Cancer Continuum
28%of exam
Treatment and Supportive Care
45%of exam
Oncologic Emergencies
12%of exam
Psychosocial Issues
10%of exam
Professional Practice and APRN Roles
5%of exam
Quick Facts
- Exam
- AOCNP
- Owner
- ONCC
- Population
- Adult oncology NPs
- Session
- 3-hour session
- Questions
- 165 MCQ
- Scoring
- 125 scored + 40 pretest
- Pass
- Scaled score 55
- Validity
- 4 years
- Drug names
- Generic only
Blueprint Weights
Continuum, Treatment, Emergencies, Psychosocial, Practice: 28-45-12-10-5
Continuum: 28%Treatment: 45%Emergencies: 12%Psychosocial: 10%Practice: 5%
Screening vs Diagnosis
Screening
- Asymptomatic population
- Early detection goal
- Abnormal needs evaluation
Diagnosis
- Suspected disease
- Confirms or excludes
- Directs staging
Detection vs confirmation
Assessment Picker
- Asymptomatic population→Screening(Early detection)
- Symptoms or abnormal screen→Diagnostic evaluation(Confirm disease)
- Estimate treatment benefit→Predictive biomarker
- Estimate disease outcome→Prognostic biomarker
- Measure daily function→Performance status
- Inherited pattern suspected→Germline assessment
- Tumor-specific alteration→Somatic testing
- After definitive treatment→Surveillance(Recurrence monitoring)
Risk and Screening
- Risk assessment
- Estimates cancer likelihood
- Screening
- Tests asymptomatic populations
- Early detection
- Finds disease sooner
- Hereditary risk
- May affect relatives
- Subsequent malignancy
- Distinct later cancer
- Surveillance
- Monitors after treatment
- Patient navigation
- Coordinates care barriers
TNM
Tumor, Nodes, Metastasis
T: primary tumorN: regional nodesM: distant metastasis
Predictive vs Prognostic
Predictive
- Treatment benefit likelihood
- Guides therapy selection
- Treatment-dependent
Prognostic
- Disease outcome likelihood
- Informs expected course
- Treatment-independent
Benefit vs outcome
Diagnosis and Planning
- Diagnostic testing
- Evaluates suspected disease
- Performance status
- Measures functional ability
- TNM
- Tumor, nodes, metastasis
- Clinical stage
- Pretreatment evidence
- Pathologic stage
- Tissue and surgical findings
- Individualized plan
- Integrates patient and tumor
- Reproductive planning
- Address before gonadotoxic therapy
Germline vs Somatic
Germline
- Inherited variant
- May affect relatives
- Present beyond tumor
Somatic
- Acquired tumor variant
- May guide treatment
- Not automatically inherited
Inherited vs acquired
Complementary vs Alternative
Complementary
- Alongside standard care
- Interaction review needed
- Supports selected goals
Alternative
- Replaces standard care
- May delay treatment
- Requires harm assessment
Alongside vs instead
Therapy Context Picker
- Whole-body drug effect→Systemic therapy
- Defined compartment delivery→Localized therapy
- Tumor removal described→Surgery
- Ionizing energy described→Radiation
- Molecular target described→Targeted therapy
- Immune activation described→Immunotherapy
- Hormone signaling blocked→Endocrine therapy
- Several modalities combined→Multimodal plan
Treatment Modalities
- Systemic therapy
- Acts throughout body
- Chemotherapy
- Targets rapidly dividing cells
- Endocrine therapy
- Blocks hormone signaling
- Targeted therapy
- Acts on molecular targets
- Immunotherapy
- Mobilizes antitumor immunity
- Cellular therapy
- Uses therapeutic living cells
- Localized therapy
- Targets defined compartment
- Surgery
- Removes local disease
- Radiation
- Uses ionizing energy
- Multimodal therapy
- Combines treatment modalities
Supportive Care
- Acute effect
- Occurs during treatment
- Late effect
- Appears after treatment
- Long-term effect
- Persists after treatment
- Myelosuppression
- Reduces marrow cell production
