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Background The role of the patient navigator in cancer care and specifically in breast cancer care has grown to incorporate many titles and functions. Objective To better evaluate the outcomes of patient navigation in breast cancer care, a comprehensive review of empiric literature detailing the efficacy of breast cancer navigation on breast cancer outcomes (screening, diagnosis, treatment, and participation in clinical research) was performed. Methods Published articles were reviewed if published in the scientific literature between January 1990 and April 2009. Searches were conducted using PubMed and Ovid databases. Search terms included MeSH (Medical Subject Headings) terms, "patient navigator," "navigation," "breast cancer," and "adherence." Results Data-based literature indicates that the role of patient navigation is diverse with multiple roles and targeted populations. Navigation across many aspects of the breast cancer disease trajectory improves adherence to breast cancer care. The empiric review found that navigation interventions have been more commonly applied in breast cancer screening and early diagnosis than for adherence to treatment. Conclusion There is evidence supporting the role of patient navigation in breast cancer to improve many aspects of breast cancer care. Implications for practice Data describing the role of patient navigation in breast cancer will assist in better defining future direction for the breast navigation role. Ongoing research will better inform issues related to role definition, integration into clinical breast cancer care, impact on quality of life, cost-effectiveness, and sustainability.

IntroductionIdiopathic pulmonary fibrosis (IPF), a progressive life-limiting lung disease affects approximately 128 000 newly diagnosed individuals in the USA annually. IPF, a disease of ageing associated with intense medical and financial burden, is expected to grow in incidence globally. Median survival from diagnosis is 3.8 years, and many of these patients succumb to a rapid death within 6 months. Despite the fatal prognosis, we have found that patients and caregivers often fail to understand the poor prognosis as the disease relentlessly progresses. Based on feedback from patients and families living with IPF, we developed the S-Symptom Management, U-Understanding the Disease, P-Pulmonary Rehabilitation, P-Palliative Care, O-Oxygen Therapy, R-Research Considerations and T-Transplantation (‘SUPPORT') intervention to increase knowledge of the disease, teach self-management strategies and facilitate preparedness with end of life (EOL) planning.MethodsThis study is a randomised trial to test the efficacy of SUPPORT intervention compared with routine care in patients with IPF and their caregivers delivered after three clinical visits. We are recruiting a cohort of 64 new IPF patient/caregiver dyads (32 for each dyad).ResultsThe trial will evaluate whether the SUPPORT intervention decreases stress, improves symptom burden, quality of life, preparedness and advance care planning for patients and caregivers, quality of dying and death for caregivers if the patient dies during the course of the study, as well as assess the impact of primary palliative care on healthcare resource use near the EOL.ConclusionBy increasing knowledge of the disease, teaching self-management strategies and facilitating preparedness with EOL planning, we will address a critical gap in the care of patients with IPF.Trial registration numberNCT02929017; Pre-results.

Although much work has been done to quantify the direct and indirect costs of cancer treatment, little is known regarding how these costs impact the daily lives of persons undergoing active treatment of cancer. Content analysis performed on open-ended interviews with 22 women in 3 income categories undergoing chemotherapy for a diagnosis of breast or ovarian cancer revealed 7 themes. Most participants stated that they felt "lucky" or "thankful" that most of the treatment costs were being covered by insurance or personal income. Women also described receiving financial assistance from friends, family, and support organizations and stated that they often made trade-offs between paying for regular family expenses and paying for treatment-related expenses. Worry about future financial expenses and frustrations dealing with regulatory agencies were also pervasive in the interviews. Finally, participants described having to access retirement/savings accounts and voiced concerns regarding the impact of cancer treatment on their work income. Data from the study illuminate the personal impact of cancer costs and suggest that interventions to assist women with cancer in financial planning and negotiating with insurance companies may offset some of the financial burden of cancer treatment.

The ability to sense and respond to subtle variations in environmental temperature is critical for animal survival. Animals avoid temperatures that are too cold or too warm and seek out temperatures favorable for their survival. At the molecular level, members of the transient receptor potential (TRP) family of cation channels contribute to thermosensory behaviors in animals from flies to humans. In Drosophila melanogaster larvae, avoidance of excessively warm temperatures is known to require the TRP protein dTRPA1. Whether larval avoidance of excessively cool temperatures also requires TRP channel function, and whether warm and cool avoidance use the same or distinct TRP channels has been unknown. Here we identify two TRP channels required for cool avoidance, TRPL and TRP. Although TRPL and TRP have previously characterized roles in phototransduction, their function in cool avoidance appears to be distinct, as neither photoreceptor neurons nor the phototransduction regulators NORPA and INAF are required for cool avoidance. TRPL and TRP are required for cool avoidance; however they are dispensable for warm avoidance. Furthermore, cold-activated neurons in the larvae are required for cool but not warm avoidance. Conversely, dTRPA1 is essential for warm avoidance, but not cool avoidance. Taken together, these data demonstrate that warm and cool avoidance in the Drosophila larva involves distinct TRP channels and circuits.

Background. Communication skills have not traditionally been included in nursing curriculum. The best educational method to improve health care providers’ practice in comunication skills is first, introduction of content, followed by continuous skills assessment and mentored feedback.Methods. A communication skills workshop using standardized patients (SPs) was planned for oncology nurse practitioner students. A 6-step development plan was used to design, implement, and evaluate the curriculum. Three patient cases using SPs were developed to represent a specific communication skill. SP teaching methodology is relatively new to nursing curriculum.Results. Four methods of evaluation revealed a high level of satisfaction with the course, a high level of communications skills demonstrated during the course, and student need to have more communication content throughout their curriculum. Confidence in communication skills increased following the workshop.Conclusions. This methodology has widespread application to other areas of cancer nursing including nurses with less oncology experience and practicing nurses on the oncology units. In addition, there is application throughout nursing curriculum for undergraduate and graduate programs. The content should be presented earlier in the curriculum and then reinforced throughout the remaining courses with clinical follow-up.

Distress in patients with cancer impacts their quality of life. The National Comprehensive Cancer Network (NCCN) created a distress thermometer and a problem checklist to aid in recognizing distress. The thermometer measures distress on a 0-10 scale, and the problem checklist identifies more specific etiologies of distress, such as practical, spiritual, physical, emotional, and family problems. Oncology nurses play a key role in the success of the distress-screening tool because they have the most patient contact. The NCCN guidelines suggest that patients complete the screening tools at each visit and clinicians review the outcome. NCCN has provided clinical pathways for treating the etiologies of distress using a multidisciplinary approach, including members from social work, pastoral services, mental health, and oncology.

