First-degree relatives of melanoma survivors have at least a twofold increased risk for developing melanoma, but studies show that they do not regularly adopt sun safety behaviors. While there is no definitive method to prevent skin cancer, there are ways to dramatically reduce the risk. Determining which interventions positively impact the adoption of prevention behaviors will assist in the development of strategies to reduce the occurrence of melanoma in first-degree relatives. A literature search was conducted using PubMed and Scopus in December 2024. The search focused on studies related to first-degree relatives of melanoma survivors and included discussion of prevention interventions. Five articles were included in this integrative review. Overall, the studies found that targeted prevention interventions led to improvements in sun protective and screening behaviors in first-degree relatives. However, the effectiveness of these interventions differed, which may have depended on how the interventions were delivered to the target audience and barriers to the adoption of sun protective behaviors. Variation in educational content did not appear to impact results. However, interactive educational content delivered online that involved the entire family was the optimal intervention to foster the adoption of sun safety behaviors in first-degree relatives. This review specifically focused on first-degree relatives of melanoma survivors. However, targeted prevention interventions can be applied to other cancers, due to family history of cancer as a risk factor and the fact that family members tend to share health habits.
Background:Cancer-related fatigue (CRF) is a common and often underreported issue in the outpatient setting. Advanced practitioners are crucial in assessing and managing CRF, as they are frequently in contact with patients and can observe changes in their condition. Implementing a multidimensional fatigue scale that incorporates images could enhance and expedite the screening process for CRF in cancer outpatient care. Objective:The purpose of this study was to create a practical tool for clinical use, specifically a brief, self-rating pictorial scale designed to assess CRF. Methods:Nine focus groups comprised of oncology clinical experts and volunteer patients/survivors were conducted at a large National Cancer Institute-designated cancer center. Clinical expert focus groups convened online for 1-hour meetings every 2 weeks, spanning four sessions. During these sessions, the focus groups examined existing cancer fatigue scales and reviewed relevant literature. One of the advanced practice providers created an initial version of a pictorial fatigue scale. Patients then contributed their insights via multiple focus groups based on their personal experiences with CRF. Subsequently, a professional graphic artist refined the images, incorporating the patients' feedback to enhance the scale's accuracy and effectiveness. Data evaluation and synthesis:Content validity was established for a Visual Fatigue Scale measuring CRF using an iterative process with nine focus groups made up of oncology clinical experts and patients. The final scale included two image sets and a 10-point numeric scale to correspond with four levels of fatigue (none, mild, moderate, severe). Implications:The Visual Fatigue Scale can help identify patients who need more comprehensive evaluation and management, ensuring timely and effective interventions. By utilizing such a scale, health-care providers can better address the multifaceted nature of CRF, improving patient outcomes and quality of life.
Advanced practitioners (APs; nurse practitioners, physician associates, clinical nurse specialists, advanced degree nurses, and pharmacists) are vital in providing high-quality, specialized patient care, particularly in oncology. Despite the tremendous value that APs bring to health-care systems, an aging workforce, turnover, and burnout underscore the urgent need for structured leadership succession planning. Nursing and pharmacy data reveal that 30% to 50% of leaders plan to retire within 5 years, yet few organizations have formal processes to replace them. Without proactive planning, there is a risk that clinical expertise, leadership continuity, and program stability will be lost. Advanced practitioner-specific succession planning is especially critical due to the unique clinical and operational roles that APs play in health-care systems outside of patient care, such as in quality improvement and clinical program development. A comprehensive framework includes aligning succession planning with organizational strategy, defining leadership roles, assessing the risk of future vacancies, and securing executive support, as well as talent identification focusing on diversity and inclusion. Clear career pathways and structured leadership training further strengthen the path from staffing to leadership. Barriers to succession planning include organizational resistance to career development pathways, limitations in funding, unconscious bias, and fear of talent loss. Addressing these challenges demands executive sponsorship, transparent hiring and promotion processes, and a culture that normalizes leadership development. In oncology-where APs are central to care coordination-the absence of succession planning threatens care continuity and program development. Institutions must adopt structured, inclusive succession planning models to maintain patient-centered care and ensure a resilient future AP leadership workforce.
