Oncology Nursing Society's Genomics and Precision Oncology Learning Library Resources for Nursing Practice

Oncology nurses need an understanding of genomic science to provide optimal care, yet they may have limited background in how this science guides treatment. The Oncology Nursing Society (ONS) responded to this identified need.

Direct-to-Consumer Genomic Testing Through an Ethics Lens: Oncology Nursing Considerations

BACKGROUND

The use of direct-to-consumer genomic testing (DTCGT) is increasing, but this testing may not be comprehensive and may lack clinical validity and utility. The ethical constructs of beneficence, nonmaleficence, justice, and autonomy provide a framework for coordinating the care of patients and their families.

OBJECTIVES

This article provides an overview of the DTCGT process and reviews the ethical implications that affect clinical care.

METHODS

A review of the literature was conducted using the following key words: genetics/genomics and direct-to-consumer testing. Common themes were identified, including test types, regulatory standards, marketing practices, ethics, privacy, and nursing implications.

FINDINGS

An increased awareness of the clinical and ethical consequences of DTCGT is needed among healthcare providers and the general population. Oncology nurses can assist patients in navigating the field of genomics through consistent and comprehensive risk assessment, patient education about the risks and benefits of DTCGT, and referral to genomics professionals when appropriate.

Germline Cancer Genetic Counseling: Clinical Care for Transgender and Nonbinary Individuals

Transgender and nonbinary (TG/NB) individuals may engage in cancer genetic counseling for a variety of reasons, including to assess risk and obtain recommendations for cancer prevention and early detection. Barriers to TG/NB.

Laboratory Selection in Germline Genetic Testing: Laboratory Science Matters

There are multiple laboratories that offer germline genetic testing, and it can be difficult to discern which one to use for testing. Some laboratories have more comprehensive analysis techniques and capability, which increases the accuracy of testing. The ordering provider has a responsibility to select the appropriate laboratory with technologic capability for the needed testing, inform the laboratory of prior testing results in the patient and family so known familial variants have targeted testing, and use appropriate terminology and nomenclature when communicating information to other healthcare professionals, patients, and families. This report presents a case illustrating the potential errors that can occur when a provider selects a laboratory that lacks the capacity to detect certain pathogenic variants, such as large deletions and duplications. False-negative germline testing results lead to missed opportunities in prevention and early detection for not only the patient but often multiple family members, which may lead to psychosocial distress and late-detected cancers. This case highlights the complexities of genetic care and why management by a genetics professional can facilitate more fiscally responsible care, appropriate genetic testing, and comprehensive care for all family members at risk.

How Did the Variant Get Its Name? Understanding Gene and Variant Nomenclature

Genomics is foundational to precision oncology. Oncology nurses regularly review germline and somatic biomarker testing reports. The taxonomy and nomenclature of biomarker results have evolved. Accurate understanding and inte.

Response to "Knowledge and Practice of Breast Self-Examination: A Cross-Sectional Study of Women at Selected Health Centers in Oyo State, Nigeria"

I would like to thank Faleti et al. (2023) for describing the practice patterns of breast self-examination (BSE) in Nigeria. Early identification of the symptoms of breast cancer is important in the effort to improve quality.

Response to "Treatment-Induced Ovarian Insufficiency and Early Menopause in Breast Cancer Survivors"

We thank Esch and Schadewald (2023) for their excellent article, "Treatment-Induced Ovarian Insufficiency and Early Menopause in Breast Cancer Survivors," which described the many symptoms that can occur subsequent to tre.

PARP Inhibition: Genomics-Informed Care for Patients With Malignancies Driven by BRCA1/BRCA2 Pathogenic Variants

BACKGROUND

Germline and somatic biomarker testing for BRCA1/2 pathogenic variants can provide important susceptibility, prognostic, and predictive information, guiding recommendations for care.

OBJECTIVES

This article reviews BRCA1/2, DNA damage and repair mechanisms, prevention and screening guidelines for patients with germline pathogenic BRCA1/2 variants, indications for poly (ADP-ribose) polymerase (PARP) inhibitor therapy, associated side effects, tumor resistance, and implications for nurses.

METHODS

A comprehensive review of the CINAHL®, MEDLINE®, and PubMed® databases was performed using the following search terms: BRCA1/2, PARP inhibitors, and genomic testing.

