Volume 21, Issue 3, December 2010
 
   
The Oncology Nurse Practitioner: A Gift to Share

Margaret (Peg) Rosenzweig, PhD, APN-BC, AOCNP®
Sewickley, PA
mros@pitt.edu

As the holidays approach, we begin to think about the lists of gifts we need to purchase for family, friends, and many other people in everyday life. The idea of planning, purchasing, wrapping, and presenting gifts can be overwhelming, particularly if the list is long. Considering how large and sometimes expensive this holiday task is, the concept of "regifting" has grown in popularity. Regifting is the process of presenting a gift originally given to you or your family to someone else. While this practice often is viewed negatively, it can be seen as economical, thoughtful (“they would like this more”), and environmentally friendly.

Many of us view our oncology nurse practitioner profession (on most days!) as a gift. Our profession allows us to utilize our advanced practice nursing skills as well as the opportunity to provide support and education to patients and families with a serious and potentially life-ending illness. This is a career that is challenging and uniquely rewarding. Consider for a minute why you chose to become a nurse practitioner in oncology. It may have been because of an oncology nurse practitioner whom you particularly admired, a time in your life when a nurse made a difference for you or your family during a cancer care experience, a particularly enthusiastic nursing instructor encouraging students to consider cancer care, or encouragement from an oncology nurse or physician who thought you would be a great oncology nurse practitioner. Regardless of the source, that person or opportunity was a gift to you, encouraging you in what would ultimately be a wonderful career choice.

A critical need exists to share or “regift” the encouragement we received to enter oncology nursing or to become an oncology nurse practitioner so that we can grow the oncology work force. The entire oncology workforce, including nurse practitioners, is not growing at the rate of expected need. By 2020, a serious shortage of oncology physicians, nurse practitioners, and nurses in cancer care is predicted (Institute of Medicine, 2008). The American Society of Clinical Oncology (ASCO) workforce statement urged the ongoing development of an oncology workforce, including nurse practitioners, to ensure continuous delivery of high-quality cancer care (Erikson, Salsberg, Gaetano, Bruinooge, & Goldstein, 2007).

Many ways exist to encourage more practitioners to consider oncology as a specialty. You can encourage a staff nurse to return to school to become a practitioner in cancer care, encourage young student nurses to consider oncology as a specialty, mentor for cancer care at any level of nursing education, mentor medical trainees so that they appreciate oncology and learn to work collaboratively with nurse practitioners, or offer to lecture on cancer topics at your local nursing school—the list is endless. A strong and well-educated cancer care work force will ensure that high-quality cancer care will be seamless for future generations. Your personal enthusiasm and mentorship will "regift" the gift given to you—the encouragement or opportunity to become a nurse practitioner in oncology.

Happy Holidays to you and yours. May all your gifts (even if regifted!) be wonderful. Also, thank you to all of the SIG members who responded to the request to organize materials for new nurse practitioners in oncology. The project is underway, and we will make you aware of the document when it is complete.

References:

Erikson, C., Salsberg, E., Gaetano, F., Bruinooge, S., & Goldstein, M. (2007). Future supply and demand for oncologists: Challenges to assuring access to oncology services. Journal of Oncology Practice, 2, 79. doi: 10.1200/JOP.0723601

Institute of Medicine. (2008). Workshop on ensuring quality cancer care through the oncology workforce: Sustaining research and care in the 21st century. Retrieved from http://www.iom.edu/CMS/26765/57463.aspx

 
The Nurse Practitioner SIG Newsletter is produced by members of the
Nurse Practitioner SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  December 2010
 
   

Editor's Column

Megan Wholey, RNC, ANP-BC, AOCNP®
Arlington, VA
megan.wholey@verizon.net


My gratitude-o-meter is always a good barometer for my mental health, and it’s been both high and steady lately. I’d attribute this in large part to some personal decisions I’ve made to begin study in a doctoral program, providing an opportunity for a whole new approach to thinking about our larger nursing profession. On day one of the program, we were invited to look around the room at our “new best friends”—a cohort of 10 people from different settings, backgrounds, and generations who are striking out on this endeavor together. Over the summer, I read some great books about mindfulness, philosophy, and clear writing in preparation for the Philosophy of Human Science course. Little did I know that we’d be blogging regularly and learning about the latest Japanese method for brief, to-the-point presentations called 20-20-6:40. It sounds like it’ll be great fun to turn PowerPoint on its head a bit because we’ll be challenged to use only 20 slides, on the screen for 20 seconds each, as a background for a 6 minute and 40 second presentation.

