CON(C) Oncology cheat sheet

Scope of practice is defined by state/provincial nurse practice acts and institutional policy; chemotherapy administration authority varies by jurisdiction and certification.

Oncology Certified Nurse (OCN) and Advanced Oncology Certified Nurse Practitioner (AOCNP) credentials are administered by the Oncology Nursing Certification Corporation.

The nurse's independent responsibilities include assessment, patient education, symptom triage, advocacy, and documentation; prescribing and diagnosis remain provider functions.

Chemotherapy competent administration requires verification of the five rights plus regimen, dose calculation by body surface area, and a second independent double-check.

Nurses serve as the primary interceptors of medication errors; a near-miss reporting culture is required for safe chemotherapy delivery.

Delegation to unlicensed assistive personnel excludes nursing judgment tasks such as symptom assessment, triage, and chemotherapy teaching.

Role boundaries in clinical trials include informed consent obtained by the investigator, not by the nurse administering the investigational agent.

Interprofessional collaboration with pharmacy, social work, rehabilitation, and nutrition is a core competency in oncology nursing practice.

Tobacco cessation is the single largest modifiable cancer risk factor; risk falls with duration of abstinence and is dose- and duration-dependent.

HPV vaccination is recommended for adolescents (routine at 11-12 years) and catch-up through age 26; shared decision-making applies for ages 27-45.

Hepatitis B vaccination reduces hepatocellular carcinoma risk; universal birth-dose vaccination is recommended.

Screening intervals: colorectal cancer screening begins at age 45; breast screening typically begins at 40-50 depending on guideline; cervical screening begins at 21 or 25 depending on guideline.

Lung cancer screening with low-dose CT is recommended for high-risk adults aged 50-80 with 20 pack-year history who currently smoke or quit within 15 years.

Sun protection and avoidance of indoor tanning reduce melanoma and keratinocyte carcinoma risk; UV exposure is cumulative and intermittent burning raises melanoma risk.

Obesity, physical inactivity, alcohol consumption, and processed meat intake are modifiable risk factors with established associations to multiple cancers.

Genetic risk assessment (e.g., BRCA1/2, Lynch syndrome) enables enhanced surveillance and risk-reducing interventions for high-risk families.

Hallmarks of cancer include sustained proliferation, evasion of growth suppressors, resistance to apoptosis, replicative immortality, angiogenesis, invasion/metastasis, and immune evasion.

Oncogenes are gain-of-function drivers (e.g., RAS, MYC, HER2); tumor suppressors are loss-of-function drivers (e.g., TP53, RB1, BRCA1/2).

Carcinogenesis is a multistep process requiring accumulated genetic and epigenetic alterations over years to decades.

Metastasis proceeds via local invasion, intravasation, survival in circulation, extravasation, and colonization of distant organs.

Tumor grade describes differentiation; stage describes anatomic extent; both independently inform prognosis.

Tumor markers (e.g., CA-125, CEA, PSA, AFP) are used for monitoring and sometimes screening, but are not diagnostic alone.

Cell cycle checkpoints (G1/S, G2/M) are targets of chemotherapy; cell-cycle phase specificity determines schedule dependence.

Angiogenesis driven by VEGF and immune evasion via PD-L1/PD-1 are validated therapeutic targets in multiple malignancies.

TNM staging: T = primary tumor size/invasion, N = regional nodes, M = distant metastasis; clinical (cTNM) and pathologic (pTNM) stages may differ.

Stage groups I-IV map to localized, locally advanced, and metastatic disease; higher stage generally means worse prognosis but stage-specific outcomes vary by cancer type.

Tissue diagnosis (biopsy with histology and often molecular profiling) is required before initiating definitive therapy in most solid tumors.

Treatment intent must be documented: curative, adjuvant/neoadjuvant, palliative, or supportive; intent determines endpoints and toxicity tolerance.

Surgery is definitive for many localized solid tumors; neoadjuvant therapy aims to downstage and improve resectability.

Radiation therapy is delivered as external beam or brachytherapy; toxicity is related to dose, fractionation, and volume of normal tissue exposed.

Chemotherapy is cytotoxic and cell-cycle dependent; targeted therapy acts on specific molecular drivers; immunotherapy modulates immune checkpoints.

Response assessment uses RECIST or disease-specific criteria; measurable disease requires reproducible imaging at defined intervals.

Chemotherapy-induced nausea and vomiting prophylaxis: 5-HT3 antagonist + dexamethasone ± NK1 antagonist based on emetogenic risk of the regimen.

Febrile neutropenia is a medical emergency: fever ≥38.3°C once or ≥38.0°C sustained over 1 hour with ANC <500/µL requires immediate cultures and empiric broad-spectrum antibiotics.

Mucositis management emphasizes oral care, saline/bicarbonate rinses, and analgesia; no proven agent reliably prevents all mucositis.

Peripheral neuropathy: dose-limiting for taxanes, platinum, vinca alkaloids; report early because dose reduction may prevent permanent deficit.

Cancer-related fatigue is managed with activity, sleep hygiene, energy conservation, and treatment of contributing factors (anemia, pain, depression).

Pain management follows the WHO analgesic ladder with scheduled dosing, breakthrough dosing, and bowel prophylaxis for opioids.

