Grand Rounds

Use of the 31-Gene Expression Profile Test to Aid in the Decision of Adjuvant Treatment of Cutaneous Melanoma

Jillian Hunt, MSN, APRN, FNP-C, AOCNP

Melanoma is the fifth most common cancer in the United States, with over 7,000 deaths annually. Although most patients diagnosed with early-stage (stage I or II) disease have an excellent prognosis, two out of three patients who die from...

Intravenous Cetirizine Premedication to Mitigate Infusion-Related Reactions

Timothy Tyler,(1) PharmD, Erik Stojanoff,(2) PharmD, Joan Cannon,(2) PharmD, MBA, Jessie J. Um,(2) PharmD, BCPS, Stacia Young,(2) PharmD, BCOP, MBA, Jarrod P. Holmes,(3) MD, FACP, Lonnie D. Brent,(2) PharmD, and Nancy Martin,(2) MD, PharmD

Infusion-related reactions (IRRs) are a recognized concern for chemotherapy, biologic agents, and newer immunotherapies. Antihistamines are frequently recommended to prevent or manage these reactions. For over 60 years, diphenhydramine h...

Management of Advanced Prostate Cancer With Relugolix: Illustrative Case Scenarios From an Advanced Practice Provider Perspective

Jared Thorley,(1) APRN, MSN, FNP, and Saneese Stephen,(2) MPAS, PA-C, MPA

Prostate cancer is the second most common cause of cancer-related mortality among men in the United States, with an estimated 34,700 deaths annually. Androgen deprivation therapy (ADT) is the cornerstone of advanced prostate cancer thera...

When Germline Genetic Testing Results Are Unclear: Highlighting Variants of Uncertain Significance

Patricia Kelly,(1) DNP, APRN, CNS, AGN-BC, AOCN®, Suzanne Mahon,(2) DNS, RN, AOCN®, AGN-BC, FAAN, and Patricia Friend,(3) PhD, APRN-CNS, AOCNS®, AGN-BC

With the advent of high-throughput next-generation sequencing (NGS) and multigene panel testing, genetic testing and interpretations have become increasingly complex. Specifically, reports demonstrating “variant of uncertain significance...

Surgical Management of Gastrointestinal Stromal Tumors

Heather Townsend, MPAP, PA-C

Gastrointestinal stromal tumors (GISTs) are considered rare, but they are one of the most common malignant mesenchymal tumors within the gastrointestinal tract, affecting 4,000 to 6,000 adults in the United States each year. Because gast...

Hyperammonemia Secondary to 5-Fluorouracil

Ashley Scott,(1,2) RN, BSN, OCN®, Sreenivas V. Rao,(2) MD, and Mary Lou Affronti,(1) DNP, RN, MHSc, ANP, FAAN

5-fluorouracil (5-FU) is one of the most common adjuvant antineoplastic agents used in the treatment of localized and metastatic colon cancer. Frequent side effects of 5-FU include myelosuppression, mucositis, nausea, vomiting, and diarr...

Management of Patients With Advanced Gastrointestinal Stromal Tumor: Emphasis on Fourth-Line Treatment With Ripretinib

Sandra Brackert,(1) NP, and Kathleen Polson,(2) NP

Gastrointestinal stromal tumors (GISTs) are considered rare, yet they represent the most common sarcomas of the gastrointestinal tract. The development of tyrosine kinase inhibitors (TKI) for the treatment of GISTs changed the way we tre...

Using Pleomorphic Adenoma Gene 1 (PLAG1) to Distinguish Carcinoma of the Parotid Gland From Primary Lung Cancer: A Case Study

Avigayil East, DNP

A 40-year-old female never-smoker with no significant medical history presented with right-side facial swelling and 3 months of progressive, radiating otalgia. This article reviews the case of a young woman with carcinoma ex pleomorphic ...

Polatuzumab Vedotin for the Front-Line Treatment of Diffuse Large B-Cell Lymphoma: A New Standard of Care?

James A. Davis, PharmD, BCOP, Abigail Shockley, PharmD, Amanda Herbst, PA-C, and Lindsey Hendrickson, DNP, APRN, FNP-C

Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma in the US. For nearly 2 decades, standard front-line treatment has consisted of chemoimmunotherapy with rituximab, cyclophosphamide, doxorub...

A Rare Event of Liver Dysfunction on Sotorasib and Management Strategy

Holly Kinahan, MSN, ANP-C, AOCNP®

KRAS mutations are the most common alteration in human cancers, accounting for approximately 30% of mutations in multiple cancer types, including colorectal, pancreatic, non–small lung cancer, and ovarian. Of these, the KRAS p.G12C mutat...