Professional development is vital to the growth and career satisfaction of oncology advanced practitioners (APs). Among the many avenues for development, publication offers a platform for APs to share knowledge, contribute to the profession, and improve patient care. This article outlines various publication opportunities available to APs, including poster abstracts, journal articles, and newsletter pieces. Poster presentations remain a dynamic method for showcasing clinical work and engaging with peers at conferences, offering both educational value and networking potential. For those seeking a more comprehensive review of findings, manuscript submission to peer-reviewed journals provides a structured format to present research, reviews, or clinical innovations. Additionally, newsletters offer accessible formats for sharing insights with a targeted professional audience. This article reviews submission processes and helpful strategies to guide APs through the often-intimidating path to publication. By engaging in publication, APs not only enhance their own professional development but also contribute to the collective advancement of oncology practice.
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that requires long-term hematologic control and symptom monitoring. Despite advanced therapies and treatment guidelines, real-world adherence to therapeutic goals and routine symptom assessment remains inconsistent, particularly outside the academic setting. To optimize care, a pharmacist-led clinical support program was implemented at Levine Cancer Institute, a large regional hematologic malignancy center, in collaboration with the integrated institutional Atrium Health Specialty Pharmacy Service (SPS). This program aimed to standardize PV care system-wide by improving hematocrit (Hct) control and supporting symptom burden assessment via Myeloproliferative Neoplasm Symptom Assessment Form (MPN-10) scores. Through diagnosis code screening and identification of patients with Hct ≥ 45%, the SPS pharmacist team provided clinical reviews, pharmacotherapy recommendations, financial access support, and coordinated care, including dispensing medication and providing medication education. Interim analysis demonstrated improved identification of opportunities for optimization, with sustained provider engagement. This model highlights the opportunity for advanced practitioners, including pharmacists, to improve disease control and quality of life for patients with PV.
Background: Mosunetuzumab is a CD20xCD3 T-cell engaging bispecific antibody that has demonstrated a manageable safety profile in patients with relapsed or refractory (R/R) non-Hodgkin lymphoma in a pivotal phase II study (GO29781; NCT02500407). Rapid identification and appropriate management of adverse events (AEs) are key for patients receiving mosunetuzumab, and advanced practice providers (APPs) play a vital role. Methods: Six APPs were surveyed, including nurse practitioners, a research nurse, clinical pharmacists, and physician assistants, from four US academic centers involved in the phase II GO29781 study of mosunetuzumab administered intravenously in patients with R/R follicular lymphoma. Advanced practice providers provided their perspectives and experiences on their roles in the education of staff and patients, and in the monitoring and management of AEs associated with mosunetuzumab treatment. Results: APPs provided education to staff and patients around the signs and symptoms of potential AEs as well as mosunetuzumab’s mechanism of action, route of administration, and dosing schedule. They were involved in monitoring patients for AEs using clinical assessments and laboratory tests and were responsible for managing AEs, ordering necessary interventions, deciding when to interrupt treatment, clearing patients for their next dose, and advising the wider medical team on steps for patient management. Conclusions: APPs play a key role as part of a multidisciplinary team to ensure the safety and comfort of patients receiving mosunetuzumab in the outpatient setting. The APP experiences presented here may be used to inform future clinical practice and care coordination for mosunetuzumab treatment.
Palmar-plantar erythrodysesthesia, also known as hand-foot syndrome (HFS), is a common dermatologic toxicity of capecitabine. In this report, the case of a 59-year-old man with metastatic pancreatic ductal adenocarcinoma who developed grade 2 HFS with rare genital involvement is described. This case underscores the importance of recognizing atypical genital involvement in HFS to support timely management.
