e12702 Background: The POSITIVE trial established the feasibility of temporary interruption of adjuvant endocrine therapy (ET) to allow pregnancy in selected patients with hormone receptor–positive early breast cancer. However, trial populations may not fully reflect the demographic, racial, and treatment heterogeneity encountered in routine clinical practice. Real-world benchmarking of pregnancy outcomes following ET interruption remains limited. We evaluated pregnancy outcomes in a contemporary institutional cohort. Methods: We conducted a retrospective cohort study of patients with stage I–III hormone receptor–positive breast cancer who temporarily interrupted adjuvant ET for pregnancy intent between 1999–2023 at a tertiary academic cancer center. Patient demographics, tumor characteristics, treatment history, duration of ET prior to interruption, and pregnancy outcomes were abstracted. Descriptive statistics were used. Results: Among 94 eligible patients, the median age at diagnosis was 32 years (IQR 29–35). Most patients received prior chemotherapy (80%) and underwent mastectomy (66%). At ET interruption, 66% were receiving tamoxifen and 34% were receiving an aromatase inhibitor with ovarian suppression (AI/OFS). Median duration of ET prior to interruption was 28.7 months (IQR 14.7–42.8). Overall, 65.9% of patients achieved a successful pregnancy following ET interruption. Pregnancy success was higher in patients <35 compared with ≥35 (75.8% vs 46.9%, p = 0.01), and in White compared with Black patients (80% vs 47%, p = 0.03). Success rates were similar for patients receiving AI/OFS versus tamoxifen (71.9% vs 62.9%, p = 0.49). After delivery, 20.3% resumed ET. Prior live-birth rates at the time of ET interruption were identical in both the successful and failed pregnancy attempt groups (66%). The overall median time to follow up was 72 months. Median DFS was 73.6 months in the failed-pregnancy cohort and 68.6 months in the successful-pregnancy cohort, while overall survival did not differ between groups. Conclusions: In this diverse real-world cohort, pregnancy success following temporary endocrine therapy interruption was high and consistent with trial-reported outcomes. Younger age, White race, and higher parity were associated with higher pregnancy success, while overall survival remained comparable between groups. These findings support the feasibility of ET interruption for pregnancy attempts across a broader patient population. Larger cohort study is planned to compare outcomes to external controls who received uninterrupted endocrine therapy.

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.

Given the current trend of delaying pregnancy and the gradual increase in age-related risk of certain cancers, the incidence of pregnancy during a cancer diagnosis will likely continue to increase. The objective of this review is to identify specific aspects of quality of life that impact women diagnosed with a cancer during pregnancy. A comprehensive search was conducted using PubMed and Health Research Premium databases, including articles from 2014 to 2024 that assessed psychological or quality-of-life outcomes in cancer during pregnancy. A total of 1,987 articles were screened with a final yield of six articles that met the inclusion criteria. Overall, themes included fear and worry, social support, and concerns over breastfeeding. These themes were identified as aspects of quality of life that impact women diagnosed with cancer during pregnancy. It is critical that all members of the health-care team recognize the unique situation that occurs when a pregnancy is complicated by a cancer diagnosis.

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.

Hematopoietic stem cell transplantation (HSCT) is an intensive treatment requiring the support of a caregiver. This role is a highly demanding responsibility, and caregivers often face distress. In a world that has become highly technological, the aim of this integrative review is to determine the availability and impact of remote interventions in reducing distress in caregivers of HSCT patients. A literature review was conducted using PubMed and Scopus databases. The search included articles published between January 1, 2013, and February 20, 2023. The search yielded 699 unique articles, of which four were included in the final review. The four included studies of the impact of remote interventions on distress or burden in caregivers of adult HSCT patients. Two organizing themes emerged: availability and impact. Availability encompassed intervention accessibility and delivery type while impact considered caregiver quality of life (QOL), mental health, and perceived usefulness. These themes were evaluated in the articles via a variety of validated assessment tools and structured interviews. Ultimately, this integrative review suggests that while remote interventions for caregivers of patients undergoing HSCT are relatively limited, initial studies are perceived as useful and are promising in their potential to improve caregiver QOL and mental health and reduce distress.