Lymphedema risk after axillary surgery or radiation is managed with compression, exercise, and skin care; early referral improves outcomes.

Nutrition support includes screening (e.g., MUST, PG-SGA), calorie/protein optimization, and enteral access when oral intake is inadequate.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; prevention with hydration and allopurinol or rasburicase in high-risk disease.

Hypercalcemia of malignancy: symptoms include confusion, constipation, polyuria, and dehydration; treat with IV fluids and bisphosphonates or denosumab.

Superior vena cava syndrome: facial/upper extremity edema, distended neck veins, dyspnea; urgent imaging and consideration of radiation or stent.

Spinal cord compression: back pain, motor weakness, sensory level, bowel/bladder dysfunction; high-dose corticosteroids and urgent MRI before irreversible deficit.

Neutropenic sepsis: hypotension and organ dysfunction may occur without fever; early antibiotic administration within 1 hour of recognition improves survival.

Malignant pericardial effusion and cardiac tamponade: Beck's triad (hypotension, distended neck veins, muffled heart sounds); pericardiocentesis is definitive.

Immune-related adverse events from checkpoint inhibitors (colitis, pneumonitis, hepatitis, endocrinopathies) require prompt corticosteroid initiation and specialist input.

Extravasation: stop infusion, aspirate residual, apply cold or warm compress per vesicant antidote protocol, and document; antidotes include dexrazoxane for anthracyclines.

Distress screening is a required standard of care (NCCN) and should be performed at diagnosis and at intervals; a score ≥4 on a 0-10 scale triggers referral.

Depression and anxiety are underrecognized in oncology; validated tools include PHQ-9 and GAD-7, with clinical interview for confirmation.

Spiritual assessment tools (FICA, HOPE) explore faith, importance, community, and address to guide supportive intervention.

Cultural humility requires eliciting the patient's explanatory model, preferred decision-making role, and language needs with qualified interpreters.

Health literacy assessment guides teach-back and plain-language education; low literacy is common and not equivalent to low intelligence.

Caregiver burden is a distinct target of assessment and support; caregivers have elevated rates of depression and financial strain.

Grief and anticipatory grief are normal responses; pathological grief is distinguished by duration and functional impairment.

Sexuality, body image, and fertility concerns are core psychosocial domains and should be proactively addressed rather than waiting for patient initiation.

Palliative care is appropriate at any stage of illness alongside disease-directed therapy; it improves quality of life and symptom control.

Hospice eligibility in the US generally requires a prognosis of 6 months or less if the disease runs its expected course, with recertification.

Advance care planning includes identifying a surrogate decision-maker and documenting goals; POLST/MOLST differs from advance directives by being actionable across settings.

Pain and symptom management at end of life may require proportional sedation; the doctrine of double effect is invoked when intent is symptom relief, not hastening death.

Survivorship care plans summarize treatment, surveillance schedule, late effects, and health promotion recommendations for the primary care team.

Late effects include cardiotoxicity (anthracyclines, trastuzumab), secondary malignancy, infertility, and neurocognitive changes; surveillance is regimen-specific.

Bereavement support should be offered to family members; risk factors for complicated grief include sudden death, prior loss, and social isolation.

Withdrawal of life-sustaining treatment is ethically and legally distinct from euthanasia or assisted death; clinicians must understand jurisdictional law.

Core ethical principles: autonomy, beneficence, nonmaleficence, justice; conflicts are resolved through ethics consultation and shared decision-making.

Informed consent requires capacity, voluntariness, disclosure of risks/benefits/alternatives, and comprehension; the treating clinician obtains consent.

Confidentiality is governed by HIPAA in the US; minimum necessary disclosure and role-based access apply to the electronic health record.

Chemotherapy safety includes closed-system transfer devices, personal protective equipment, spill kits, and safe handling of body fluids for 48 hours post-administration.

Just culture distinguishes human error, at-risk behavior, and reckless behavior; only reckless behavior warrants punitive response.

Quality improvement frameworks: Plan-Do-Study-Act cycles, root cause analysis for sentinel events, and failure mode and effects analysis for prospective risk.

Oncology nursing standards include ONS chemotherapy and biotherapy administration safety standards and institutional policy compliance.

Nurse well-being and moral distress are recognized quality issues; second-victim phenomenon affects clinicians after adverse events.

Teach-back is the validated method for confirming comprehension; asking the patient to explain in their own words is preferred over asking 'do you understand?'

Shared decision-making integrates best evidence, clinician expertise, and patient values; decision aids improve knowledge and reduce decisional conflict.

Plain-language principles: short sentences, active voice, common words, and chunking of information into 3-5 key points per session.

Written materials should be at or below a 6th-8th grade reading level; readability tools (e.g., SMOG, Flesch-Kincaid) guide revision.

Self-management support includes goal setting, action planning, problem-solving, and symptom monitoring with clear escalation instructions.

Symptom action plans (e.g., for fever, diarrhea, mucositis) reduce unplanned acute care visits when paired with 24-hour contact access.

Motivational interviewing uses open questions, affirmation, reflection, and summarization to build behavior change self-efficacy.

Health numeracy affects risk comprehension; absolute risk and natural frequencies are preferred over relative risk in patient communication.