Radiotherapy-Induced Neurocognitive Impairment Is Driven by Heightened Apoptotic Priming in Early Life and Prevented by Blocking BAX.

Unlabelled: Although external beam radiotherapy (xRT) is commonly used to treat central nervous system (CNS) tumors in patients of all ages, young children treated with xRT frequently experience life-altering and dose-limiting neurocognitive impairment (NI) while adults do not. The lack of understanding of mechanisms responsible for these differences has impeded the development of neuroprotective treatments. Using a newly developed mouse model of xRT-induced NI, we found that neurocognitive function is impaired by ionizing radiation in a dose- and age-dependent manner, with the youngest animals being most affected.

Predicting Acute Care Events Among Patients Initiating Chemotherapy: A Practice-Based Validation and Adaptation of the PROACCT Model.

Purpose: Acute care events (ACEs), comprising emergency department visits and hospitalizations, are a priority area for reduction in oncology. Prognostic models are a compelling strategy to identify high-risk patients and target preventive services, but have yet to be broadly implemented, partly because of challenges with electronic health record (EHR) integration. To facilitate EHR integration, we adapted and validated the previously published PRediction Of Acute Care use during Cancer Treatment (PROACCT) model to identify patients at highest risk for ACEs after systemic anticancer treatment.

Use of an Analytics and Electronic Health Record-Based Approach for Targeted COVID-19 Vaccine Outreach to Marginalized Populations.

This quality improvement study uses an analytics-based approach to examine which patients could potentially benefit from targeted nonelectronic communication regarding COVID-19 vaccination.

A new proactive virtual resource center navigation model identifies patient risk factors to reduce barriers to cancer care during the COVID-19 pandemic.

Purpose: The COVID-19 pandemic has exacerbated cancer treatment disparities, including accessibility to resources. We describe the process and outcomes of a new proactive, virtual nurse-led, resource center navigation model enhanced by using volunteer patient navigators. Using known patient risk factors, this model provides interventions to reduce barriers to care, with an emphasis on non-English-speaking populations.

A Multi-Institutional Validation of the Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients With Diffuse Large B-Cell Lymphoma: A Study From The Latin American Group of Lymphoproliferative Disorders (GELL).

Introduction: We aimed at investigating the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) in 2 independent cohorts of Latin American patients with diffuse large B-cell lymphoma (DLBCL) treated with chemoimmunotherapy.

Patients And Methods: The learning cohort was composed of 274 patients and the validation cohort of 323 patients, for a total of 597 patients. An optimal NLR cutoff ≥ 4 was determined using receiver operating characteristic analysis.

Caring for the Pediatric, Adolescent, or Young Adult Patient with Acute Lymphoblastic Leukemia.

Objective: To summarize the issues pediatric, adolescent, and young adult patients face during and after a diagnosis of acute lymphoblastic leukemia (ALL) and guide appropriate nursing care for patients with ALL in these young age groups.

Data Sources: Peer-reviewed journal articles, published guidelines, patient and family resources, and data from the Surveillance, Epidemiology, and End Results Program.

Conclusion: Nursing care of children, adolescents, and young adults with ALL requires a comprehensive approach that is appropriate for the developmental needs of patients in this age group.

Pilot randomized trial of an electronic symptom monitoring and reporting intervention for hospitalized adults undergoing hematopoietic stem cell transplantation.

Purpose: Patients undergoing a hematopoietic stem cell transplantation (HCT) have varied symptoms during their hospitalization. This study examined whether daily symptom reporting (with electronic patient-reported outcomes [PROs]) in an inpatient bone marrow transplant clinic reduced symptom burden on post-transplant days +7, +10, and +14.

Methods: A prospective, single-institution 1:1 pilot randomized, two-arm study recruited HCT patients.

An assessment of prognostic immunity markers in breast cancer.

Tumor-infiltrating lymphocytes (TIL) and immunity gene signatures have been reported to be significantly prognostic in breast cancer but have not yet been applied for calculation of risk of recurrence in clinical assays. A compact set of 17 immunity genes was derived herein from an Affymetrix-derived gene expression dataset including 1951 patients (AFFY1951). The 17 immunity genes demonstrated significant prognostic stratification of estrogen receptor (ER)-negative breast cancer patients with high proliferation gene expression.

Experiences of Inpatient Bone Marrow Transplantation Nurses and Providers Using Electronic Symptom Reporting.

Purpose: To investigate the use of electronic patient-reported outcomes (PROs) to assess symptoms and how they can provide opportunities to clinicians to address symptoms in a timely manner to improve clinical care. As part of a larger study to evaluate whether providing standardized symptom reports to the medical team would decrease the time to treatment of reported symptoms in hematopoietic stem-cell transplant recipients, we assessed nurses' and providers' perceptions of electronic symptom reporting.

