e24131 Background: Many patients report severe pain and anxiety during bone marrow biopsies (BMBx... more e24131 Background: Many patients report severe pain and anxiety during bone marrow biopsies (BMBx), but there is no formal consensus on the best approach to managing these symptoms during the procedure. The aims of this study were to evaluate the effect of simple foot touch on pain and anxiety during BMBx, and to describe the patients’ experience during the procedure. Methods: A single-center randomized control trial using permuted block randomization was conducted at a rural academic cancer center. Nursing assistants without specialized massage training performed simple foot touch on patients in the intervention arm, while the BMBx was performed by advanced practice registered nurses. The patients in the control arm received usual care. Patients rated pain and anxiety levels before and after BMBx using the Visual Analog Scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI) scales, respectively. All participants completed a post-intervention survey about their experience....
Radioimmunotherapy (RIT) is a useful addition to the armamentarium against NHL. Due to concerns a... more Radioimmunotherapy (RIT) is a useful addition to the armamentarium against NHL. Due to concerns about chronic myelosuppression and the possible inability to mobilize stem cells or tolerate further therapy after RIT, this modality has not been commonly utilized in potential transplant candidates. We report the successful mobilization, collection, transplantation and engraftment of 5 patients with NHL following yttrium-90 ibritumomab tiuxetan. Patients had follicular lymphoma, grade I or II (n=3), transformed follicular lymphoma (n=1) or blastic variant mantle cell lymphoma (n=1). Time from RIT to mobilization was 10 months (median; range 7–27 months). The median number of regimens prior to RIT was 2.5 (range 1–4) including prior autologous transplant (n=1). The median number of regimens following RIT and prior to transplant was 1.5 (range 1–2). All patients exhibited chemosensitive disease. Patients were mobilized with R-ICE/G-CSF (n=4) or G-CSF alone (n=1) and required 2.8 leukapher...
Alemtuzumab is an active drug in the treatment of a number of lymphoid malignancies and is curren... more Alemtuzumab is an active drug in the treatment of a number of lymphoid malignancies and is currently indicated for intravenous administration to patients with B-cell chronic lymphocytic leukemia (CLL) who have failed therapy with fludarabine. Unfortunately, despite premedication, grade 3/4 infusion-related reactions (IRR) are common during alemtuzumab IV administration (fever = 19%, rigors = 16%, and hypotension = 5%, amongst others). If grades 1/2 IRR are included, these numbers increase to 86%, 85%, and 32%, respectively. Nausea also occurs in 54% of patients. In addition to complicating therapy, these reactions sometimes make it necessary to prematurely discontinue therapy. These toxicities may be avoided by administering alemtuzumab subcutaneously (SC); a promising modality, but one with limited supporting data. We report the results of our institutional experience with SC alemtuzumab administration. We performed a retrospective chart review examining data points related to demo...
Elderly patients with AML (>60) have a poor prognosis due to high risk cytogenetics and a high... more Elderly patients with AML (>60) have a poor prognosis due to high risk cytogenetics and a high incidence of secondary AML. Comorbid conditions make induction therapy more risky and less effective. There is a need for less toxic and more effective treatment for these patients. The combination of bortezomib (B) and melphalan (M) demonstrate synergistic cytotoxicity in vitro against AML cell lines providing a rationale for this combination in patients with AML. We report the initial results of a pilot study of low-dose M and B for the treatment of patients with AML and high-risk myelodysplastic syndromes. Eligibility requirements included a diagnosis of AML or high-risk MDS and subjects were not candidates for standard induction therapy or had failed therapy. Strata 1 included patients who had received no previous therapy and strata 2 patients with refractory or relapsed disease. Treatment consisted of M (2mg) oral daily dose and B (1.0mg/M2) on day 1, 4, 8 &11 of a 28 day cycle. Te...