Timely Genetic Testing and Therapy Management in Patients With gBRCA-Mutated Metastatic Breast Cancer Receiving Talazoparib

Ashley Martinez,(1) DNP, APRN, FNP-BC, AOCNP®, CBCN, CPHQ, NEA-BC, Tiffany Jones,(2) MSN, ACNP-BC, Joanne C. Ryan,(3) PhD, RN, Chad M. Barnett,(3) PharmD, BCOP, Elpitha L. Soussou,(3) PharmD, MBA, and Sarah Donahue,(4) MPH, NP, AOCNP®

Talazoparib is a poly(ADP-ribose) polymerase (PARP) inhibitor that has demonstrated strong efficacy with manageable side effects for patients with germline breast cancer susceptibility genes 1 or 2 (gBRCA1/2)-mutated, human epidermal gro...

Richter Transformation: Clinical Manifestations, Evaluation, and Management

Melanie Douglas, MS, PA-C

Richter transformation is a devastating and rare but not uncommon development of an aggressive B-cell lymphoma in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma. Prognosis is dismal, with survival generally in t...

A Focus on Special Populations in Relapsed Multiple Myeloma

Mary Steinbach,(1) DNP, APRN, Kathleen Colson,(2) RN, BSN, BS, and Beth Faiman,(3) PhD, MSN, APRN-BC, AOCN®, BMTCN, FAAN

The overall care of patients with multiple myeloma can present similar challenges. However, disparities in health care require that providers consider each individual’s unique circumstances. Disparities based on ethnic/racial group, reli...

A Focus on CAR T-Cell Therapy and Bispecific Antibodies in Multiple Myeloma

Donna Catamero, ANP-BC, OCN®, CCRC, Tiffany Richards, PhD, ANP-BC, AOCNP®, and Beth Faiman,(3) PhD, MSN, APRN-BC, AOCN®, BMTCN, FAAN

Significant strides have been made in the management of patients living with myeloma. However, patients with multiply relapsed or refractory multiple myeloma (MM) have a shorter overall survival; therefore, new treatments with novel mech...

A Focus on Waldenström Macroglobulinemia and AL Amyloidosis

Rebecca Lu, MS, FNP, and Tiffany Richards, PhD, ANP-BC, AOCNP®

Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma that is characterized by the overproduction of an IgM monoclonal protein. It may cause adenopathy, hepatomegaly, splenomegaly, as well as other disease-related complicati...

A Focus on Newly Diagnosed Multiple Myeloma

Kevin Brigle,(1) PhD, ANP, Daniel Verina,(2) DNP, RN, ACNP-BC, and Beth Faiman,(3) PhD, MSN, APRN-BC, AOCN®, BMTCN, FAAN

Multiple myeloma (MM) is an incurable plasma cell disorder that affects nearly 35,000 people annually. Over 149,000 individuals are estimated to live in the United States with MM. Research has generated a greater understanding of the pat...

A Focus on Relapsed Multiple Myeloma

Kimberly Noonan,(1) DNP, ANP-BC, AOCN®, Sandra Rome,(2) RN, MN, AOCN®, CNS, and Beth Faiman,(3) PhD, MSN, APRN-BC, AOCN®, BMTCN, FAAN

Multiple myeloma (MM) is a relapsing disease for many patients with multiple myeloma. At relapse, patients have many options for treatment once disease has progressed. Advanced practitioners are well suited to set expectations for ongoin...

Myasthenia Gravis: A Rare Neurologic Complication of Immune Checkpoint Inhibitor Therapy

Yelena Shames, MS, ACNP-BC, CNRN, CTNL, Mimma Errante, MS, ANP-C, OCN®, and Nana Prempeh Keteku, MS, ANP-BC

Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction, which is characterized by the production of autoimmune antibodies to acetylcholine or muscle-specific kinase receptors, causing an error in transmission of...

Uterine Leiomyosarcoma

Katherine L. Byar,(1) MSN, APN, BC, BMTCN®, and Tricia Fredericks,(2) MD, MPH

Leiomyosarcoma (LMS) is the most common soft tissue sarcoma in adults and can occur in any part of the body. Uterine leiomyosarcoma (uLMS) is the most common location for LMS, making up 2% to 5% of all uterine malignancies. It is an aggr...

Retroperitoneal Liposarcoma: An Unusual Presentation of a Rare Cancer

Jennifer L. Spicer, MA, PA-C

Retroperitoneal liposarcomas (RLPS) are rare tumors that have variable clinical behavior and complex treatment strategies based on presentation, histopathology, and genomics. Early identification is critical, and complete surgical resect...

Addiction in Patients With Cancer: Challenges and Opportunities

Gretchen A. McNally, PhD, ANP-BC, AOCNP®, and Ashley Sica, MSN, RN, CNL

Addiction is complex and multifactorial. Recognition provides the opportunity to provide potentially life-saving treatment. Oncology patients are not excluded from substance use disorders (SUDs) and the opioid epidemic. Patients with cur...

