participants generally were performing 49% of their usual activities 30 days after transplantation, 70% of their premorbid activities 100 days after transplantation, and 77% of their premorbid activities six months after transplantation. Level of activity engagement increased over time, with the greatest changes observed from 30-100 days after SCT. Men retained more of their activities than women in the domains of low physical-demand leisure and social activities. CONCLUSIONS: rehabilitation screening may be most helpful in the period from 100 days to six months, when activity levels begin to plateau. Activity recovery may differ for men and women; future research should explore how this could affect rehabilitation needs. IMPLICATIONS FOR NURSING: nurses can use structured surveys to explore and promote patients' satisfaction with and ability to engage in daily activities and ensure appropriate referrals to rehabilitation during recovery from SCT.

Putting evidence into practice: prevention and management of bleeding in patients with cancer.

The primary cause of bleeding in patients with cancer is thrombocytopenia and it commonly is attributed to myelosuppressive chemotherapy, radiation therapy, or bone marrow infiltration of the malignancy. Oncology nurses have a critical role to play in the prevention and management of bleeding in patients with cancer. As part of an Oncology Nursing Society Putting Evidence Into Practice (PEP) project team, the authors of this article reviewed the current literature to identify effective interventions in the prevention and management of bleeding in patients with cancer. The authors evaluated research studies conducted since 1991, current clinical practice guidelines, and systematic reviews. The literature was reviewed, synthesized, and developed into evidence tables that were ultimately published in a PEP card. All data were reviewed by experts in the field of thrombocytopenia. The Prevention of Bleeding PEP card was unveiled at the 8th Annual Institutes of Learning in November 2007.

Alemtuzumab (Campath 1-H).

Alemtuzumab is an exciting targeted therapy for patients with CD52-sensitive malignancies. The drug is being used in a variety of hematologic malignancies in different dosing schedules and different routes of administration. The Cancer and Leukemia Group B is conducting a study using alemtuzumab as consolidation treatment for patients with B-CLL. The group also is conducting a phase I and II dose-escalation study using alemtuzumab during intensification therapy in adults with untreated acute lymphoblastic leukemia. A national pharmaceutical protocol is actively accruing participants for a trial in which alemtuzumab is used in combination with fludarabine for relapsed and refractory B-CLL. The SQ route of administration is gaining popularity because it is highly effective with fewer side effects than IV infusions. Nurses administering alemtuzumab are in a unique position to ensure patient safety and tolerance of the therapy. By understanding the mechanism of action and the potential complications associated with alemtuzumab, nurses will be better able to provide optimal care to patients as the use of targeted monoclonal therapy continues to progress.