Venous access devices are ubiquitous in nearly every direct care nursing setting. But as technology becomes more complex and new evidence emerges, nurses must evaluate it against their current practice: Should I use saline or heparin to flush this access device? Am I placing this peripheral venous catheter correctly? What does the latest evidence say? Do I need to implement a practice change? 

Comprehensive preventive care and screening guidelines for women and infants, children, and adolescents under the Affordable Care Act expanded in January 2022, requiring certain group health plans and insurance plans to provide coverage with no out-of-pocket costs for preventive health services, according to the U.S. Department of Health and Human Services (HHS) and U.S. Health Resources and Services Administration (HRSA).

Access to treatment for opioid use disorder is a priority in the Biden-Harris administration’s healthcare program, with resources from the U.S. Department of Health and Human Services (HHS) dedicated to raise awareness of the issue. In April 2021, HHS released new practice guidelines to expand evidence-based treatment to more Americans with opioid use disorder.

I am a clinician in my heart and soul. I was an ONS charter member and one of the first nurse practitioners (NPs) at Memorial Sloan Kettering Cancer Center in New York, NY, before any NP laws were in place and before colony-stimulating factors. The inability to prevent death secondary to chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) haunted me and led me to conduct several funded studies. 

Only 19% of strategies to implement clinical practice guidelines are fully effective and the majority (43%) are not effective at all, according to the findings from a clinical review in the European Union. Effective guideline implementation requires teamwork, interprofessional engagement, and selecting the most appropriate tool for the job. 

Guidelines give oncology nurses an evidence-based, standardized approach to cancer care. But guidelines are most effective used when they’re used as a regular part of practice—a process referred to as implementation. 
With several oncology societies releasing new guidelines in 2020 and 2021, including ONS and the American Society of Clinical Oncology (ASCO), the implementation process requires nurse managers and leaders to facilitate staff education, maintain a high quality of care, and answer the all-important question: “Why are we doing this?”

Did you ever imagine that you could do your job remotely? I did not, but that’s what I’m doing right now. Working remotely has become the new normal for certain professional roles, including some in nursing. An estimated 31% of new hires since March 2020 work from home. In February 2020, the Centers for Disease Control and Prevention released social distancing guidelines and recommended the use of telehealth for patient visits. In March 2020, telehealth visits increased 154% compared to March 2019. Working at home has affected both healthcare workers and patients.

When they launched in 2020, oncology nurses recognized the first five ONS Guidelines™ for cancer treatment-related symptoms and adverse events as the evidence-based standard for patient care. Now, the ECRI Guidelines Trust, a national evaluation organization, has given them that distinction as well, including all of ONS’s current guidelines in its repository.

Painful skin reactions may develop in as many as 95% of patients receiving radiotherapy treatments for cancer. Patients report that it affects their quality of life and that purchasing interventions to soothe their skin increases their out-of-pocket costs. Supporting patients who experience the side effect is critical for their well-being.

Immunocompromised patients with cancer are three times more likely to die from complications of the COVID-19 coronavirus. New resources from the Centers for Disease Control and Prevention (CDC) provide ideas for preventing infections like COVID-19 in patients with cancer.

As many as 43%–58% of patients with cancer experience constipation related to their treatment, and the side effect is both distressing and potentially life threatening if severe enough. Constipation-related emergency department visits increased by 41.5% from 2006–2011, with older adults (aged 85 years or older) making up most of the visits. Estimates suggest that the cost of managing severe cancer-related constipation may range from $500 to more than $2,300 per person per month. Supporting patients who experience the side effect is critical for their well-being.

Patients with cancer are at increased risk for complications from the common flu. Plus, ensuring they receive recommended influenza vaccinations will reduce flu-related healthcare demands and decrease stress on the United States’ healthcare system, which is crucial as the nation approaches 10 million COVID-19 coronavirus cases. In response, the Centers for Disease Control and Prevention (CDC) isn’t waiting until National Influenza Vaccination Week, December 6–12, 2020, to promote vaccinations to high-risk populations.

From chemotherapy to immunotherapy, many of today’s cancer treatments are associated with skin toxicities. Left unmanaged, they can affect patients’ activities of daily living, self-image, and overall quality of life and may lead to treatment disruptions, delays, or even discontinuation.

People with a cervix who are aged 25–65 years should receive a human papillomavirus (HPV) test every five years, according to the new American Cancer Society (ACS) guidelines for cervical cancer screening.

