Alison Tray discusses the chemo shortage in an interview with CURE

Patient-Provider Communication Is Key During Chemo Shortage

For patients with cancer, the ongoing chemotherapy shortage may cause some anxiety as they wonder how they will receive their drugs. However, measuring drugs “down to the minutiae of the milligrams” helped patients receive the drugs they needed, said Alison Tray.

Tray is an advanced oncology certified nurse practitioner and current vice president of ambulatory operations at Rutgers Cancer Institute in New Jersey.

If patients are concerned about getting their cancer drugs, Tray noted that having “an open conversation” between patients and providers is key.

“As a provider and a nurse myself, having that conversation, that reassurance and sharing the information is a two-way conversation,” she said. “So just knowing that we're taking care of you, we're going to make sure that you receive the care that you need is the key takeaway.”

In June 2023, many patients were unable to receive certain chemotherapy drugs, such as 

 because of an ongoing shortage. By October 2023, experts saw an improvement, although the 

Patients With Lung Cancer Face Unmet Needs During Drug Shortages

“We’re really proud of the work that we could do and achieve that through a critical drug shortage,” Tray said. “None of our patients missed a dose of chemotherapy and we were able to provide that for them.”

Tray sat down with CURE® during the 49th Annual Oncology Nursing Society Annual Congress to discuss the ongoing chemo shortage and how patients and care teams approached these challenges.

Particularly at Hartford HealthCare, when we established this infrastructure, our goal was to make sure that every patient would get the treatment that they need and require, utilizing the data that we have from ASCO guidelines to ensure that we're getting the optimal high-quality standard of care in a timely fashion that we didn't have to delay therapies. So, we were able to do that by going down to the minutiae of the milligrams on hand, particularly when we had a lot of critical drug shortages. So it was really creating that process to really ensure that every patient would get the treatment that they needed.

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During chemo shortages, nurses have helped many patients receive enough treatment, measuring them down to the “minutiae of the milligrams.”

Treatments to reduce frequent transfusion visits can contribute towards a better quality of life for those with low-risk MDS.

Receiving early red blood cell transfusion for low-risk myelodysplastic syndromes (MDS) may help improve patients’ “functional abilities,” an expert told CURE®.

Journal of the National Comprehensive Cancer Network

 determined that transfusion burden during first-line therapy is optimal. Specifically, researchers reported that survival outcomes are optimal when patients with low-risk MDS who require red blood cell transfusions, receive them during first-line therapy.

Researchers analyzed data from the COMMANDS and MEDALIST trials within the study. They established that patients within the first-line setting lived 14.8 months longer than patients in the second-line setting.

Of note, patients within the first-line setting experienced better overall outcomes. Particularly, these patients had fewer complications and hospitalizations, and required less amounts of red blood cells during transfusion, the study stated.

Blood Cancer Drug Decreases Levels of Anti-Fungal Medication

Importance of Early Transfusions and Treatments in Low-Risk MDS

Recent changes in the treatment landscape for MDS have also changed, Dr. Adam Zayac said during an interview with CURE®.

“MDS has a number of treatments, especially now in 2024,” he explained. “Predominately, there are some medications that can be added to improve patients’ transfusion independence or transfusion burden.”

Zayac is a hematologist/oncologist at Rutgers Cancer Institute and RWJBarnabas Health. He is also an assistant professor of medicine at Rutgers Robert Wood Johnson Medical School.

For patients with low-risk MDS, Zayac also noted that it’s important for patients to know about these findings regarding transfusions.

“It’s important for patients to know this information. There are a number of options available now, beyond just the supportive care of transfusions,” he said. “These therapies are well-tolerated and don’t have many of the severe side effects people think about when they think about chemotherapy in its classical state.”

Benefits of Early Transfusion and Treatments for Low-Risk MDS

The benefits for patients with low-risk MDS to receive transfusions early can help improve functional abilities, said Zayac.

“A lot of the benefits of the therapies for low-risk MDS are aimed at reducing the transfusion needs. So, the benefits would really be improving one’s functional abilities,” he explained. “Patients come in who are severely anemic and need transfusions to manage getting around their home, to manage their self-care and then feel a little bit better with transfusion.”

Zayac emphasized that even with early transfusions, patients may feel well for only a short time. However, “the potential for improving their blood counts is tremendous” after treatment, he said.

He explained that transfusions can “carry a number of risks” for patients with low-risk MDS who have chronic transfusion dependency. Iron overload and organ dysfunction, he noted, are some of the included risks, among others.