FINDINGS

PARP inhibitors are indicated for select patients with malignancies associated with BRCA1/2 pathogenic variants. Awareness of PARP inhibitors, their mechanism of action, indications for use, and associated side effects helps oncology nurses guide patients and families in care recommendations, provide detailed patient education, effectively monitor for side effects, and promote adherence to therapy.

Oncology Nurse Practitioners in Genetics: Examining Scope of Practice and Competence

Genomic science is rapidly evolving, and ordering germline testing requires appropriate and comprehensive assessment of a patient's personal and family history, as well as the knowledge base to facilitate selection of the best test or panel of tests, provision of pretest counseling for informed consent, interpretation of test results, post-test recommendations, and coordination of care for other at-risk family members. Prior to ordering germline genetic testing, an advanced practice RN's scope of practice accountability includes consideration of competence in the provision of genomic care. This article provides a case study to illustrate the complexities of issues related to competence when ordering germline genetic testing.

Peripheral Neuropathy: Common Side Effect

For peripheral neuropathy, standards of care are based on established evidence-based practice. Peripheral neuropathy is disease or dysfunction of one or more peripheral nerves (i.e., motor, sensory, or autonomic), resulting in numbness or weakness. Peripheral neuropathy occurs outside of the brain and spinal cord and is caused by cancer, treatment, or both. Chemotherapeutic agents that can cause peripheral neuropathy include epothilones, platinum analogs, taxanes, and vinca alkaloids, as well as immunomodulating drugs and proteasome inhibitors.

Skin Toxicities: Common Side Effect

For skin toxicities, standards of care are based on established evidence-based practice. Cancer treatment-related skin toxicities are a frequent and distressing side effect of antineoplastic therapies, particularly chemotherapy and targeted therapies. Toxicities associated can appear as rashes, hand-foot skin reaction, hand-foot syndrome, and hair loss. As many as 90% of patients will experience some skin toxicity at some point in their therapy.

Sleep-Wake Disturbances: Common Side Effect

For sleep-wake disturbances, standards of care are based on established evidence-based practice. Sleep-wake disturbances are defined as ongoing issues with sleep or daytime sleepiness (e.g., circadian rhythm disorder, hypersomnia, insomnia, narcolepsy, sleep apnea). Sleep-wake disturbances are estimated to occur in 35%-75% of patients with cancer.

Fatigue/Lack of Endurance: Common Side Effect

For fatigue/lack of endurance, standards of care are based on established evidence-based practice. Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to the activity and interferes with usual function. Lack of endurance refers to limited physical capability to sustain an exercise or activity for an extended period of time. From 80% to 100% of patients with cancer report experiencing fatigue. It can be isolated or occur within a symptom cluster with pain, depression, dyspnea, anorexia, and sleep disturbance.

Colon Cancer: Survivorship Care Case Study, Care Plan, and Commentaries

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Hot Flashes: Common Side Effect

For hot flashes, standards of care are based on established evidence-based practice. Hot flashes are a sensation of heat that can be accompanied by facial flushing, perspiration, chills, heart palpitations, night sweats, and anxiety. Hot flashes occur in 51%-82% or women treated for breast cancer and 80% of men treated for prostate cancer with surgical or chemical castration.

Breast Cancer: Survivorship Care Case Study, Care Plan, and Commentaries

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Hematologic Malignancy: Survivorship Care Case Study, Care Plan, and Commentaries

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Genitourinary Distress: Common Side Effect

For genitourinary distress, standards of care are based on established evidence-based practice. Genitourinary distress is accidental urine leakage that can dampen underwear or saturate clothes. It is a sense of urgency, frequent urination, and/or pain or discomfort when urinating. Genitourinary distress is found in 35%-75% of patients with prostate cancer.

Prostate Cancer: Survivorship Care Case Study, Care Plan, and Commentaries

This case study highlights the patient's status in care plan format and is followed by commentaries from expert nurse clinicians about their approach to manage the patient's long-term or chronic cancer care symptoms. Finally, an additional expert nurse clinician summarizes the care plan and commentaries, emphasizing takeaways about the patient, the commentaries, and additional recommendations to manage the patient. As can happen in clinical practice, the patient's care plan is intentionally incomplete and does not include all pertinent information. Responding to an incomplete care plan, the nurse clinicians offer comprehensive strategies to manage the patient's status and symptoms. For all commentaries, each clinician reviewed the care plan and did not review each other's commentary. The summary commentary speaks to the patient's status, care plan, and nurse commentaries.