Surgical treatment for breast, gynecologic, prostate, lymphoma, melanoma, or head and neck cancers puts patients at risk for developing secondary lymphedema at any point in the remainder of their life. Studies show that as many as 10%–40% of patients with breast cancer may experience breast cancer–related lymphedema. 

Resources that can be used by nurses and other oncology healthcare professionals, patients, and policymakers to improve the care of patients with cancer, were recently launched by the Oncology Nursing Society (ONS) in its first set of five systematically reviewed clinical practice ONS Guidelines™ for managing cancer treatment-related side effects.

As the United States combats the COVID-19 coronavirus pandemic, federal agencies like the U.S. Food and Drug Administration’s (FDA’s) Oncology Center of Excellence (OCE) are reassuring specific populations, such as those in the cancer community, that the agency is still patient-centered in its mission.  

Although many federal health agencies are involved in the COVID-19 coronavirus pandemic, central to every discussion has been the Centers for Disease Control and Prevention (CDC). Charged with the safety of the American public’s health, CDC is spearheading the United States’ epidemiologic approach, including how healthcare workers should recognize, test for, report, and respond to the coronavirus. 

Tara Schwetz, PhD, acting director of the National Institute of Nursing Research (NINR), issued a statement acknowledging the role of nurses as more essential than ever to patient care during the COVID-19 coronavirus pandemic. 

As an industry standard, the National Comprehensive Cancer Network (NCCN) screening guidelines have served a huge role in cancer prevention and early detection efforts, helping providers identify diagnoses early and give patients their best possible chance at survival. Ensuring screening guidelines are up to date and using the best available evidence is an ongoing process that requires an interprofessional approach.

Lymphedema is one of the most common treatment side effects in patients with breast cancer. Estimates suggest that approximately 40% of all breast cancer survivors are at risk to develop lymphedema at some point in their lives. But as far back as 1998 and even before, some healthcare experts were predicting that lymphedema would be eliminated as a side effect from breast cancer treatment. Twenty-one years later, it’s still prevalent among breast cancer survivors, requiring careful management recommendations from oncology nurses to help patients live with this chronic issue.

Evidence-based practice is central to successful patient care—not only in oncology but throughout the entire healthcare community. Currently, the way health care is delivered varies throughout the United States. Not all hospitals or clinics are the same, nor do all institutions operate the same. Many treatments are given to patients without clear evidence of the benefit, and unity and standardization are lacking, which could lead to wide variances in the efficacy and safety of care provided to patients.

As part of the rigorous process of transitioning ONS Putting Evidence Into Practice recommendations into formal, actionable clinical practice guidelines, the draft guidelines must undergo a public comment period. The first five guidelines to reach that step will be open for public comment in December 2019 and early 2020.

Leading organizations like ONS develop nationally recommended, evidence-based cancer care guidelines to inform practice, unify and standardize the way patient care is delivered, and ensure successful outcomes. By clarifying gray areas and codifying practice, guidelines enable providers to deliver efficacious, safe oncology care for patients and all care providers.

Just before ONS kicked off its Fourth Annual Capitol Hill Days, the ONS Board of Directors met face-to-face in Washington, DC, on September 20, 2019. On the agenda were several discussion topics that support and advance ONS as a leader and trailblazer in cancer care, including position statements that convey the Society’s viewpoint on key issues and guidelines that will set the standard of care for symptom management.

Initially approved in 2018, talazoparib (Talzenna^®) capsules are indicated for the treatment of adult patients with deleterious or suspected deleterious germline breast cancer susceptibility gene HER2-negative locally advanced or metastatic breast cancer.

The Commission on Cancer (CoC), an organizational consortium of which ONS is a governing member, provides standards for cancer programs to follow to achieve a high level of continuous quality improvement. Last updated in 2016, the standards are currently undergoing analysis and revision, and CoC is seeking public comments until June 3, 2019.

To ensure that the Oncology Nursing: Scope and Standards of Practice are consistent with overall nursing standards and to increase the visibility of the oncology nursing standards in the greater nursing and healthcare communities, ONS released an updated version of its reference book in March 2019. The American Nurses Association (ANA) recognizes oncology nursing as a nursing specialty, and the new edition carries ANA’s approval of the oncology nursing scope of practice and acknowledgement of the oncology nursing standards of practice.

A. Diagnostic liquid biopsies

B. Hematologic staging criteria

C. Anatomic prognostic factors

D. Nonanatomic prognostic factors

To ensure that patients and providers are equipped with the latest, most up-to-date knowledge and resources, ONS routinely works with patient advocacy groups, subject matter experts, and other provider organizations to develop and refine critical information for clinical practice. Following safety standards and meeting patient education requirements are critical to successful oral chemotherapy practice.