Focal amplification and activating point mutation of the MET gene are well-characterized oncogenic drivers that confer susceptibility to targeted MET inhibitors. Recurrent somatic splice site alterations at MET exon 14 (METex14) that result in exon skipping and MET activation have been characterized, but their full diversity and prevalence across tumor types are unknown. Here, we report analysis of tumor genomic profiles from 38,028 patients to identify 221 cases with METex14 mutations (0.6%), including 126 distinct sequence variants. METex14 mutations are detected most frequently in lung adenocarcinoma (3%), but also frequently in other lung neoplasms (2.3%), brain glioma (0.4%), and tumors of unknown primary origin (0.4%). Further in vitro studies demonstrate sensitivity to MET inhibitors in cells harboring METex14 alterations. We also report three new patient cases with METex14 alterations in lung or histiocytic sarcoma tumors that showed durable response to two different MET-targeted therapies. The diversity of METex14 mutations indicates that diagnostic testing via comprehensive genomic profiling is necessary for detection in a clinical setting. Significance: Here we report the identification of diverse exon 14 splice site alterations in MET that result in constitutive activity of this receptor and oncogenic transformation in vitro. Patients whose tumors harbored these alterations derived meaningful clinical benefit from MET inhibitors. Collectively, these data support the role of METex14 alterations as drivers of tumorigenesis, and identify a unique subset of patients likely to derive benefit from MET inhibitors. Cancer Discov; 5(8); 850–9. ©2015 AACR. See related commentary by Ma, p. 802. See related article by Paik et al., p. 842. This article is highlighted in the In This Issue feature, p. 783

Fulvestrant, the first drug of the pure estrogen antagonists to be approved for clinical use, is a new therapeutic option for metastatic breast cancer. Fulvestrant offers a unique metastatic breast cancer treatment option because its mechanism of action is the destruction, rather than the blockade, of estrogen receptors. No known agonistic activity exists, limiting potential side effects and receptor exhaustion. The side effect profile of fulvestrant is related to its antiestrogen effect and includes gastrointestinal disturbance, urinary tract infection, and vaginitis. Suggestions for managing the side effects of fulvestrant are described, and a case study is provided as an illustrative aid in understanding the role of this new hormonal agent.

In an aging population, the number of patients with cancer continues to rise. Little research has focused on the treatment of cancer in the elderly. Therefore, the treatment for various cancers differs across the healthcare system. A uniform approach in assessing the elderly person with cancer is lacking. This article describes two case studies in the elderly population, focusing on two common cancers: acute myelogenous leukemia and breast cancer. Common side effects of treatment and determinants of treatment options are discussed. It is important that the elderly receive appropriate screening, early detection, treatment, and management of comorbidities.

e23047 Background: Though 93% of patient present with early stage breast cancer (EBC), metastatic recurrence is expected in 7-13%. To prevent estrogen receptor (ER) positive disease recurrence, endocrine therapy (ET) is given after local disease. ET guidelines recently extended therapy —specifically tamoxifen—from 5 years to 10 based on ATLAS and aTTom. This pilot study used blood samples from women 6 months post-ET to determine cell free DNA (cfDNA) mutation prevalence in disease-free patients Methods: Patients with EBC and continued follow-up after ET were recruited from the Magee Women’s Breast Cancer Clinic. Inclusion criteria were EBC, ER+, and completion of ET > 6 months prior to visit; the exclusion criterion was active disease. Patients gave 2 blood samples, placed in Streck and EDTA tubes and processed at 2 laboratory sites for cfDNA. Blood from patients with metastatic breast cancer (MBC) served as controls for mutation detection. cfDNA was amplified for ESR1 and PIK3CA genes. Targeted amplifications underwent digital droplet PCR to identify mutations: 4 for ESR1 (D538G, Y537C/N/S), 2 for PIK3CA (E545K, H1047R) Results: Ten EBC patients > 6 months post-ET (post-EBC; 2/5/3 of stage I/II/III) and 10 MBC patients gave samples. cfDNA yield between plasma isolated from EDTA and Streck tubes (including mutation allele frequencies) was not significantly different (p > 0.05); cfDNA yield from patients with MBC was > 2X higher than post-EBC (p < 0.001). MBC cfDNA had 2 monoclonal and 1 polyclonal (2 different) mutations in ESR1, while post-EBC cfDNA had none Conclusions: This pilot study shows cfDNA can be consistently isolated from Streck or EDTA-processed blood from patients with MBC and post-EBC; however, cfDNA levels are significantly higher in MBC. There were no mutations (ESR1 or PIK3CA) in post-EBC samples, though ESR1 mutations were found in MBC. Further studies are needed to determine if mutations in cfDNA can be found in patients without evidence of disease

Background NTRK fusions are known oncogenic drivers and have recently been effectively targeted by investigational agents in adults. We sought to assess the frequency of NTRK fusions in a large series of pediatric and adolescent patients with advanced cancers. Procedure Genomic profiles from 2,031 advanced cancers from patients less than 21 years old who were assayed with comprehensive genomic profiling were reviewed to identify NTRK fusions. Results Total of nine cases (0.44%) harbored NTRK fusions, including novel partners. Four of these cases were in children less than 2 years old for which infantile fibrosarcoma was considered as a diagnosis, and two harbored the canonical ETV6-NTRK3. The remaining cases carried other diagnoses, at least one that carried the diagnosis of inflammatory myofibroblastic tumor. Conclusions NTRK fusions occur in a subset of young patients with mesenchymal or sarcoma-like tumors at a low frequency, and are eminently druggable targets via either investigational agents or approved drugs.

Advanced practitioners (APs) specializing in cancer care will most likely need to perform or participate in obtaining the history and physical (H & P) of a new patient. The core infrastructure of the history-taking and physical examination process remains the same across all patients regardless of diagnosis. There are, however, important distinctions in the H & P of the patient with cancer. These distinctions can be challenging for the student or novice oncology AP, leading to frustration and potentially poor patient satisfaction and outcomes. In each component of the patient history, certain considerations related to the cancer and its diagnosis and/or treatment to date must be included; these elements are different from those in the general medical H & P. This article focuses mainly on the structure and elements of the history of the present illness phase of the H & P. The similarities and differences between taking a cancer-focused H & P vs. a traditional medical one are discussed as well.

