Our continuing professional development (CPD) articles are designed to assist with your nursing skills and practice.
Why you should read this article: • To gain knowledge of the mechanism of action of CDK4 and CDK6 inhibitors and how you could explain this to patients • To understand the dosing, administration and potential side effects of abemaciclib in the treatment of metastatic breast cancer, and where to find prescribing information: https://www.lillyoncology.co.uk/assets/pdf/verzenios-api-a4-landscape.pdf • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Many patients with metastatic breast cancer develop resistance to endocrine therapy. Therefore, treatments with novel molecular targets have been developed to overcome endocrine resistance in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer, including cyclin-dependent kinase 4 and 6 (CDK4 and CDK6) inhibitors. CDK4 and CDK6 inhibitors such as abemaciclib offer a new treatment option for patients with metastatic breast cancer. Nurses have an important role in providing guidance, education and support to patients with breast cancer. Since more patients are likely to receive abemaciclib, it will become increasingly important for nurses to understand how it works, how to effectively manage potential side effects and how to support patients with adhering to treatment. This article describes the rationale for the use of CDK4 and CDK6 inhibitors in patients with breast cancer, and provides practical advice on how to manage patients with metastatic breast cancer who have been prescribed abemaciclib.
Oral complications can cause distress, long-term complications and increased morbidity
A systematic approach for nurses at any level or experience to engage with service evaluation
Receiving a new diagnosis of cancer or of its recurrence is distressing and there are increasing numbers of people living with the disease, some taking continuous treatment, as well as others who have been cured. Living with cancer and the possibility of recurrence requires psychological strength to deal with the treatment, effects of the illness and uncertainty about the future. The attributes of self-efficacy and psychological well-being can reduce the effects of chronic stress. Excellent symptom control is essential and fatigue, the most prevalent and often most distressing symptom for those with cancer, requires targeted support. Well-being and psychological resilience may be improved by specific actions and psychological approaches, some of which are encompassed by Foresight Mental Capital and Well-being Project’s (2008) five ways to well-being framework, which can be used to deliver personalised care. This is the second of a two-part article that reviews interventions promoting well-being and resilience in patients living with cancer. It describes the framework and suggests practical ways in which clinicians can integrate it and other interventions into clinical practice. It also offers time out exercises and a multiple choice quiz to aid readers’ learning and test their knowledge.
There is increasing recognition of the importance of making the Recovery Package available to more people affected by cancer. The cancer treatment summary is one of the core components of the Recovery Package and aims to improve communication between secondary and primary care, and help patients manage their care following treatment. The Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance is developing a suite of best practice treatment summary templates for each cancer site to improve the quality of the information in the documents, and to support cancer teams to begin the process of introducing them to practice.
Oral vinorelbine has been a well-established cytotoxic treatment for non-small cell lung cancer and metastatic breast cancer since 2004. This article summarises the applications of the drug, the advantages and challenges of using an oral agent in palliative oncology settings and how oral vinorelbine has been used to develop nurse-led services and chemotherapy outside traditional hospital environments. The article includes two case studies to place this treatment in a clinical context.
Advance care planning (ACP) is a process of establishing a person’s preferences and wishes, which can then be used to inform future care. These conversations are often held with a healthcare professional and may include a family member. ACP is one method of promoting person-centred care and respecting choice when a person may have lost capacity and be unable to communicate what matters to them. This article aims to explore the advantages of, and challenges to, the ACP process in the context of end of life care. It examines the practicalities of establishing patients’ preferences and wishes from a clinical perspective. Fictitious case studies based on numerous clinical encounters are used to illustrate the complexities of this process.
Treatment regimens involving the monoclonal anti-CD20 antibody rituximab are the standard of care for patients with CD20-positive non-Hodgkin lymphoma (NHL). It has conventionally been given by intravenous (IV) infusion, which requires intermittent patient monitoring during administration. A subcutaneous (SC) formulation is also available for the treatment of NHL, which takes less time to administer and could simplify treatment. With the newer formulation available, there is an ongoing need for education and understanding from the patient’s and the healthcare professional’s perspective. The authors review their personal experience of rituximab IV and SC formulations together with data on their safety, and provide an overview of the use of SC formulation in daily nursing practice.
Nurses should understand the role and purpose of the new generation of therapies available for patients with cancer. One such drug is the poly (ADP-ribose) polymerase inhibitor olaparib (Lynparza™▼). As it becomes available, it will be important for nurses to understand how it works, how to anticipate any side effects and how to manage these effectively. This article describes the importance of BRCA gene mutations in women with ovarian cancer and introduces olaparib, a targeted agent for use in these women in accordance with its label indication.
This article provides nurses with an update on diagnosis, management and care of patients with myelodysplastic syndromes (MDS), a complex group of disorders of the bone marrow. MDS has wide-ranging effects on patients’ lives. Understanding the effect of a diagnosis of MDS on patients’ quality of life is an important part of the nursing role and includes consideration of physical, mental, emotional and social wellbeing. Many treatment options are available and nurses can educate patients on recognising and managing side effects. While there have been promising developments in management, nurses should ensure that patients and their families have a realistic understanding of MDS and ensure that they are aware that treatments other than haematopoietic stem cell transplantation are non-curative.
Medication errors remain one of the most common causes of unintended harm to patients. They contribute to adverse events that compromise patient safety and result in a large financial burden to the health service. The prevention of medication errors, which can happen at every stage of the medication preparation and distribution process, is essential to maintain a safe healthcare system. One third of the errors that harm patients occur during the nurse administration phase: administering medication to patients is therefore a high-risk activity. This article highlights factors that contribute to medication errors, including the safety culture of institutions. It also discusses factors that relate specifically to nurses, such as patient acuity and nursing workload, the distractions and interruptions that can occur during medication administration, the complexity of some medication calculations and administration methods, and the failure of nurses to adhere to policies or guidelines.
Survivorship is an important issue in cancer care in the UK. More people are being diagnosed with the disease and many more are living for longer after diagnosis. The National Cancer Survivorship Initiative recommends that patients with cancer have a package of care designed to improve outcomes and support for those living with and beyond the disease. The recovery package consists of a holistic needs assessment, treatment summary, cancer care review and health and wellbeing event. Although these interventions are recommended as a way to improve care, many people do not have access to the combined package, or even some of its components. The Cancer Nursing Partnership (CNP), a collaboration of cancer nursing organisations and communities of influence, has been established to support nurses with delivery of the recovery package in practice. This article describes the package and its components, introduces the CNP and outlines the work it has carried out to date.