Transitioning From Thrombopoietin Agonists to the Novel SYK Inhibitor Fostamatinib: A Multicenter, Real-World Case Series

David M. Hughes,(1) PharmD, BCOP, Charina Toste,(2) DNP, APN, Christopher Nelson,(3) ACNP-BC, Juliet Escalon,(4) ANP, Frances Blevins,(5) PA-C, and Bhavesh Shah,(1) RPh, BCOP

Fostamatinib is an oral spleen tyrosine kinase (SYK) inhibitor used for the treatment of adult patients with chronic immune thrombocytopenia (ITP) who have had an insufficient response to a previous treatment. Clinical and operational ba...

Management of Adverse Events Associated With Tyrosine Kinase Inhibitor Use in Adult Patients With Chronic Myeloid Leukemia in Chronic Phase: An Advanced Practice Perspective

Stephanie Bauer, RN, MSN, BC-FNP, Holly Comer, MSN, APRN, Brooke Ramsey, RN, MSN, ANP-BC, and Katy Thomas, RN, MSN, ANP-C

The tyrosine kinase inhibitors (TKIs) imatinib, dasatinib, nilotinib, bosutinib, and ponatinib have drastically improved the life expectancies of patients with chronic myeloid leukemia in chronic phase (CML-CP). While survival outcomes a...

Essential Thrombocythemia in a 15-Year-Old Female: Presentation, Workup, and Treatment Considerations in the Pediatric Population

Crystal Flagg, MPAS, PA-C, and Brad Pierce, MPAS, PA-C

Essential thrombocythemia (ET) is a diagnosis most often seen in adults but can also present in children in rare cases. This article reviews the presentation, diagnosis, and treatment of ET in a 15-year-old female followed by a review of...

Exploring the Use of Medical Marijuana for Supportive Care of Oncology Patients

Deena Damsky Dell,(1) MSN, APRN, AOCN®, LNC, and Daniel P. Stein,(2) MD

Medical marijuana, also known as cannabis, is being sought by patients and survivors to alleviate common symptoms of cancer and its treatments that affect their quality of life. The National Academy of Sciences (2017) reports conclusive ...

Advanced Practice Perspectives on Preventing and Managing Tumor Lysis Syndrome and Neutropenia in Chronic Lymphocytic Leukemia

Amy Goodrich, RN, MSN, CRNP

Tumor lysis syndrome (TLS) and neutropenia are significant toxicities in the treatment of chronic lymphocytic leukemia (CLL). Both TLS and neutropenia can lead to potentially life-threatening complications for patients with chronic lymph...

Metastatic Melanoma With Leptomeningeal Disease

Amanda M. Marinova, MS, PA-C, Jennifer L. Reilly, CRNP, BSN, MSN, RN, AANP, Victoria Wong, MS, PA-C, Stephanie Weiss, MD, and Anthony J. Olszanski, MD

Leptomeningeal disease in patients with melanoma historically portends a grim prognosis, with median survival measured in weeks to months. The advent of effective immunotherapy and targeted agents may modify the outcome of such patients....

Acute Myeloid Leukemia: Advanced Practice Management From Presentation to Cure

Meredith Beaton, RN, MSN, AG-ACNP, Glen J. Peterson, RN, DNP, ACNP, and Kelly O’Brien, RN, MSN, ANP-C, ACNP-BC

Acute myeloid leukemia (AML) is the most common acute leukemia in adults, diagnosed in approximately 21,450 individuals annually in the US with nearly 11,000 deaths attributable to this disease (National Cancer Institute, 2020). Acute my...

Budd-Chiari Syndrome as Initial Manifestation of Polycythemia Vera: Complexities in the Management of Younger Patients

Lindsey Lyle,(1) MS, PA-C, and Lindsey E. Kalhagen,(2) PA

Advanced practitioners (APs) play an integral role in early identification, diagnosis, and treatment of patients with polycythemia vera (PV). This Grand Rounds article highlights the case of a younger patient who presented with a spontan...

Optimizing Treatment Strategies in Patients With Polycythemia Vera Who Develop a Thrombotic Event on Frontline Therapy

Lindsey Lyle,(1) MS, PA-C, and Julie Huynh-Lu,(2) PA

Advanced practitioners are ideal advocates for their patients with polycythemia vera who have had a thrombotic event to ensure that secondary prevention measures are in place, including the implementation of close monitoring and tailorin...

