ONS ONCC CHEMO RENEWAL EXAM ACTUAL

ONS ONCC CHEMO RENEWAL EXAM (ACTUAL / )

QUESTIONS AND ANSWERS GRADED A+ LATE ST

Neoadjuvant therapy does not increase survival when compared to adjuvant therapy. It only changes the timing of treatment and can change surgical options if the tumor is shrunk enough. If this occurs, the patient may only require a lumpectomy plus radiation therapy instead of needing a mastectomy Main benefit of neoadjuvant chemotherapy (breast cancer patient)

A comprehensive geriatric assessment (CGA) is a multidisciplinary evaluation to assess life expectancy and risk of morbidity and mortality in the older patient. This assessment tool would evaluate

and include the following areas: functional status, socioeconomic

issues, psychosocial distress, comorbidities, cognitive function, nutritional status, polypharmacy, and a medication review (NCCN Older Adult Oncology Guidelines, version 1.2015).Due to Mrs. Turner's age and comorbidities, her oncologist performs a comprehensive geriatric assessment. You know that this assessment

covers all but which of the following:

65 The NCCN Older Adult Oncology Guidelines (version 1.2015) provides information on what is included in a comprehensive geriatric assessment. Currently, more than 60% of cancers in the United States occur in people age ______and older and as the oncology world ages, nearly half (46%) of cancer survivors are 70 years of age or older

• / 3

Effectiveness Unlikely:

Colony Stimulating Factors By Intravenous Rather Than Subcutaneous Route Frequent IV Tubing and Component Changes Restriction of Fresh Fruits and Vegetables

Not Recommended for Practice:

Extended Post-Operative Antibiotics Implantable Gentamycin Sponge Use of Live Attenuated Vaccines

Prevention on Infections: Practices No Long Recommended

Per the NCCN Guidelines

(http://www.nccn.org/professionals/physician_gls/pdf/myeloid_growt

h.pdf), because of Mrs. Turner's age ≥ 65 as well as a previous neutropenic episode, she would be a candidate to receive a GCSF. Her febrile neutropenic episode requiring hospitalization puts her at high risk for additional neutropenia.Which of the following do you feel will be done with the remaining cycles of chemotherapy to hopefully prevent Mrs. Turner from having additional problems with neutropenia?

full dose 2 / 3

Evidence shows that older patients with cancer can safely obtain the same treatment benefits as younger patients when they receive ________ standard chemotherapy regimens. Many physicians are reluctant to give full-dose chemotherapy to older adults perhaps due to of fear of adverse events like febrile neutropenia. Suboptimal dosing from increasing the length of time between cycles or from dose reduction is a serious issue because large, randomized clinical trials have demonstrated that the delivery of lower doses or shorter courses of chemotherapy can reduce overall survival in older patients with breast cancer or lymphoma

85% Amgen (2007) defines RDI as "is a quantification of how closely an administered course of chemotherapy treatment adheres to a specific regimen." Three separate clinical trials evaluating outcomes in patients with breast cancer related to RDI have demonstrated improved overall survival and 10-year disease free survival in patients who receive a RDI > or = ____?_____

Per the prescribing information for Perjeta

(http://www.gene.com/download/pdf/perjeta_prescribing.pdf) it states

to assess LVEF prior to initiation of PERJETA and at regular intervals (every six weeks in the neoadjuvant setting) during treatment to ensure that LVEF is within the institution's normal limits. Mrs.Turner's chemotherapy is given every 3 weeks so she should have her LVEF evaluated prior to cycle #3. If Mrs. Turner was receiving trastuzumab without pertuzumab, the recommendation per the prescribing information for Herceptin

(http://www.gene.com/download/pdf/herceptin_prescribing.pdf) is to

monitor baseline LVEF measurement immediately prior to initiation

• / 3