I’m grateful also for the enormous learning curve that a switch from a medical oncology office practice to hospital-based radiation oncology has exposed me to over the last six months. I’ve been able to network through the Radiation SIG and spent telephone time in my local Washington, DC, area finding out just how unusual the Radiation Oncology nurse practitioner position is. I’ve gone from feeling that I never have the answer (not a good feeling for someone who’s felt pretty confident in a longstanding position prior to this) to a deep appreciation of the team approach used in my new setting. Our hospital just rolled out a new electronic medical record that is far easier to use than the old one, and information technology people are standing by all the time to help me negotiate all those features of Microsoft Office that I never had training in.

As we all know, healthcare reform promises big changes for nursing’s role—I’m grateful to have a state representative who championed nurse practitioners as “medical home” providers despite the fact that our current practice regulations include supervisory language. Great changes seem to be on the horizon as we approach the winter months. Let’s enjoy the holidays, and then get busy making our practice settings all that they can be. All the best to all of you!

 
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Special Interest Group Newsletter  December 2010
 
   

Vitamin D Testing in the Patient With Cancer

Wendy H. Vogel, RN, MSN, FNP, AOCNP®
Kingsport, TN
wvogel@charter.net
 

Rationale
Vitamin D has multiple physiologic functions in the body including regulating mineral metabolism, bone health, and likely risk reduction of chronic disease (including autoimmune diseases, infectious disease, cardiovascular diseases, diabetes, and cancer). Evidence also indicates that vitamin D plays a role in solid tumor prevention (breast, colorectal, ovarian, prostate, and lung).

Deficiency is extremely common, particularly in women, African Americans, and older persons. More than 50% of postmenopausal women on medications for osteoporosis are deficient (Holick et al., 2005). Up to 90% of patients with cancer are deficient (Everett, 2008; Hershman et al., 2006).

Signs and Symptoms of Deficiency
Many people with vitamin D deficiency are asymptomatic. Some patients complain of musculoskeletal pain, weakness, leg heaviness, and fatigue (Droste, Holmes, Hernandez, & Mahdjoubi, 2010).

Testing
The blood test for vitamin D is called 25(0H)D. It is a competitive protein-binding assay. Patients should not eat or drink for 8–12 hours before the test. Corticosteroids or anticonvulsants may affect test results (i.e., may decrease results) (Chernecky & Berger, 2008). Blood levels should be tested twice a year (end of summer and end of winter) for high-risk individuals.

Normal Levels/Goals of Treatment (Chernecky & Berger, 2008)

  • Sufficient vitamin D level: greater than 30 ng/mL (70 nmol/L)
  • Mild deficiency: 10–20 ng/mL (25–50 nmol/L)
  • Moderate deficiency: 5–10 ng/mL (12.5–25 nmol/L)
  • Severe deficiency: less than 5 ng/mL (less than 12.5 nmol/L)

For Breast Cancer Risk Reduction

  • 33 ng or higher (82.5 nmol/L) (Zhou, Stoitzfus, & Swan, 2009)

For Colorectal Cancer Risk Reduction

  • 52 ng/mL or higher (130 nmol/L) (Zhou, Stoitzfus, & Swan, 2009)

Treatment of Deficiency
Recommended Daily Intake for Bone Health and Cancer Risk Reduction

  • 1,000–2,000 IU per day(Zhou, Stoitzfus, & Swan, 2009). (The U.S. Food and Drug Administration recommendations for vitamin D daily intake are no longer supported by the evidence, and experts are recommending an update.) No health risk has been reported for this dose recommendation.

Ergocalciferol (vitamin D2)

  • 25(OH)D level 20–32 ng/ml: 50,000 IU weekly for 4 weeks
  • 25(OH)D level 15–20: 50,000 IU weekly for 8 weeks
  • 25(OH)D level of less than 15 ng/ml: 50,000 IU twice a week for 12 weeks
  • Recheck level 1–2 weeks after repletion, and repeat repletion as needed.
  • Ergocalciferol comes in 50,000 u capsules and 8,000 u/mL.

For daily dosing of vitamin D, cholecalciferol (vitamin D3) may be used. It comes in 400, 1,000, 2,000, and 5,000 units. Vitamin D found in calcium is not enough to maintain good bone health or for treatment of deficiency. Food sources of vitamin D are limited. Diet alone will not meet vitamin D sufficiency levels.

Risk Factors for Deficiency (Droste, Holmes, Hernandez, & Mahdjoubi, 2010; Zhou, Stoitzfus, & Swan, 2009)

  • Age greater than 50 years
  • Cancer
  • Cardiovascular disease
  • Celiac sprue disease
  • Chronic fatigue syndrome
  • Chronic kidney disease
  • Chronic musculoskeletal pain
  • Crohn disease
  • Darker skin color
  • Fibromyalgia
  • Gastrointestinal malabsorption
  • Homebound persons
  • Liver disease
  • Migraines
  • Northern latitude location
  • Obesity or inactivity
  • Osteoporosis, osteopenia
  • Patients on anticonvulsants, glucocorticoids, HIV/AIDS treatments, anti-rejection (immunosuppressant) medications
  • Rheumatoid arthritis
  • Young children

References:

Chernecky, C., & Berger, B. (2008). Laboratory tests and diagnostic procedures (5th ed.). St Louis, MO: Saunders Elsevier.

