Hi ,

Welcome back to the Oncology Insights Newsletter which helps you learn oncology, and other nuggets, as you progress in your oncology career. 

Last time you learned about GLP-1 agonists making their way into oncology, lorlatinib toxicity pearls, and policies for pregnant staff

This week you'll learn about the importance of the rasburicase collection process, VTE risk, and why feeling dumb should be a goal

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

Rasburicase is so effective at transforming uric acid to allantoin, that if it’s not collected and stored appropriately, the results you get may be falsely low

Samples should be collected in tubes 🧪 containing heparin and be immediately stored in ice water to minimize the enzyme’s activity

When in the lab, it even needs a pre-cooled centrifuge and it needs to be run within 4 hours

Can you see how many steps in the process are open to errors?

This is why it’s important to treat the patient and not the numbers, sometimes the numbers can be wrong. If you suspect a falsely low uric acid, run it again and look at the process.

Pearl

Wouldn’t it be great if we could predict the future? 🔮

It would come in handy for a lot of things, including knowing what’s going to happen to our patients, such as those that will develop a venous thromboembolism (VTE)

As many as 20% of our patients with cancer will develop blood clots so it should be top of mind for supportive care management in your practice

Even though we can’t predict the future, we do have some tools to help us assess risk in a given patient, and one is the Khorana score

This score (named after the physician that developed it, Alok Khorana) is used to predict the future risk of VTE in the general cancer population

It’s not used in every cancer (such as brain tumors and multiple myeloma) because they weren’t included in the validation study but is helpful in the general oncology setting

This scoring system tells us that patients with low scores have a low risk of developing a VTE (<1.5%) in the first 6 months of therapy

As the score goes up, the risk goes up

Guidelines recommend prophylaxis in the high risk group and potentially in the intermediate risk group but it depends on other factors, such as bleeding risk

Many of our patients are at an increased risk of bleeding and clotting, which makes management very tricky and one reason why pharmacists are such an important part of the team. Learning about these nuances can help prevent toxicities from both treatment and disease.

Sundry

The saying “be the dumbest person in the room” sounded strange to me initially

No one likes to feel dumb

Surely it’s better to be in rooms where you know what’s going on, right?

It’s not actually (unless your goal is to maintain the status quo and not grow)

This popped into my head as I was doing some writing about regret. After leaving clinical practice, I took a role where I felt dumb on many accounts. The job was to help an org build their Cerner treatment plans, and I knew zero about Cerner (literally zero, never used it before).

And despite the first several months being very scary, it quickly became apparent that I was on the fast track of learning because I was surrounded by much smarter people who knew all the Cerner things

In my career since, stepping into roles that have a steep learning curve have propelled me much farther than likely would have happened otherwise

And I’m doing it again this fall. I just signed up for a MasterMind event in England with a bunch of really smart people running online education businesses. And I can’t wait to experience it!

How can you get into rooms that you don’t think you belong in? Because there is tremendous learning and growth to be had if you can get out of your own way.

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