Downloaded on 09 26 2017. Single-user license only. Copyright 2017 by the Oncology Nursing Society. For permission to post online, reprint, adapt, or reuse, please email pubpermissions@ons.org
`
`Oncology Nursing Society 31st Annual Congress
`Podium and Poster Abstracts
`
`For your convenience, all Podium and Poster Abstracts have been indexed
`according to subject (page 486) and fi rst author (page 491).
`The abstracts appear exactly as they were submitted and have not undergone editing
`or the Oncology Nursing Forum Editorial Board’s review process. We have made every effort to be accurate.
`If any errors or omissions have been made, please accept our apologies.
`Abstracts that are not being presented do not appear.
`
`the oncology nurse. Oncology nurses consider patient education a high
`priority. This was described in the ONS Ambulatory Offi ce Nurse Survey
`published in 2004. Oncology nurses are often faced with the challenge
`of integrating teaching into a busy schedule of patient care activities.
`Although oncology nurses consider patient education a high priority,
`chart reviews often refl ect incomplete patient education or incomplete
`documentation. The lack of specifi c guidelines related to patient education
`has lead to variable teaching practices among oncology nurses.
`Purpose: The purpose of this project is to develop and implement
`an outcome oriented, multidisciplinary patient education carepath that
`ensures a consistent, high quality standard of patient education at an
`NCI-designated Comprehensive Cancer Center.
`Intervention: A sub-group of the Ireland Cancer Center Patient Educa-
`tion Committee completed an assessment of the current patient educa-
`tion practices. Committee members outlined patient education topics
`relevant to general oncology treatments (i.e. nausea, infection, fatigue)
`and described the content necessary to provide comprehensive patient
`education. A carepath was designed with major treatment-related patient
`education topics organized in rows. Columns across the page represented
`periods of time. Individual blocks on the carepath list topics of patient
`education that should be discussed at a specifi c point in time. Each block
`includes bullet points of information to ensure consistent topic teaching
`among oncology RN staff. Group discussions, staff meetings, and poster
`presentations were used to introduce the patient education carepath proj-
`ect. The carepath was then introduced into three disease specifi c medical
`oncology practices for a six-week trial.
`Evaluation: A retrospective chart audit to assess for documentation
`trends and completeness. All oncology RNs using the new patient educa-
`tion carepath will complete an evaluation tool to determine ease of use
`and the comprehensiveness of the carepath content.
`Discussion: Implications for oncology nursing practice include consis-
`tent high quality patient education, as well as improved documentation.
`Integration of the patient education carepath into standard practice at the
`Ireland Cancer Center is the fi nal project goal.
`
`3A
`
` VIDEO IS WORTH A THOUSAND WORDS. Ellen Carroll, BSN, RN, and
`Bazetta Blacklock-Schuver, BS, BSN, RN, National Institutes of Health,
`Bethesda, MD.
`Patient education is the cornerstone of oncology care. Consistent and
`accurate patient teaching impacts patient outcomes, especially for diverse
`populations. Increasingly, patients are asked to take on more self-care
`responsibilities, such as central line care. With a rise in both non-English
`speakers and self-care responsibilities, new approaches to patient educa-
`tion are required. Moreover, oncology nurses at this institution identifi ed
`a variation in the care of central lines by patients/caregivers.
`To address inconsistencies and improve effectiveness in teaching line care,
`this project involved developing a video to enhance and complement writ-
`ten materials and patient instruction for both English/Spanish speakers.
`Patient, caregivers and staff were informally surveyed on existing teach-
`ing methods related to line care. Using responses and hospital protocols,
`
`1B
`
`UILDING A COLLABORATIVE NURSING PRACTICE TO PROMOTE PA-
`TIENT EDUCATION: AN INPATIENT AND OUTPATIENT PARTNERSHIP.
`Kristin Negley, MS, RN, AOCNS, Sheryl Ness, MA, RN, Janine Kokal, MS,
`RN, Kelli Fee-Schroeder, BSN, RN, Jeanne Voll, MS, RN, Chris Hunter, AD,
`RN, and Kristi Klein, BSN, RN, Mayo Clinic, Rochester, MN.