Background: Counseling and anticipatory guidance of the expected course of treatment for women newly diagnosed with metastatic breast cancer (MBC) are difficult due to multiple factors influencing survival following metastatic breast cancer therapy. In order to better tailor counseling at the onset and through the duration of metastatic breast cancer we used non-clinical trial data to better characterize real life experience of sequential metastatic breast cancer treatment. We examined the following aims: 1. What demographic and tumor characteristics are predictive of survival in metastatic breast cancer? 2. What is the median duration of each sequential chemotherapy regimen and subsequent survival of women following each sequence of chemotherapy regimen in metastatic breast cancer? Methods: Retrospective study included 792 women diagnosed from January 1999 through December 2009 at the University of Pittsburgh Cancer Institute Breast Cancer Program. Results: Median duration of sequential chemotherapy regimen and median survival from completion of sequence of chemotherapy regimens were relatively short with a wide range of treatment duration and survival. Characteristics for poor survival included hormone status, human epidermal growth factor receptor-2 (HER 2/neu) status, and increased number and type of metastatic sites. Women who took more than the second sequential chemotherapy regimens had no more than median 3 months of treatment duration and 6 months survival from treatment termination. Discussion: Median clinical response and survival shorten with sequential chemotherapy regimen but with wide ranges. The rare clinical response of the minority should not set the standard for treatment expectations. All cancer clinicians, including oncology nurses, must ensure that patients are receiving tailored counseling regarding their specific risks and benefits for sequential metastatic breast cancer chemotherapy.

Bisphosphonates are important therapies used to reduce the risk of skeletal-related events in patients with bone metastases from breast cancer (BC). This retrospective cohort study evaluated the incidence of osteonecrosis of the jaw (ONJ) and renal impairment in women (n = 221) with bone metastases from BC treated with intravenous bisphosphonates from January 1999 to June 2008. In the long-term cohort, 159 patients received pamidronate (n = 9), zoledronic acid (n = 110), or both (n = 40) for ≥24 months. The comparator group consisted of patients treated with intravenous bisphosphonates for 12-23 months (n = 62). After 39 months' median follow-up, six of 159 patients developed ONJ (3.8%; median 38.5 treatment cycles and 44 months' exposure) in the long-term cohort. Of patients who developed ONJ, 50% resumed intravenous bisphosphonates after a 12-month treatment holiday. Renal impairment developed in 19 patients in the long-term cohort (11.9%; median 26 treatment cycles and 26 months' exposure). Of these 19 patients, 11 (57.9%) recovered baseline renal function and seven (36.7%) showed partial recovery. After modification of the intravenous bisphosphonate regimen, 17 of 19 patients (89.4%) resumed therapy. Of the 62 patients in the comparator cohort, one patient developed ONJ (1.6%) and six developed renal impairment (9.7%). Similar incidence rates of ONJ and renal impairment were observed for the long-term and comparator cohorts. Times to ONJ or renal impairment also were similar across intravenous bisphosphonate type. Long-term (≥24 months) intravenous bisphosphonate use in metastatic BC is well tolerated, with low incidences of ONJ and renal impairment.

Case Study A.K. is a 50-year-old Caucasian female who was recently diagnosed with breast cancer and is presenting for an opinion regarding adjuvant therapy following a right segmental mastectomy and sentinel lymph node biopsy. The advanced practitioner (AP) in the outpatient oncology treatment center will be expected to participate in the discussion regarding the patient's care plan. In her review of the final pathology, the AP notes that the breast tumor is infiltrating ductal carcinoma, the most common type of invasive breast cancer. It starts in the cells that line the milk ducts in the breast, grows outside the ducts, and often spreads to the lymph nodes. Infiltrating ductal carcinoma represents 65% to 85% of all breast cancer cases (College of American Pathologists, 2011). The breast tumor measures 1.2 × 0.9 × 1.0 cm(3) (T1), is estrogen receptor positive with an H score of 280, is progesterone receptor negative with an H score of 0, and is HER2 equivocal 2+ by immunohistochemistry with a fluorescence in situ hybridization ratio of 1.9 with a copy number of 5. The Ki-67 proliferation rate is 60%, and the nuclear grade is 2/3, with a Nottingham score of 5/9. The surgical margins from the segmental mastectomy are clear by 0.4 mm. There is lymphovascular invasion present. Of two sentinel lymph nodes, none is positive (N0). There has been no workup for metastatic disease. Additionally, the AP notes that the patient is premenopausal and that A.K.'s family history is positive for a maternal aunt diagnosed with a stage I breast cancer at age 75. What is the recommended plan of care for A.K.?

Background Patients with acute leukemia (AL) require immediate and aggressive inpatient treatment that results in many weeks to months of hospitalization. Thus, it is not surprising that distress has been found in as many as 45.5% of patients. Although distress is a regularly reported outcome measure in clinical research, currently, there is a lack of a clear, consistent, and universal definition of this concept. Objective The purposes of this article were to examine the current state of the science surrounding the concept of distress and to propose a model of distress for patients with AL. Interventions/methods The Walker and Avant framework was used to guide the analysis of the concept of distress in patients with AL. The findings from this analysis were then used to generate a model guided by the current science. Results Distress in AL is generally accepted as multidimensional, quantifiable, subjective, and temporal. Antecedents to distress include demographics, intrinsic factors, social support, disease progression, treatment, and communication. Consequences to distress include decreased quality of life, patient outcomes, as well as the severity of physical and psychological symptoms. Conclusions Distress is an outcome measure that is frequently assessed and reported within the literature. The operationalization of distress varies by investigator, limiting its generalizability. Implications for practice The proposed conceptual model may be used to guide further research on distress in patients with AL at high risk for negative outcomes. Improved understanding of patient distress may guide interventions aimed at managing the psychosocial needs for patients receiving treatment for AL.