Medical aid in dying (MAID) is a treatment option that allows a patient to end their life prematurely. It has been a widely discussed topic over recent years regarding individuals with terminal illness. This review examined the cancer patient’s views on MAID and the factors influencing their perspective. A literature review was conducted using PubMed and Scopus databases. The search included articles published between 1997 and 2024. The initial search yielded 184 articles and 12 of those articles were included for review. These articles all examined variables that affect the adult patient perspective on MAID in individuals with cancer. The factors include demographic characteristics, physical and mental health, social support, quality of life, spirituality, and psychosocial burden. Findings suggest a need for further research to be completed on this topic, especially from the perspective of those with terminal cancer, which would assist patients and caregivers alike in assessing available end-of-life options. Consideration of the variables that influence cancer patients’ opinions regarding MAID is essential for healthcare professionals to establish respectful, patient-centered care and informed decision-making surrounding end-of-life decisions. Exploration regarding cancer patient perspectives, ethical perspectives, and clinical experiences to provide a comprehensive understanding of this complex and challenging topic. This review gives unique insights regarding cancer perspectives, which allows for compassionate, patient care that respects individual autonomy at the end of life.

BACKGROUND: The out-of-pocket cost of oral oncolytics led to the creation of patient assistance programs (PAPs) as an intervention to mitigate financial toxicity. Despite these programs, eligibility and accessibility barriers may disqualify patients from receiving financial assistance for prescribed oral oncolytics. OBJECTIVES: The objective of this integrative review was to identify eligibility and accessibility barriers related to PAPs. METHODS: Acomprehensive search was conducted in PubMed (R) and Ovid (R) databases for articles published from January 2014 through December 2023. Five articles were included in the review. FINDINGS: Eligibility and accessibility barriers of PAPs include insurance status, income ceilings, out-of-pocket costs, and prescription-to- initiation timeline delays. Overall, findings were mixed on what would qualify a patient fora PAP. Transparency from PAPs and the use of pharmacy- based interventions for PAPs can help clinicians efficiently prescribe oral oncolytics.

Colorectal cancer (CRC) is a significant cause of morbidity and mortality, with incidence on the rise, particularly in younger adults. Surgery is a key treatment modality and often results in the construction of an ostomy, either temporary or permanent. This integrative review discusses psychosocial implications of ostomies in women with CRC. A literature review was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and PubMed. The search included articles published between January 1, 2012, and December 31, 2022. The search yielded 684 articles, with a total of six included in the final review. Articles were excluded for not being specific to CRC, not being specific to ostomates, lacking data specific to women, and focusing solely on sexual health. The main issues that emerged were the loss of bodily control, impaired social support and acceptance, social limitations, altered body image, and alterations in sense of self. This review found that factors such as time since surgery, age, relationship status, and cultural background may influence the degree of psychosocial impact of ostomies in women with CRC. Given these factors are substantial and multifaceted, future research should be directed at identifying the subset of women with ostomies as a result of CRC with high-risk demographics.

Tongue cancer treatment often involves glossectomy and flap reconstruction. Since the tongue plays a vital role in swallowing, chewing, speaking, airway protection, and taste, it also plays a major role in the patient's quality of life (QOL) after reconstruction. Therefore, the flap that best preserves QOL should be determined. A literature review was conducted using PubMed, Scopus, and Ovid MEDLINE, with a total of 446 articles retrieved. Four studies were included in this integrative review, which all utilized the University of Washington Quality of Life questionnaire to assess QOL in tongue cancer patients post-glossectomy and flap reconstruction. The articles specifically compared radial forearm free flap to pectoralis major myocutaneous flap, submental island pedicled flap, anterolateral thigh flap, and lateral upper forearm flap. Based on the included articles, no flap significantly preserved QOL. However, a certain flap may be more suitable for a patient based on the patient's preferences, lifestyle, health status, and goals. Therefore, it is important for providers to complete a thorough history and assessment prior to surgery so that the flap chosen upholds the patient's goals and preserves overall QOL.