Distress: Common Side Effect

For distress, standards of care are based on established evidence-based practice. Distress is a multifactorial and unpleasant emotional experience of a psychological (e.g., cognitive, behavioral, emotional), social, and/or spiritual nature that can interfere with the ability to effectively cope with a cancer diagnosis, physical symptoms and treatment, and long-term consequences of treatment. All patients are expected to experience some level of distress at some point in the cancer trajectory.

Lymphedema: Common Side Effect

For lymphedema, standards of care are based on established evidence-based practice. Lymphedema is the accumulation of lymph fluid that obstructs the flow of the lymphatic system, causing persistent swelling of the affected body part. Lymphedema is most commonly seen after lymph node dissection or radiation therapy. It occurs in 10%-40% of patients with breast cancer and 80% of patients with lymph node dissection in the groin.

Survivorship Care: More Than Checking a Box

In 1987, the 12th Annual Oncology Nursing Society (ONS) Congress® held in Denver, Colorado, featured a session moderated by Deborah A. Boyle, MSN, RN, AOCNS®, FAAN, with Fitzhugh Mullan, MD, and Susie Leigh, BSN, RN, cofounders of the National Coalition for Cancer Survivorship, titled "The Seasons of Survival," which was one of the earliest presentations to oncology nurses that proposed cancer was not necessarily a deadly disease and that nurses could address the needs of survivors. As an advanced practice nurse (APN) in oncology hearing this presentation, I began to look at long-term needs of survivors who had advanced beyond acute care and benefited from effective treatments. Cancer survivorship now is a priority in oncology clinical practice.

Cognitive Dysfunction: Common Side Effect

For cognitive dysfunction, standards of care are based on established evidence-based practice. Cognitive dysfunction is the decline in function in one or more cognitive domains, including attention and concentration, executive function, information processing speed, language, visuospatial skill, psychomotor ability, and/or learning and memory. Cognitive dysfunction occurs in 80% of patients with brain tumors, 40% of patients with acute myeloid leukemia, and as many as 75% of patients with breast cancer.

Constipation: Common Side Effect

For constipation, standards of care are based on established evidence-based practice. Constipation is the decreased passage of stool characterized by infrequent bowel movements, hard stool, a sensation of abdominal bloating or cramping, straining with bowel movements, and the feeling of incomplete evacuation. Constipation occurs in 43%-58% of people with a diagnosis of cancer.

Pain: Common Side Effect

For pain, standards of care are based on established evidence-based practice. Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain can be acute or chronic. Syndromes include neuropathic pain, chronic pain syndromes, arthralgias, skeletal pain, and gastrointestinal, genitourinary, and pelvic pain. Pain occurs in 59% of patients undergoing treatment and almost 100% of those with advanced disease.

Myeloid Malignancies: Recognizing the Risk of Germline Predisposition and Supporting Patients and Families

There is increasing recognition of the role of inheritance in myeloid malignancies. Differentiating germline from somatic variants in a hematologic malignancy is challenging but important. Oncology nurses need to be knowledgeable about the germline risk associated with myeloid malignancies; the inherited risk is well established and has implications for affected individuals as well as family members who may be at risk for malignancy themselves or who are being evaluated to serve as a related donor for allogeneic hematopoietic stem cell transplantation.

Hereditary Neuroendocrine Tumors: Providing Comprehensive Care for Individuals Who Have a Germline Pathogenic Variant Associated With Paragangliomas and Pheochromocytomas

Both paragangliomas and pheochromocytomas can be associated with germline pathogenic variants. Although these neuroendocrine tumors are relatively rare, the identification of patients and families with germline risk enables the implementation of surveillance programs to decrease the morbidity and mortality associated with these tumors. Individuals with germline risk require lifelong screening, which is implemented as early as age 5 years. In addition to ensuring that surveillance protocols are implemented, nurses provide education about symptoms that require prompt evaluation.

COVID-19 Pandemic 101: An Epidemiology and Public Health Primer for Oncology Nurses

BACKGROUND

Understanding basic epidemiology and public health concepts is essential to the provision of safe care during a pandemic. These basic concepts and terms include containment, mitigation, predictive modeling, latent period, incubation period, reproduction number, case fatality rate, and test sensitivity and specificity.

OBJECTIVES

Public health concepts and terms are defined, described in the context of the COVID-19 pandemic, and specific implications for oncology nursing practice are discussed.