“With blood transfusions, there’s of allergic or infectious reactions. So the mainstay of therapy for low-risk MDS is really to minimize the demands and requirements for transfusion of either red blood cells or platelets,” Zayac said.

Quality of Life for Patients With Lower-Risk MDS

Having to regularly attend blood transfusion visits also affects patients’ quality of life, he noted.

“On a patient level, the burden of regular transfusion needs include frequent office visits and lab monitoring,” Zayac explained. “This can be as often as two to three times per week for patients with severe anemia and severe thrombocytopenia that require regular, more frequent transfusions.

“So, there’s a tremendous burden on quality of life between travel time spent in infusion or treatment centers to receive these.”

A combination of fewer transfusions because of effective treatments can improve patients’ quality of life, he said. This may allow patients to go several weeks without a transfusion visit, meaning they now have the option to travel.

“I treat a number of patients with low-risk MDS, and some of them travel around the world now because they're able to be free of having to come back and forth,” Zayac said. “For frequent transfusions or blood count monitoring, and they're aware of the symptoms, they begin to feel as are becoming a little bit low in their blood counts. So from a quality life perspective, that's tremendous.”

Receiving early transfusions and treatment to reduce transfusion dependency significantly improves survival and quality of life in low-risk MDS. 

Early Transfusions, Treatments May Improve Outcomes in Low-Risk MDS

They say that no two cancer journeys are the same. We all go through our unique experiences from beginning to end. I have learned how true that is.

My cancer diagnosis of non-Hodgkin lymphoma took a circuitous route that would make the greatest explorer get lost, even with a compass and map. It all began with a tingling in my left hand. Month after month, the tingling turned into electrical shocks. I’d almost jump out of my skin from the sudden shock that felt like I grabbed an exposed, hot wire.

But it wasn’t the hand that caused the pain or the increasing loss of use. Unbeknownst to me, there was a tumor growing in my left armpit. The tumor was strangling the nerve bundle that runs from the spine down the arm to the hand and fingers. My pinky finger and neighboring ring finger were dying. I was losing the use of both fingers. My pinky lost all sensation.

My family doctor thought it had to do with lifting weights at the gym. He said to stop lifting so much weight. His advice reminded me of the old joke: Patient: “Doctor, it hurts when I do this.” Doctor: “Then stop doing that.”

He had me do some X-rays, but they yielded nothing. After the pain and loss of use got worse, he recommended I see a local neurologist. He and his assistant did one of those painful needle tests where they “listen” for nerve damage. You can actually hear what sounds like static to indicate healthy or damaged nerve connections. I was sitting there. I heard the same thing they heard. It didn’t make sense to them or me.

But, in true used-car-salesman fashion, he said maybe the nerve was being impinged (pressed on) where the nerve funnels through a small gap at the elbow. He said he could cut open my elbow and re-wire my nerve to go around it. But there was no guarantee that it would work, and there was the possibility that the re-wiring would leave my left arm unusable in the future. I knew from hearing the same static sounds they did, that they had no idea what was wrong with me. I passed on the idea.

I went to see a sports medicine doctor. He, too, had no idea what was going on. This all happened over a year or so. All the while, the tumor was growing, destroying my nerves, spreading. I was now able to feel the mass in my armpit. Finally, having exhausted my local medical professionals, I was sent to a specialist in a larger city 100 miles away. In no time at all, he ordered a scan, which revealed something was there. The very next day he scheduled a biopsy. Even as the image came up during the surgery, the doctor said it was indeed a tumor. No doubt about it. He had seen thousands of others just like it.

Right then and there, I was sent to meet the chief oncologist. He told my wife and me that the cancer was so aggressive and spreading so quickly that I’d have only three months to live if I did nothing. He wanted to admit me to the hospital to begin chemotherapy right then and there. My wife started sobbing.

We had driven 100 miles thinking we were only doing a scan and that we’d be home in time for our 11-year-old daughter to get home from school. We hadn’t imagined where the day would lead us so quickly. It was a Friday. Our daughter was in school. We were able to talk the doctor into waiting to admit me until Monday morning. We needed time to digest the devastating news and what it would mean to our family.

The story has a happy ending. I spent the next six months in and out of the hospital for chemo and immunotherapy. My body went through the usual degradation. I lost weight, hair, strength and libido. You name it. At my lowest point, I looked like Elmer Fudd or a gaunt Mr. Clean. I rang the bell, signaling that I was cancer-free. It’s been more than a year, and there’s no sign of the cancer returning. Everything I lost has returned. Today, I feel like my old self.

