Carrie Tompkins Stricker, PhD, RN, ANP-BC:
We have discussed so many crucial points about prevention of skeletal-related events, complications of bone metastases, complications of bone loss in our patients, predominantly with solid tumors like breast and prostate cancer today. Many of the principles we discussed apply beyond to myeloma, to lung cancer and to other diseases. We're going to close out now this discussion today by talking just a little bit more in conclusion about the important role that advanced practice providers fill. We heard a lot about the PharmD role. We've integrated each of us, Dr. Sieber, the collaborative clinic with a nurse practitioner with whom he practices. Saneese, you've shared a little bit. But why don't you share with us a little bit more, to close out this discussion, your perspective on the important role that APP has played in caring for individuals with metastatic disease with bone involvement or at risk for the same?
Saneese Stephen, MPAS, PA-C:
Sure. Thanks, Carrie. And it's an excellent talk, that entire panel today. I think we've covered so many topics that I wanted to discuss in summary, but overall APPs are growing in terms of how much they're working with medical doctors, oncologists, and this general field of oncology care. And, really, we spend a lot of time with the patient in terms of educating patient and family. Patients entering this situation of new diagnosis of metastatic disease, very apprehensive, tons of labs, tons of tests is very overwhelming for them. So we really had to sit down with them and take a deep breath and go over things step-by-step, make sure they understand us in a manner that's appropriate for them based on their education level, their background, and cultural sensitivity is very important. So we want to make sure we educate them about the risks, how to explain the risks, how to discuss prevention, how to discuss treatment selection, treatment options, how to monitor on treatment, and all these things happen over not in one session, on a continuous basis.
And it's very important to work with, collaboratively as was mentioned previously, with all the different team members, including other APPs pharmacists, and physicians. So as a PA and nurse practitioner, we work with our one or maybe a group of physicians, very important to know their style of practice, their rationale for decision-making. And many times we mirror what they do because we work with them and you want to be on the same page with them. But you should also be able to have a dialogue with them in terms of understanding what's driving their decision-making and be able to support, and contradicting a view if you have one. But I think it's very important to educate yourself, to know the data, and to be able to have that conversation and especially to present to the patients in a manner that they can understand it.
And finally, I think skeletal-related events, you have to be able to be cognizant thinking about that. So a patient has new pain or new complaints that are seem mild at first, if you work them up and follow them, it may be something that you could address early. If it's something that's looming with weakness or spinal cord compression, it's very crucial to get dexamethasone-R started early. So I think the complications of bone therapy, be it ONJ or skeletal-related events, as a clinician, we have to make sure we have a very quick kind of assessment and looking for it very closely.
Carrie Tompkins Stricker, PhD, RN, ANP-BC:
Thank you for that, Saneese. I guess, particularly with relation to the role of the advanced practice provider, I would say, I agree with everything you say, and on top of that, this issue of supportive care management really just feels so centered, so much my wheelhouse in my role as a nurse practitioner, I have to laugh. One of my colleagues doesn't even look at the DEXA scan reports in particular. He says, "You're the expert here." But also we do have very interdisciplinary discussions, particularly when oncology treatment decisions have to be made in conjunction. Anybody else want to make a brief statement or share any clinical pearls, parting words on this topic overall, or particularly with relation to the advanced practice role?
Christine Cambareri, PharmD, BCPS, BCOP, CSP:
I think I would just echo the comments that were made. And I think more and more in practice we're learning, it truly takes a village and everyone's different perspectives.
I think everyone on this panel could read the same journal article and take away different things that they would take to change their practice, outside of the "we should use this therapy or that therapy", but kind of how you incorporate it and how you would make sure you remember it when you come across a patient case and a decision point or when you're counseling or talking with the patient. And I think that's why it's so important to focus on the interdisciplinary care that can be offered because of what we can each bring with our own flavor and spin on it, based on our practice and experiences.
Carrie Tompkins Stricker, PhD, RN, ANP-BC:
What a privilege to have this discussion with all of you today. To the audience, thank you so much for joining us. And I do want to thank my colleagues again, Saneese Stephen, Paul Sieber, and Christine Cambareri, for taking time out of their very busy day to have this discussion and share their insights on how interdisciplinary approaches to bone metastasis and bone health management are so crucial. For more information, please visit JADPRO online at advancedpractitioner.com. Thank you so much and have a wonderful day all!