Adolescent and young adult cancer survivors (AYAs) are uniquely challenged with navigating health care systems during an important developmental phase of life. During the Coronavirus disease 2019 (COVID-19) pandemic, many people experienced social isolation, mental health symptoms, and schooling and employment changes, which may have affected vulnerable AYA cancer survivors. The purpose of this integrative review is to explore the psychosocial impact of the COVID-19 pandemic on AYA cancer survivors in the United States. A literature search was conducted in November 2022 using PubMed, Web of Science, and SCOPUS databases with the following search terms: distress*, depress*, lonel*, anx*, insomnia*, cancer*, neoplasm, COVID-19, coronavirus, young adult, AYA, teen*, and adolescen*. The initial search yielded 468 articles. Inclusion criteria required that studies were conducted in the United States, published in English, with a sample of patients diagnosed with cancer between ages 15 and 39. After review and appraisal of each relevant article, eight were included. Through comparative analysis of eight articles, including qualitative and quantitative studies, three themes emerged: mental health impact, health care impact, and financial impact. Mental health impact included increased anxiety, worsening depression and social isolation, and sleep disturbances. Changes in health care included delays in care, medical cost-coping and benefits of virtual care. Financial difficulties included employment changes and benefits of remote work. The COVID-19 pandemic had an immense impact on the psychosocial health of AYA cancer survivors. It is essential that oncology providers and health care teams consider specific interventions to best serve the psychosocial needs of their AYA patients.

The purpose of this review is to assess the efficacy and adverse events associated with intratumoral injection in the treatment of solid tumor malignancies. A literature review was conducted using PubMed, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus databases from 2009 to 2022. A total of 588 articles were retrieved, with five selected based on inclusion and exclusion criteria. Inclusion criteria specified English language publications, in human trials, and use of intratumoral anticancer agents. The findings from this integrative review demonstrate treatment efficacy as measured by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with increased stable disease and partial response in patients as well as a prolonged survival period. Additionally, findings show that this therapy is associated with predominantly mild adverse events.

Patients undergoing chimeric antigen receptor (CAR) T-cell therapy may experience side effects including cytokine release syndrome (CRS), immune effector cell–associated neurotoxicity syndrome (ICANS), neutropenia, and infection. Growth factor has historically been used to treat neutropenia; however, its role in CAR T-cell therapy is not well explained. Existing data on the safety and efficacy of growth factor are conflicting. The purpose of this integrative review was to explore the safety and efficacy of growth factor in adult patients with hematologic malignancies undergoing CAR T-cell therapy. A literature review was conducted using PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), and Scopus databases. A total of 2,635 articles were retrieved. Four studies were included that looked at the use of growth factor in the CAR T-cell setting. Safety outcomes evaluated included CRS, ICANS, neutropenic fever and/or infection, and neutropenia duration. Efficacy outcomes evaluated included CAR T-cell expansion and treatment response. The literature suggests that growth factor may not increase CRS prevalence, but may lead to an increased grade of CRS, namely grade 2. Growth factor administration does not have any association with ICANS toxicity, CAR T-cell expansion, or treatment response. Its use may not necessarily lead to decreased infection rates but may shorten the duration of neutropenia. Practice implications for providers working with this unique patient population include using growth factor early in the course of CAR T-cell therapy as treatment to shorten the duration of neutropenia rather than infection prophylaxis.

The adolescent and young adult (AYA) ages are a time when individuals are susceptible to risky behaviors, including binge drinking, tobacco, marijuana, and illicit drug use. AYAs are at an increased risk for developing chronic health problems compared with their healthy peers, and substance use can pose additional risks. The purpose of this review is to compare substance use in AYAs with their healthy peers and identify contributing factors. A literature search was conducted of PubMed, Scopus, and OVID databases using keywords substance*, adolescent*, adolescence*, teens*, teenager*, young adult*, pediatric*, childhood*, cancer*, and oncology*. The initial search yielded 148 articles. Inclusion criteria specified English language and articles from January 1, 2013, to December 31, 2023. Studies were excluded if they did not include participants aged <18 years and without a noncancer comparison group. Five relevant articles were included after review and appraisal. Substance use was examined by substance use type and contributing factors, including caregiver-AYA relations, age, and depression/coping. Findings were mixed for substance use, including tobacco and alcohol use. Findings indicate no consistent pattern-substance use was both more and less common in AYAs than in their noncancer peers, or substance use did not differ between AYAs and their noncancer peers. With mixed results, each study identified some level of substance use in AYAs. Given this knowledge, when treating AYAs, providers should be diligent about screening for substance use during each visit. AYAs should be educated about the risk of substance use, especially as a vulnerable, at-risk population.