One thing I learned from my experience is that the oncologist said he would always rule out cancer first, while the local doctors put off thinking about cancer as a last resort. With cancer, time is paramount. The sooner it is diagnosed, the sooner it can be treated before it spreads throughout the body and goes from one stage to the next. My cancer was discovered just in the nick of time.

The day I found out I had cancer, my wife and I thought I would just be going in for a scan. 

The Long and Winding Road Leading to My Non-Hodgkin Lymphoma 

Aspirin users with esophageal or colorectal cancers were shown to have a lower risk of metastasis than non-aspirin users.

Aspirin use may be associated with lower rates of metastasis among patients with esophageal and colorectal cancer, researchers have found in two studies.

 drew on data from 190,655 patients with esophageal cancer. Of these patients, researchers found that 20,650 (10.8%) were aspirin users. They also established a 28.9% incidence of metastasis among aspirin users, versus a 38.7% incidence of metastasis among non-aspirin users.

Rates were similarly disparate when broken down by type of metastasis. Aspirin users versus non-aspirin users experienced a GI metastasis incidence of 14.2% and 20.6%, non-GI metastasis of 15.1% and 22% and lymphoid metastasis of 8.9% and 11.3%, respectively.

Different Esophageal Cancer Surgery Types Have Similar Outcomes

“Our study noted that aspirin use is associated with a reduction in the rate of metastasis in patients with [esophageal cancer],” researchers noted in the study. “These [findings] support the use of aspirin in patients with [esophageal cancer] and suggest the need for further studies to understand the mechanism by which aspirin use reduces metastasis in patients with [esophageal cancer].”

More aspirin users were older than 65 than non-aspirin users (74.6% versus 57.4%), the study showed. Most were male (82.1% versus 77.8%), White (84% versus 78.4%) and had three or more comorbidities (94.9% versus 89.9%).

Aspirin users, researchers stated, also had higher incidence of diabetes (34.7% versus 22.4%, hypertension (79.4% versus 57.6%), chronic pulmonary disease (31% versus 25.8%), coronary artery disease (47.4% versus 18.1%), chronic kidney disease (15.3% versus 11%) and congestive heart failure (21.7% versus 13.4%), while non-aspirin users had higher rates of coagulopathy (1.3% versus 0.8%) and alcohol use disorder (7% versus 5.3%).

Similar Results Among Patients With Colorectal Cancer

Elsewhere, researchers in a smaller study published in 

 found that cancer spread to the lymph nodes “significantly” less frequently among patients who were aspirin users. The study included 238 patients who underwent surgery for colorectal cancer, including 12% of whom were aspirin users. Researchers noted that these same patients had higher infiltration of immune cells into their tumor cells.

“These data suggested that regular aspirin use may have an active role in enhancing immunosurveillance against [colorectal cancer],” researchers noted.

Long-Term Use of Baby Aspirin May Lower Risk of Colorectal Cancer Death

“Our study shows a complementary mechanism of cancer prevention or therapy with aspirin besides its classical drug mechanism involving inhibition of inflammation,” principal investigator Dr. Marco Scarpa of the University of Padova in Italy stated in a news release announcing the findings. “Aspirin is absorbed in the colon by passive diffusion to a significant degree. Its absorption is linear and depends on concentration along the bowel, and in the rectum, the concentration of orally administered aspirin can be much lower than in the rest of the colon. Thus, if we want to take advantage of its effects against colorectal cancer, we should think of how to guarantee that aspirin reaches the colorectal tract in adequate doses to be effective.”

Research has shown aspirin use to be associated with lower rates of metastasis for some patients.

Aspirin Linked to Lower Metastasis in Esophageal, Colorectal Cancers

Meaghan Mooney, B.S.N, RN, OCN won the 2024 Extraordinary Healer Award. 

From left: Kristie L. Kahl, Meredith Cooper, Meaghan Mooney, B.S.N, RN, OCN, Kristen Dahlgren

CURE Media Group recognized Meaghan Mooney, B.S.N., RN, OCN, as the winner of its 2024 Extraordinary Healer® award, which honors nurses in the cancer community who dedicate their lives to make a difference in the lives of patients and their loved ones.

Essays were submitted by colleagues, patients and family members identifying Mooney, two finalists and 73 other Extraordinary Healer® nominees, all detailing the noble acts of oncology nurses, from, “they leave no stone unturned when meeting and assessing patients,” to “it is not just about the cancer or the patient’s treatment; it is about the person and seeing their smiles through often sad times.”

The Extraordinary Healer® award event, sponsored by Johnson & Johnson, was hosted on April 24, during an in-person celebration held in conjunction with the 49th Annual Oncology Nursing Society Congress in Washington, D.C.