Docetaxel is an antineoplastic chemotherapy agent widely used in the treatment of a variety of malignancies. Despite its widespread use, ocular toxicities remain rare and literature is sparse regarding the identification and management of these toxicities, especially when they occur in combination with dermatologic toxicities. Here, we report two cases of combined ocular and dermatologic toxicities caused by the administration of docetaxel. Case 1 describes a 64-year-old man who developed epiphora, eye discharge, eyelid margin sores, and facial rash after cycle 2 of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy for esophageal adenocarcinoma. Case 2 describes a 50-year-old woman with breast cancer who developed a widespread erythematous, desquamating rash with ocular lesions and discharge after cycle 2 of docetaxel-containing chemotherapy. Both cases included a previously reported, less serious constellation of symptoms one cycle prior to the onset of the more severe reaction(s) and concurrent presentation of significant dermatologic and ocular adverse events. Rapid identification and intervention under the care of both the oncology team and an ophthalmologist are crucial to minimize morbidity.
Background:Oncology advanced practitioners (APs) are integral to the daily care of patients with cancer. There is a gap in the literature addressing APs' training in genetics, specifically in baseline oncogenomics. The objective of this study was to evaluate the reported oncogenomic training and proficiency of APs working in hematology/oncology. Methods:An interventional pre- and post-test study was conducted with the target population of hematology/oncology APs, which was facilitated through a partnership with the Advanced Practitioner Society for Hematology and Oncology (APSHO). A survey was created to assess demographic variables, oncogenomic training, and concepts of knowledge proficiency among the participants. The intervention was an oncogenomic course. Results:75 participants enrolled in the study, with 37 completing both the pre-test and post-test surveys. 78% of the participants reported limited genetics/genomics training in their master's or doctoral professional programs. 35% of the participants were undecided about access to oncogenomic on-the-job training. Many participants expressed uncertain or limited proficiency with ordering and interpreting tumor genomic profiling for somatic and potential pathogenic germline variants. A statistically significant improvement in the median scores was observed after taking the course in all six of the oncogenomic proficiency statements in the 37 participants who completed the study (t score = -8.841, p value < .001). Discussion:This study evaluated the importance of perceived genetics/genomics training in formal and informal educational settings, as well as oncogenomic knowledge in APs working in hematology/oncology. The statistically significant increase in all the oncogenomic proficiency concepts analyzed in the post-test indicates that a focused oncogenomic course for APs is an effective learning strategy.
Colorectal cancer (CRC) impacts about 1 in 13,000 pregnancies in the United States. Although chemotherapy is generally avoided in pregnant patients due to a concern for adverse effects to the fetus, there are situations where the benefits outweigh the potential risks. In this article, we discuss a unique patient case of a 36-year-old woman diagnosed with CRC while pregnant. She received chemotherapy during her second and third trimesters and delivered a healthy baby at 34 weeks. Specific information about oncologic therapies for colorectal cancer in the setting of pregnancy is discussed. Additionally, this article highlights considerations around CRC diagnosis and cancer treatment during pregnancy.
Head and neck cancer is a life-changing experience. Treatment can be single-modality or multimodality therapy, including surgery, radiation, chemotherapy, or clinical trials. All cancer survivors experience distress, but head and neck cancer survivors are more likely to experience it due to the bodily functions affected by this disease. Distress screening is now a part of routine cancer care at diagnosis, treatment, and pivotal times of the journey. However, in a survivorship clinic in this study, a distress screening tool was not implemented at routine follow-up appointments after completing treatment. Head and neck cancer survivors were followed for cancer surveillance by specialists or primary care providers on a 6- to 12-month basis, where patients could routinely self-report any distress. The purpose of this quality improvement (QI) project was to determine how the use of a distress screening tool over a 12-week period affected referrals for psychosocial needs among head and neck cancer patients who were 2 or more years post-treatment. The sample consisted of head and neck cancer survivors in a survivorship clinic (n = 260). This study found that using the NCCN Distress Thermometer (DT) screening tool to measure distress in survivorship patients significantly (p = .0001) increased the number of referrals for psychosocial needs, with 0 referrals made pre-intervention compared with 12 referrals made post-intervention. Screening for psychosocial distress using the DT screening tool was effective in identifying head and neck cancer survivors in this clinic who were candidates for a referral to address psychosocial needs.