Background: Racial breast cancer survival disparity is attributed, in part, to disparity in breast cancer treatment. Cancer related distress and symptom incidence and associated distress is historically higher than comparative white women during breast cancer chemotherapy and may influence the ability of African American women to receive full dose and timely chemotherapy. Therefore symptom incidence, distress and overall cancer related distress may be under recognized as a potential etiology of racial survival disparity. Objective: To describe the incidence and severity of symptoms and overall cancer-related distress in African American women and the association of symptom and cancer-related distress to adherence (receiving full dose prescribed without delay) to prescribed chemotherapy over three time points (baseline, midpoint and completion). Methods: A descriptive, correlational analysis was conducted of longitudinal data from a recently completed randomized controlled trial of a psycho-educational intervention entitled the Adherence, Communication, Treatment and Support (ACTS) to encourage adherence to chemotherapy for African American women with breast cancer. In the ACTS Trial we assessed symptom incidence and severity and overall cancer-related distress as potential moderators of women's willingness and/or ability to receive timely and full dose chemotherapy. We measured change of symptom incidence and severity and cancer-related distress at three time points: pre-chemotherapy (Time 1); midpoint of chemotherapy (Time 2) and completion of chemotherapy (Time 3). The Cancer Distress Thermometer (DT) was used to measure cancer-related distress; the total number of symptoms (TOTNS) and the McCorkle Symptom Distress Scale (SDS) total score were to measure symptom incidence and severity, respectively. Adherence data in terms of the number of days delayed related to the patient, clinician, and overall were extracted from medical records. Random coefficient modeling was used for analysis to accommodate the variability in the timing of treatment cycles at the key time points. Results: Subjects (n=142) were diagnosed with any stage invasive breast cancer and were undergoing chemotherapy. Results were based on 131 patients with evaluable data over at least two time points. DT, SDS, and TOTNS significantly changed over time suggesting that SDS and TOTNS increases linearly over time (SDS: b1=0.03324, p Conclusions: Worsening in number of symptoms, overall cancer-related distress and symptom distress over the course of chemotherapy was demonstrated among African American women receiving breast cancer chemotherapy. Worsening symptom and cancer-related distress was associated with lack of ability to receive full dose chemotherapy at the prescribed time. Implications for Practice: The influence of total number of symptoms, symptom distress and overall cancer-related distress on chemotherapy treatment delays is evident among this cohort of African American women receiving chemotherapy. Clinically this emphasizes the importance of close monitoring of cancer-related distress and symptom incidence and severity among African American women in order to allow timely breast cancer chemotherapy. Citation Format: Melissa K. Yee, Susan Sereika, Margaret Quinn Rosenzweig. The effect of longitudinal symptom distress and overall cancer distress on the ability of African American women to receive prescribed breast cancer chemotherapy without delay. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C25.

Introduction: Racial survival disparity in breast cancer persists despite advances in breast cancer screening and treatment. Attention has been recently focused on breast cancer treatment disparity as a causative etiology for breast cancer survival disparity. Our previous work has indicated that symptom related toxicity, specifically pain may interfere with the ability to receive full dose and timely chemotherapy among African American women receiving chemotherapy and that pain and nausea are two symptoms that present in a differential manner between races in the immediate breast cancer post-operative period. Pain and nausea were chosen for this study as possible dose limiting symptoms. We We compared pain and nausea between African American and White women as they underwent breast cancer chemotherapy. Experimental Procedures: Two large cohorts of women undergoing breast cancer treatment were combined. The first cohort of largely Caucasian women were recruited between 2006 and 2013 in order to study cognitive function among woman undergoing Anastrazole treatment for early stage breast cancer (AIM). One cohort underwent chemotherapy before Anastrazole therapy, and another received only chemotherapy. These groups constitute the first cohort for this study, from which baseline (before chemotherapy) and 6 month after initiation of chemotherapy measurements were abstracted. The second cohort was recruited into a study of only African American women recommended to receive breast cancer chemotherapy. Recruitment began December, 2009 and ended September, 2014. Measurement from both cohorts were at baseline (prior to chemotherapy) and at completion of chemotherapy (4-6 months after initiation). Pain was measured in the AIM study by the Brief Pain Inventory (PBI), using an 11-point scale increasing with severity. Nausea was measured using the Breast Cancer Prevention Trial (BCPT) symptom checklist as a 0-4 point scale. Symptoms in the ACTS study were measured with the McCorkle Symptom Scale on a 1-5 scale increasing with severity. Scores for all instruments were rescaled to categorical 0 (none/hardly any), 1 (minimal), 2 (moderate) or 3 (severe) to indicate worsening severity of symptoms. Descriptive analysis was used for demographics and chi square for group differences. Data Results: Data were combined for analysis. There were 297 women between the 2 studies with data for analysis, n=148 (White) and n=149 (African American). The mean age for the AIMS Study was 59.37 (5.74), the mean age for the ACTS study was 53.7 (9.83). At baseline, white women experienced significantly less pain (p < .001) and these differences persisted at 6 months. (p < .001). African American women reporting pain levels at 0 (None/Hardly) at baseline was N=51 and at 6 months N =42. White women reporting pain levels at O (None/Hardly) at baseline was N=90 and at 6 Months N=80. African American women reporting 3 (Severe) was N=31 at baseline and N=28 at 6 month measurement while N=0 white women reported severe pain at baseline and only N=2 at 6 month measurement. There were low levels of nausea with no racial differentiation at baseline and at 6 months. Of the white sample, 93.2 % and 93% of the African American women reported experiencing nausea “not at all” or “hardly ever” at baseline. At 6 months post-baseline, 98% of the white and 90.5% of the African American women reported experiencing nausea not at all or hardly ever. Conclusions and Implications for Practice: The results of this study document racial differences in symptoms in breast cancer. Understanding these differences is imperative, especially knowing that pain may be a primary reason for interruptions in the treatment plan. These interruptions cause treatment disparity in dose and completion rates which may be implicated in breast cancer survival disparity. Citation Format: Margaret Quinn Rosenzweig, Susan Wesmiller. Racial differential in pain and nausea during breast cancer chemotherapy. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C11.