The night featured a keynote address from Kristen Dahlgren, an award-winning journalist turned breast cancer advocate. Throughout her career, she has traveled the world to document major news stories for outlets like NBC Nightly News and NBC’s Today Show. Earlier this year, she announced on the Today Show that she would be stepping down from her role at the network to start the Pink Eraser Project, which is teaming up with cancer vaccine researchers to get a safe and effect breast cancer vaccine on the market in the next five to 10 years.

Dahlgren also has a personal connection to cancer, as she was diagnosed with of stage 2 breast cancer in 2019. She recalled a family friend — who was also an oncology nurse — who took time off to come to the cancer center to spend time with Dahlgren while she underwent treatment.

“Really what I remember most is that through it all, she made me feel like a human, even a friend, at a time when nothing at all felt normal. That is a gift that I won’t forget,” she said.

Although she is currently a survivor, she emphasized the importance of the little efforts that meant so much to her throughout her cancer experience.

“Please know that all of those small, thoughtful things you do are noticed and appreciated,” she said. “In the throes of treatment, it is not always easy or top of mind for patients to say thank you, but from the bottom of our hearts, I’m going to do that for patients tonight and say thank you so much. In some of the most difficult moments of our lives, you bring hope and comfort. You give up yourselves to strangers. You sacrifice time with your families. And during the pandemic, you put yourselves at risk. All of that is appreciated. You care for every single patient who comes through the door. So we see you, we appreciate you, and while you’re about to meet all of these wonderful ladies who were nominated tonight, I think all of you are heroes.”

Mooney, chief of staff at Ascension Medical Group Texas in Austin, was nominated by Meredith R. Cooper, cofounder of the organization Wonders & Worries, which provides support services for children and teenagers of parents with cancer and other serious illnesses. Since serving as a chair in 2023 and cochair in 2024, she has helped to raise over $2.1 million to make sure that children receive the support they need during their parents’ illness.

In addition, she uses her years of experience as an oncology nurse to move from clinical roles to significant roles overseeing the wellbeing of patients of Ascension Medical Group.

“It is Meaghan’s unwavering dedication to supporting children and families during a parent’s illness, along with her willingness to take her direct patient care to practices within her professional position and her community service, that allows me to say Meaghan is truly an extraordinary healer deserving of this honor,” Cooper said during the ceremony.

The other finalists for the Extraordinary Healer award were Jessica McDade, B.S.N., RN, OCN, charge nurse at the Dana-Farber Cancer Institute in Boston, and Lauren Yakelis, B.S.N., RN, manager of the Bone Marrow Transplant Clinical Program at Benson Cancer Center at Ochsner Health in New Orleans. 

Encircling Patients With Care and Kindness

McDade was nominated by Susan Ayers, M.S.N., RN, OCN, of the Dana-Farber Cancer Institute, who detailed the many ways that she has been dedicated to her role as an oncology nurse since 2009. She provides care to patients with cancer, leads her department, supports new staff, serves as a resource to her team, and teaches nursing students in the clinical setting at a nearby nursing school.

In Ayers’ nominating essay, she detailed a patient on their hematology oncology unit who had a complex history of opioid use disorder while newly diagnosed with metastatic bladder cancer.

“The patient was frustrated, feeling the medical world had judged and failed her,” Ayers said. “Jessica, a master of the art of nursing, bonds with patients who it can be hard to make connections with. Jessica encircles them with care and kindness. Patients talk to Jessica, and share hardships and challenges that were unknown to others.”

McDade also continued that care to the patient’s family to help them participate in her care.

“She helped Kim’s family cope with her poor prognosis,” Ayers noted. “Jessica taught them how to care for Kim and treat her like a person and not just a patient. Jessica helps patients find their voice and supports the patient during challenging conversations with family members.”

Illuminating the Pivotal Influence of Oncology Nurses

Yakelis was nominated by Kristin Linde, MHA, B.S.N., RN, BMTCN, of Benson Cancer Center, who mentioned her innate ability to lead by example and go beyond the call of duty. Some of these examples include washing the clothes of some of her hospitalized patients, organizing a Christmas reunion for a mother undergoing a stem cell transplant, and personally transporting a patient’s mother to her apartment so she can retrieve the patient’s necessary medication while they were unexpectedly admitted to the hospital 26 days after transplant.

She also played a role in launching a CAR-T cell program, marking the first of its kind in Louisiana.

“Lauren’s efforts successfully onboarded three CAR-T medications into their program, significantly broadening the spectrum of treatment options for three distinct patient populations that previously faced limited prospects,” Linde said. “She stands as an exemplary role for nurses, simultaneously illuminating the pivotal influence that nurses can have within the realm of health care."

