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Nicole Perera-Low



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    MA18 - Advances in Diagnosis of Common Types of NSCLC (ID 145)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Pathology
    • Presentations: 1
    • Now Available
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      MA18.07 - Identification of Neuroendocrine Transformation in Anaplastic Lymphoma Kinase Rearranged (ALK+) Tumors After Tyrosine Kinase Inhibitors (Now Available) (ID 1137)

      11:30 - 13:00  |  Author(s): Nicole Perera-Low

      • Abstract
      • Presentation
      • Slides

      Background

      Acquired resistance after ALK tyrosine kinase inhibitors treatment has multiple known mechanisms: new mutations or gene amplifications, bypass signaling and rarely neuroendocrine histological transformation. Here we describe results of a program utilizing routine biopsy post-progression in ALK+ patients for clinical and research purposes.

      Method

      Since 2014, ALK+ lung cancer patients treated at the Princess Margaret Cancer Centre have undergone routine biopsies at disease progression time points upon failure of an ALK-tyrosine kinase inhibitor (TKI) for both clinical purposes and research purposes, in particular to obtain tissue for primary derived xenograft (PDX) engraftment.

      Result

      All 9/9 patients consented for research sampling during clinical biopsy procedures (median 2 extra cores/passes); 2 patients were biopsied more than once; 3 PDX models from 2 patients have engrafted; 3 additional models are too early to assess engraftment. Engraftment occurred in patients with clinically aggressive tumors and poor survival outcomes. In this process, we identified 2 patients with neuroendocrine transformation post-second generation ALK TKI: (a) a 59 yo Asian female, never smoker, diagnosed six years prior with metastatic disease, heavily pretreated with crizotinib (12 months), pemetrexed (16 months), ceritinib (25 months), alectinib (6 months) and brigatinib (3 months); post-alectinib biopsy showed no transformation, while post-brigatinib liver biopsy demonstrated transformation to large cell neuroendocrine carcinoma; (b) a 75 yo Caucasian female, never smoker, diagnosed eight months prior and started on alectinib with a partial response, progressed in a single site; endobronchial biopsy demonstrated high grade neuroendocrine transformation. Both biopsies were positive for neuroendocrine markers (chromogranin and synaptophysin), TTF-1 and diffusely co-expressed ALK on immunohistochemistry. Assessment of PDX engraftment of these models is ongoing.

      Conclusion

      Routine combined clinical and research biopsy of ALK+ patients at time of TKI failure helped to identify these recent cases of neuroendocrine transformation as a possible mode of resistance and provide tissue for model development. This is the first time that ALK+ transformation to large cell neuroendocrine carcinoma is reported in the literature. (PP, AFF, SNMF, LN contributed equally).

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    P1.07 - Nursing and Allied Professionals (ID 171)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Nursing and Allied Professionals
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.07-20 - Evaluation of the Efficacy of Continuing Nursing Education Sessions for Oncology Nurses at Princess Margaret Cancer Centre (Now Available) (ID 1908)

      09:45 - 18:00  |  Author(s): Nicole Perera-Low

      • Abstract
      • Slides

      Background

      Background: The evolving health care systems and ongoing advances in cancer treatments require continual education. Continuing Education (CE) is one of the most common methods that healthcare professions use to keep their members aware of new information issues, and trends in healthcare. Advocates for continuing education state that CE serves to sustain the effectiveness of healthcare professionals by ensuring Clinical competence, thereby enhancing the quality of healthcare1,2 and reducing malpractice issues3.

      To advance the quality of healthcare, it is expected that participants of CE

      programs acquire and retain information so that it may be transferred into professional practice4.

      Adult learning theory (5,6,7) and research suggest that effective CE programs should progress from the traditional lecture-based approach and seek new avenues of effective presentation for the adult learner.

      Nursing education has been said to be effective when it leads to improvement in practice and patient care. The current landscape in oncology nursing is ever evolving which leads nurses to adapt rapidly to the changing practices and therapies to update and improve their knowledge and skills. In February 2018 the Nursing Unit Council at Princess Margaret Cancer Centre recognized a need and developed a plan to implement education sessions for clinical trial, ambulatory, chemo-daycare and student nurses.

      Method

      Method: 10 educational sessions lasting 1 hour on various oncologic topics presented by staff oncologists (radiation, medical & pathologists) were held from March 9th 2018 to Mar 29, 2019 for nurses. A questionnaire, which contained 11 sections was created specifically for this project to assess the effectiveness of these sessions. These were completed anonymously by 41 participants (19 trial nurses, 8 ambulatory nurses, 4 student nurses & 10 staff nurses).

      Result

      Results: Feedback from nurses was evaluated through a multiple choice survey questionnaire (Likert scales). The information provided contributed to the understanding of the effectiveness of continuing education. The 1 hour format was feasible and liked among the nurses as it generally occurred during the lunch hour.

      The RN respondents reported collecting 10 hours total continuing education hours, with 84% related to current work. 65% of respondents indicated they learned new skills/information that they will apply to nursing practice. 30 % indicated the CE sessions validated their current practice and 100% of respondents indicated the content of each session fit with their experience level.

      Conclusion

      Conclusion: Nurses perceived that learning new skills and information was a strong contributor to their professional development. Furthermore, participating in these sessions enhanced their learning needs. Collecting CE hours and session content were other contributing factors that impacted their decision to attend these sessions. Nursing Educational sessions were deemed valuable and well received by nurses in the various departments at Princess Margaret to improving clinical practice and guiding the future of oncology nursing.

      References

      1. Boissoneau R. 1977;71:35-50.

      2. Thurston HI. 1992;23:6-14.

      3. Little CD. J Contin Educ Health Prof. 1993;13:159-167.

      4. Oliver SK. J Contin Educ Nurs.

      1984;15:130-134.

      5. Knowles MS. Associated Press; 1975.

      6. Cross KP.. San Francisco, CA: Jossey-Bass; 1981.

      7. Jerin JM, Rea TD. Emerg Care. 2005;9:333-337.

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