ONLINE Special Article: Nursing care for patients with non-small cell lung cancer receiving adjuvant chemotherapy: Evidence–based implications for practice

Oncology nurses provide care to patients and their families across the cancer care continuum including counselling patients on issues related to treatment completion, providing education directed towards the prevention of side effects, assessing and managing symptoms, and follow-up. Believing that a nursing-specific perspective related to these concerns was necessary to improve care for patients with resected, non-small cell lung cancer (NSCLC) receiving adjuvant chemotherapy, a nursing guidance report was initiated. This report was developed by utilizing evidence retrieved in a practice guideline report, general principles established by CANO/ACIO, Fitch’s supportive care model, and the clinical experiences of Lung DSG members. Evidence on the toxicity and adverse events that are caused by adjuvant chemotherapy and side effects and symptoms that are amenable to nursing intervention are highlighted and discussed

Article offert EN LIGNE : Soins infirmiers pour patients atteints du cancer du poumon non à petites cellules recevant une chimiothérapie adjuvante : implications pour la pratique fondée sur les données probantes

Les infirmières en oncologie prodiguent des soins aux patients et à leur famille dans tout le continuum des soins de cancérologie, notamment en offrant des services de counseling aux patients relativement à l’achèvement du traitement, en dispensant de l’enseignement en vue de prévenir les effets secondaires, en évaluant et en gérant les symptômes et en effectuant le suivi nécessaire. Comme nous jugions qu’il était nécessaire d’explorer ces préoccupations du point de vue des soins infirmiers en vue d’améliorer les soins aux patients atteints d’un cancer du poumon non à petites cellules (CPNPC) avec résection tumorale recevant une chimiothérapie adjuvante, nous avons amorcé la préparation d’un rapport d’orientation pour les soins infirmiers. Ce dernier a été élaboré à partir des données d’un rapport sur les lignes directrices de pratique, des principes généraux établis par l’Association canadienne des infirmières en oncologie (ACIO), du modèle des soins de soutien de Fitch et de l’expérience clinique des membres du Groupe spécialisé dans le cancer pulmonaire. On y souligne et aborde les résultats liés à la toxicité et aux événements indésirables causés par la chimiothérapie adjuvante et les effets secondaires et symptômes qui peuvent se prêter à une intervention infirmière

Implementation

A mixed methods approach to understand variation in lung cancer practice and the role of guideline

A mixed methods approach to understand variation in lung cancer practice and the role of guidelines

Abstract Introduction Practice pattern data demonstrate regional variation and lower than expected rates of adherence to practice guideline (PG) recommendations for the treatment of stage II/IIIA resected and stage IIIA/IIIB unresected non-small cell lung cancer (NSCLC) patients in Ontario, Canada. This study sought to understand how clinical decisions are made for the treatment of these patients and the role of PGs. Methods Surveys and key informant interviews were undertaken with clinicians and administrators. Results Participants reported favorable ratings for PGs and the evidentiary bases underpinning them. The majority of participants agreed more patients should have received treatment and that regional variation is problematic. Participants estimated that up to 30% of patients are not good candidates for treatment and up to 20% of patients refuse treatment. The most common barrier to implementing PGs was the lack of organizational support by clinical administrative leadership. There was concern that the trial results underpinning the PG recommendations were not generalizable to the typical patients seen in clinic. The qualitative analysis yielded five themes related to physicians’ decision making: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence. A dynamic interplay between these factors exists. Conclusion Our study demonstrates the challenges inherent in (i) the complexity of clinical decision making; (ii) how quality of care problems are perceived and operationalized; and (iii) the clinical appropriateness and utility of PG recommendations. We argue that systematic and rigorous methodologies to help decision makers mitigate or negotiate these challenges are warranted

Novel pathogenic variants and quantitative phenotypic analyses of Robinow syndrome:WNT signaling perturbation and phenotypic variability

Robinow syndrome (RS) is a genetically heterogeneous disorder with six genes that converge on the WNT/planar cell polarity (PCP) signaling pathway implicated (DVL1, DVL3, FZD2, NXN, ROR2, and WNT5A). RS is characterized by skeletal dysplasia and distinctive facial and physical characteristics. To further explore the genetic heterogeneity, paralog contribution, and phenotypic variability of RS, we investigated a cohort of 22 individuals clinically diagnosed with RS from 18 unrelated families. Pathogenic or likely pathogenic variants in genes associated with RS or RS phenocopies were identified in all 22 individuals, including the first variant to be reported in DVL2. We retrospectively collected medical records of 16 individuals from this cohort and extracted clinical descriptions from 52 previously published cases. We performed Human Phenotype Ontology (HPO) based quantitative phenotypic analyses to dissect allele-specific phenotypic differences. Individuals with FZD2 variants clustered into two groups with demonstrable phenotypic differences between those with missense and truncating alleles. Probands with biallelic NXN variants clustered together with the majority of probands carrying DVL1, DVL2, and DVL3 variants, demonstrating no phenotypic distinction between the NXN-autosomal recessive and dominant forms of RS. While phenotypically similar diseases on the RS differential matched through HPO analysis, clustering using phenotype similarity score placed RS-associated phenotypes in a unique cluster containing WNT5A, FZD2, and ROR2 apart from non-RS-associated paralogs. Through human phenotype analyses of this RS cohort and OMIM clinical synopses of Mendelian disease, this study begins to tease apart specific biologic roles for non-canonical WNT-pathway proteins

The value of open-source clinical science in pandemic response: lessons from ISARIC

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