Optimizing Palbociclib Therapy Across the Age Spectrum: Hypothetical, Illustrative Case Scenarios in HR+, HER2– Metastatic Breast Cancer

Kimberly Podsada,(1) MSN, NP-C, Joanne C. Ryan,(2) PhD, RN, and Kristi Orbaugh,(3) RN, MSN, RNP, AOCN®

Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors in combination with endocrine therapy are a preferred treatment option for premenopausal and postmenopausal women with hormone receptor–positive (HR+), human epidermal growth factor rec...

Pseudoprogression and Immunotherapy Phenomena

Elizabeth S. Waxman, RN, MSN, AOCN®, ANP-BC, and Donna Lee Gerber, CNS

Traditionally, treatment responses to chemotherapy had been based on Response Evaluation Criteria in Solid Tumours (RECIST) criteria evaluating tumor shrinkage, stabilization of disease, growth, or development of new metastatic lesions. ...

A Patient-Centered Approach for the Treatment of Fungating Breast Wounds

Karlyn L. Rupert, MPAS, PA-C, and Andrea J. Fehl, CRNP, AOCNP®

Nearly 2% to 5% of locally advanced breast cancers develop a fungating breast wound (FBW). Fungating breast wounds develop when malignant cells infiltrate the skin and cause breakdown, ulceration, and infection. Although systemic and loc...

Waldenström Macroglobulinemia: Clinical Presentation, Diagnosis, and Management

Miriam Hobbs, DNP, APRN, CNP, Amie Fonder, PA-C, and Yi L. Hwa, DNP, APRN, CNP

Waldenström macroglobulinemia is a rare hematologic malignancy characterized by an IgM-associated lymphoplasmacytic lymphoma. Often, it is associated with an indolent disease course, and many patients are candidates for careful monitorin...

A Tale of Two Sisters: Breast Reconstruction Options for Women With or at High Risk of Breast Cancer

Kathryn Trotter,(1) DNP, CNM, FNP, FAAN, Jennifer K. Plichta,(2) MD, MS, FACS, and Michael Zenn,(3) MD, MBA, FACS

Breast reconstructive surgery has changed significantly over the past decade. The incidence of nipple-sparing procedures and prophylactic mastectomy has also increased significantly as women and their surgeons use shared decision-making ...

Management of Acute Pancreatitis Associated With Checkpoint Inhibitors

Barbara Barnes Rogers, CRNP, MN, AOCN®, ANP-BC, Terri Cuddahy, RN, MSN, OCN®, and Carolyn Zawislak, MPAS, PA-C

Pancreatitis is a rare immune-related adverse event (irAE) associated with the use of immune checkpoint inhibitors (ICIs). It is more often associated with combined immunotherapy than by any single agent. Early signs of pancreatitis may ...

Dihydropyrimidine Dehydrogenase Deficiency: To Screen or Not to Screen?

Wendy H. Vogel,(1) MSN, FNP, AOCNP®, Ahmed Minhas,(2) MD, and Steven Baumrucker,(1) MD

5-fluorouracil (5-FU) and its prodrug capecitabine are frequently prescribed in oncology. While usually well tolerated, toxicity can be severe, and even life-threatening. A dihydropyrimidine dehydrogenase (DPD) deficiency can cause sever...

The Role of Advanced Practitioners in Optimizing Clinical Management and Support of Patients With Cytokine Release Syndrome From CAR T-Cell Therapy

Sherry Adkins, MSN, ANP-C

CAR T-cell therapy is rapidly emerging as a promising treatment for many hematologic malignancies. However, CAR T cells can be associated with unique toxicities, including cytokine release syndrome (CRS), which can be severe or fatal if ...

Chronic Neutrophilic Leukemia: A Case Report of a Rare Myeloproliferative Neoplasm With a CSF3R Mutation

Lorinda A. Coombs, PhD, FNP-BC, AOCNP

Cases of chronic neutrophilic leukemia (CNL) are extremely rare and easily missed. The World Health Organization revised criteria in 2016 to include evaluation for CSF3R somatic mutations. In this article, we discuss an 84-year-old man w...

Optimizing the Management of Carcinoid Syndrome to Reduce the Impact of Diarrhea

Rory Randall,(1) CNP, AOCNP®, Bonita Bennett,(2) RN, BSN, Tiffany Valone,(3) PA-C, MS, OT, and Kirsten Blue,(3) PA-C, MS

Diarrhea is often a presenting symptom in patients with neuroendocrine tumors (NETs). Frequently diagnosed in advanced stages, carcinoid syndrome diarrhea negatively impacts patients’ well-being and quality of life. This article will rev...

Treatment of Pregnancy-Associated Breast Cancer

Bernadette Labriola, RN, MSN, FNP-C

Case Study KS is a 33-year-old Caucasian married woman who works full time as an accountant and has one daughter who is 2 years old. She enjoys reading and exercising in her spare time. She initially presented in July 2015 at the age of...

