Oncology Practice Update.com

Our cancer education group in Miami is thrilled to launch this series targeting nurse practitioners and physician assistants specializing in oncology. We’ve been producing physician education programs for more than 20 years and stuff every piece with p-values and survival curves in an attempt to satisfy that audience’s insatiable interest in numbers and data. Our oncology nurse education programs are also rewarding to produce because these professionals are deeply interested in the complex and fascinating psychosocial issues of cancer practice.

We figured that ARNPs and PAs would combine the best of both education components, and when we invited a handful of these oncology professionals to present cases to medical oncologists Gary Lyman and Chuck Vogel, they did not disappoint.

Enza Luke started things off with a fascinating clinical dilemma: A 61-year-old woman with node-positive breast cancer clearly requiring adjuvant chemotherapy. Initially, the patient absolutely refused this treatment because of a prior devastating life experience — assisting her 38-year-old daughter through adjuvant chemotherapy three years previously. Eventually, the patient changed her mind, largely due to the encouragement of her daughter, who pleaded with her mom to fight for every possible chance for cure.

Maureen Major then presented another compelling and insightful case to the group — a 70-year-old woman with a node-positive, HER2-positive tumor and a prior history of diabetes and peripheral neuropathy. This situation raised the challenging issue of whether to use taxane-based chemotherapy with trastuzumab.

Clinical trials first reported a year ago proved that this clinical approach reduces the risk of relapse by about 50 percent above and beyond the benefits of endocrine therapy and nontrastuzumab-based chemotherapy.

The question looming before the treatment team was whether a taxane would worsen the patient’s neuropathy and how much this might affect her quality of life. To hear equally compelling cases presented by Desiree Grogan and James Glendening, pop the enclosed CDs into your car stereo or listen to them while you work out to learn what happened.

The discussion during this tumor panel recording session was so lively and intense that we never got around to Julie Plantamura’s patient, a 49-year-old woman with metastatic breast cancer treated in her practice for four and a half years. The patient, who died last October, was a teacher who at age 18 was cured of an osteosarcoma by a right leg amputation. The patient’s husband was also a teacher and also an amputee.

Like our other roundtable participants, Ms Plantamura has a unique insight into oncology practice that is evident from her comments about this case during our planning conference for this meeting:

Both the patient and her husband were always very optimistic and hopeful, and even in the few days before she passed away, the patient never thought she would die from breast cancer. She understood how serious her disease was but just had such a will to fight and such support from her family that she did not think that she would die from breast cancer.

We’re always honest with our patients and help them hope for the best, but we also let them know from the beginning that when breast cancer is metastatic, although it’s often controllable, it is generally not curable.

This patient’s tumor responded well to both endocrine treatment and chemotherapy, and her quality of life was excellent for most of the years we treated her. She went on a number of vacations to a home her family rented every summer in New Jersey. She was also able to get her son packed up and off to college, which was important as part of her need to keep normalcy at home.

This woman had prolonged periods of being asymptomatic during the years we treated her. She was very active, worked full time and volunteered in the community. She was also very involved with breast cancer support groups.

The patient was very nervous when we first started chemotherapy, but she was one of those patients who accepts whatever is put in front of them. She would do anything to beat breast cancer. One year we were able to give her a three-month chemo holiday, during which she helped plan her daughter’s wedding.

Last summer, after more than four years of therapy, the disease finally started to progress rapidly while she was vacationing in New Jersey. She was terrified and called me, but I was away on vacation. Our office tracked me down and I coordinated a last-ditch effort, arranging for her transfer by ambulance to our hospital, where she received services not only from us but from the pulmonology, cardiology, nephrology and infectious disease services for a variety of complications. She insisted on pursuing every possible therapy and, in fact, received chemotherapy on the day she died.

She was a wonderful human being, as is her husband. They kept meticulous notes about every blood count, every treatment, every office visit and every scan. They came to each appointment with a list of questions and were very appreciative of all the time that we spent with them. They were a truly wonderful and amazing family. Occasionally, her husband still visits our practice.

— Julie Plantamura, RN, MSN, FNPc

We have focused most of our continuing education efforts on audio because it allows multitasking while learning, but I wish you could have seen Ms Plantamura’s facial expressions as she told this fascinating story. It is obvious that her patients receive the best of both oncology worlds: scientific advances that can provide precious years of life and the empathy, love and hope that patients need and deserve.

It’s a pleasure to bring professionals like Ms Plantamura and her colleagues to you. Let us know your thoughts on this program — what you like, what could be improved and what other education needs you have in both worlds.

— Neil Love, MD
NLove@ResearchToPractice.net

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