The management of newly diagnosed transplant-ineligible multiple myeloma remains challenging, largely because frailty complicates treatment decisions and frequently leads to the exclusion of frail patients from pivotal clinical trials. Recent subgroup analyses provide useful insight into whether quadruplet therapy may offer advantages over triplet therapy in this population. Data from the IMROZ and CEPHEUS trials were reviewed to compare outcomes between quadruplet and triplet regimens in both the overall intent-to-treat cohorts and the frailty-defined subgroups. Frailty was assessed using the International Myeloma Working Group (IMWG) frailty index in CEPHEUS and the simplified IMWG frailty score in IMROZ. Across both trials, patients with impaired performance status receiving quadruplet therapy demonstrated longer progression-free survival and higher rates of minimal residual disease negativity compared with those receiving triplet therapy. These findings suggest that quadruplet regimens may provide meaningful clinical benefit even among selected frail patients when treatment decisions are guided by comprehensive frailty assessment and individualized clinical judgment. Additional real-world evidence is needed to confirm tolerability, optimize patient selection, and further clarify the role of quadruplet therapy in this vulnerable population.
The treatment landscape for advanced-stage Hodgkin lymphoma (HL) continues to evolve, with immune checkpoint inhibitors now pivotal to improving patient outcomes. One of the most promising developments is the nivolumab-AVD regimen, which combines nivolumab with doxorubicin, vinblastine, and dacarbazine. This novel approach has demonstrated encouraging efficacy and is increasingly integrated into frontline treatment regimens. This article provides practical, evidence-based knowledge for advanced practitioners to effectively manage the most common toxicities associated with nivolumab-AVD. It reviews the most frequently observed adverse events, including immune-mediated events, and outlines best practices for monitoring and management. A real-world case study illustrates how proactive management and clinical judgment can influence outcomes in patients receiving nivolumab-AVD.
Breast cancer is the second most common cancer in women in the US. With advancements in treatments, the life expectancy of breast cancer survivors (BCSs) continues to increase. Sexual dysfunction is a lasting effect of treatment and can impact BCSs’ quality of life. This review examined the impact of different levels (none/low, moderate, and high) of physical activity on sexual outcomes in BCSs. A literature review of PubMed and Scopus restricted to articles published within the last 10 years yielded a total of 326 articles, with nine selected based on inclusion and exclusion criteria. Compared with no physical activity, low, moderate, or high levels of physical activity are effective in improving sexual outcomes in BCSs. Findings were particularly pertinent to sexual pleasure and sexual function. Advanced practice providers (APPs) should recommend physical activity to BCSs and other cancer survivors who are experiencing sexual dysfunction. This paper contributes to the current body of knowledge by offering a unique intervention to address certain aspects of sexual functioning in BCSs.
Recently, I presented a webinar for the Advanced Practitioner Society for Hematology and Oncology (APSHO) on the topic of artificial intelligence (AI) in cancer care, where I reviewed practical, ethical, and clinical applications. We discussed how advanced practitioners (APs) can use AI tools for clinical documentation, research, and scholarly communications. We discussed AI subcategories, including machine learning (ML), deep learning (DL), large language models (LLMs), and generative AI (GenAI), which are now common in medicine (Celik, 2025; Oermann et al., 2025).
Collaboration between medical science liaisons (MSLs) and advanced practice providers (APPs) is essential for advancing oncology care in an increasingly complex treatment landscape. Medical science liaisons serve as scientific resources, engaging in non-promotional exchange, delivering tailored education, supporting clinical research, and gathering real-world insights. These interactions help APPs stay current with evolving standards of care, interpret clinical trial data, and address knowledge gaps, while APPs provide perspectives that inform medical strategy and research priorities. This article outlines the origins and responsibilities of the MSL role, clarifies distinctions from commercial functions, and explores key pillars of collaboration: clinical research, medical education, and insight gathering. Through practical examples, it demonstrates how effective partnerships between MSLs and APPs bridge the gap between scientific innovation and clinical application, ultimately improving patient outcomes.