Therapy Management Using Modified 2-Weeks-On/1-Week-Off Dosing Schedule in Patients With Metastatic Renal Cell Carcinoma Receiving Sunitinib: A Hypothetical, Illustrative Case Scenario

Kimberly D. Allman,(1) CNP, Joanne C. Ryan,(2) PhD, RN, Andrew Clair,(2) PhD, and Sarah Yenser-Wood,(3) NP

Case Study This patient case is fictional and does not represent events or a response from an actual patient. The authors developed this fictional case for educational purposes only. Brady, a 54-year-old white male, was diagnosed wit...

Breast Cancer in the Transgender Population

Andrea Fehl,(1) FNP-C, MSN, AOCNP®, Shannon Ferrari,(1) PA-C, MPAS, Zoe Wecht,(1) BS, and Margaret Rosenzweig,(2) PhD, FNP-C, AOCNP®, FAAN

Case Study ES is a 41-year-old transgender male who presented to medical oncology as a referral from surgical oncology for T2N0M0 right breast cancer. At that time, he was receiving weekly testosterone injections intramuscularly at 0.25...

Advances in HER2-Positive Breast Cancer: Novel Therapies and Adverse Event Management

Reshma Mahtani, DO, and Lisa Hineman, MS, AOCN®, PHN, ANP-C

Abstract Although breast cancer is a heterogeneous disease, approximately 20% to 25% of patients diagnosed with breast cancer have amplification of the HER2 gene. The FDA approval of trastuzumab for the treatment of HER2-positive (HER2+...

Scalp Cooling: A Patient’s Experience

Lynn Weatherby, RN, BSN, OCN®, and Lynne Brophy, MSN, RN-BC, APRN-CNS, AOCN®

Case Study Ms. X is a 23-year-old female who presented to clinic with stage 2A endometrial cancer of the ovary. At her first visit, Ms. X was prescribed paclitaxel and carboplatin on day 1 for 6 cycles. During the visit, the nurse noted...

Challenges and Role Changes in Caring for Adult Children With Cancer

Laura Bourdeanu, NP, PhD, and Patricia Cannistraci, DSN, RN, CNE

Case Study Here we present a case of a mother’s struggle, in her own words, about defining her new role after her adult son’s cancer diagnosis and the importance of practicing family-centered care in this scenario. A Mother’s Role At ...

Comprehensive Geriatric Assessment in Oncology: Best Practices in Caring for Older Patients

Janine Overcash,(1) PhD, GNP-BC, FAANP, Nikki Ford,(2) BA, BSN, RN, OCN®, H. Paige Erdeljac,(2) PharmD, BCACP, Susan Fugett,(2) MSW, LISW-S, OSW-C, Brittany Knauss,(2) PT, DPT, CLT, Elizabeth Kress,(2) CNP, Cari Utendorf,(2) PT, DPT, MBA, CLT-LANA, and Anne Noonan,(3) MD, MB BCh BAO, MSc, MRCPI

Case Study Michele Green received the results of her breast cancer biopsy last week. Before surgery for infiltrating ductal carcinoma to her left breast, Michele was advised to meet with the members of the Senior Adult Oncology Program ...

Clinical Management of Pneumonitis in Patients Receiving Anti–PD-1/PD-L1 Therapy

Case Study A 48-year-old gentleman with metastatic melanoma currently receiving the cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) inhibitor, ipilimumab (Yervoy), and the programmed cell death protein 1 (PD-1) inhibitor, nivolumab...

Paraneoplastic Encephalopathy in a Patient With Metastatic Lung Cancer: A Case Study

Case Study RS, a 36-year-old female, presented to the emergency department (ED) of a large academic medical center upon the advice of her primary care provider because of 3 weeks of progressive mental status changes, weakness, and decre...

The Role of Advanced Practitioners in Optimizing Clinical Management and Support of Patients With Polycythemia Vera

Case StudyMr. M, a 65-year-old male, presented to his primary care physician with progressive fatigue, difficulty sleeping, and daily headaches for the past 3 weeks. His headaches were not associated with visual disturbances, cognitive d...

Management of Older Patients With Metastatic Renal Cell Carcinoma Receiving Sunitinib: A Hypothetical, Illustrative Case Scenario

Case Study Tom, a 75-year-old white male, was recently diagnosed with metastatic renal cell carcinoma (RCC; Tom’s case is not an actual clinical case but has been developed by the authors as an exemplar). Two years prior, he had undergo...

Practical Strategies for Management of Lenalidomide-Associated Cytopenias in Myelodysplastic Syndromes With del(5q)

Case Study A male patient aged 67 years with a 2-year history of refractory anemia and myelodysplastic syndromes (MDS) with del(5q) started lenalidomide (Revlimid) treatment as a participant in the MDS-001 trial (List et al., 2005). At ...