Background: Racial breast cancer survival disparity is attributed, in part, to disparity in cancer treatment. Changes in HRQOL influencing treatment adherence over the chemotherapy course may be under recognized as a potential etiology of racial disparity in breast cancer treatment. Objective: To describe African American breast cancer women's HRQOL and the relationship of HRQOL with adherence (dose prescribed without delay) rates to prescribed chemotherapy over three time points of chemotherapy (baseline, midpoint and completion). Methods: Descriptive analysis of an ongoing randomized controlled trial of a psycho-educational intervention to encourage acceptance and adherence to chemotherapy for African American women with breast cancer. The present study used HRQOL data from the parent study and descriptively reported change of quality of life over three time points: baseline – pre chemotherapy (Time 1); at midpoint of chemotherapy (Time 2) and at completion of chemotherapy (Time 3). A further analysis of HRQOL and its role as a potential mediator with treatment adherence was assessed. Descriptive analysis of secondary aim of the parent study, The Attitudes, Communication, Treatment and Support (ACTS) intervention. The Functional Assessment of Cancer Therapy (FACT) was used to measure HRQOL including physical, social, functional and emotional subscales. Adherence data were extracted from medical records. Linear mixed modeling analysis method was used. Results: One hundred and twenty six African American patients were included from the ongoing parent study for this analysis, 67 from the intervention group and 69 from the usual care group. Subjects were recruited from four cancer centers in western Pennsylvania and one from Western Ohio. Subjects were diagnosed with any stage invasive breast cancer and were undergoing chemotherapy. Overall HRQOL decreased significantly over three time points (p0.5 from time1 to time3). Energy and pain were the items with the lowest scores for the physical well-being subscale at baseline and the two follow up assessments (mean score Conclusions: Worsening in physical symptoms and functional status was demonstrated over time among African American women receiving breast cancer chemotherapy. Lack of adherence to prescribed chemotherapy was significantly correlated with declining HRQOL. Implications for Practice: The influence of HRQOL on chemotherapy dose reduction and early treatment cessation was primarily from physical factors during chemotherapy for African American women. Clinically this emphasizes the importance of close QOL and symptom screening, encouraging symptom reporting and the need to exhaust symptom management options before early treatment termination. Citation Format: Rosenzweig MQ, Liang Z. Longitudinal health related quality of life (HRQOL) and subsequent adherence to breast cancer chemotherapy among African American women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-01.

14 Background: The Oncology Nurse Practitioner Web Education Resource (ONc-PoWER) is an online course developed specifically for nurse practitioners (NPs) in their first year of oncology practice paired with an onsite mentor (physician, nurse practitioner or physician assistant). Based on the Oncology Nursing Society’s Competencies for Entry to Practice, the course consists of 5 interactive modules: 1) the new patient visit 2) presenting a patient with cancer 3) cancer visits across the continuum of care 4) palliative and hospice care 5) self-care and professional development. The purpose of this study was to examine the NPs and mentors experience with the learning activities and to what degree the learning objectives were met. Methods: Dyads of NPs and mentors completed the course over 4-6 months. There are items for course evaluation with Likert scaled responses of 1) did not meet objective 2) somewhat met objective 3) met objective 4) more than met objective 5) exceeded objective expectation. Results: Enrollment is ongoing. Thirty NPs new to practice and 22 oncology mentors have completed evaluations thus far. Responses overall are favorable. Conclusions: The ONcPoWER web enhanced oncology orientation program was favorably evaluated by nurse practitioners new to cancer care and their mentors. This method of electronic orientation could standardize the exposure of essential basic cancer care competencies at entry to oncology nurse practitioner practice and, with some edits to content, for community based primary care nurse practitioners caring for cancer survivors. [Table: see text]

Patients with hematologic malignancies often require urgent, aggressive, and lengthy chemotherapy treatment. These treatment regimens, divided into cycles, result in extended, often isolating periods of hospitalization where any direct clinical benefit for the patient, such as remission or "no evidence of disease" is not immediately declared. Consequently, this population is at a high risk of experiencing severe levels of cancer related distress. Cancer related distress is a complex psychosocial phenomenon that has consequences for patients, their families as well as the healthcare staff. Thus the importance of prevention, early recognition, treatment and management is unquestionable. Nurses have an important role to help identify and manage the presence of cancer related distress in these patients, as well as their family's. Nurses should work proactively in close partnership with an interdisciplinary team to effectively provide the necessary support for patients experiencing or who are at risk for high levels of cancer related distress. This case study and subsequent discussion illustrates the symptom management needs and challenges related to cancer related distress in the patient with a hematologic malignancy. Current evidence-based practice guidelines for the assessment and management of cancer related distress will be presented.

Purpose/objectives To determine readmission rates post-pancreaticoduodenectomy (PD), readmission reasons following PD, and patients' postoperative education prior to discharge. Design Retrospective, descriptive study of established medical records of patients who have undergone PD from 2006-2008. Setting PD cohort from a pancreatic cancer program. Sample 62 patients aged 18 years or older, diagnosed with pancreatic cancer, who had PD. Methods Data abstracted from inpatient and outpatient electronic records as per study protocol and entered into Excel® spreadsheet for analysis. Main research variables Incidences of and reasons for readmissions post the PD procedure. Discharge education given to patients prior to discharge. Findings Patients were discharged at mean postoperative day 11.3. Readmission rate was 28%. Reasons for readmission were dehydration or malnutrition (n = 10, 16%) and surgical site infection (n = 7, 11%); 10% of patients (n = 6) had documented difficulties with dehydration, malnutrition, and failure to thrive noted at follow-up. PD discharge teaching was documented in a mandatory discharge form. No standard curriculum was used. Conclusions Patients undergoing PD experience an increase in self-care demand postdischarge. Poor discharge education can lead to high rates of readmission, specifically for dehydration and malnutrition, mandating an assessment of patient education prior to discharge. Implications for nursing Close attention must be given to the needs of patients with pancreatic cancer postdischarge. Trying to identify the areas of educational deficit at patient readmission could help nurses identify what they can do to minimize preventable complications. Educational focus for patients undergoing PD should be on prevention of dehydration, malnutrition, and surgical site infections.

PURPOSE/OBJECTIVES To identify the knowledge and skill needs of oncology nurse practitioners (ONPs) as they enter cancer care practice, and to identify necessary educational resources. DESIGN Cross-sectional, descriptive. SETTING A national e-mail survey. SAMPLE 610 self-described ONPs from the Oncology Nursing Society's database. METHODS The project team developed a 28-item electronic survey. The survey was randomly distributed via e-mail. MAIN RESEARCH VARIABLES ONPs' feelings of preparedness in the first year of ONP practice. FINDINGS In the first year of practice, 90% of ONPs rated themselves as prepared or very prepared in obtaining patient history, performing physical examination, and documenting findings. ONPs rated themselves as not at all or somewhat prepared in clinical issues of chemotherapy/biotherapy competency (n = 81, 78%), recognizing and managing oncologic emergencies, (n = 77, 70%), and recognizing and managing drug toxicities (n = 63, 61%). The primary source of oncology education for ONPs new to practice was almost exclusively the collaborating or supervising physician (n = 84, 81%). CONCLUSIONS Specific knowledge and skills, such as information about chemotherapy, oncologic emergencies, and side effects of therapy, are needed before an ONP enters a cancer care practice. IMPLICATIONS FOR NURSING Cancer-specific education should be made available to new ONPs as they begin independent practice.