Journal of the Advanced Practitioner in Oncology, 2019
Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have b... more Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have better coordinated follow-up care, higher overall satisfaction, and report significantly fewer posttreatment emotional concerns. The Commission on Cancer, a program of the American College of Surgeons, has developed a standard of care in which 100% of eligible patients are to receive an SCP by the end of 2019. Nurse practitioners at a National Cancer Institute (NCI)-designated academic medical center worked to develop a standardized process to deliver SCPs to all eligible patients. The primary objective of the project was to standardize how SCPs were completed and embed them into the electronic medical record (EMR) using a templated note created for the EMR. Through an interdisciplinary steering committee, survivorship priorities were established and aligned with LIVESTRONG and American Society of Clinical Oncology guidelines. In addition, survivorship care planning was identified as an essential service to be provided by all cancer disease management groups (DMG) at the cancer center. A cancer SCP subcommittee was formed to explore methods to expand the delivery of SCPs and standardize the SCP process. Prior to this project, SCPs were being done by less than 10% of the providers and only for a few diagnoses, and no standardized method of documentation existed prior to this quality improvement initiative. The standardization of the SCP has increased both participation of other DMGs as well as increased the rate of completion to 34%. We believe that continuous reassessment and process improvement will help us reach the Commission on Cancer goal of providing SCPs to all eligible patients.
This feature provides a platform for oncology nurses to illustrate the many ways that leadership ... more This feature provides a platform for oncology nurses to illustrate the many ways that leadership may be realized and professional practice may transform cancer care. Possible submissions include, but are not limited to, overviews of projects, accounts of the application of leadership principles or theories to practice, and interviews with nurse leaders. Descriptions of activities, projects, or action plans that are ongoing or completed are welcome. manuscripts should clearly link the content to the impact on cancer care. manuscripts should be six to eight double-spaced pages, exclusive of references and tables, and accompanied by a cover letter requesting consideration for this feature. For more information, contact Associate Editor mary Ellen smith
To describe the natural pace and pattern of activity resumption in the first six months after ste... more To describe the natural pace and pattern of activity resumption in the first six months after stem cell transplantation (SCT).
Stem cell transplantation is an aggressive therapy for hematological malignancies in which a dama... more Stem cell transplantation is an aggressive therapy for hematological malignancies in which a damaged immune system is essentially destroyed and replaced with healthy stem cells. This article reports the results of semi-structured interviews with 18 survivors of either autologous or allogeneic stem cell transplantation. Participants were interviewed after they had reached 100 days post-transplant and asked to discuss their activities, daily routines, and experiences since being discharged from the hospital. Activity engagement was mentioned by participants as a way to promote health, help reconnect one with his or her pre-transplant identity and lifestyle, and measure progress toward improved stamina. Although many participants reported a gradual resumption of previous routines, some participants described a more complicated process of reconstructing their daily routine in response to changes in their environment or career.
e24131 Background: Many patients report severe pain and anxiety during bone marrow biopsies (BMBx... more e24131 Background: Many patients report severe pain and anxiety during bone marrow biopsies (BMBx), but there is no formal consensus on the best approach to managing these symptoms during the procedure. The aims of this study were to evaluate the effect of simple foot touch on pain and anxiety during BMBx, and to describe the patients’ experience during the procedure. Methods: A single-center randomized control trial using permuted block randomization was conducted at a rural academic cancer center. Nursing assistants without specialized massage training performed simple foot touch on patients in the intervention arm, while the BMBx was performed by advanced practice registered nurses. The patients in the control arm received usual care. Patients rated pain and anxiety levels before and after BMBx using the Visual Analog Scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI) scales, respectively. All participants completed a post-intervention survey about their experience....
Radioimmunotherapy (RIT) is a useful addition to the armamentarium against NHL. Due to concerns a... more Radioimmunotherapy (RIT) is a useful addition to the armamentarium against NHL. Due to concerns about chronic myelosuppression and the possible inability to mobilize stem cells or tolerate further therapy after RIT, this modality has not been commonly utilized in potential transplant candidates. We report the successful mobilization, collection, transplantation and engraftment of 5 patients with NHL following yttrium-90 ibritumomab tiuxetan. Patients had follicular lymphoma, grade I or II (n=3), transformed follicular lymphoma (n=1) or blastic variant mantle cell lymphoma (n=1). Time from RIT to mobilization was 10 months (median; range 7–27 months). The median number of regimens prior to RIT was 2.5 (range 1–4) including prior autologous transplant (n=1). The median number of regimens following RIT and prior to transplant was 1.5 (range 1–2). All patients exhibited chemosensitive disease. Patients were mobilized with R-ICE/G-CSF (n=4) or G-CSF alone (n=1) and required 2.8 leukapher...