`Oncology nursing staff, in a large Midwestern medical facility, identi-
`fi ed that patient education for oncology patients can be incomplete or
`duplicative between the inpatient & outpatient practices. Although excel-
`lent patient education is provided in both settings, the messages taught
`are unknown between practice areas without extensive chart review.
`Developing a formal partnership that promotes communication and
`consistent information and education helps to assure standards of care
`are congruent between these two settings.
`The purpose of this project was to build a collaborative nursing prac-
`tice between inpatient and outpatient practice settings that promotes a
`seamless, integrated process of meeting the educational needs of oncol-
`ogy patients and families, along with providing a unique opportunity to
`enhance oncology nurse’s professional development.
`Two inpatient nurses, partnered with oncology nurse educators, worked
`one day every two weeks for three months in an outpatient Cancer Educa-
`tion Center interacting with cancer patients and families, teaching classes,
`and working on specifi c projects. In addition to promoting available educa-
`tional materials, the nurse educators focused on professional development
`skills such as learning theories and education competencies, formal pre-
`sentations, teaching strategies, and individual and group patient education
`interactions. The inpatient nurses provided the unique clinical knowledge
`and expertise of bedside nursing to the outpatient education practice.
`An extensive evaluation, utilizing Kirkpatrick’s four levels of evaluation,
`was conducted to assess collaborative practice, staff development, and
`nursing job satisfaction. Evaluation was completed by written assessment
`and oral interviews pre and post project with nurse participants, nurse
`educators, and nurse managers (post only). Participants were also asked
`to keep anecdotal comments of patient encounters.
`The evaluation showed positive results with themes including: in-
`creased collaboration and communication between practices; increased
`awareness and application of educational materials; enhancement of
`professional development skills; and the provision of seamless, integrated
`care. This collaboration project has started a direct communication pro-
`cess between the Cancer Education Program and the inpatient oncology
`nurses with future projects in process. Collaboration between nurses is
`important but infrequently documented in literature. This project, though
`small scale, resulted in nursing collaboration with high impact outcomes
`of positively affecting nursing knowledge and patient care.
`
`2T
`
`HE DEVELOPMENT OF A PATIENT EDUCATION CAREPATH: A PILOT
`PROJECT. Marlana Mattson, RN, BSN, OCN®, University Hospitals of
`Cleveland Ireland Cancer Center, Cleveland, OH.
`Background/Problem: Patient education regarding chemo therapy
`treatments, side effects and symptom management is a responsibility of
`
`ONCOLOGY NURSING FORUM – VOL 33, NO 2, 2006
`394
`
`
`
`lmAbstracts.indd 394lmAbstracts.indd 394
`
`
`
`02/22/2006 8:18:34 AM02/22/2006 8:18:34 AM
`
`IPR2018-00685
`Celgene Ex. 2027, Page 1
`
`

`

`these study patients through upfront education, effective assessment, and
`appropriate intervention.
`Oncology nurses may encounter these toxicities in patients being
`treated with Gefi tinib and Rapamycin. This information will assist nurses
`in developing treatment strategies to effectively manage these toxicities
`prior to the patients’ initiating therapy.
`45
`SAFETY PERSPECTIVES ON THE ROLE OF AMG 706, AN INVESTIGA-
`TIONAL, ORAL, MULTIKINASE INHIBITOR (MKI), FOR SECOND-LINE
`TREATMENT OF GASTROINTESTINAL STROMAL TUMORS (GIST). Marilyn
`Mulay, RN, MS, OCN®, Premiere Oncology, Santa Monica, CA.
