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Annual NCONN Conference

Michael L. Krychman, MD, Medical Director of Sexual Medicine, Hoag Memorial Presbyterian Hospital, Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine, discusses managing and treating sexual health concerns in cancer patients and survivors.

Krychman believes it is important to development a sexual health treatment paradigm, irrespective of the cancer diagnosis. There are often systemic changes due to the treatment of cancer that have a far-reaching effect on sexual function, regardless of the location of the tumor.

While it is important to have a general view for evaluating and assessing the implications of cancer on sexuality, the anatomical site of the cancer also plays an important role. Krychman notes that certain cancers have a direct effect on sexual function, such as cancers of the breast or the genito-pelvic sexual response organs.

Krychman adds that taking the cancer into consideration is important but having a global view of the effect of cancer on the human experience of sexuality is critical as well.

Michael L. Krychman, MD, Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine, discusses managing and treating sexual health concerns in cancer patients and survivors.

Dr. Krychman on Treating Cancer-Related Sexual Issues

Karen Masino, MS, CNP, ACNP-BC, AOCNP, RN, RD, LDN, Cancer Nurse Navigator, Ingalls Memorial Hospital, discusses the importance of training and education in the construction of a cancer survivorship program.

To build a successful survivorship program, collaboration is needed between those who provide the resources to develop the program and those involved in providing patient care. Overall, a successful survivorship program should include those involved in administrative support, directors, vice presidents, physicians, and ancillary staff. It is important to include everyone involved in the process, especially those who may have an opportunity to provide direct education and support services to survivors.

Masino adds that it is important to get people who have been properly trained and educated on the needs of cancer survivors. She adds that it is easy assume that working with cancer patients provides the needed training but that is not always the case.

Karen Masino, from Ingalls Memorial Hospital, discusses the intricacies of developing a survivorship program.

Karen Masino on Building a Survivorship Program

Rajni Kannan, BS, MS, RN, ANP-BC, Nurse Practitioner, NYU Cancer Institute, NYU Langone Medical Center, discusses the importance of educating patients with metastatic melanoma on the side effects associated with the immunotherapy ipilimumab (Yervoy) and the BRAF inhibitor vemurafenib (Zelboraf).

Kannan states that patient education is essential for the proper management of the side effects associated with ipilimumab and vemurafenib. In order to be able to intervene early and provide proper symptom management, patients must know which side effects need to be reported.

Kannan notes that very few patients get the severe side effects associated with ipilimumab; however, if these adverse events do occur, early intervention is the best chance to avoid discontinuing or pausing treatment. Additionally, with vemurafenib, proper education on sunscreen and liver changes will affect how side effects are reported, which ultimately affects how effectively they are managed.

Rajni Kannan discusses the importance patient education or managing the side effects associated ipilimumab and vemurafenib in metastatic melanoma. 

Rajni Kannan on the Side Effects of Yervoy and Zelboraf

Photos from the 2012 National Coalition of Oncology Nurse Navigators' (NCONN) annual conference that was held at the Gaylord Opryland Hotel from October 4th to 6th, in Nashville, Tennessee.

The latest NCONN conference offered a full agenda, dozens of exhibitors, and multiple members in attendance. The conference facilitated interaction between oncology nurse navigators from all regions of the United States. Pictures from the conference provide a glimpse into the latest installment of the meeting and the Gaylord Opryland Hotel. The latest meeting held true to the conferences ongoing title, 

Photos From the 2012 NCONN Conference

Not surprisingly, melanoma nurse practitioner Rajni Kannan is passionate about helping her patients at NYU’s Cancer Institute to fight this devastating disease.

That’s why Kannan, BS, MS, RN, ANP-BC, is excited about the remarkable developments she’s seen in the treatment of metastatic melanoma over the last 5 years—including last year’s FDA approval of two new agents, ipilimumab and vemurafenib.

At the same time, Kannan is determined to reduce the number of patients she sees at the Manhattan facility based at the Langone Medical Center by being an advocate for increased awareness of the dangers of tanning, she told attendees during a presentation at NCONN 2012.

The incidence of melanoma, the deadliest of all skin cancers, is quickly rising, and the disease is responsible for more than 8000 deaths each year, Kannan said, adding that the average survival for melanoma patients with metastatic disease is 7 months, and that 50% of these patients will develop brain metastases. Kannan reminded audience members that exposure to ultraviolet (UV) radiation is a major risk factor for skin cancer, and that the World Health Organization has declared UV-emitting tanning devices carcinogenic.

In discussing ipilimumab (Yervoy), Kannan described the mechanism of the immunotherapy as “amazing.” The treatment is given intravenously every 3 weeks for a total of four doses, and Kannan explained that “patients have had a hard time understanding that they get four doses, and that’s all they get” before returning for tumor evaluations after 12 and 24 weeks and then every 3 months thereafter. Kannan noted that nurses have an important role to play in explaining to worried patients that “this is enough.”