Alemtuzumab is an active drug in the treatment of a number of lymphoid malignancies and is curren... more Alemtuzumab is an active drug in the treatment of a number of lymphoid malignancies and is currently indicated for intravenous administration to patients with B-cell chronic lymphocytic leukemia (CLL) who have failed therapy with fludarabine. Unfortunately, despite premedication, grade 3/4 infusion-related reactions (IRR) are common during alemtuzumab IV administration (fever = 19%, rigors = 16%, and hypotension = 5%, amongst others). If grades 1/2 IRR are included, these numbers increase to 86%, 85%, and 32%, respectively. Nausea also occurs in 54% of patients. In addition to complicating therapy, these reactions sometimes make it necessary to prematurely discontinue therapy. These toxicities may be avoided by administering alemtuzumab subcutaneously (SC); a promising modality, but one with limited supporting data. We report the results of our institutional experience with SC alemtuzumab administration. We performed a retrospective chart review examining data points related to demo...
Elderly patients with AML (>60) have a poor prognosis due to high risk cytogenetics and a high... more Elderly patients with AML (>60) have a poor prognosis due to high risk cytogenetics and a high incidence of secondary AML. Comorbid conditions make induction therapy more risky and less effective. There is a need for less toxic and more effective treatment for these patients. The combination of bortezomib (B) and melphalan (M) demonstrate synergistic cytotoxicity in vitro against AML cell lines providing a rationale for this combination in patients with AML. We report the initial results of a pilot study of low-dose M and B for the treatment of patients with AML and high-risk myelodysplastic syndromes. Eligibility requirements included a diagnosis of AML or high-risk MDS and subjects were not candidates for standard induction therapy or had failed therapy. Strata 1 included patients who had received no previous therapy and strata 2 patients with refractory or relapsed disease. Treatment consisted of M (2mg) oral daily dose and B (1.0mg/M2) on day 1, 4, 8 &11 of a 28 day cycle. Te...
Journal of the Advanced Practitioner in Oncology, 2019
Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have b... more Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have better coordinated follow-up care, higher overall satisfaction, and report significantly fewer posttreatment emotional concerns. The Commission on Cancer, a program of the American College of Surgeons, has developed a standard of care in which 100% of eligible patients are to receive an SCP by the end of 2019. Nurse practitioners at a National Cancer Institute (NCI)-designated academic medical center worked to develop a standardized process to deliver SCPs to all eligible patients. The primary objective of the project was to standardize how SCPs were completed and embed them into the electronic medical record (EMR) using a templated note created for the EMR. Through an interdisciplinary steering committee, survivorship priorities were established and aligned with LIVESTRONG and American Society of Clinical Oncology guidelines. In addition, survivorship care planning was identified as an essential service to be provided by all cancer disease management groups (DMG) at the cancer center. A cancer SCP subcommittee was formed to explore methods to expand the delivery of SCPs and standardize the SCP process. Prior to this project, SCPs were being done by less than 10% of the providers and only for a few diagnoses, and no standardized method of documentation existed prior to this quality improvement initiative. The standardization of the SCP has increased both participation of other DMGs as well as increased the rate of completion to 34%. We believe that continuous reassessment and process improvement will help us reach the Commission on Cancer goal of providing SCPs to all eligible patients.
This feature provides a platform for oncology nurses to illustrate the many ways that leadership ... more This feature provides a platform for oncology nurses to illustrate the many ways that leadership may be realized and professional practice may transform cancer care. Possible submissions include, but are not limited to, overviews of projects, accounts of the application of leadership principles or theories to practice, and interviews with nurse leaders. Descriptions of activities, projects, or action plans that are ongoing or completed are welcome. manuscripts should clearly link the content to the impact on cancer care. manuscripts should be six to eight double-spaced pages, exclusive of references and tables, and accompanied by a cover letter requesting consideration for this feature. For more information, contact Associate Editor mary Ellen smith
To describe the natural pace and pattern of activity resumption in the first six months after ste... more To describe the natural pace and pattern of activity resumption in the first six months after stem cell transplantation (SCT).
Stem cell transplantation is an aggressive therapy for hematological malignancies in which a dama... more Stem cell transplantation is an aggressive therapy for hematological malignancies in which a damaged immune system is essentially destroyed and replaced with healthy stem cells. This article reports the results of semi-structured interviews with 18 survivors of either autologous or allogeneic stem cell transplantation. Participants were interviewed after they had reached 100 days post-transplant and asked to discuss their activities, daily routines, and experiences since being discharged from the hospital. Activity engagement was mentioned by participants as a way to promote health, help reconnect one with his or her pre-transplant identity and lifestyle, and measure progress toward improved stamina. Although many participants reported a gradual resumption of previous routines, some participants described a more complicated process of reconstructing their daily routine in response to changes in their environment or career.
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Papers by Anna Schaal