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The NCCN Guidelines for Older Adult Oncology address specific issues related to the management of cancer in older adults, including screening and comprehensive geriatric assessment (CGA), assessing the risks and benefits of treatment, preventing or decreasing complications from therapy, and managing patients deemed to be at high risk for treatment-related toxicity. CGA is a multidisciplinary, in-depth evaluation that assesses the objective health of the older adult while evaluating multiple domains, which may affect cancer prognosis and treatment choices. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines providing specific practical framework for the use of CGA when evaluating older adults with cancer.

The NCCN Guidelines for Older Adult Oncology address specific issues related to the management of cancer in older adults, including screening and comprehensive geriatric assessment (CGA), assessing the risks and benefits of treatment, preventing or decreasing complications from therapy, and managing patients deemed to be at high risk for treatment-related toxicity. CGA is a multidisciplinary, in-depth evaluation that assesses the objective health of the older adult while evaluating multiple domains, which may affect cancer prognosis and treatment choices. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines providing specific practical framework for the use of CGA when evaluating older adults with cancer.

Racism, ethnocentrism, segregation, stereotyping, and classism are tightly linked to health equity and social determinants of health. They lead to lack of power, money, resources, and education which may result in poor health care access and outcomes. Health profession faculties must address the complex relationships that exist between individual, interpersonal, institutional, social and political factors that influence health outcomes in both clinical and research training. Thus, the purposes of this paper are to provide examples of training strategies from nursing education that foster cultural sensitivity. First, assumptions about health equity, culture, ethnicity and race are explored. Second, clinical training within an undergraduate and graduate context are explored, including an undergraduate cancer case study and in a graduate pediatric nursing program are described to demonstrate how cultural models can be used to integrate the biomedical and psychosocial content in a course. Third, research training for summer scholars and doctoral and post doctoral fellows (short and long term) is described to demonstrate how to increase the number and quality of scholars prepared to conduct research with vulnerable populations. Research training strategies include a summer research institute, policy fellowship, and a scholars “pipeline” program. A unique perspective is presented through collaboration between a nursing school and a center for health disparities research.

Carrie Tompkins Stricker, PhD, RN, AOCN, is an oncology nurse practitioner in the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, and the Chief Clinical Officer and cofounder of On Q Health, Inc., Miami, FL. This is an exciting and challenging time in which to care for women at risk for, with a diagnosis of, or a history of breast cancer. Scientific advances in cancer genetics and immunology have resulted in dramatic increases in the number and complexity of treatment options available to these women, and these treatment options have led to significant improvements in survival rates and length of survival. Advances in the state of multidisciplinary science, including nursing research, have informed the management of critical aspects of patient care along the illness continuum. The authors of the articles in this In Focus series highlight three of these areas: genetic predisposition to breast cancer, pregnancy and fertility concerns of breast cancer survivors, and late/long-term effects from breast cancer therapies and disease surveillance.

Objective To describe the knowledge of, and attitudes toward, out-of-pocket expenses (OOPE) associated with prostate cancer treatment and the influence of OOPE on the treatment choices of patients with prostate cancer. Materials and Methods We undertook a qualitative research study for which we recruited patients with clinically localized prostate cancer. Patients answered a series of open-ended questions during a semistructured interview and completed a questionnaire about the physician’s role in discussing OOPE, the burden of OOPE, the effect of OOPE on treatment decisions, and previous knowledge of OOPE. Results A total of 41 (26 white and 15 black) eligible patients were enrolled from the urology and radiation oncology practices of the University of Pennsylvania. Qualitative assessment revealed 5 major themes: (a) “my insurance takes care of it”; (b) “health is more important than cost”; (c) “I did not look into it”; (d) “I cannot afford it but would have chosen the same treatment”; and (e) “It is not my doctor’s business.” Most patients (38 of 41, 93%) reported that they would not have chosen a different treatment even if they had known the actual OOPE of their treatment. Patients who reported feeling burdened by OOPE were socioeconomically heterogeneous, and their treatment choices remained unaffected. Only 2 patients stated they knew “a lot” about the likely OOPE for different prostate cancer treatments before choosing their treatment. Conclusion Among insured patients with prostate cancer treated at a large academic medical center, few had knowledge of OOPE before making treatment choices.

Opioid-induced bowel dysfunction (OBD) is characterized by a constellation of symptoms, including constipation; dry, hard stools; strain- ing; and incomplete evacuation. The use of a prophylactic bowel regimen that includes a stimulant laxative and stool softener generally is accepted and should be initiated at the start of opioid therapy. Effective prevention and treatment of OBD reduce the risk of associated physiologic complications and can improve pain management and quality of life for patients and their families.

Objectives To identify treatment modalities and corresponding nursing implications for the high-risk and metastatic melanoma patient. Data Sources Textbooks, research articles, and professional experience. Conclusions Recent advances in the field of melanoma include identification of prognostic factors, refinement of surgical techniques, and identification of effective adjuvant therapy. Novel therapies are currently under investigation. Implications for Nursing Practice Nurses play a vital role in the treatment of melanoma patients through education regarding their disease and treatment options, patient identification for clinical trials, and intensive monitoring and management for treatment-related side effects.