IntroductionPrior studies of patients treated for breast cancer during pregnancy (PrBC) report mixed outcomes and are limited by substandard treatment, small cohorts, and short follow-up. This study compared survival outcomes of PrBC patients treated with chemotherapy during pregnancy with nonpregnant patients matched by age, year of diagnosis, stage, and subtype.MethodsPrBC patients treated from 1989 to 2022 on prospective institutional protocols were eligible. Disease-free survival (DFS), overall survival (OS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method and multivariable Cox proportional hazards regression.ResultsAmong 143 PrBC and 285 nonpregnant patients, median follow-up was 11.4 years. Survival differences were statistically significant, with median DFS and OS not attained for PrBC patients versus 5.6 years (95% confidence interval [CI], 3.6-15.4; p = .0001) and 19.3 years (95% CI, 14.1-not estimated; p = .0262) for nonpregnant patients, respectively. Median PFS was 24.1 years (95% CI, 15.8-not estimated) for PrBC patients versus 8.4 years (95% CI, 6.4-10.9) for the nonpregnant cohort (p = .0008). Study cohort was associated with DFS, PFS, and OS in multivariable analyses, with the nonpregnant cohort having increased risks of disease recurrence (hazard ratio [HR], 1.91; 95% CI, 1.33-2.76; p = .0005) and disease progression or death (HR, 1.68; 95% CI, 1.19-2.39; p = .0035), and shorter OS (HR, 1.52; 95% CI, 1.01-2.29; p = .0442).ConclusionThese data suggest that PrBC patients treated with chemotherapy during pregnancy have at least comparable, if not superior, outcomes than nonpregnant patients with similar age, cancer stage, and subtype. Analyses excluding patients with postpartum breast cancer were unable to be performed and are a priority for future confirmatory studies.

Introduction The addition of taxanes to anthracycline-based chemotherapy is considered standard of care in the treatment of breast cancer. However, there are insufficient data regarding the safety of taxanes during pregnancy. The aim of this study was to describe the incidence of obstetric and neonatal adverse events associated with the use of taxane-containing chemotherapy regimens for the treatment of breast cancer during pregnancy.Methods This is a multicenter, international cohort study of breast cancer patients treated with taxanes during pregnancy. A descriptive analysis was undertaken to synthetize available data.Results A total of 103 patients were included, most of whom were treated with paclitaxel and anthracyclines given in sequence during gestation (90.1%). The median gestational age at taxane initiation was 28 weeks (range = 12-37 weeks). Grade 3-4 adverse events were reported in 7 of 103 (6.8%) patients. The most common reported obstetric complications were intrauterine growth restriction (n = 8 of 94, 8.5%) and preterm premature rupture of membranes (n = 5 of 94, 5.3%). The live birth rate was 92 of 94 (97.9%), and the median gestational age at delivery was 37 weeks (range = 32-40 weeks). Admission to an intensive care unit was reported in 14 of 88 (15.9%) neonates, and 17 of 70 (24.3%) live births resulted in small for gestational age neonates. Congenital malformations were reported in 2 of 93 (2.2%).Conclusion Obstetric and neonatal outcomes after taxane exposure during pregnancy were generally favorable and did not seem to differ from those reported in the literature with standard anthracycline-based regimens. This study supports the use of taxanes during gestation when clinically indicated.

Background To advance oncology nursing science and clinical practice, researchers and clinicians must understand the important real-world concerns of nurses who provide direct care to people with cancer or manage processes that support patient care. Objective This study developed a comprehensive compendium of real-world concerns among oncology nurses and built consensus regarding their importance. Methods Using Delphi survey methodology, this prospective, descriptive study was performed in 3 phases: (1) identification of experts, defined as registered nurses (RNs) employed within a comprehensive cancer center; (2) qualitative content analysis of 353 responses from 267 RNs who responded to the question, “What do you see as nursing research concerns, problems, and/or issues on your unit or in your work environment that needs to be studied?”; and (3) rating the importance of 62 research themes identified from the qualitative content analysis (n = 247 RNs). Results The top research priority was patient safety followed by patient education, oncologic emergencies, patient expectations and adherence with care, team communication, patient psychosocial needs, patient-reported outcomes and quality of life, healthcare team burnout, workload, and nurse burnout. Conclusions The findings support the nursing discipline’s fundamental focus on patient safety, the top-rated nursing research priority, along with other patient-related and work environment issues. Implications for Practice Oncology nursing is complex and complicated. This study identified and prioritized the real-world concerns, issues, and problems of oncology RNs who provide direct care or manage the processes that support care, supporting the need to focus on patient-related and work environment research.