Palliative care is a necessary inclusion in the care of all people with a serious illness, no matter the diagnosis or setting, and it’s the responsibility all healthcare providers, including specialty providers in oncology. The National Consensus Project (NCP) expanded on these two key tenets in its new release of the fourth edition of the Clinical Practice Guidelines for Quality Palliative Care. ONS is one of 80 organizations endorsing the new guidelines.

ONS chapters, endorsed recommendations and guidelines, and the role of nurses caring for patients with cancer topped the ONS Board of Directors’ discussion topics during its August 2018 conference call meeting.

Pap tests have long been the gold standard to screen women for cervical cancer, but a new study published in JAMA says that in women older than 30 years, HPV testing is less invasive and more accurate.  

Mrs. Johnson has just been told she's in remission from breast cancer. Which of the following isn't a surveillance recommendation?

A. Routine mammography screening every 12 months for locally recurrent tumors or new primary cancers  

B. Screening for cervical and colorectal cancer every six months for two years 

C. Gynecologic evaluation every 12 months for women on tamoxifen therapy who have an intact uterus 

D. Detailed history and physical examination every three to six months for three years  

Nearly a century ago, cancer staging was a simple categorization of disease as either local, regional, or distant. Then in the 1940s, a French surgeon developed the concept for a staging system that uses the size of the primary tumor (T), its lymphatic involvement (N), and the presence of metastases (M) to stage a patient’s cancer based on the anatomic extent of the disease at the time of diagnosis.

Although care coordination and interdisciplinary collaboration are essential components of every oncology nurse’s role, oncology nurse navigators (ONNs) take that work even farther by helping patients and caregivers navigate a complex healthcare system and access much-needed resources. By ONS’s definition, ONNs are key in meeting patient and caregiver needs while providing evidence-based, cost-effective, and quality cancer care by eliminating barriers to timely care.

As of July 16, 2018, the Agency for Healthcare Research and Quality (AHRQ) through the U.S. Department of Health and Human Services ceased maintenance on guideline.gov, the website that housed the National Guideline Clearinghouse. The website had been a resource for healthcare providers for more than 20 years.

Which of the following is not an ONS recommendation for practice when accessing an implanted port? 

A. Sterile gloves must be worn during the procedure. 

B. Palpate the outline of the port body prior to accessing. 

C. Aspirate to confirm blood return after accessing. 

D. Use only a noncoring needle. 

New guidelines and consensus recommendations for managing immune-related adverse events (irAEs) from checkpoint inhibitors are available from several key cancer and immunotherapy organizations: a collaboration between the American Society of Clinical Oncology and National Comprehensive Cancer Network, and a separate consensus recommendation from the Society for Immunotherapy of Cancer. ONS contributed to the development of both sets of guidelines.

The American Cancer Society has partnered with the Centers for Disease Control and Prevention (CDC) to promote public awareness and adoption for the human papilloma virus (HPV) vaccine. The joint initiative, dubbed the National HPV Vaccination Roundtable, brings together public, private, and voluntary experts to raise awareness of the benefits of the vaccine in an effort to decrease incidence and mortality rates associated with HPV cancers.

Vince was diagnosed with non-muscle invasive, high-grade bladder cancer at age 54 and treated with intravesical Bacille-Calmette Guerin immunotherapy. He stopped smoking and began a consistent walking program. 

Oncology nursing is rapidly evolving specialty. Nurses need to stay on top of a complex technologic environment, ever-changing science, and rapid assimilation of research into practice. In doing so, they attain and maintain a high level of competency to adequately and safely care for people with cancer.

Although USP Chapter <800> implementation has been delayed, ONS experts are receiving questions about clarifications and specifics for wearing gowns when handling hazardous drugs (HDs). Questions include topics such as hanging gowns and reusing, length of time gowns can be worn, the need for gowns with oral chemotherapy agents, and materials requirements of gowns. 

In clinics and oncology floors across the country, IV pumps are infusing, chemotherapy is administered through IV push, and nurses are moving swiftly from one patient to the next. Administering chemotherapy is a complex, in-depth procedure that requires training, education, and a level of experience beyond that of the standard healthcare professional. However, even the best oncology nurses need the support of their team members and the administration to provide the safest possible care environments for their patients.

So far, 2017 has seen an incredible amount of U.S. Food and Drug Administration approvals for new agents and indications. Biotherapy and targeted agents represent many of the newly approved treatment options—a great deal of which are offered in oral form, increasing the opportunity for patients to receive treatment at home.