Background: Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. Objective: This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. Design: An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. Setting/Participants: Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. Measurements: Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. Results: Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of −0.7 (95% CI: −1.3498 to −0.0570), P = .03. Conclusions: Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.

Chimeric antigen receptor (CAR) T-cell therapy has recently emerged as a groundbreaking treatment for CD19-expressing hematologic malignancies and received rapid approval by the U.S. Food & Drug Administration. Tisagenlecleucel and axicabtagene ciloleucel are now widely available at CAR T-cell therapy centers around the United States. Many patients have achieved complete response or remission despite failing multiple previous lines of therapy, but some patients endure the severe risks of cytokine release syndrome, neurotoxicity, and other immunologic effects. As more patients receive this therapy, they will present to their primary oncologists in the community setting for continued follow-up. Oncology-trained advanced practitioners must then have a working knowledge of CAR T-cell therapy, its toxicities, and follow-up care. This review presents the CAR T-cell therapy development and infusion process with associated immediate management. In addition, patient assessment and disease monitoring, relevant diagnostics, unique grading systems to CAR T-cell therapy toxicities, indications for hospitalization, infection prophylaxis, and management of nonneutropenic and neutropenic fever are presented.

Patients undergoing treatment for cancer often experience stress, fatigue, and pain during their treatment. Medical management of these symptoms can cause additional adverse effects, but it is possible that noninvasive complementary therapies may be able to reduce these symptoms without unwanted adverse effects. The purpose of this study was to assess the feasibility and impact of the Seva Stress Release acupressure protocol on stress, fatigue, pain, and vital signs of patients hospitalized for cancer treatment. Thirty patients receiving cancer treatment and experiencing stress, fatigue, and pain were recruited for the study. After obtaining informed consent, baseline data (survey and vital signs) were obtained, followed by administration of the Seva Stress Release. After the intervention, vital signs were obtained, and patients completed 2 additional surveys. After Seva, patient stress, fatigue, pain, heart rate, and respirations were significantly decreased (P = .000). Sixty-six percent of participants experienced symptom relief for at least 1 to 4 hours. Qualitative findings also indicated that patients reported better sleep and mental clarity after the intervention. The Seva protocol could be taught to nurses and be used as an independent intervention for patients experiencing adverse effects of cancer treatment, to promote comfort and reduce stress and fatigue.

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