Methods: Semistructured interviews of RNs, MDs, NPs and PAs were conducted at an academic cancer center in the southeastern United States.

Antiemetic Guidelines: Using Education to Improve Adherence and Reduce Incidence of CINV in Patients Receiving Highly Emetogenic Chemotherapy.

Background: With the development of increasingly effective antiemetic regimens, guideline adherence can prevent 70%-80% of chemotherapy-induced nausea and vomiting (CINV) in patients with cancer.

Objectives: This quality improvement project aims to increase rates of adherence to national guidelines and, ultimately, decrease rates of CINV experienced by patients receiving highly emetogenic chemotherapy.

Methods: A retrospective chart analysis was performed.

The Nurse's Role in Health Literacy of Patients With Cancer.

Patients with cancer are often faced with complex diagnoses that require decision making in a highly stressful environment. The role of the healthcare team is to ensure that patients have the information, tools, and resources needed to make informed decisions. However, low health literacy is a common and undervalued factor in the outcomes of patients, particularly those with cancer.

Perturbation of water-equivalent thickness as a surrogate for respiratory motion in proton therapy.

Respiratory motion is traditionally assessed using tumor motion magnitude. In proton therapy, respiratory motion causes density variations along the beam path that result in uncertainties of proton range. This work has investigated the use of water-equivalent thickness (WET) to quantitatively assess the effects of respiratory motion on calculated dose in passively scattered proton therapy (PSPT).

Phase 3 trial of defibrotide for the treatment of severe veno-occlusive disease and multi-organ failure.

Hepatic veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), is a potentially life-threatening complication of hematopoietic stem cell transplantation (HSCT). Untreated hepatic VOD/SOS with multi-organ failure (MOF) is associated with >80% mortality. Defibrotide has shown promising efficacy treating hepatic VOD/SOS with MOF in phase 2 studies.

"Error Bars" in Medical Imaging: Stealth and Treacherous.

Given the critical role that diagnostic radiology has in patient care, it is important for providers and patients to understand the level of certainty associated with imaging. Over-reliance on imaging and failure to appreciate its limitations can lead to unforeseen consequences. Further, there are uncertainties and inconsistencies in the manner in which imaging-based information is considered, communicated, and applied.

The incidence of catheter-associated venous thrombosis in noncritically ill children.

Objective: Previous studies estimated the incidence of catheter-associated venous thrombosis to be between 2% and 81%. Our goals were to define the incidence rate of catheter-related thrombosis in a hospitalized, noncritically ill, pediatric population and to determine modifiable factors that alter the risk of thrombosis.

Methods: A retrospective cohort study was performed at the North Carolina Children's Hospital from 2009 to 2012.

Implementing survivorship care plans for colon cancer survivors.

Purpose/objectives: To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis.

Design: Prospective, descriptive, single-arm study.

Setting: A National Cancer Institute-designated cancer center in the southeastern United States.

Ethical challenges: managing oncology drug shortages.

This vignette highlights the ethical issues surrounding restricted access to oncology drugs caused by drug shortages. A review of selected literature and a framework for creating institutional guidelines for reacting to shortage is provided.

Vemurafenib (PLX4032): an orally available inhibitor of mutated BRAF for the treatment of metastatic melanoma.

Objective: To summarize the preclinical and clinical data on vemurafenib, approved by the Food and Drug Administration (FDA) on August 17, 2011, and discuss the drug's clinical advantages and limitations.

Data Sources: An English-language literature search of MEDLINE/PubMed (1966-August 2011), using the terms PLX4032, RG7204, RO5185426, vemurafenib, and metastatic melanoma, was conducted. In addition, information and data were obtained from meeting abstracts, clinical trial registries, and news releases from the FDA.

Management of menorrhagia associated with chemotherapy-induced thrombocytopenia in women with hematologic malignancy.

Abnormal uterine bleeding in women with a blood dyscrasia, such as leukemia, or who experience thrombocytopenia secondary to myelosuppressive chemotherapy is a clinical condition associated with significant morbidity. Consequently, effective management is necessary to prevent adverse outcomes. Prevention of menorrhagia, defined as heavy regular menstrual cycles with more than 80 ml of blood loss/cycle or a cycle duration longer than 7 days, in this patient population is the goal of therapy.

Communicating the benefits/risks of radiation therapy: maintaining context, perspective, and reassurance.

When communicating the benefits and risks of radiation therapy, it is important to provide context, perspective, and reassurance. Radiation is inherently frightening. While this may make discussions about medical radiation's benefits-risks challenging, it also reinforces our responsibility for meaningful and clear discussions with patients, families, colleagues in non-radiation fields, and the public.