METHODS

A review of public health literature and reputable websites with a focus on COVID-19 data. This article defines epidemiologic and public health concepts and uses examples from the pandemic to illustrate oncology nursing implications.

FINDINGS

The COVID-19 pandemic is changing oncology nursing care delivery. Oncology nurses need to understand these concepts to anticipate and advocate for optimal oncology care.

Shifting to a Biomarker Paradigm Across Cancer Care

Precision medicine has revolutionized multiple facets of care across the cancer trajectory, from prevention through treatment. Sometimes referred to as personalized medicine, precision medicine uses information contained in an individual's genes, as well as biomarkers and genetic alterations detected in tumor cells, to prevent, diagnose, and treat malignancy. It can provide valuable information about an individual's risk for developing malignancy, facilitate an accurate diagnosis, inform or revise a plan of treatment, or offer information about prognosis.

Tumor Genomic Testing: Identifying Characteristics Associated With Germline Risk for Developing Malignancy

Tumor genomic testing is used primarily to facilitate the selection of the best possible treatment for a malignancy based on the genomic characteristics of the tumor. Germline genomic testing has implications for care and recommendations for cancer prevention and early detection for the patient and their family. Careful review of specific components of tumor genomic testing reports and of the family history of malignancy can help ensure that families with potential germline risk are identified and referred for genetic counseling and genetic testing.

Considerations for the Telephone Disclosure of Genetic Test Results to Patients With Cancer

I would like to thank Cantril, Moore, and Yan (2019) for their informative article on patient preferences for the disclosure of a breast cancer diagnosis in the December issue of the Clinical Journal of Oncology Nursing. The findings of Cantril et al.'s (2019) study suggest that patients prefer in-person disclosure. Additional patient priorities included knowing the results of tests quickly, having those results disclosed by an expert with a sensitive touch, and having a clear understanding of the next steps in the treatment plan.

Genetic Service Delivery Models: Exploring Approaches to Care for Families With Hereditary Cancer Risk

BACKGROUND

Providing timely access to quality genetic counseling is becoming necessary as the awareness and availability of high-risk screening and genetic testing increase. The results of genetic testing directly influence treatment decisions and recommendations for cancer screening and prevention. Evolving service delivery models of genetic counseling can lessen patient and system barriers to comprehensive genetic care.

OBJECTIVES

The aim of this article is to note known barriers to accessing genetic care, review strategies and delivery models to enhance access to the genetic counseling process, and discuss how oncology nurses can play a supportive role in facilitating the genetic counseling process.

METHODS

A review of the literature was conducted using PubMed, CINAHL®, and Ovid.

FINDINGS

Alternative service delivery models can increase the accessibility of genetic counseling services to at-risk populations. Additional research is needed to identify the models that can balance improved access to care with effective counseling.

The DNA of a Testing Scam

Federal agents raided a number of genetic testing laboratories in September 2019, resulting in 35 people being charged with fraudulent genetic testing associated with an estimated $2.1 billion in losses to federal healthcare insurance programs. The scams work in several ways. In some cases, an older adult is contacted by a customer service representative of the testing laboratory and told that Medicare pays for the genetic testing ordered, based on a simple cheek swab sample. This occurs when representatives of the testing laboratory have "arrangements" with providers who order the tests, often without the provider examining the patient. These providers may receive financial payment or other gifts for their efforts.

Coordination of Genetic Care: More Important and Complicated Than it Seems

Families with hereditary risk for developing malignancy benefit from organized, coordinated care by a genetics professional. This report presents a case illustrating the potential errors that can occur when genetic care is fragmented and not coordinated, including ordering too much or not enough genetic testing, failing to communicate with the family who is at potential genetic risk, failing to communicate what the results of testing mean, and failing to recommend appropriate care, which may lead to psychosocial distress and late-detected cancers. This case highlights the complexities of genetic care and why management by a genetics professional results in more fiscally responsible care, appropriate genetic testing, and comprehensive care for all family members at risk.

Response to "Taking Photos of Presentations: Dissemination or Distraction?"