‘A Composition of Compassion, Expertise and Resilience’

Kristie L. Kahl, vice president of oncology content at MJH Life Sciences, the parent company of CURE Media Group, reflected on the nominations that were received for this year’s Extraordinary Healer® award and the appreciation that shone through them all.

“Each of you in this room encompasses a composition of compassion, expertise and resilience,” she said during the ceremony. “We are so proud to have the unique opportunity to recognize our oncology nurses. This was apparent to me how adored all of you are. … It is through these essays that a picture is painted of how you go above and beyond the call of duty, forging deep connections with patients, forging trust and understanding.”

Lynn Hall, Senior Director of Patient Experience in the Oncology Patient Engagement Customer Solutions Organization at Johnson & Johnson, noted how the role oncology nurses play in patient care is engrained in the company’s mission.

“We know it takes nurses to make health care work and support for our nurses improves healthcare for all,” Hall said during the event.

She also looked back at her own experience with cancer and how the nurses she encountered before she underwent surgery gave her the confidence she needed during a scary time.

“I have these incredible nurses around me who really lightened my fear and helped me feel confident that I would beat my cancer,” she added.

Also during the event, Robert M. Goldsmith, senior vice president of corporate development at MJH Life Sciences, recognized the commitment oncology nurses have in the caring of patients with cancer.

“To be committed to oncology nursing and ultimately to give care to patients with cancer and the cancer community worldwide is a mission that our company stands behind and something that we are very excited about,” he said. “We’re just so thrilled to be here with all of you to celebrate and give back to our wonderful oncology nurses. We can’t thank you enough for what you do each and every day of caring for cancer patients. So thank you. You are all truly heroes, and we appreciate all that you do.”

During this in-person event, over 500 attendees celebrated the remarkable efforts made by oncology nurses in the care of patients with cancer.  

Meaghan Mooney, B.S.N., RN, OCN, Wins CURE’s 2024 Extraordinary Healer® Award

Dr Linhares gives a comprehensive overview of tests a patient might expect to undergo at the time of diagnosis and why they are important.

Diagnostic Tests in CLL

Yuliya P.L Linhares, MD, and Josie Montegaard, MSN, AGPCNP-BC, give an overview of CLL, highlighting symptoms and patient presentation.

Understanding a CLL Diagnosis

Yuliya P.L Linhares, MD, and Josie Montegaard, MSN, AGPCNP-BC, introduce themselves and give an overview of chronic lymphocytic leukemia (CLL), highlighting symptoms and patient presentation.

With Carvykti now approved for pretreated myeloma, there are conversations that patients should have with their providers before treatment, a nurse said.

Nurse Suggests Questions to Ask Before Carvykti Treatment for Myeloma

The “most scary thing” for patients with pretreated multiple myeloma may be not knowing what their next treatment option is, or if their current therapy is going to work, according to Ishmael Applewhite, a registered nurse from the University of Rochester.

Before starting a new therapy such as Carvykti (ciltacabtageneautoleucel; cilta-cel), Applewhite said patients should feel confident asking their health care providers about what the treatment process will look like, and what the potential next lines of treatment may be.

Carvykti Provides Good Long-Term Quality of Life in Pretreated Myeloma

At the 49th Annual Oncology Nursing Society Annual Congress, Applewhite and colleagues presented the efficacy and side effects of Carvykti in the as-treated population in the 

 that led to the drug’s April 8 approval. He sat down with CURE® ahead of the event to discuss what patients need to know about this new CAR-T cell therapy.

A patient who has had multiple therapies for myeloma may be their biggest advocate at that point. They may know the game inside and out. However, they always need to ask questions.

If they are at a point where they're thinking, ‘this is the last thing that I can do,’ [they should know] that's not always true. They don't need to make a rash decision. There are so many implications and decisions that need to be made. They're always in the driver's seat. And this is another option for them to take them on their trip.

But what does it mean to get [Carvykti]? How long do you have to wait? What happens while I'm waiting for those cells? What happens in the engineering lab may take time. It doesn't work for every patient as well. So what are your options outside of that? Or if it does delay me? What happens next?

The most scary thing that happens for a patient is not knowing what their next treatment is, or if it isn't going to [work], what happens next? So just always being a champion for having a conversation with your provider or your nurse or anyone. [Ask] ‘What does this mean for my life? And how are we going to navigate it?’ is the most important thing a patient can ask. [They should] always feel comfortable receiving that information from us.

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