- Mucositis
- Inflamed mucosal lining
- Neuropathic pain
- Burning, shooting, tingling
- Breakthrough pain
- Transient pain flare
- Palliative care
- Quality-of-life focused care
- Comorbidity review
- Checks competing risks
- Controlled-substance safety
- Balances benefit and harm
Trials and Response
- Clinical trial
- Prospective research study
- Informed consent
- Voluntary informed choice
- Phase I
- Safety and dose
- Phase II
- Preliminary activity
- Phase III
- Comparative efficacy
- Phase IV
- Postapproval surveillance
- Response assessment
- Integrates multiple findings
- Complementary care
- Alongside standard care
- Alternative care
- Replaces standard care
Tumor Lysis Pattern
Potassium, phosphate, urate rise; calcium falls
K: risesPhosphate: risesUrate: risesCalcium: falls
Emergency Picker
- Fever with neutropenia→Urgent infection pathway
- Back pain plus weakness→Cord compression pathway
- Facial edema plus dyspnea→SVC pathway
- Potassium and urate rise→Tumor lysis pathway
- Confusion plus dehydration→Hypercalcemia pathway
- Bleeding plus thrombosis→DIC pathway
- Fever plus hypotension→CRS pathway
- Intent plus suicide plan→Immediate safety response
Emergency Patterns
- Febrile neutropenia
- Fever plus low neutrophils
- Cord compression
- Back pain plus neurologic change
- SVC syndrome
- Upper-body edema plus dyspnea
- Tumor lysis
- Abrupt metabolic derangement
- Hypercalcemia
- Confusion, weakness, dehydration
- Disseminated intravascular coagulation
- Bleeding plus thrombosis
- Cytokine release syndrome
- Fever, hypotension, hypoxia
- Raised intracranial pressure
- Headache plus neurologic change
Palliative vs End-of-Life Care
Palliative care
- Any disease stage
- May accompany treatment
- Relieves suffering
End-of-life care
- Dying phase focus
- Goals guide decisions
- Supports patient and family
Broad support vs dying phase
PDSA Cycle
Plan, Do, Study, Act
Plan: define changeDo: test smallStudy: examine resultsAct: adapt or adopt
QI vs Research
Quality improvement
- Improves local process
- Measures practice change
- Iterative testing
Research
- Produces generalizable knowledge
- Protocol-driven inquiry
- Human-subject protections
Local improvement vs generalizable knowledge
Professional Practice
- Scope of practice
- Defines authorized practice
- Licensure law
- Jurisdiction controls authority
- Documentation
- Records assessment and decisions
- Cultural humility
- Centers patient perspective
- Implicit bias
- Unconscious judgment pattern
- Evidence-based care
- Integrates evidence and context
- Quality improvement
- Improves local care processes
- Peer review
- Peers evaluate practice
- Competency validation
- Demonstrates observable performance
- Accreditation
- Verifies organizational standards
Common Traps
Pretest identification
Pretest items unlabeled ≠ Answer every question
Drug naming
Generic names tested ≠ Brand recall not required
Screening trigger
Screen asymptomatic people ≠ Diagnose suspected disease
Stage vs function
Stage describes cancer extent ≠ Performance describes function
Palliative timing
Palliative care any stage ≠ Not limited to final days
Knowledge vs authority
Exam tests knowledge ≠ Blueprint does not grant authority
Last Minute
- 1.Weights: 28, 45, 12, 10, 5
- 2.165 total; 125 scored; 40 pretest
- 3.Pass = scaled 55, not percent
- 4.Use generic drug names
- 5.Recognize emergencies before treatment details
- 6.Pair symptoms with urgent pathways
- 7.Predictive selects; prognostic forecasts
- 8.Screen asymptomatic; diagnose suspected disease
- 9.Palliative care can accompany treatment
- 10.Respect scope, law, and policy
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