`Multikinase inhibitors (MKIs) are being examined for the treatment of
`gastrointestinal stromal tumors (GIST), a rare neoplasm characterized by
`well-defi ned mutations in growth factor receptors (incidence estimated
`at 5000 cases per year in the US). Patients with GIST frequently possess
`mutations in c-KIT, which encodes for a receptor tyrosine kinase involved
`in tumor cell proliferation. Imatinib, a small molecule cancer therapeutic,
`inhibits Kit and is currently approved for the treatment of GIST. Many
`imatinib-treated patients with GIST relapse due to additional mutations
`that confer imatinib resistance. Therefore, new therapeutics targeting
`mutant Kit and other oncogenic pathways are needed. Angiogenesis, the
`formation of blood vessels from the existing vasculature, is involved in
`the malignant potential of GIST. Inhibitors of angiogenesis are important
`therapeutic candidates for the treatment of imatinib-resistant GIST.
`To provide a fundamental introduction to GIST and the side effects
`seen with AMG 706 treatment, along with methods for managing them.
`AMG 706 is an oral MKI that inhibits vascular endothelial growth
`factor receptors (VEGFR), Kit, and platelet-derived growth factor recep-
`tors (PDGFR), resulting in potent inhibition in models of angiogenesis,
`tumor proliferation, and lymphangiogenesis. AMG 706 inhibits tumor
`growth directly and blocks its blood supply. AMG 706 is being examined
`in patients with imatinib-resistant GIST.
`Side effects of AMG 706 most commonly include hypertension, diar-
`rhea, fatigue, nausea, and headache. Hypertension has been observed with
`other antiangiogenic agents and is easily manageable with antihyperten-
`sive medication. Patients treated with AMG 706 should be frequently
`monitored for blood pressure changes. Antihypertensive drugs may be
`prescribed to bring blood pressure to acceptable levels. The short half-
`life of AMG 706 allows for rapid treatment interruption in the case of
`serious adverse effects.
`AMG 706 is generally well tolerated, and its activity on multiple kinase
`targets, including VEGFR, PDGFR, and possibly mutant Kit, makes it an
`ideal candidate for imatinib-resistant GIST. The side effects of AMG 706
`tend to be related to its antiangiogenic activity, and are easily monitored
`and managed.
`46
`CLINICAL CHARACTERISTICS AND MANAGEMENT STRATEGY OF REV-
`LIMID INDUCED TUMOR FLARE REACTION IN PATIENTS WITH CLL. Kena
`Miller, FNP, Laurie Musial, RN, and Dawn Depaolo, RN, Roswell Park Cancer
`Institute, Buffalo, NY; and Cynthia Crystal, RN, Celgene, New Jersey.
`Tumor Flare Reaction (TFR) is new side effect (SE) unique to chronic
`lymphocytic leukemia (CLL) patients treated with lenalidomide. This SE
`is not reported but pose major concern in patient management. Oncology
`nurses (ON) learn fi rst hand about SE occurring with new therapies and
`must develop effective strategies to identify and manage these SE and to
`promote patient education.
`Purpose: To bring forth the clinical characteristics of TFR and share
`our management experience. Lenalidomide, an immunomodulatory oral
`agent, FDA approved for 5q deletion MDS and currently investigated in
`multiple myeloma and CLL patients.
`TFR is characterized by a sudden/tender increase in disease effected
`lymph nodes (LN)/spleen with rash and/or low-grade fever, occurring
`within 24-48hours of lenalidomide treatment. Usually during 1st cycle
`and lasting for 14 days. Some patients show an increase in WBC.
`Twenty-nine patients with relapsed/refractory CLL enrolled on a
`phase II trial received lenalidomide 15- 25 mg/d for 21d of 28-day cycle.
`ON noted sudden tender increase in LN sizes. Progressive disease was a
`concern but a concurrent decrease in leukemia counts helped identify
`this an immune reactivation phenomenon, now referred as TFR. TRF
`
`incidence was 67% mostly Grade 1/2. The ON devised following man-
`agement strategy:
`1. Ibuprofen(400-600mg) Q8-Hr x 10-14 days, at onset of pain/LN
`swelling.
`2. Counseling
`3. Oxycodone PRN for severe pain.
