Evidence-Based Nursing of Patients with Hematologic Malignancies

  • Patrick CrombezEmail author
Part of the Principles of Specialty Nursing book series (PSN)


Actual insides in the pathogenesis of hematologic malignancies have contributed to significant advances in the diagnosis and evolving treatment options for these diseases. This evolution warrants expanded and specialized knowledge and skills development for nurses to provide expert care to these patients. Understanding these new approaches needs, beyond basic training in hematology, a continuing education program for nurses as well as the development of critical thinking when reading scientific literature to provide evidence-based nursing interventions.

Expert and highly complex practice includes comprehensive assessment with validated tools, early recognition of a complication, prompt action, and care management (preventive and curative) in collaboration with the patient and other healthcare providers. Supportive care to improve the quality of life of our patients extends beyond symptom management and includes social, psychological, and spiritual care.

Nurses in hematology should also take the leadership in the development of new models of care such as nurse-led consultation, outpatient care, patient self-management, and survivorship care provision for the increasing number of hematology cancer survivors.

New and more general challenges to be faced by the hematology nurse are the occurrence of antimicrobial resistance, adherence to oral treatment, and effective and equal care to all patients in a context of multiculturality.

This chapter will highlight these recent advances and, there were possible, describe the evidence-based nursing interventions to assure high-quality physical and psychosocial care for hematologic patients.


evidence-based nursing interventions specialized knowledge and skills comprehensive assessment validated tools early recognition leadership new models of care patient self-management innovative models of hematology survivorship care plans 