The other new agent, vemurafenib (Zelboraf), is a targeted therapy approved for patients with unresectable or metastatic melanoma who test positive for the 

mutation—approximately 40% of melanoma patients, according to Kannan. Testing for 

 mutational status, she said, must be conducted at a site of metastatic disease, presenting another important role for oncology nurses and navigators: to help patients with earlier-stage cancers understand why they can’t be tested. Moreover, she said, “if you give this drug to patients who don’t have the mutation, you can actually accelerate the disease.”

“Eighty percent of patients respond to vemurafenib, but the question is, for how long?” Kannan noted. In some patients, disease quickly returns, while others do extremely well. “We need to determine why some patients have a sustained response,” she said.

These two agents offer new hope for metastatic melanoma patients, but both have complex side-effect profiles. Nurses are important in this regard, too, Kannan said, since they can share their expertise about the drugs with patients, who often “don’t communicate well about their side effects.”

National Comprehensive Cancer Center guidelines recommend clinical trials as first-line therapy for metastatic melanoma patients, and a number of new agents are under investigation for treatment of the disease, Kannan reported. PD-1, an immune checkpoint inhibitor, is about to go into phase III testing. Researchers are also looking at MEK inhibitors, vaccines, and combination therapies.

This is an area where nurse navigators also can make a huge difference, she said, by helping patients locate not only the right trials for their diseases, but also studies that will accept their health insurance plans. Kannan stays abreast of virtually all relevant clinical trials underway at NYU and elsewhere. “It’s not about us,” she said. “We’ll send patients anywhere to get the care they need.”

Kannan is currently writing a grant application to establish a melanoma survivorship program at NYU. “Survivorship is now a reality in melanoma,” she said, “but we don’t have the magic medicine yet.”

The incidence of melanoma, the deadliest of all skin cancers, is quickly rising, and the disease is responsible for more than 8000 deaths each year.

New Metastatic Melanoma Therapies Create Hope for Patients, Key Role for Oncology Nurses

One recent development on the minds of NCONN 2012 attendees is the new patient navigation standard announced in March by the American College of Surgeons Commission on Cancer (CoC). Facilities seeking CoC accreditation now need to have a patient navigation process in place by 2015.

Mary Lou Woodford, RN, BSN, MBA, CCM, care coordination program director for the Massachusetts Department of Health, offered practical guidance to the group on how to use the CoC standard to help their institutions design programs that break down barriers and ensure equal access to care in the communities they serve.

	“My Hospital Is CoC-Accredited: What Do I Need to Do to Comply?”

When Woodford hears this question, and she often does, she explains that under 

, facilities will need to demonstrate that they have a process in place that removes barriers to care. This does not mean that facilities have to employ patient navigators; however, Woodford emphasized these key elements:

		Perform a community “needs assessment” to documents disparities and barriers to care for patients in the community

		Identify resources—either on-site or through referral&mdash;to address these disparities / barriers

		Present patient navigation process to cancer committee annually for formal evaluation

		Modify or enhance patient navigation process to address results and recommendations from the committee evaluation

“To do a thorough needs assessment, and to do it well, can take 12 months,” noted Woodford. “Look at your own state’s comprehensive cancer plan. Every state health department has one. They can help you get the data you need for the assessment.”

She emphasizes that CoC is looking for measurable data on what prevents some people from accessing care at a facility and cites community interviews and focus groups as examples of ways to secure the required data. “Bringing in other units, such as cardiovascular or chronic disease specialists, to work with you on the needs assessment may also be an approach that will work for your facility,” Woodford added.

The purpose of the assessment, Woodford explained, is to identify: (1) the needs of the population a facility serves, (2) health disparities in the community, and (3) resources to prevent barriers and improve access to care. Armed with this information, facilities can create building blocks for program development, implementation, and evaluation.

“The assessment is broader than just who comes to your facility,” said Woodford.  “You need to get into the community and find out why some people don’t access care.”

Woodford pointed out that it would be hard for one individual, such as a navigator, to set up this process alone, and suggested engaging a multidisciplinary group at each facility to work on the project. Members of the multidisciplinary team  might include evaluation research, quality improvement, discharge planning, medical records, and community resources.

Despite the extended 2015 deadline, Woodford strongly advised facilities to get started no matter where they happen to be in their own CoC 3-year survey cycle for accreditation. “[The CoC] wants facilities to succeed. If you start working on implementation before the survey staff visit, it will be a great opportunity to get their guidance. We all know what the standard is, and survey evaluators will be looking at your progress.”

“The ultimate goal is to serve the whole community,” concluded Woodford.

For more information on the standards, visit 

Facilities seeking Commission on Cancer accreditation now need to have a patient navigation process in place by 2015.


Opportunity Knocks: New ACoS Standard Requires Navigation Process in Place by 2015

While breast cancer patients may have better 5-year survival rates than other cancer patients if their tumors are detected early, the mortality associated with the disease is still very high, with an estimated 39,520 women in the United States dying from the disease this year.