Symptom Management Strategies for Patients Receiving Anaplastic Lymphoma Kinase Inhibitors for Non–Small Cell Lung Cancer

Managing Drug Interactions in Cancer Therapy: A Guide for the Advanced Practitioner

Mrs. P is a 30-year-old woman who presented to our bone marrow transplant program with myelodysplastic syndrome (MDS). She received a haploidentical allogeneic stem cell transplant with a conditioning regimen consisting of busulfan and c...

Brentuximab Vedotin Infusion Reaction Management: A Case Study

We report a case of a grade 3 (Common Terminology Criteria for Adverse Events [CTCAE]) infusion reaction to brentuximab vedotin (Adcetris), in a patient with refractory Hodgkin lymphoma, at a large National Cancer Institute–designated ca...

Risk Assessment and Risk-Adapted Treatment Selection: A Case-Based Approach for Chronic Lymphocytic Leukemia

Selected Patient Cases From the APSHO Regional Lecture Series Introduction As the official publication of the Advanced Practitioner Society for Hematology and Oncology (APSHO), JADPRO is pleased to offer Part 3 of an accredited educati...

Treatment of a Locally Invasive Cutaneous Fusarium Species Infection With Voriconazole and Liposomal Amphotericin B in a Patient With Relapsed Acute Myeloid Leukemia

Case Study In February 2011, a 69-year-old, 1.91 m2 Caucasian male was diagnosed with acute myeloid leukemia (AML). Immediately prior to the diagnosis of AML, the patient was otherwise healthy until he developed multiple infections, inc...

Integrating Emerging Data Into Clinical Practice: A Case-Based Approach for Multiple Myeloma

Selected Patient Cases From the APSHO Regional Lecture Series Introduction As the official publication of the Advanced Practitioner Society for Hematology and Oncology (APSHO), JADPRO is pleased to offer Part 2 of an accredited educa...

Palliative Chemotherapy: Does It Only Provide False Hope? The Role of Palliative Care in a Young Patient With Newly Diagnosed Metastatic Adenocarcinoma

Case Study A 48-year-old female with recent diagnosis of adenocarcinoma of unknown origin and metastatic disease to the peritoneum initially presented to a nearby academic hospital with abdominal pain. She underwent exploratory laparoto...

Current and Emerging Therapies for HER2-Positive Women With Metastatic Breast Cancer

Case Study DE, a 31-year-old premenopausal woman with a nonsignificant medical history, noticed a right breast mass after playing basketball in September 2011. She initially attributed the mass to slight trauma, but after 2 weeks, she r...

Use of Diagnostic Tests in Advanced Non–Small Cell Lung Cancer

Introduction As the official publication of the Advanced Practitioner Society for Hematology and Oncology (APSHO), JADPRO is pleased to offer Part 1 of an accredited educational activity based on the recently concluded APSHO Regional Le...

Anisocoria and an Array of Neurologic Symptoms in an Adult With Ewing Sarcoma

Case Study Ms. M, a 50-year-old female, reported a progressive 2-year history of sacral pain that became severe in the 2 to 3 months prior to her diagnosis of Ewing sarcoma (ES) and was initially evaluated by her gynecologist. Her prese...

Symptom Management for Patients With Esophageal Cancer After Esophagectomy

Case Study KD is a 67-year-old man with a medical history of hypertension, asthma, and a 20-pack/year smoking history who developed progressive dysphagia 8 months ago. Upon consultation with his primary care provider, he underwent an es...

Chemoembolization With Drug-Eluting Beads for the Treatment of Hepatocellular Carcinoma

CASE STUDY THA is a 40-year-old immigrant from Myanmar who has been living in the United States for about 6 years. He has a history of hepatitis B virus (HBV) infection for many years, for which he has never received any treatment. He i...

Case Study of a Young Adult With Ewing Sarcoma

Case Study Maria was a 23-year-old woman who initially presented with a 1-year history of pain in the left heel. Over time, the pain had progressively worsened. Eventually, her foot had swollen, and she had difficulty walking, which req...

Palbociclib Plus Letrozole for the Treatment of Metastatic Breast Cancer: An Illustrative Case Scenario

Case Study Betty, a 66-year-old white female, was diagnosed with stage IIB, T2N1M0, estrogen receptor/progesterone receptor–positive, HER2-negative breast cancer in 2007. It was detected on screening mammography when she was age 59, and...

Multigene Panel Testing for Hereditary Cancer Risk

A Case-Based Look at Healthy Weight Loss for Survivors of Cancer

Patients with cancer are generally encouraged to prevent weight loss during their active treatment phase. Yet when a patient completes active treatment and transitions into survivorship, weight loss may be needed. Although it is ideal fo...