  1. 1.
    Röllig C, Bornhäuser M, Thiede C, Taube F, Kramer M, Mohr B, Aulitzky W, Bodenstein H, Tischler HJ, Stuhlmann R, Schuler U, Stölzel F, von Bonin M, Wandt H, Schäfer-Eckart K, Schaich M, Ehninger G. Long-term prognosis of acute myeloid leukemia according to the new genetic risk classification of the European Leukemia Net recommendations: evaluation of the proposed reporting system. J Clin Oncol. 2011;29(20):2758–65. Scholar
  2. 2.
    Turner JA, Schneider SM. Blinatumomab: a new treatment for adults with, relapsed acute lymphocytic leukemia. Clin J Oncol Nurs. 2016;20(2):165–8. Scholar
  3. 3.
    Blumel S, Goodrich A, Martin C, Dang NH. Bendamustine: a novel cytotoxic agent for hematologic malignancies. Clin J Oncol Nurs. 2008;12(5):799–806. Scholar
  4. 4.
    Vose J, Armitage J, Weisenburger D, International T-Cell Lymphoma Project. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol. 2008;26(25):4124–30. Scholar
  5. 5.
    Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, Klasa R, Savage KJ, Shenkier T, Sutherland J, Gascoyne RD, Connors JM. The revised international prognostic index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 2007;109(5):1857–61. Scholar
  6. 6.
    Teo EC-Y, Chew Y, Phipps C. A review of monoclonal antibody therapies in lymphoma. Crit Rev Oncol Hematol. 2016;97:72–84. Scholar
  7. 7.
    Cheah CY, Fowler NH, Wang ML. Breakthrough therapies in B-cell non-Hodgkin lymphoma. Ann Oncol. 2016;27(5):778–87. Scholar
  8. 8.
    O’Leary H, Savage KJ. The spectrum of peripheral T-cell lymphomas. Curr Opin Hematol. 2009;16(4):292–8. Scholar
  9. 9.
    Gutiérrez-García G, García-Herrera A, Cardesa T, Martínez A, Villamor N, Ghita G, Martínez-Trillos A, Colomo L, Setoain X, Rodríguez S, Giné E, Campo E, López-Guillermo A. Comparison of four prognostic scores in peripheral T-cell lymphoma. Ann Oncol. 2011;22(2):397–404. Scholar
  10. 10.
    National Comprehensive Network. NCCN clinical practice guidelines in oncology: non-hodgkin lymphoma. 2018. Retrieved from Accessed 7 June 2018.
  11. 11.
    Foss FM, Zinzani PL, Vose JM, Gascoyne RD, Rosen ST, Tobinai K. Peripheral T- cell lymphoma. Blood. 2011;117(25):6756–67. Scholar
  12. 12.
    Zinzani PL, Musuraca G, Tani M, et al. Phase II trial of proteasome inhibitor bortezomib in patients with relapsed or refractory cutaneous T-cell lymphoma. J Clin Oncol. 2007;25(27):4293–7.CrossRefGoogle Scholar
  13. 13.
    Evens AM, Gordon LI, Patton D, et al. Phase I results of combination gemcitabine and bortezomib (Velcade) for relapsed/refractory nodal T-cell non-Hodgkin lymphoma (T- NHL) and aggressive B-cell NHL (B-NHL). Blood. 2008;112(11). Abstract 2005.Google Scholar
  14. 14.
    Rajkumar SV. Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol. 2010;86:57–65. Scholar
  15. 15.
    Faiman B, Richards T. Innovative agents in multiple myeloma. J Adv Pract Oncol. 2014;5(3):193–202.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Cavo M, Rajkumar SV, Palumbo A, Moreau P, Orlowski R, Bladé J, Sezer O, Ludwig H, Dimopoulos MA, Attal M, Sonneveld P, Boccadoro M, Anderson KC, Richardson PG, Bensinger W, Johnsen H, Kroeger N, Gahrton G, Bergsagel PL, Vesole DH, Einsele H, Jagannath S, Niesvizky R, Durie BG, Lonial S. International Myeloma Working Group (IMWG) consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem-cell transplantation. Blood. 2011; Scholar
  17. 17.
    Lokhorst H, Einsele H, Vesole D, Bruno B, San Miguel J, Pérez-Simon JA, Kröger N, Moreau P, Gahrton G, Gasparetto C, Giralt S, Bensinge W. International myeloma working group consensus statement regarding the current status of allogeneic stem- cell transplantation for multiple myeloma. J Clin Oncol. 2010;2829:4521–30.CrossRefGoogle Scholar
  18. 18.
    Lenz H-J. Management and preparedness for infusion and hypersensitivity reactions. Oncologist. 2007;12:601–9. Scholar
  19. 19.
    Lieberman P, Kemp SF, Oppenheimer J, Lang DM, Bernstein IL, Nicklas RA, et al. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005;115(3, Suppl. 2):S483–523. Scholar
  20. 20.
    Breslin S. Cytokine-release syndrome: overview and nursing implications. Clin J Oncol Nurs. 2007;11(1, Suppl):37–42.; 10.1188/10.CJON.E10-E21.CrossRefPubMedGoogle Scholar
  21. 21.
    Vogel WH. Infusion reactions. Clin J Oncol Nurs. 2010;14(2):E10–21.CrossRefGoogle Scholar
  22. 22.
    Hughes RA. Peripheral neuropathy. BMJ. 2002;324:466–9.CrossRefGoogle Scholar
  23. 23.
    Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C. Putting evidence into practice®: evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs. 2007;11(6):901–13. Scholar
  24. 24.
    Cavaletti G, Frigeni B, Lanzani F, Piatti M, Rota S, Briani C, et al. The Total neuropathy score as an assessment tool for grading the course of chemotherapy-induced peripheral neurotoxicity: comparison with the National Cancer Institute- common toxicity scale. J Peripher Nerv Syst. 2007;12:210–5.CrossRefGoogle Scholar
  25. 25.
    Tariman JD, Love G, McCullagh E, Sandifer S. IMF Nurse Leadership Board. Peripheral neuropathy associated with novel therapies in patients with multiple myeloma: consensus statement of the IMF Nurse Leadership Board. Clin J Oncol Nurs. 2008;12(3 Suppl):29–36. Scholar
  26. 26.
    Calhoun EA, Welshman EE, Chang CH, Lurain JR, Fishman DA, Hunt TL, Cella D. Psychometric evaluation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group—Neurotoxicity (Fact/GOG-Ntx) questionnaire for patients receiving systemic chemotherapy. Int J Gynecol Cancer. 2003;13:741–8. Scholar
  27. 27.
    Cella DF FACIT: Functional Assessment of Cancer Therapy. 1997. Retrieved September 24, 2007, from
  28. 28.