	Night Shift Increases Breast Cancer Risk

That is why updates on risk factors, screening methods, and treatments are very valuable, especially for the nurse navigators who are guiding patients from diagnosis to treatment and, hopefully, through survivorship. At the 4th Annual National Coalition of Oncology Nurse Navigators (NCONN) conference, Beth Baughman DuPree, MD, medical director of the Breast Health Program at the Holy Redeemer Health System in Pennsylvania, presented nurse navigators with some important updates that have taken place over the course of the last year.

DuPree said that many new nurses begin their careers by working the night shift at various hospitals in clinics. However, working the occasional night shift and disrupting the body’s natural rhythm could increase the risk of breast cancer, according to a study published in the 

Scandinavian Journal of Work, Environment, and Health

“This night shift work disrupts the body's natural rhythm,” DuPree said. “And it's especially risky in young nurses who may have not had children yet and therefore their breasts haven't fully developed.”

In reviewing the data, DuPree said that the fact that women who worked three night shifts or less per week suggests that the body cannot adapt.

	The Continued Mammography Debate and New Screening Methods

DuPree said that the disruption of melatonin production could be tied to the increased risk. The study's authors suggest that melatonin supplementation should be considered.

DuPree was critical of the United States Preventive Services Task Force (USPSTF) recommendations on mammography, specifically the fact that biennial screening is recommended for women between the ages of 50 and 75 but not for younger patients.

“Mammograms certainly have their limitations,” DuPree said. “They can't screen the whole breast. They don't catch every case of cancer. But for now, they're still the best thing we have.”

However, DuPree said that there are new methods that are particularly promising. At her own health network, DuPree said she's been able to use a method called 3-D tomosynthesis. This technique takes multiple images of the breast from different angles, which are then used to create a three-dimensional rendering of the breast.

By doing this, oncologists are able to detect smaller cases of cancer and exactly where the tumors are located within the breast.

	Nipple-Sparing Mastectomy Benefits Patients

“This really is revolutionary,” DuPree said, citing a case example at the conference that she said could not have been detected through a traditional mammogram.

DuPree reminded the nurse navigators that surgery has come a long way since the days of the mentality of William Stewart Halsted, mainly that the more you cut, the more you cure. Rather, DuPree said that numerous studies are confirming that patients may perform better with less surgery.

One example she provided was a study presented at the 2012 meeting of the American Society of Breast Surgeons (ASBS). A 6-year retrospective analysis found that out of 205 nipple-sparing mastectomies performed on 130 patients, only 1.8% of patients had local recurrence. Another 1.8% of patients had distant recurrence, but DuPree said that would not be a result of a mastectomy, which is designed to prevent local recurrence.

Another study followed patients who had received a combined total of 325 nipple-sparing mastectomies. After a mean period of 30 months, there was no local regional recurrence.

“These procedures are demonstrating a great oncologic result,” DuPree said.

Updates on breast cancer risk factors, screening methods, and treatments for the nurse navigators who are guiding patients from diagnosis to treatment and, hopefully, through survivorship.

Beth DuPree, MD, Updates Navigators on Breast Cancer Treatments

Cristi Radford, MS, CGC, Certified Genetic Counselor, Genetic Education Program, Sarasota Memorial Hospital, explains the multifaceted role that oncology nurse navigators play in the genetic counseling and cancer risk assessment process.

Radford believes that nurse navigators are able to impact genetic counseling the most in the community setting, since this is where many patients are diagnosed and treated. As one of the first individuals to interact with a patient, the nurse navigator should look for signs of a hereditary symptom in order to determine if the patient is a good candidate for genetic counseling or risk assessment. If the navigator feels the patient's cancer is hereditary they can advise the treatment team and the patient to seek genetic counseling.

Nurse navigators may also be tasked with addressing many of the myths associated with genetic counseling and cancer risk assessment. Patients have many questions regarding their insurance and possible discrimination that nurse navigators may need to answer first in order to move forward with the risk assessment process.

Cristi Radford, a Certified Genetic Counselor, explains the multifaceted role that oncology nurse navigators play in the genetic counseling process.

Cristi Radford on the Nurse Navigator's Role in Genetic Counseling

OncLive presents live coverage from the 2012 National Coalition of Oncology Nurse Navigators' (NCONN) annual conference, 

, held at the Gaylord Opryland Hotel from October 4th to 6th, in Nashville, Tennessee.

Presentations and breakout sessions at the NCONN meeting feature expert insight into the optimal multidisciplinary management of patients with cancer.

The meeting seeks to address the real-time needs of oncology nurses, oncology nurse navigators, clinical nurse specialists, social workers, community healthcare workers, and patient navigators.

OncLive’s conference coverage features video interviews with leading specialists and articles highlighting the top presentations from the meeting.

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View coverage from the 2012 NCONN Conference

OncLive presents live coverage from the 2012 NCONN Changing the Face of Cancer Care Conference, held at the Gaylord Opryland Hotel from October 4th to 6th, in Nashville, TN.

Annual NCONN Conference | Conference