Hypercalcemia of Malignancy

Case Study A 60-year-old man initially presented with pain in the right upper quadrant in October 2010. A computed tomography (CT) scan of the abdomen pelvis completed at that time showed a mass at the junction of the body and tail of t...

Use of Flow Cytometry in Clinical Practice

Case Study Mrs. K is a 63-year-old woman who presented to the clinic with complaints of fatigue, bruising, weight loss of 20 pounds in the past 2 months, and decreased appetite. She stated that she had constant moderately severe joint p...

Hypnosis for the Management of Anticipatory Nausea and Vomiting

Case Study BJ is a 34-year-old woman who was diagnosed with metastatic breast cancer. She was treated with surgical removal of the primary tumor and sentinel node biopsy. Following surgery, she received chemotherapy. She was given antie...

Multidisciplinary Management of the Patient With Metastatic Colorectal Adenocarcinoma

View Continuing Education Information here. Case Study A 60-year-old man initially presented with rectal bleeding in March 2006. He underwent a colonoscopy, which revealed a rectosigmoid mass, and the biopsy specimen confirmed adenocar...

The Role of the Advanced Practice Nurse in Survivorship Care Planning

Spiritual Assessment in a Patient With Lung Cancer

CASE STUDY Mr. G., an 82-year-old retired European man, was diagnosed with stage 4 non–small cell lung cancer (NSCLC) and recently enrolled on a phase II clinical trial. He is married and has two adult children, who are very supportive....

Human Herpesvirus-6 Encephalitis After Hematopoietic Stem Cell Transplantation

CASE STUDY Mrs. L. was in good health until she was diagnosed with acute myeloid leukemia (AML) at the age of 63. She had presented to her primary care provider with a productive cough and was found to have pancytopenia, with 16% myeloi...

Management of Malignant Pericardial Effusion

Case Study In early 2010, Mrs. Y., a 58-year-old Japanese woman, underwent a routine mammogram that revealed left focal asymmetry. A biopsy demonstrated invasive ductal carcinoma, and she was referred to surgery. She underwent a lumpect...

Delayed Presentation of DPD Deficiency in Colorectal Cancer

Case Study Mr. D., a 55-year-old male, presented to the medical oncology service with a diagnosis of stage III adenocarcinoma of the sigmoid colon. He presented 7 weeks post sigmoid colectomy with lymph node resection and was initiated ...

A Case of Complicated Survivorship Care

At age 34, Ms. P., a premenopausal African American woman, was diagnosed with stage IA poorly differentiated invasive ductal carcinoma of the left breast. Her tumor was estrogen and progesterone receptor (PR) positive but HER2 negative. ...

Breathlessness With Pulmonary Metastases: A Multimodal Approach

Case Study Sarah is a 58-year-old breast cancer survivor, social worker, and health-care administrator at a long-term care facility. She lives with her husband and enjoys gardening and reading. She has two grown children and three grand...

Sexuality, Lung Cancer, and the Older Adult: An Unlikely Trio?

CASE STUDY Mrs. L. is a 60-year-old retired female teacher with stage IIIA squamous cell carcinoma of the lung, status postchemoradiation. She recently developed radiation pneumonitis, which was managed conservatively, and she did not ...

Two Patients With Brain Tumors Who Received Bevacizumab and Radiotherapy: Optic Neuropathy and Quality-of-Life Issues

Case Studies Case 1 The first case we present is that of Mr. R., a 70-year-old Hispanic man with a diagnosis of unresectable World Health Organization grade II oligodendroglioma in bilateral frontal lobes. Although he did not have a hi...

Understanding the Implications of the Breast Cancer Pathology Report: A Case Study

Case Study A.K. is a 50-year-old Caucasian female who was recently diagnosed with breast cancer and is presenting for an opinion regarding adjuvant therapy following a right segmental mastectomy and sentinel lymph node biopsy. The advan...

Breast Cancer and Autism

Case Study Amy is a 44-year-old woman with severe autism. She lives with her sister Susan, who is her caregiver and guardian. Amy is ambulatory and able to dress and feed herself. She is a healthy individual with no other significant co...

Having Difficult Conversations: The Advanced Practitioner’s Role

Throughout the course of their disease, patients with cancer and their families look to the oncology advanced practitioner (AP) for support and guidance as they struggle with the emotional impact of a life-limiting illness, complex treat...

Superior Vena Cava Syndrome in the Cancer Patient: A Case Study

Case Study Mr. P. is a 67-year-old male who was originally seen by the pulmonologist after a chest x-ray revealed a right upper-lobe lung mass (Figure 2). Bronchoscopy revealed an extensive endobronchial tumor, and a biopsy was positive...