    Cella DF, Tulsky DS, Gray G, Serafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.CrossRefGoogle Scholar
  29. 29.
    Ocean AJ, Vahdat LT. Chemotherapy-induced peripheral neuropathy: pathogenesis and emerging therapies. Support Care Cancer. 2004;12:619–25.PubMedGoogle Scholar
  30. 30.
    Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg MB, Paice J, Schneider B, Smith ML, Smith T, Terstriep S, Wagner-Johnston N, Bak K, Loprinzi CL. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline summary. J Oncol Pract. 2014;106:e421–4.CrossRefGoogle Scholar
  31. 31.
    Smith EM, Pang H, Cirrincione C, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013;309:1359–67. Scholar
  32. 32.
    Pachman DR, Barton DL, Watson JC, et al. Chemotherapy-induced peripheral neuropathy: prevention and treatment. Clin Pharmacol Ther. 2011;90:377–87.CrossRefGoogle Scholar
  33. 33.
    National Cancer Institute. NCI dictionary of cancer terms: Myelosuppression. 2017. Retrieved from Accessed 17 May 2018.
  34. 34.
    National Cancer Institute. Common terminology criteria for adverse events [v.4.03]. 2010. Retrieved from Accessed 20 May 2018.
  35. 35.
    Crighton GL, Estcourt LJ, Wood EM, Trivella M, Doree C, Stanworth S. A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database Syst Rev. 2015;9:CD010981.PubMedCentralGoogle Scholar
  36. 36.
    Villafuerte-Gutierrez P, Villalon L, Losa JE, Henriquez-Camacho C. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol. 2014; Scholar
  37. 37.
    Laffan A, Biedrzycki B. Immune reconstitution: the foundation for safe living after an allogeneic hematopoietic stem cell transplantation. Clin J Oncol Nurs. 2006;10:787–94. Scholar
  38. 38.
    Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, et al. Recommendations of the Center for International Blood and Marrow Transplant Research (CIBMTR®), the National Marrow Donor Program (NMDP), the European Blood and Marrow Transplant Group (EBMT), the American Society of Blood and Marrow Transplantation (ASBMT), the Canadian Blood and Marrow Transplant Group (CBMTG), the Infectious Disease Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the Association of Medical Microbiology and Infectious Diseases Canada (AMMI), and the Centers for Disease Control and Prevention (CDC), guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective. Biology of blood and marrow transplantation. J Am Soc Blood Marrow Transplant. 2009;15(10):1143–238. Scholar
  39. 39.
    Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. The multinational association for supportive care in cancer risk index: a multinational scoring system for identifying low risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18:3038–51.CrossRefGoogle Scholar
  40. 40.
    Wilson BJ, Zitella LJ, Erb CH, Foster J, Peterson M, Wood SK. Prevention of infection: a systematic review of evidence-based practice interventions for management in patients with cancer. Clin J Oncol Nurs. 2018;22(2):157–68. Scholar
  41. 41.
    Oncology Nursing Society. Prevention of infection: Transplant. 2017. Retrieved from Accessed 17 May 2018.
  42. 42.
    Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, et al. Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer. 2012;20:367–73. Scholar
  43. 43.
    Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB. Mucositis Study Section of the Multinational Association for Supportive Care in Cancer; International Society for Oral Oncology. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100(9 Suppl):1995–2025.CrossRefGoogle Scholar
  44. 44.
    Eilers J, Harris D, Henry K, Johnson LA. Evidence-based interventions for cancer treatment-related mucositis: putting evidence into practice. Clin J Oncol Nurs. 2014;18(6):80–96. Scholar
  45. 45.
    Shepherd JD, Pringle LE, Barnett MJ, Klingemann HG, Reece DE, Phillips GL. Mesna versus hyperhydration for the prevention of cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplantation. J Clin Oncol. 1991;9:2016–20.CrossRefGoogle Scholar
  46. 46.
    Turkeri LN, Lum LG, Uberti JP, Abella E, Momin F, Karanes C, et al. Prevention of hemorrhagic cystitis following allogeneic bone marrow transplant preparative regimens with cyclophosphamide and busulfan: role of continuous bladder irrigation. J Urol. 1995;153:637–40.CrossRefGoogle Scholar
  47. 47.
    Leung AY, Mak R, Lie AK, Yuen KY, Cheng VC, Liang R, et al. Clinicopathological features and risk factors of clinically overt hemorrhagic cystitis complicating bone marrow transplant. Bone Marrow Transplant. 2002;29(6):509–13.CrossRefGoogle Scholar
  48. 48.
    Miller AN, Glode A, Hogan KR, Schaub C, Kramer C, Stuart RK, Costa LJ. Efficacy and safety of ciprofloxacin for prophylaxis of polyomavirus BK virus-associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant. 2011;17:1176–81. Scholar
  49. 49.
    Droller MJ, Saral R, Santos G. Prevention of cyclophosphamide-induced hemorrhagic cystitis. Urology. 1982;20:256–8.CrossRefGoogle Scholar
  50. 50.
    Mohty M, Malard F, Abecassis M, Aerts E, Alaskar AS, Aljurf M, et al. Revised diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a new classification from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2016;51(7):906–12. Scholar
  51. 51.
    Sung AD, Chao NJ. Concise review: acute graft-versus-host disease: immunobiology, prevention, and treatment. Stem Cells Trans Med. 2013;2(1):25–32.CrossRefGoogle Scholar
  52. 52.
    Carpenter P. How I conduct a comprehensive chronic graft-versus-host disease assessment. Blood. 2011;118(10):2679–87.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Hematology and Hematopoietic Stem Cell TransplantationJules Bordet InstituteBrusselsBelgium

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