The presence of comorbidity becomes increasingly important for its prognostic effect on survival in breast cancer patients with advancing age. This study aimed to evaluate the role of comorbidities including hypertension as a mediator of disparity in survival after metastasis diagnosis between younger (≤51 years) and older (>51 years) patients. A total of 553 patients 26–88 years of age with breast cancer metastasis diagnosis from 1 large urban practice were followed between January 1, 1999, and June 30, 2008. Comorbidity variables and survival were analyzed using Cox regression model. To assess comorbidity variables as a mediator of age-survival relationship, 2 approaches have been applied: (1) Baron Kenny approach and (2) alternative assessment to compute the percentage change in the hazard ratios (HRs). The median survival was 40 months, with 265 (47.9%) alive and 288 (52.1%) dead. Older patients had worse survival than younger patients (HR, 1.43; 95% confidence interval [CI], 1.11–1.84). Hypertension was related to survival (HR, 1.45; 95% CI, 1.12–1.89) when age and other covariates were controlled. The effect of age on survival was no longer significant after adjustment for hypertension (HR, 1.26; 95%, CI 0.97–1.65) or hypertension-augmented Charlson comorbidity score (HR, 1.24; 95% CI, 0.95–1.63). Hypertension-augmented Charlson comorbidity score or hypertension was a strong mediator of age-survival relationship among metastatic breast cancer patients, explaining survival disparity between younger and older patients by 44% and 40%, respectively. The study findings suggest that hypertension should be included in the comorbidity information for decision-making support programs.

Pain is a significant medical concern and represents a major unmet clinical need. The ability to perceive and react to tissue-damaging stimuli is essential in order to maintain bodily integrity in the face of environmental danger. To prevent damage the systems that detect noxious stimuli are therefore under strict evolutionary pressure. We developed a high-throughput behavioral method to identify genes contributing to thermal nociception in the fruit fly and have reported a large-scale screen that identified the Ca²⁺ channel straightjacket (stj) as a conserved regulator of thermal nociception. Here we present the minimal anatomical and neuronal requirements for Drosophila to avoid noxious heat in our novel behavioral paradigm. Bioinformatics analysis of our whole genome data set revealed 23 genes implicated in Ca²⁺ signaling that are required for noxious heat avoidance. One of these genes, the conserved thermoreceptor TrpA1, was confirmed as a bona fide "pain" gene in both adult and larval fly nociception paradigms. The nociceptive function of TrpA1 required expression within the Drosophila nervous system, specifically within nociceptive multi-dendritic (MD) sensory neurons. Therefore, our analysis identifies the channel TRPA1 as a conserved regulator of nociception.

It is generally accepted that delay in receiving treatment for breast cancer results in adverse outcomes. The purpose of this study was to evaluate the impact of delay in treatment after the diagnosis of metastatic disease on survival measured from metastatic breast cancer diagnosis and from first treatment while controlling for immortal time effect among patients with metastatic breast cancer. A total of 553 patients with breast cancer metastasis diagnosis from one large urban practice have been followed between January 1, 1999 and June 30, 2008. Prognostic factors and outcomes of these patients were analyzed using log-rank test and Cox regression model. Backward stepwise selection of covariates was conducted to assess the association of treatment delay with survival. The median survival was 40 months (range 1-114 months), with 265 (47.9%) women alive and 288 (52.1%) having died at the end of the follow-up period. Treatment delays of more than 12 weeks had impact on poor survival from first treatment than the delays of 4-12 weeks with borderline significance level (HR 1.76, 95% CI 0.99-3.13, P = 0.056) in multivariate analysis, adjusted by BMI, history of hypertension, ER/PR status, HER2 status, number of metastatic sites, and liver metastasis. Moreover, the interval of 12-24 weeks, compared to the interval of 4-12 weeks was associated with greater risk of death from first treatment (HR 2.39, 95% CI 1.19-4.77, P = 0.014). The treatment delay interval of >12 weeks was not related with survival since metastatic breast cancer diagnosis, compared to the 4-12 weeks of treatment delays. This study demonstrated that delays of over 12 weeks in receiving treatment for metastatic breast cancer were related to adverse survival outcomes measured from initiation of first treatment. The findings of this study support targeted efforts to ensure prompt treatment initiation in patients diagnosed with metastatic breast cancer.

A mechanistic understanding of animal navigation requires quantitative assessment of the sensorimotor strategies used during navigation and quantitative assessment of how these strategies are regulated by cellular sensors. Here, we examine thermotactic behavior of theDrosophila melanogasterlarva using a tracking microscope to study individual larval movements on defined temperature gradients. We discover that larval thermotaxis involves a larger repertoire of strategies than navigation in smaller organisms such as motile bacteria andCaenorhabditis elegans. Beyond regulating run length (i.e., biasing a random walk), theDrosophila melanogasterlarva also regulates the size and direction of turns to achieve and maintain favorable orientations. Thus, the sharp turns in a larva's trajectory represent decision points for selecting new directions of forward movement. The larva uses the same strategies to move up temperature gradients during positive thermotaxis and to move down temperature gradients during negative thermotaxis. Disrupting positive thermotaxis by inactivating cold-sensitive neurons in the larva's terminal organ weakens all regulation of turning decisions, suggesting that information from one set of temperature sensors is used to regulate all aspects of turning decisions. TheDrosophila melanogasterlarva performs thermotaxis by biasing stochastic turning decisions on the basis of temporal variations in thermosensory input, thereby augmenting the likelihood of heading toward favorable temperatures at all times.

