JL323. CREAM Principles: The Advanced Nursing Role in the Management of Dermatologic Adverse Events to Anticancer Therapy
Kathryn Ciccolini, RN, BSN, OCN, DNC, Memorial Sloan Kettering Cancer Center, New York, NY
Background: Dermatologic adverse events (dAE) can occur during and after all anticancer treatment regimens such as, but not limited to, rashes, nail abnormalities hand and feet symptoms, alopecia, xerosis, pruritus, radiation dermatitis, new onset proliferative skin lesions, hypersensitivity reactions, mucositis, secondary skin infections, and graft versus host disease. Therapies include chemotherapy, targeted therapy, immunotherapy, radiotherapy, hormone therapy, therapeutic transplants, and surgery. Consequences of these dAE have various negative impacts on quality of life (QoL), psychosocial and physical impact, instrumental and self-care activities of daily living and financial health. Most importantly, dAE can lead to alteration or discontinuation of anticancer therapy and trials. The advanced nursing role in the management of these untoward dAE is integral in ensuring adherence to anticancer and dermatologic treatment and optimizing disease outcomes. Methods: PubMed was searched filtering to humans only and English language from 2005 to June 30th, 2015 resulting in 788 articles. Further, a trail of citations from similar and cited references were followed to ensure the search was all encompassing of the topic. Articles selected for review were dedicated to oncologic literature mentioning dermatologic adverse events resulting from anticancer therapy or cancer diagnosis itself. The selected articles also mentioned the role of nursing in the management of these conditions under the CREAM principle subheadings. Findings: Trending themes were extracted from 133 articles to create the CREAM principles: Communication, Referral, Education/Encouragement, Assessment and Management/Monitoring. Further, the unique clinical experience from the role of the oncodermatology nurse at Memorial Sloan Kettering Cancer Center has been interlaced in the principles. This is the first definition in the philosophy of the advanced oncodermatologic nurse caring for the patient experiencing all types of dermatologic adverse events to any anticancer therapy. Discussion & Implications: Advanced oncology nurses should be well versed in the encompassing role by developing highly specialized skills in the management of dermatologic adverse events to anticancer therapy during treatment and survivorship setting for all types of cancers. Future studies are essential to elucidate the indispensable role of the advanced nursing in the management of dAE to anticancer therapy and the impact on patient outcomes.
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