As many as 24.7% of cancer patients are also parents to children younger than 18 years of age. This population faces unique challenges, and quality of life in parental cancer patients has not been well studied. This integrative review assessed parental cancer patients' quality of life. PubMed and Scopus were searched using the following terms: quality of life, distress, anxiety, coping, emotion, social support, employment, work, psychosocial, physical, function, parental cancer, and parents with cancer. English publications conducted within the past 15 years that used an objective instrument to measure quality of life in adult cancer patients with children 18 years of age or younger were included. Studies with an intervention focus were excluded. After review of 672 articles, nine studies met the criteria for inclusion. Several instruments were utilized to measure quality of life. Some parental cancer patients reported decreased quality of life when compared with other cancer patients and the general population at diagnosis and years after. Parental cancer patients may be at an increased risk of decreased quality of life. With this understanding, health-care providers should complete comprehensive assessments routinely so that these patients' unique needs may be more adequately addressed.

Introduction: Cytomegalovirus (CMV) is a major cause of morbidity and mortality in stem cell transplant (SCT) patients. Cytomegalovirus hyperimmunoglobulin (CMV-HIG) therapy has been described in the solid organ transplant setting. However, no review has focused on preemptive use of intravenous CMV immunoglobulins in the SCT setting. This review aims to consolidate findings regarding the preemptive use of CMV-HIG for CMV viremia in SCT patients. Methods: PubMed and Scopus were searched using specific search criteria for publications from 2011 to 2021. Search terms were: cytomegalovirus, CMV, immunoglobulins, immunoglobulin, IVIG, CMVIG, hematopoietic stem cell transplantation, and stem cell. Included studies discussed stem cell transplantation, immunoglobulins, and cytomegalovirus. 366 articles were identified from the search. Five articles met the inclusion and exclusion criteria. Results: Preemptive CMV-HIG resulted in an overall response in 65% to 100% of patients with a clearance time of 14 to 21 days. Early use of CMV-HIG may shorten clearance time. No treatment-related mortality or serious adverse events were associated. Conclusion: CMV-HIG is an effective treatment option in SCT patients that is as safe as antivirals alone. Preemptive CMV-HIG with antivirals may provide the added advantage of reduced time to viremia clearance without adding renal injury. Larger, prospective studies are needed to evaluate CMV-HIG’s impact on time to viremia clearance and the effectiveness of preemptive CMV-HIG use with antivirals.

ABSTRACT:Nurse practitioners and physician associates (NPs and PAs) have become an integral part of health care delivery in every clinical setting. Both NPs and PAs possess the knowledge and skills to deliver quality care to patients that may otherwise go without. There is a push to have NPs and PAs work to the top of their licenses and take on leadership roles as they help reshape health care delivery in the United States. However, high-level leadership positions for this group of clinicians are not abundant, and no specific pathway has been established to develop these skills. The aim of this report is to share the early experience of a small group of NPs and PAs, given the opportunity to function as inpatient medical directors (IMD) and the qualities that make them ideal for this novel leadership role.

Retinoblastoma is the most common type of eye cancer in infants and children. Probability of saving vision and survival depends upon two main factors: progression of the disease from unilateral to bilateral and severity of the disease. In order to effectively treat retinoblastoma and retain vision, it is crucial to focus treatment options on reducing toxicity and nonspecific targeting while enhancing drug delivery, cellular uptake, and accumulation of chemotherapeutic agents to their specific target sites. Rapid elimination from blood circulation is the greatest obstacle that conventional chemotherapeutic agents face on journey to their target sites. Target specific nanoparticles have proven to be a useful tool in efforts to overcome challenges typically encountered by targeting strategies. Development of nanoparticles loaded with chemotherapeutic agents can allow for more selective tumor targeting, extended drug circulation times, and reduced drug-associated toxicity. Nanoparticles can significantly improve the treatment efficacy in retinoblastoma. The purpose of this review is to discuss the important characteristics and differences of nano delivery systems used against cellular and in vivo models of retinoblastoma, particularly as they relate to the popular Y79 retinoblastoma cell line.