Kristen L. Fessele

Setting the bar: developing quality measures and education programs to define evidence-based, patient-centered, high-quality care.

In 2008, the Oncology Nursing Society (ONS) initiated a multi-year project to develop and test quality measures in areas judged by oncology nurses as high-priority opportunities to improve quality of life for patients across the cancer continuum, and to provide education to oncology nurses on how to achieve high-quality care. Supported through a grant to the ONS Foundation by the Breast Cancer Fund of the National Philanthropic Trust, two teams of expert nurses convened to review the literature and draft potential measures that are considered important to providers and patients, are high-volume, high-impact issues, and are supported by strong clinical evidence linking high-quality care processes to improved outcomes. The ONS Foundation contracted with the Joint Commissions Department of Quality Measurement to combine its measure-development experience with ONSs ambulatory oncology perspective to create a reproducible testing process. A third project team designed and implemented a series of 10 regional education workshops illustrating the use and benefits of quality measurement in clinical care.

Factors Associated With Unplanned Hospitalizations Among Patients With Nonmetastatic Colorectal Cancers Intended for Treatment in the Ambulatory Setting.

BackgroundChemotherapy administration and supportive management for solid tumors is intended to take place in the ambulatory setting, but little is known about why some patients experience treatment-related adverse events so severe as to require acute inpatient care. ObjectiveThe aim of the study was to identify predictors of initial and repeated unplanned hospitalizations and potential financial impact among Medicare patients with early-stage (Stages I–III) colorectal cancer receiving outpatient chemotherapy. MethodsAdvanced statistical modeling was used to analyze a cohort of patients (N = 1,485) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed from 2003 to 2007 with colorectal cancer as their first primary malignancy. Patients were of ages 66 and older at diagnosis, had uninterrupted Medicare Parts A and B coverage with no health maintenance organization component, and received chemotherapy at least one time. ResultsFemale gender, younger age, multiple comorbidities, rural geography, higher high school completion rates, and lower median income per census tract were significant predictors of the likelihood of initial unplanned hospitalizations. Non-White race, receipt of radiation therapy, rural geography, and higher weighted comorbidity scores were factors associated with the number of hospitalizations experienced. The total Medicare charges calculated for these admissions was

Improving Practice One Patient, One Nurse, One Day at a Time: Design and Evaluation of a Quality Education Workshop for Oncology Nurses

38,976,171, with the median charge per admission at

Agent Orange: management of patients exposed in Vietnam.

20,412. DiscussionDemographic and clinical factors that form the foundation of work toward development of a risk factor profile for unplanned hospitalization were identified. Further work is needed to incorporate additional clinical data to create a clinically applicable model.

Non-Hodgkin's lymphoma

High-quality nursing care is not delivered consistently to the millions of Americans treated for invasive cancer in the United States. As part of its quality initiative, the Oncology Nursing Society (ONS) developed and tested nursing-sensitive quality measures for breast cancer care. Findings from the pilot testing suggested significant knowledge and practice gaps that could be addressed through member education.

Primer in Genetics and Genomics, Article 6: Basics of Epigenetic Control:

Since the Vietnam War ended in 1975, numerous studies have been conducted to determine if an association exists between Agent Orange exposure and certain disabling conditions specifically cancer. Although a definite causal relationship has not yet been established, sufficient data associate Agent Orange with certain conditions. Because of their advancing age similar to other baby boomers, Vietnam veterans are at a higher risk of developing malignancies. However, their exposure to Agent Orange also may increase their risk for cancer and other associated diseases. This article examines the latest findings of scientific research sponsored by the Department of Veterans Affairs and discusses the importance of well-informed oncology nurses when providing care for patients with cancer exposed to Agent Orange.

Speed of Adoption of Immune Checkpoint Inhibitors of Programmed Cell Death 1 Protein and Comparison of Patient Ages in Clinical Practice vs Pivotal Clinical Trials

OBJECTIVES To review the etiology, epidemiology, classification, diagnosis, staging, prognosis, treatment, and nursing implications of non-Hodgkins lymphoma. DATA SOURCES Research studies, review articles, and book chapters pertaining to non-Hodgkins lymphoma. CONCLUSIONS Non-Hodgkinss lymphomas are a heterogeneous group of lympho-proliferative disorders, increasing in frequency, for which therapy ranges from supportive to curative. IMPLICATIONS FOR NURSING PRACTICE An understanding of the variety of presentations and treatments of non-Hodgkins lymphomas will enable the oncology nurse to assist patients and their families to cope with the disease, make treatment-related decisions, and optimize the patients quality of life.