Background:Patients with gliomas face significant challenges in daily life due to rapidly progressing neurological and cognitive symptoms. In recent years, there has been increased awareness of the importance of timely referral to specialized palliative care (SPC) for patients with gliomas. This study evaluated referral processes and interdisciplinary services used by patients with gliomas and their caregivers. Methods:Patients with gliomas (World Health Organization [WHO] grade 2-4) treated at Odense University Hospital in Denmark from 2016 to 2020 were retrospectively identified. Data on demographics, treatment, and SPC referrals were collected from medical records and the Danish Palliative Care Database. Descriptive statistics and survival analysis were performed using STATA 17. Results:Among 443 patients, 185 initiated SPC, generally 7 months after the primary diagnosis. Patients with WHO grade 4 gliomas received SPC for a median of 2.5 months before death. All SPC patients had contact with both a palliative care physician and a designated contact nurse; in addition, 63% utilized the services of at least one other multidisciplinary professional, most commonly a physiotherapist. Use of the services of two or more multidisciplinary professionals was most frequent in patients under 50 years old (67%), compared with 39% of patients aged 50 to 70 years and 16% of patients over 70 years. Conclusion:Patients with gliomas are often referred to SPC but typically late in their disease trajectory. The involvement of various SPC professionals underscores a significant demand for interdisciplinary support, which may be underestimated in this study. Younger patients made greater use of SPC services than older patients, indicating an age-dependent need for support from different professionals within the SPC team. Further investigation is needed, particularly in older patients.
Tamoxifen, a selective estrogen receptor modulator (SERM), is commonly prescribed in hormone receptor-positive breast cancer. While effective in reducing recurrence and mortality, tamoxifen is associated with weight gain in a significant proportion of patients. This weight gain complicates survivorship care, particularly given obesity’s association with recurrence risk and all-cause mortality. Although lifestyle modification remains the standard of care for weight management, many breast cancer survivors struggle to achieve sufficient results with behavioral interventions alone. Current guidelines from oncology and obesity societies provide limited, nonspecific direction regarding pharmacologic weight management for tamoxifen-treated patients. Medication classes including GLP-1 receptor agonists, tirzepatide, phentermine-topiramate, bupropion-naltrexone, and orlistat are reviewed with attention to efficacy, safety, potential interactions, and tamoxifen-specific considerations. Practical monitoring strategies and prescribing considerations are provided to support oncology practitioners. This narrative review summarizes available evidence on tamoxifen-associated weight gain and outlines considerations for the use of anti-obesity medications in this population.
Introduction: In September 2021, the National Cancer Institute (NCI) expanded the ability for advanced practice providers (APP) to practice more autonomously by being able to write orders for research-related anti-cancer therapy. Objectives: The goal was to align with NCI guidance to permit APPs to independently write non-Cycle 1 Day 1 study agent orders. Methods: An academic institution created a process to comply with the NCI’s memorandum. Health-system policy was updated to reflect this new capability. A tracking system was established to monitor NCI’s Registration and Credentialing Roster (RCR) expiration dates. An audit process was created to verify alignment between signed electronic research-related anti-cancer therapy orders and Delegation of Tasks Logs. Results: To date, no adverse comments about APPs’ abilities to sign anti-cancer trial orders have been received from organizations that accredit or support clinical trials. In addition, no APPs have lost the ability to sign anti-cancer therapy orders because they failed to renew their RCR within the expiration period. To facilitate this capability in a timely manner, a research-specific onboarding experience was created. Conclusion: APPs may safely write anti-cancer treatment orders for patients enrolled in clinical trials. Additionally, such privilege may contribute to the enhanced participation of APPs through research.