I would like to thank Anne Katz, PhD, RN, FAAN, for her thoughtful editorial in the July 2018 issue of Oncology Nursing Forum. At least twice, that I am aware of, someone has used my slides without my permission. The first time happened about 10 years ago. I gave an educational program on the fundamentals of hereditary cancer syndromes at a regional conference for oncology nurses. I provided a detailed outline for note-taking and a list of references and resources. On one slide, there was a picture of my entire extended family at our cabin in a remote area of the Ozarks in Missouri, as well as several other photos that I had taken of my daughters and dog. Only I had access to those photos.&nbsp.

Direct-to-Consumer Genetic Testing: Helping Patients Make Informed Choices

Using direct-to-consumer genetic testing (DTCGT), individuals can order a genetic test, collect and submit a saliva sample, and obtain results about their genetic risk for a variety of traits and health conditions without involving a healthcare provider. Potential benefits of DTCGT include personal control over genetic information and health management decisions, whereas potential risks include misinterpretation of results, psychosocial distress, and lack of informed consent. Oncology nurses can provide education, support, and advocacy to enable patients to truly understand the positives and negatives associated with DTCGT.
.

Response to "Male Patients With Breast Cancer: Addressing Needs Using an Educational Task Force"

Male breast cancer is associated with hereditary risk for developing breast and other cancers. An estimated 4% of men with breast cancer have BRCA1 mutations, and 4%-16% have BRCA2 mutations. Men with a diagnosis of breast cancer have unique needs that need to be addressed in a caring and comprehensive manner.

Errors in Genetic Testing: Common Causes and Strategies for Prevention

Genetic testing for hereditary cancer syndromes is an integral component of oncology care. Various types of common errors that occur in the genetic testing process are presented in this article with actual clinical case examples and commentary. Genetic errors are expensive and may result in poor outcomes for the patient and his or her family. Oncology nurses need to be aware of potential sources of error and advocate for comprehensive genetic care.
.

The Three-Generation Pedigree: A Critical Tool in Cancer Genetics Care

The family history, a rather low-tech tool, is the backbone of genetic assessment and guides risk assessment and genetic testing decisions. The importance of the pedigree and its application to genetic practice is often overlooked and underestimated. Unfortunately, particularly with electronic health records, standard pedigrees are not routinely constructed. A clear understanding of how pedigrees are employed in clinical oncology practice may lead to improved collection and use of family history data.
.

Genetics and Genomics: An Oncology Nurse's Journey in Practice

BACKGROUND

Cancer genetics and genomics are now an integral component of oncology care. Genetics and genomics guide recommendations not only for cancer prevention and early detection, but also for cancer treatment. 
.

OBJECTIVES

This article documents the personal experiences of an oncology nurse who has worked in cancer prevention and early detection since the 1990s and describes the many changes that have occurred in cancer-related genetic and genomic care during that time. 
.

METHODS

This is a personal account of genetic practice in the past 30 years. 
.

FINDINGS

Nurses can no longer ignore cancer genetics and genomics in oncology care. Some aspects of care have changed dramatically, including the number of genetic tests and potential uses for genomic information; however, some remain the same, particularly the human component of care. Patients and families need comprehensive education and support to understand the role that genetics and genomics play in cancer care. Oncology nurses are well suited to provide this care.

Colorectal cancer screening: Using evidence-based guidelines

Colorectal cancer is the third most common cancer diagnosed in men and women. There are multiple options for prevention and early detection. Evidence-based guidelines are available to select the best option based on personal and family history. NPs should utilize these guidelines in clinical practice to select the appropriate screening for their patients.

Genetic Testing: Challenges and Changes in Testing for Hereditary Cancer Syndromes

BACKGROUND

The practice of genetic testing for hereditary cancer syndromes has changed dramatically in recent years, and patients often approach oncology nurses requesting information about genetic testing.
.

OBJECTIVES

This article aims to explore changes in cancer genetics, the role of genetics professionals in providing comprehensive genetic care, and the implications of these new developments in genetics for oncology nurses.
.

METHODS

A literature review was conducted and focused on articles about the updating of genetic tests with panel testing, insurance changes, alternative genetic counseling strategies, and direct-to-consumer genetic testing.
.

FINDINGS

Oncology nurses play an important role in identifying and referring patients, including those who have tested negative for hereditary susceptibility genes, to genetics professionals. Genetics professionals can assist with insurance issues, interpretation of test results, clarification when a variant of unknown clinical significance is detected, and recommendations for care based on personal and family history and testing results. Oncology nurses can assist families with understanding the limitations of direct-to-consumer genetic testing.

