Download Objectives has given way to as a less judgmental term….how

4/16/2015
PaulaFulghamRNOCN
CancerCenterofKansas
Objectives
• Toprovideaperspectiveonnewadvances
inoncologytreatments
• Toexplainthenewevolvingissuesfacing
physicians and nurses
physiciansandnurses
• Toexaminetheroleofthenursein
educatingpatientsandtheirfamilies
• Topresentviablestrategiesinovercoming
adherencechallenges
hasgivenwayto
asalessjudgmental
term….how consistently a
term….howconsistentlya
patienttakesmedications
exactlyasprescribed.
Discov Med2013April15(83)231‐41.Adherencetotargetedoralanticancermedication.Geynisman DM,WickershamKE.
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Patientfollowstherapeuticplan:doses/day,timing
Patient follows therapeutic plan: doses/day timing
Patientstickswithplanovertime
Dezii CM.ManagedCare.2001;10(2);42‐45.
ParadigmShift
Wearemovingfroman
environmentofdirectly‐
observedintermittentIV
therapytoself‐administered
oral chronic therapy.
oralchronictherapy.
Itisnolongerjusta
trend– it’saSEISMIC
SHIFT!
It’sbeenalongjourneyfor
OncologyNurses
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Nauseaand
Vomiting
5Ht3Antagonists
PoorVeinStatus
Neutropenia
Colony
Stimulating
Factor
CentralLines
For patients with life‐threatening illnesses,
the nurse plays an essential role in helping
to translate information provided by the
physician, and assisting the patient and
their family in making sense of the illness
and its treatment.
NewmanAR;Helft PR.“ReliabilityandValidityofaTooltoAssessOncologyNurses’ExperiencesWithPrognosis‐Related
Communication,”OncologyNursingForum,Vol 42,No.1,Jan2015,p.65.
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TheNewFrontier
FromCellCycletoPathways
Whatwehavelearned
OverproductionofRNA
• Canceriscausedbyabnormalgenefunction.
• RNAregulatesgeneexpression.
In cancer a particular gene is overexpressed
• Incanceraparticulargeneisoverexpressed
orpermanentlyturnedon.
• Wecannoweasilyfindthesegenes.
• Thepossiblenumberofgenestoscreenhas
increaseddramatically.
USNationalLibraryofMedicine.HowGenesWork– GeneticHomeReference.Published
March2,2015.http://ghr.nlm.nih.gov/handbook/howgeneswork?
Weareable
toidentify
thetarget
mutation.
mutation
FoundationOne PromotionalBrochureofGenomicProfiles.AccessedMarch,2015.
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MTORInhibitors
Justoneofmanytargeted
pathwayscurrentlyused
inthetreatmentof
breastcancer
Solit DB,GarrawayLA,Pratilas CA,Sawai A,GetzG,BassoA,YeQ,LoboJM,She
Y,OsmanI,Golub TR,Sebolt‐LeopoldJ,etal.BRAFmutationpredictssensitivity
toMEKinhibition.Nature2006;439:358‐62.
25‐30%ofthepipeline
involvesoralagents
Morethan50oralanticancermedications
havebeenapprovedbytheFDA
Advantages
• Lesstimespentinthedoctor’sofficeand
waitingroom
• Senseofempowerment
Disadvantages
•
•
•
•
•
Lesscommunicationtimewithnurses
Lesseducateddecisionmaking
Lessfrequentassessment
Lessinteractionwithotherpatients
Cost
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Non‐AdherenceinOralOncolytics
Lessaccuracyoftreatmentefficacy?
• Compromiseddiseaseoutcomes
• Survival1
• TimetoRelapse1
PhysicianVisits2
Hospitalizationrates2
Lengthofhospitalstays2
Cost
PatientSatisfaction
Poorpatient–providerrelationships
1. PartridgeAH,etal.JNatl CancerInst 2002;94(9):652‐661.
2. PartridgeAH.AnnOncol. 2006;17(2):183‐184.
What CanOncologyNursesDotoImprove
AdherencetoOralTherapies?
Adherence*
• Keepingscheduledappointments
• Takingmedicationsasprescribed
(numberofpills,timing,storage)
• Followingdietarychanges
Following dietary changes
• Lifestylechangesorrestrictions
• Followingpreventativemeasures
* Falvo DR.EffectivePatientEducation:AGuidetoIncreasedCompliance. 3rd ed.Sudbury,Ma:JonesandBartlettPublishers.
2004.
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Howexactlydoyoumonitorcompliance?
•
•
•
•
•
Pillcount
Patientreporting
P i
Patientdiary
di
SideEffects
Itiswhatthepatientsaysitis
Youcanusethefollowingtools
•
•
•
•
•
•
•
•
•
Brochures
Podcasts
YouTubevideos
VideosorDVDs
PowerPoint presentations
PowerPointpresentations
Postersorcharts
Modelsorprops
Groupclasses
Trainedpeereducators
I’vegot10minutes?
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Wehavealreadygiventhem
somuchinformation
DevelopConciseandEasy‐to‐
UnderstandEducationalTools
•
•
•
•
•
Druginformation
Medicationtohaveonhand
Whentotake
Whentocall
Whotocall
Thegoalistokeepthepatientonthedrug
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PhysicianInvolvement
ThePhysicianshoulddiscuss:
•
•
•
•
•
Disease,itssymptoms,andpossibleprogression
Benefitsandrisksoftreatment
g g
Drugregimen
Adverseeventsandmanagement
Anydruginteractionswithcurrentmeds
Patientshouldbeprovidedclearinstructionson:
PATIENTEDUCATION
Medicationstotake
Whentocall
AdditionalMedications
tohaveonhand
Howtogetrefills
Whotocallifproblems
SideEffectPrevention
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Tools for oral adherence toolkit. Oncology Nursing Society website. Published 2009. Updated December 24, 2009.
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References
•
Discov Med2013April15(83)231‐41.Adherencetotargetedoralanticancermedication.
Geynisman DM,WickershamKE.
•
Dezii CM.ManagedCare.2001;10(2);42‐45.
•
NewmanAR;Helft PR.“ReliabilityandValidityofaTooltoAssessOncologyNurses’
ExperiencesWithPrognosis‐RelatedCommunication,”OncologyNursingForum,Vol 42,No.1,
Jan2015,p.65.
•
USNationalLibraryofMedicine.HowGenesWork–
US
National Library of Medicine How Genes Work GeneticHomeReference.PublishedMarch
Genetic Home Reference Published March
2,2015.http://ghr.nlm.nih.gov/handbook/howgeneswork?
•
FoundationOne PromotionalBrochureofGenomicProfiles.AccessedMarch,2015.
•
Solit DB,GarrawayLA,Pratilas CA,Sawai A,GetzG,BassoA,YeQ,LoboJM,SheY,OsmanI,Golub
TR,Sebolt‐LeopoldJ,etal.BRAFmutationpredictssensitivitytoMEKinhibition.Nature
2006;439:358‐62.
•
PartridgeAH,etal.JNatl CancerInst 2002;94(9):652‐661.
•
PartridgeAH.AnnOncol. 2006;17(2):183‐184.
•
Falvo DR.EffectivePatientEducation:AGuidetoIncreasedCompliance. 3rd ed.Sudbury,Ma:
JonesandBartlettPublishers.2004.
•
Toolsfororaladherencetoolkit.OncologyNursingSocietywebsite.Published2009.Updated
December24,2009.
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