`4. Benadryl PRN
`These interventions through ON resulted in adequate management of
`TFR and improved compliance.
`TRF is a new SE of lenalidomide with high incidence, peculiar to CLL.
`As this agent becomes commercially available, it is germane to the safety
`and welfare of patients that effective SE management strategies are utilized
`by ON and be shared with and clinical practitioners to improve patient
`outcomes. In our experience patient education, counseling and support
`by the ON played a critical role in early identifi cation and management
`of this SE.
`47
`PERFORMANCE IMPROVEMENT: FATIGUE INTERVENTION PROJECT.
`Sandy Balentine, RN, OCN®, Mary Dinos, RN, OCN®, Maureen Flannery,
`LSW, and Fran Cartwright, RN, PhD, AOCN®, Valley Hospital, Paramus, NJ;
`Bette Williams, RN, Valley Hospital, Ridgewood, NJ; and Linda Ohnikian,
`RN, Valley Hospital, Paramus, NJ.
`Fatigue remains a common and distressing symptom in individuals
`with cancer. ONS recommends that all patients with cancer should be
`assessed for fatigue and receive fatigue education and management.
`The Performance Improvement Cancer Committee (PICC) identifi ed
`the need to standardize the assessment and management of fatigue in in-
`patient oncology, radiation oncology and the ambulatory infusion center.
`A fatigue management packet was developed based on a literature review.
`The information packet is consistent with the interventions listed on the
`ONS “Evidence that nursing interventions infl uence fatigue”.
`The 0 to 10 fatigue scale was entered into the plan of care in inpa-
`tient oncology, radiation oncology and the ambulatory infusion center.
`Patients are assessed at the start of treatment, at defi ned intervals, and
`when patients complain of fatigue. All patients are given the fatigue
`management packet. Consistent with the NCCN guidelines (2005) and
`OCN® (2006 - 2009), patients who score 4 or greater on the 0 -10 scale
`(moderate to severe fatigue) are referred to a fatigue counselor for a more
`comprehensive assessment.
`Data for the fi rst month of the fatigue intervention project was reported
`at the PICC. Although it is a small sample, the data suggests that there
`are signifi cant differences across diagnoses and treatment regimens. This
`will remain on the PICC agenda. Data will be examined to identify pa-
`tients response to the intervention packet and counseling. Revisions to
`the project will be made. Topics for research will be explored based on
`this outcome data.
`The oncology nurse is in a pivotal position to measure fatigue and
`to provide information about fatigue management that can infl uence
`severity of fatigue and/or the distress experienced form this troubling
`symptom.
`48
`VIRTUAL REALITY INTERVENTION FOR CHEMOTHERAPY SYMPTOMS.
`Susan Schneider, RN, PhD, AOCN®, Duke University, Durham, NC.
`Successful completion of chemotherapy offers a greater chance for
`tumor response and quality of life. Many patients have diffi culty adher-
`ing to the regimen because of chemotherapy-related symptoms. Virtual
`reality (VR) provides a distracting, immersive environment, which blocks
`out competing stimuli, ameliorates symptoms, and helps patients toler-
`ate treatments.
`To determine the immediate and short-term effects of a VR intervention
`on symptom distress in adults with lung, colon or breast cancer who were
`receiving intravenous chemotherapy.
`Lazarus and Folkman’s Stress and Coping Model identify distraction
`as a coping strategy for managing stressful situations.
`123 adults at Duke University participated in the study. The average
`participant was 54 years old, female and Caucasian. A crossover design was
`used to examine VR as a distraction intervention to relieve symptom distress
`in outpatients receiving chemotherapy and to determine the immediate
`and 48-hour post-treatment effect on symptom distress. Participants were
`
`ONCOLOGY NURSING FORUM – VOL 33, NO 2, 2006
`407
`
`
`
`lmAbstracts.indd 407lmAbstracts.indd 407
`
`
`
`02/22/2006 8:18:41 AM02/22/2006 8:18:41 AM
`
`IPR2018-00685
`Celgene Ex. 2027, Page 2
`
`