Mosaicism: Implications for Genetic Counseling and Medical Management

Mosaicism describes the presence of two or more populations of cells with different genotypes in one individual that have developed from a single fertilized egg. This article reviews the various clinical presentations of mosaicism associated with hereditary cancer syndromes and the challenges in providing patients and their families with appropriate genetic testing, as well as provides recommendations for cancer presentation and early detection. Management of mosaicism is based on personal and family history, along with genetic testing results. 
.

Germline BRCA1 mutations and pancreatic adenocarcinoma: A literature review

e15716

Abstract Background: Pancreatic adenocarcinoma (PAC) is the fourth leading cause of cancer-related deaths in the United States. Although the vast majority of cases are sporadic, up to 10% of cases are related to a hereditary cancer predisposition syndrome, the most common of which is germline BRCA mutation. Although BRCA2 mutation has been well described in the literature, data on BRCA1 mutation-associated PAC is limited. This work aims at reviewing the literature on BRCA1 mutation-associated PAC and discussing the relevant findings. Methods: We have searched the Pubmed database for articles using the search terms “pancreatic”, “BRCA”, BRCA1”, “adenocarcinoma” or any combination of these keywords. Data about epidemiology, staging, prior history of other tumors, and management were collected. Systematic data extraction and assessments of quality were carried out by two reviewers, and good agreement was found. Results: A total of 13 studies were selected for review and included a total of 149 patients. The prevalence rate of PAC among patients with germline BRCA1 mutations ranged between 0.002% and 0.03%. Moreover, the prevalence of BRCA1 mutations in patients with BRCA-related PAC was found to be between 27% and 30%. Of note, PAC was diagnosed as the first tumor in 74% of patients with BRCA1-related PAC. The most common stage at diagnosis was stage 4 (56%) followed by stage 2 (22%). Conclusions: Germline BRCA1 mutation-associated PAC is an under-recognized entity when compared to BRCA2 mutations. Given the incredibly poor prognosis and the growing interest in targeted therapies, physicians need to be familiar with BRCA1 mutations as a possible etiology of PAC. A significant number of patients with BRCA1 mutation-associated PAC were diagnosed with PAC as the first tumor. Therefore, upper gastrointestinal screening should be considered in patients with germline BRCA1 mutations.

Response to "Patient-Inspired Research: A Better Way to Go?"

I would like to thank Anne Katz for her thoughtful editorial on the importance of patient opinion in defining research questions. Nurse researchers choose to study specific topics for a variety of reasons. These reasons often relate to research funding priorities. It costs a lot of money to do research; topics may be chosen not because they are necessarily the passion of the researcher, but because that is where the funding dictates.
.

Behavioral and Neurologic Assessment: Using the National Institutes of Health Toolbox

Cognition, psychological well-being, stress, functional status, and pain are all priority outcomes of interest to oncology nurses. However, it can be challenging to choose an instrument for clinical assessment or for use in research projects that assess these constructs. The National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function was created for measuring emotional health and cognitive, motor, and sensory function. The toolbox can be a potentially useful resource for clinicians and nurse researchers.

Frequency and Significance of Abnormal Pancreatic Imaging in Patients with BRCA1 and BRCA2 Genetic Mutations

Objective. Pancreatic adenocarcinoma is typically diagnosed in advanced stages resulting in a significant reduction in the number of patients who are candidates for surgical resection. Although the majority of cases are believed to occur sporadically, about 10% show familial clustering and studies have identified an increased frequency of BRCA germline mutations. The role of screening for pancreatic adenocarcinoma in these populations is unclear. Our study aims to identify the abnormal pancreatic imaging findings in BRCA1 and BRCA2 mutation carriers. Methods. A retrospective review of patient medical records with known BRCA1 and BRCA2 mutations was conducted. Data was collected and all available abdominal imaging studies were reviewed. Results. A total of 66 patients were identified, 36 with BRCA1 and 30 with BRCA2 mutations. Only 20/66 (30%) had abdominal imaging (14 BRCA1 and 6 BRCA2 patients). Of those patients with abdominal imaging, abnormal pancreatic imaging findings were detected in 7/20 (35%) cases. Conclusion. Our study shows a high incidence of abnormal pancreatic imaging findings in patients with BRCA genetic mutations (35%). Larger studies are needed to further define the role of pancreatic cancer screening and the significance of abnormal imaging findings in BRCA1 and BRCA2 mutation carriers.