Preparatory information at the time of metastatic breast cancer diagnosis can be used to enhance patients’ coping ability. Women with metastatic breast cancer evaluated a multimedia educational intervention designed to provide sensory and coping information regarding illness. Twenty women with metastatic breast cancer evaluated the materials. The intervention was evaluated very favorably and women identified the materials as needed information. However, they expressed dislike of content outlining possible concerns suggesting future iterations include only positive content. Findings confirm the acceptability and usability of these materials for further testing and ultimately for integration into cancer care practice.

A new strategy for oncology care delivery that includes increasing the numbers and expanding the roles of nonphysician practitioners is critically important to meet the current and potential cancer care needs of the US population.

Randomized clinical trials support the efficacy of a wide range of psychoeducational interventions. However, the mechanisms through which these interventions improve outcomes are not always clear. At times, the theoretically specified factors within interventions have been shown to have specific effects on patient outcomes. But it has also been argued that other factors not identified in the intervention theory (e.g., “nonspecific” factors such as patient expectations and therapeutic patient—clinician alliances) have powerful nonspecific effects that account for most, if not all, of the observed efficacy of psychoeducational interventions. This article describes important concepts in this debate and discusses key issues in distinguishing between specific and nonspecific effects of psychoeducational nursing interventions. Four examples are used to illustrate potential methods of identifying and controlling for nonspecific effects in clinical intervention trials.

Objective:Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income.Method:Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC.Results:Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups.Significance of results:There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.

Cancer-related fatigue is a substantial problem for cancer patients and their caregivers, but no effective treatment exists. Acupuncture has been suggested to improve cancer-related fatigue, but no randomized clinical trials have been conducted. We hypothesized that true acupuncture, compared with sham acupuncture, would reduce cancer-related fatigue in cancer patients receiving external radiation therapy. The aim of this study was to determine effect size and feasibility. A modified, double-blind, randomized, placebo-controlled trial was conducted. The subject, clinical staff, and assessor were blinded, but the acupuncturist was not. Subjects received acupuncture once to twice per week during the 6-week course of radiation therapy. Data were collected at baseline, 3 weeks, 6 weeks, and 10 weeks, which was 4 weeks after that last radiation session. Twenty-seven subjects enrolled, and 23 completed the last data collection. Both true and sham acupuncture groups had improved fatigue, fatigue distress, quality of life, and depression from baseline to 10 weeks, but the differences between the groups were not statistically significant. The true acupuncture group improved 5.50 (SE, +/- 1.48) points on the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-F), whereas the sham acupuncture group improved by 3.73 (SE +/- 1.92) points. This difference was not statistically significant (p = .37). All subjects guessed that they were in the true acupuncture group. Our study was underpowered to find a statistically significant difference. To demonstrate a statistically significant improvement between true and sham acupuncture would require 75 subjects per group in a future study. Owing to poor recruitment, the feasibility of a larger trial using the same methodology is low. Despite being underpowered, it appears that subjects receiving true acupuncture may benefit more than subjects receiving sham acupuncture. In the discussion section, we review our experience with using a sham-needle controlled study.

The aim of this study was to determine if nurses, using patient-centered care (PCC), affect patient satisfaction, perceptions of nursing care, and quality outcomes.The Institute of Medicine proposed PCC as 1 of 6 national quality aims, whereas the Centers for Medicare and Medicaid Services highlighted integration of PCC as 1 of 12 actions for quality improvement.A total of 116 patients were randomized into an intervention (PCC) or control group. Patients who were to receive PCC were called before admission and cared for by nurses who trained to administer/practice PCC. Control patients received usual care. Both groups completed questionnaires and received postdischarge calls. Length of stay, falls, infections, and adverse events were measured to assess quality of care.No significant differences were found between groups for length of stay, infection, falls, postoperative complications, quality of care, satisfaction level, or perceptions of nursing care.Patient-centered care did not affect patient's level of satisfaction or quality of care. However, findings yielded clinically relevant results regarding patient/staff responses.

Animals from flies to humans are able to distinguish subtle gradations in temperature and show strong temperature preferences. Animals move to environments of optimal temperature and some manipulate the temperature of their surroundings, as humans do using clothing and shelter. Despite the ubiquitous influence of environmental temperature on animal behaviour, the neural circuits and strategies through which animals select a preferred temperature remain largely unknown. Here we identify a small set of warmth-activated anterior cell (AC) neurons located in the Drosophila brain, the function of which is critical for preferred temperature selection. AC neuron activation occurs just above the fly's preferred temperature and depends on dTrpA1, an ion channel that functions as a molecular sensor of warmth. Flies that selectively express dTrpA1 in the AC neurons select normal temperatures, whereas flies in which dTrpA1 function is reduced or eliminated choose warmer temperatures. This internal warmth-sensing pathway promotes avoidance of slightly elevated temperatures and acts together with a distinct pathway for cold avoidance to set the fly's preferred temperature. Thus, flies select a preferred temperature by using a thermal sensing pathway tuned to trigger avoidance of temperatures that deviate even slightly from the preferred temperature. This provides a potentially general strategy for robustly selecting a narrow temperature range optimal for survival.

Purpose/Objectives—To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. Design—Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. Setting—School of Nursing at the University of Pittsburgh. Sample—The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. Methods—Analysis of existing comorbidity and symptom data collected from both studies. Main Research Variables—Symptom clusters, chronic disease, and cancer as a comorbidity. Findings—Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. Conclusions—The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. Implications for Nursing—Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical.

Although studies have quantified the costs of cancer treatment, few have evaluated the widespread impact of cancer costs on the family unit. Specifically, little is known regarding how cancer affects patients and their families financially, and how they cope with these costs. The purpose of this descriptive study was to explore the financial impact of cancer care in neuro-oncology. Content analysis was used to examine data from interviews with 20 adults receiving treatment for a primary malignant brain tumor. Participants were recruited from across the United States through an advertisement in a national support group newsletter. Four major themes were identified -“paying for medication/healthcare”, “strategies to offset costs”, “impact of cancer costs”, and “fear/uncertainty”. Within the major themes several sub-themes were also recognized. In the theme of paying for medication/healthcare, participants emphasized sub-themes such as frustrations over “not qualifying/red tape” and being “thankful” for what was covered. Some of the strategies used to offset cancer costs included “cashing in” and relying on “family/friends” for financial support. When describing the impact of cancer costs, participants mentioned sub-themes including the “cost to their family”, the “cost of their disability”, and the impact of a “change in income/job”. Results elucidate the financial concerns and coping strategies of persons undergoing treatment for cancer. These data help target patients’ support needs during treatment, such as providing for their family and navigating their insurance policies, and suggest more efficient implementation of financial interventions are needed to alleviate the emotional burden of cancer costs.