Droste, L., Holmes, C., Hernandez, J., & Mahdjoubi, M. (2010). Diagnosis and management of vitamin D deficiency in adults. American Journal for Nurse Practitioners, 14, 25–32.

Everett, P. (2008). The prevalence of vitamin D deficiency and insufficiency in a hematology-oncology clinic. Clinical Journal of Oncology Nursing, 12, 33–35. doi: 10.1188/08.CJON.33-35

Hershman, D., McMahon, D., Irani, D., Cucchiara, G., Crew, K., Raptis, G., & Shane, E. (2006). High prevalence of vitamin D deficiency in premenopausal women with early-stage breast cancer. Journal of Clinical Oncology ASCO Meeting Abstracts, 24 (Suppl. 18), 8568.

Holick, M.F., Siris, E.S., Binkley, N., Beard, M.K., Khan, A., Katzer, J.T., & de Papp, A.E. (2005). Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. Journal of Clinical Endocrinology and Metabolism, 90, 3215–3224. doi: 10.1210/jc.2004-2364

Zhou, G., Stoitzfus, J., & Swan, B. (2009). Optimizing vitamin D status to reduce colorectal cancer risk: An evidentiary review. Clinical Journal of Oncology Nursing, 13, E3–E17. doi: 10.1188/09.CJON.E3-E17

 
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Special Interest Group Newsletter  December 2010
 
   

The 25th National American Academy of Nurse Practitioners Conference

Patricia Pinkard
Mesa, AZ
Pat.Pinckard@bannerhealth.com


I had the privilege of attending on behalf of ONS the National Conference of the American Academy of Nurse Practitioners from June 23 to June 27, 2010, held in Phoenix, AZ. It was an exhilarating experience. It is hard to imagine a room full of almost 4,000 nurse practitioners who are so dedicated to their profession and their patients. I heard from and met some of the amazing leaders of our organization and had a difficult time choosing which sessions to attend because they were all intriguing.

It was exhausting despite the fact that I was able to go home and sleep in my own bed every night. I rode the light rail (my first experience) so that I wouldn’t have to deal with traffic and parking, and that was also a great experience. It dropped me off right next to the Phoenix convention center. My days ran from 6 am to 7:30 or 8 pm and were always busy. I attended breakout sessions on gynecologic cancer, anemia, yoga, blood coagulopathies, palliative care, pharmacology, and infectious diseases to mention a few. Some of the information was a good review for me, and much of the information was new. Even the presentations that were not directed at oncology were very useful because patients’ health and illness are not isolated to their cancer. A few of the pearls to take away included which drugs are the most likely to cause a rash (Phenytoin & SMZ), that serum sickness occurs one to two weeks after drug exposures, and that patients on proton pump inhibitors have an increased risk of osteoporosis and must supplement with calcium citrate to help mitigate this.

I attended a special interest oncology session in which those of us with this interest could discuss what we are doing. One nurse practitioner attended because her brother had just been diagnosed, and another attended to discuss cultural barriers. In our regional nurse practitioner group meeting, we discussed healthcare reform and the role of the nurse practitioner. The general sessions included a lecture by Dr. Loretta Ford, cofounder of the role, and the keynote speaker was Peter Van Sant of CBS News, who discussed the role of the nurse practitioner in the media.

In the legislative sessions, we discussed how and why to be involved. Our collective voice can make an impact on legislation and the future of healthcare—as one of the participants stated, “If you are not at the table, you are on the menu.” My favorite informative poster session was one that showed the different free applications that can be downloaded to your phone to assist with patient care. Applications exist for managing diabetes, calculating dosages, and tracking illnesses, and quite a few applications are related to pharmacology. The exhibits included some new drugs, information on managing post-traumatic stress disorder and substance abuse, new screening tests for narcotics misuse and breast cancer, and some new diagnostic tools.

The networking opportunities were great too. I met several nurse practitioners who were involved in running cancer clinics, and I have been able to use them as resources for questions involving my work setting. I have a new appreciation for the power of this group and the legislative process. I believe that nurse practitioners will be a major force in healthcare reform. I hope to attend this conference again, and I highly recommend it to all nurse practitioners.

 
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Special Interest Group Newsletter  December 2010
 
   

The Quality Oncology Practice Initiative Certification Program

The Quality Oncology Practice Initiative (QOPI®) Certification Program offers a three-year, practice-level designation to outpatient oncology practices that meet scoring requirements on quality measures and practice standards for safe chemotherapy administration. Find out more about the certification program.