Primer in Genetics and Genomics, Article 5—Further Defining the Concepts of Genotype and Phenotype and Exploring Genotype–Phenotype Associations

The epigenome is a collection of chemical compounds that attach to and overlay the DNA sequence to direct gene expression. Epigenetic marks do not alter DNA sequence but instead allow or silence gene activity and the subsequent production of proteins that guide the growth and development of an organism, direct and maintain cell identity, and allow for the production of primordial germ cells (PGCs; ova and spermatozoa). The three main epigenetic marks are (1) histone modification, (2) DNA methylation, and (3) noncoding RNA, and each works in a different way to regulate gene expression. This article reviews these concepts and discusses their role in normal functions such as X-chromosome inactivation, epigenetic reprogramming during embryonic development and PGC production, and the clinical example of the imprinting disorders Angelman and Prader–Willi syndromes.

The Rise of Big Data in Oncology

Importance The US Food and Drug Administration (FDA) is increasing its pace of approvals for novel cancer therapeutics, including for immune checkpoint inhibitors of programmed cell death 1 protein (anti–PD-1 agents). However, little is known about how quickly anti–PD-1 agents agents reach eligible patients in practice or whether such patients differ from those studied in clinical trials that lead to FDA approval (pivotal clinical trials). Objectives To assess the speed with which anti–PD-1 agents agents reached eligible patients in practice and to compare the ages of patients treated in clinical practice with the ages of those treated in pivotal clinical trials. Design, Setting, and Participants This retrospective cohort study, performed from January 1, 2011, through August 31, 2016, included patients from the Flatiron Health Network who were eligible for anti–PD-1 agents treatment of selected cancer types, which included melanoma, non–small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). Main Outcomes and Measures Cumulative proportions of eligible patients receiving anti–PD-1 agents treatment and their age distributions. Results The study identified 3089 patients who were eligible for anti–PD-1 agents treatment (median age, 66 [interquartile range, 56-75] years for patients with melanoma, 66 [interquartile range, 58-72] years for patients with RCC, and 67 [interquartile range, 59-74] years for patients with NSCLC; 1742 male [56.4%] and 1347 [43.6%] female; 2066 [66.9%] white). Of these patients, 2123 (68.7%) received anti–PD-1 agents treatment, including 439 eligible patients with melanoma (79.1%), 1417 eligible patients with NSCLC (65.6%), and 267 eligible patients with RCC (71.2%). Within 4 months after FDA approval, greater than 60% of eligible patients in each cohort had received anti–PD-1 agents treatment. Overall, similar proportions of older and younger patients received anti–PD-1 agents treatment during the first 9 months after FDA approval. However, there were significant differences in age between clinical trial participants and patients receiving anti–PD-1 agents treatment in clinical practice, with more patients being older than 65 years in clinical practice (range, 327 of 1365 [60.6%] to 46 of 72 [63.9%]) than in pivotal clinical trials (range, 38 of 120 [31.7%] to 223 of 544 [41.0%]; all P < .001). Conclusions and Relevance Anti-PD-1 agents rapidly reached patients in clinical practice, and patients treated in clinical practice differed significantly from patients treated in pivotal clinical trials. Future actions are needed to ensure that rapid adoption occurs on the basis of representative trial evidence.

Predictors of unplanned hospitalizations in patients with nonmetastatic lung cancer during chemotherapy

As nurses begin to incorporate genetic and genomic sciences into clinical practice, education, and research, it is essential that they have a working knowledge of the terms foundational to the science. The first article in this primer series provided brief definitions of the basic terms (e.g., genetics and genomics) and introduced the concept of phenotype during the discussion of Mendelian inheritance. These terms, however, are inconsistently used in publications and conversations, and the linkage between genotype and phenotype requires clarification. The goal of this fifth article in the series is to elucidate these terms, provide an overview of the research methods used to determine genotype–phenotype associations, and discuss their significance to nursing through examples from the current nursing literature.