Amplification and point mutation in MET are well-characterized oncogenic drivers that confer susceptibility to MET inhibitors, such as crizotinib, particularly in non-small cell lung cancer. Splice site alterations at exon 14 of the MET (METex14) gene result in exon skipping and MET activation through loss of a DpYR motif (Y1003) that recruits the ubiquitin ligase CBL, targeting MET for degradation. METex14 skipping mutations have primarily been detected in lung adenocarcinoma, occurring in ∼3% of cases, but also in neuroblastoma and gastric cancer cell lines. 17 distinct variants have been characterized, however, their full diversity and prevalence across tumor types is unknown. Most importantly, it is unknown whether these mutations confer clinical susceptibility to targeted therapy with multiple MET inhibitors. We report here analysis of 29,714 cancer genomes to identify 168 harboring METex14 splicing mutations, including 101 distinct genomic variants. They are detected most frequently in lung adenocarcinoma (3.1%, 104/3360), but also in other lung neoplasms (2.0%, 40/2022), brain glioma (0.5%, 6/1312), tumors of unknown primary origin (0.4%, 11/2516), and other tumor types (0.03% 7/20504). Lung malignancies with these mutations do not have other characteristic driver mutations, and have a distinct profile of co-occurring mutations, supporting the role of METex14 skipping as the primary drivers of oncogenesis in these specimens. Most importantly, patients with tumors harboring these mutations demonstrate durable response to anti-MET targeted therapy, in several tumor types. These data demonstrate that METex14 splicing mutations define a distinct class of tumors that are responsive to targeted therapy. The diversity of these variants indicates that diagnostic testing via massively parallel sequencing is necessary for detection in a clinical setting. The data also suggest that thousands of cancer genome profiles will be required to discover non-coding cancer drivers with degenerate genomic signatures. Citation Format: Garrett M. Frampton, Siraj Ali, Juliann Chmielecki, Mark Rosenzweig, Timothy Brennan, Zachary Chalmers, Julia Elvin, Alex Fichtenholtz, Kyle Gowan, Joel Greenbowe, Adrienne Johnson, Lily Khaira, Doron Lipson, Caitlin McMahon, Steven Roels, Roman Yelensky, Deborah Morosini, Philip Stephens, Vincent Miller. Activation of MET via diverse exon 14 skipping mutations occurs in multiple tumor types and confers clinical sensitivity to MET inhibitors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1118. doi:10.1158/1538-7445.AM2015-1118

e20505 Background: End-of-life chemotherapy (EOLC) use in metastatic breast cancer (MBC) is poorly described. We aimed to estimate the prevalence and identify the predictors of EOLC in MBC. Methods...

e11561 Background: Invasive lobular carcinoma (ILC) histology comprises around 10 percent of invasive breast cancers. To our knowledge, patterns of metastases over the entire disease course of ILC ...

11007 Background: Amplifications and activating mutations in the c-MET proto-oncogene are known oncogenic drivers that have proven responsive to targeted therapy. Alterations affecting the splice s...

PURPOSE/OBJECTIVES To discuss the process, considerations, benefits, and challenges of the nurse as principal investigator in a cancer care drug trial. DATA SOURCES Published articles, anecdotal experience, and completed research studies. DATA SYNTHESIS The specific processes that must be considered are funding sources, protocol development, trial implementation, dissemination of results, and ethical implications involved in industry sponsorship. Specific protocols are designed for evaluating adverse events. Working with pharmaceutical companies to receive financial support offers advantages but poses additional issues for consideration. CONCLUSIONS Nurses can serve successfully as principal investigators in medication trials for cancer care. Regulatory bodies and specific procedures, as well as general considerations, mandate and guide investigator conduct when embarking on a pharmaceutical trial. IMPLICATIONS FOR NURSING Oncology nurse researchers can look to pharmaceutical companies for potential funding in the evaluation of medications used in cancer care.

Thermotaxis is important for animal survival, but the molecular identities of temperature sensors controlling this behavior have not been determined. We demonstrate dTRPA1, a heat-activated Transient Receptor Potential (TRP) family ion channel, is essential for thermotaxis in Drosophila. dTrpA1 knockdown eliminates avoidance of elevated temperatures along a thermal gradient. We observe dTRPA1 expression in cells without previously ascribed roles in thermosensation and implicate dTRPA1-expressing neurons in mediating thermotaxis. Our data suggest that thermotaxis relies upon neurons and molecules distinct from those required for high-temperature nociception. We propose dTRPA1 may control thermotaxis by sensing environmental temperature.

Purpose To describe three commercial weight loss programs (Jenny Craig, LA Weight Loss, and Weight Watchers), including efficacy data when available, and to provide clinicians with information for patient counseling. Data Sources Personal interviews, journal articles, and Web site information. Conclusions Commercial weight loss programs provide weight loss services. Benefits are experience, planned menus, and psychological support. Limitations are cost, sales promotions that encourage on-the-spot commitment to prepaid contracts, and the cost of program food and additional vitamins. Implications for Practice Weight loss is a necessary goal for many patients. Clinicians are mandated to provide counseling regarding weight loss.

As the role of the Acute Care Nurse Practitioner (ACNP) gains more recognition, ACNPs as well as prospective employers are eager to incorporate the position into a practice setting. Because the role is in its infancy, there has been limited experience from which to draw on to provide guidance in ACNP role implementation within a practice, either private or institutional. This article will provide foundational information and strategies on how to integrate the ACNP role into a practice setting. These strategies will be useful to not only the ACNP, but also nurse administrators, case managers, clinical nurse specialists, and nurse educators in acute and critical care who are responsible for seeking innovative ways to maintain seamless quality and cost-effective patient care.

The role of the acute care nurse practitioner is being implemented in acute and tertiary care settings. As the role evolves, questions arise. Some of these questions relate to: 1) whether a need for the role has been clearly established; 2) whether the scope of acute care nurse practitioner practice has been identified distinctly; 3) the adequacy of educational preparation; 4) certification versus licensure; and 5) the nature of the relation between this role and other forms of advanced practice nursing. In this article, the authors identify and discuss some of these questions, provide information regarding current status, and postulate further potential resolutions.