 
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Special Interest Group Newsletter  December 2010
 
   

Re:Connect

RE:Connect is a blog written by oncology nurses on a variety of topics of interest to other nurses in the specialty, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses. This month on RE:Connect, you’ll find discussions titled Life—Is Three Months Worth It?, End of Studies Can Be Compared to a Treatment Break, and ACOs: How Accountable Should We Be? As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

 
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Special Interest Group Newsletter  December 2010
 
   

Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service takes a look at Nursing Considerations for Managing Acute Promyelocytic Leukemia and Its Side Effects, which appeared in the December 2010 issue of the Clinical Journal of Oncology Nursing.

 
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Special Interest Group Newsletter  December 2010
 
   

ONS Podcasts of Interest

ONF Podcasts
ONF Associate Editor Ellen Giarelli, EdD, RN, interviews Jeanne Erickson, PhD, RN, AOCN®, the lead author of the July 2010 ONF article "Patterns of Fatigue in Adolescents Receiving Chemotherapy." Listen in as Dr. Erickson discusses her article and describes patterns of fatigue through the eyes of the adolescent.

CJONPlus Podcasts
In the first-ever installment of CJONPlus, Cindy Tofthagen, PhD, ARNP, AOCNP®, addressed questions based on a descriptive study she conducted with adults experiencing chemotherapy-induced peripheral neuropathy. Listen in as Dr. Tofthagen is interviewed about the study and her June 2010 CJON article "Patient Perceptions Associated With Chemotherapy-Induced Peripheral Neuropathy."

 
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Special Interest Group Newsletter  December 2010
 
   

Help Improve Evidence-Based Practice: Get Involved in PEP

Do you want to help make evidence readily available to nurses in oncology practice? Do you want to easily stay up to date with all of the evidence in particular PEP topic areas or learn more about summarizing and critically appraising evidence? Become a PEP topic contributor or reviewer today. Those who participate in PEP activities are eligible for ONC-Pro points on an annual basis. Contact us to learn more about how you can become involved today.

 
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Special Interest Group Newsletter  December 2010
 
   

Make Sure You're Getting the Latest SIG Info!

All SIG newsletters and communiqués are posted to their respective SIG Virtual Community, and members with valid e-mail addresses receive notification when the latest newsletters and communiqués are posted. As of January 1, 2011, ONS will no longer distribute via U.S. mail hard copy printouts of the SIG newsletters and communiqués to members who have not provided a valid e-mail address.

If you currently are not receiving e-mails from ONS, please go to www.ons.org and select “login.” Enter your username and password (or, if you do not have a profile, select “Create One Now”). Once you are logged in, go to your profile and select “My Personal Info.”Here you can add or change your e-mail address in our database.

If you wish to receive SIG correspondence but not other e-mails from ONS, select “My Preferences” on the left, and then, select “Manage Subscriptions” under “E-mail Preferences.” From this page, you can select any kind of e-mail that you do NOT want to receive. You still will receive your SIG information as part of your membership as long as we have a valid e-mail address on file for you.

If you do not provide an e-mail address, you will not be notified when a new SIG newsletter or communiqué is posted. However, you always can access newsletters and communiqués by going to your SIG’s Virtual Community.

 
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Special Interest Group Newsletter  December 2010
 
   

Membership Information

SIG Membership Benefits

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Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is

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Subscribe to Your SIG’s Virtual Community Discussion Forum
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Participate in Your SIG’s Virtual Community Discussion Forum

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As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.

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Special Interest Group Newsletter  December 2010
 
   

Nurse Practitioners SIG Officers

Coordinator (2010–2012)
Margaret (Peg) Rosenzweig, PhD, APN-BC, AOCNP®
Sewickley, PA
mros@pitt.edu

Ex-Officio (2010–2011)
Barbara Biedrzycki, MSN, CRNP, AOCNP®
Baltimore, MD
npbiedrzycki@aol.com

Editor
Megan Wholey, RNC, ANP-BC, AOCNP®
Arlington, VA
megan.wholey@verizon.net

Co-Editor
Karen Overmeyer, MS, RN, APRN-BC
Mechanicsville, VA
Karen.overmeyer@hcahealthcare.com
 

Web Administrator
Jennifer Wulff, RN, MN, ARNP, AOCNP®
Lynwood, WA
jwulff@u.washington.edu

Legislative Issues
Wendy H. Vogel, RN, MSN, FNP, AOCNP®
Kingsport, TN
wvogel@charter.net

Archives
Barbara Biedrzycki, RN, MSN, CRNP, AOCNP®
npbiedrzycki@aol.com

ONS Copy Editor
Emily Nalevanko, MFA
Pittsburgh, PA
enalevanko@ons.org

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View past newsletters.

ONS Membership & Component Relations Department Contact Information

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btheil@ons.org
412-859-6244

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The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

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