Response to Degarelix After Resistance to Leuprolide in a Patient With Metastatic Prostate Cancer

Mr. R., a 70-year-old man, presented to the emergency department of our hospital with urinary retention and acute renal failure in April 2011. On presentation, his prostate-specific antigen (PSA) level was 2,628.2 ng/mL. He was examined ...

Intraventricular Topotecan for the Treatment of Neoplastic Meningitis: Five Case Studies

Many systemic cytotoxic agents cannot penetrate the blood-brain barrier. Because of this, in approximately 5% of cancer cases, metastatic disease is seen in the leptomeninges. Without treatment, patients with neoplastic meningitis (NM) g...

Management of Refractory Metastatic Anal Squamous Cell Carcinoma Following Disease Progression on Traditional Chemoradiation Therapy

Case Study Ms. S.G., a 56-year-old woman with a poorly differentiated squamous cell carcinoma of the anal canal, American Joint Committee on Cancer stage III (T2, N1, M0), was initially diagnosed in December, 2007 at an outside institut...

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,...

Pituitary Adenoma and Secondary Radiation-Induced Meningioma in an Adult Patient

The patient, D.P., was a Caucasian male who was diagnosed in 1989 with a null-cell or nonfunctioning pituitary adenoma at age 29. His only symptoms at that time were visual field changes and fatigue. He was seen by an ophthalmologist for...

Hereditary Breast and Ovarian Cancer Syndrome

Case Study A.G. is a 56-year-old Caucasian female with metastatic breast cancer who was originally diagnosed with breast cancer at age 41, in 1995, when she presented to her primary care physician with a right breast mass. This was the ...

Carboplatin Hypersensitivity in Recurrent Ovarian Cancer

Case Study Mrs. A.Z. is a 61-year-old Caucasian woman who was diagnosed with stage IV (pleural effusion cytology positive), grade 3, papillary serous adenocarcinoma of the ovary at age 56. She underwent standard of care procedures with ...

Thrombocytopenia, Deep-Vein Thrombosis, and Pulmonary Emboli in a Patient With Primary CNS Lymphoma

Case Study M.F. is a 64-year-old male who presented to an outside hospital in May 2003 with chief complaints of headache, confusion, facial edema, and dysphasia. A magnetic resonance imaging (MRI) scan revealed a left frontal lobe mass....

Medication Self-Management: Important Concepts for Advanced Practitioners in Oncology

Case Study Mrs. K is a 66-year-old female with a long history of hypertension and hyperlipidemia and a 45-pack-year history of cigarette smoking. She was diagnosed with multiple myeloma (MM), a cancer of the bone marrow plasma cells, 5 ...

Collaborative Approach to Managing a 59-Year-Old Woman With Stage IIB Pancreatic Cancer and Diabetes

The American Diabetes Association and the American Cancer Society recently published a consensus statement on diabetes and cancer based on the increased risk of selected cancers, including malignancies of the liver, pancreas, endometrium...

A Case Study Approach to Chronic Myelogenous Leukemia

Chronic myelogenous leukemia (CML) is a bone marrow disorder characterized by the translocation of chromosomes 9 and 22. CML typically progresses through three stages: chronic phase, accelerated phase, and blast phase or blast crisis. Tr...

Collaborative Approach to Managing a 47-Year-Old Male with Stage IIB Rectosigmoid Colon Cancer and New Onset of Diabetes

Both cancer and diabetes are significant health-care challenges, and the coexistence of these diseases has been linked with increased mortality. To safely and effectively manage the patient with cancer and diabetes, the advanced practiti...

Identifying and Treating Insomnia in the Adult Cancer Patient

Case Study A.R. is a 45-year-old woman who was diagnosed with an infiltrating ductal carcinoma of her right breast (T3N0M0; estrogen- and progesterone-receptor–positive, HER2-negative). She underwent a modified radical mastectomy follow...

Identification of an Adenomatous Polyposis Coli Mutation Associated with Attenuated Familial Adenomatous Polyposis

Case Study D.R. is a healthy 42-year-old male who presented to the High Risk Familial Cancer Clinic because his father had been recently diagnosed with attenuated familial adenomatous polyposis. His father, L. R., age 65 years with a hi...

Updates in the Diagnosis and Monitoring of Multiple Myeloma

Abstract Multiple myeloma (MM) is a plasma cell neoplasm characterized by malignant transformation and clonal expansion of mature plasma cells, resulting in an overproduction of monoclonal proteins (immunoglobulins). Due to the heteroge...

Managing Chemotherapy-Induced Nausea and Vomiting: An Adaptable, Collaborative Approach for a Patient With Colon Cancer

Treatment of Patients With Multiple Myeloma: A Relapsed and Refractory Case Study