Oncology nursing takes patients from treatment to survivorship

In January 2020, the American Cancer Society reported the death rate from cancer in the U.S. fell 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017 — the largest drop in a year ever recorded.

Cancer survival has taken on a new meaning, and it’s not only patients who are affected but the nurses, doctors and others who care for oncology patients, said Deena Damsky Dell, MSN, APRN, AOCN, LNC. Dell, an oncology nurse and professional development specialist at Sarasota Memorial Cancer Institute, Sarasota, Fla., is among the speakers for Nurse.com’s Oncology Nursing Review and Certification Prep course.

One of the biggest changes in the specialty is there are so many new treatment options, according to Dell. New treatments focused on molecular biology and genomics, for example, can be tailored to each patient and target a patient’s cancer with greater precision.

“Immunotherapy is important now and is curing some cancers thought to be incurable,” Dell said. “It’s providing a longer quality of life. Because of all these advances in treatment, we have so many more survivors.”

According to the American Cancer Society, more than 2.9 million cancer deaths have been “avoided” since 1991.

“We know we have to focus on survivors,” Dell said. “We have survivorship clinics, and we’re seeing a lot of focus on managing long-term side effects [from treatment],”

Managing long-term side effects

Managing treatment-related side effects includes not only short-term side effects, like nausea, but also long-term problems that could impact patients’ lives, like fertility.

“We now know that people get through cancer and go on to have babies,” Dell said. “We want to help them do that.”

Part of what makes oncology nursing an exciting subspecialty is there are so many options.

“The importance of nurse navigators is huge and it’s a wonderful job for a lot of people because you get to really follow patients from beginning to end,” Dell said. “Nurses, especially nurse practitioners, are running survivorship clinics.”

A special nurse-patient relationship

Patients are surviving longer, so nurses have more opportunities to form deep nurse-patient relationships. Nurses might see the same patients for screening tests, diagnostic tests, surgery, treatment and into survivorship.

Dell said this is both a strength and difficulty of oncology nursing.

“You have the opportunity to develop such deep relationships with patients that you don’t have in other areas,” she said. “On the other hand, sometimes it’s hard to remain emotionally stable when you’re dealing with human suffering and emergencies .”

Still, oncology nursing is not as disheartening as some nurses might think. The intrinsic rewards and successes have kept Dell, who once was a critical care nurse, in oncology since 1989.

“You help people make an awful time as tolerable as it can be,” she said. “And their appreciation is so great that you feel really good. You also get to share celebrations. You just get to know people very intimately. It’s kind of a reward in itself to be allowed to share these life events with them.”

Oncology nursing — a rewarding career

Dell said there’s always something new to learn in the quickly changing oncology specialty.

“There always are great career opportunities,” she said. “If you don’t like what you’re doing, there’s something else to do. There’s inpatient and outpatient.”

It’s important that nurses keep up with the changes.

“Before it was chemotherapy,” Dell said. “Now you have to know chemotherapy, but also biologic therapy, targeted therapy, immunotherapy. You need to know about genetics and genetic testing.”

Certification helps to validate an oncology nurse’s knowledge, according to Dell.

Achieving certification can improve nurses’ self-confidence in the care the provide oncology patients and demonstrates their commitment to the specialty, Dell said.

Dell, who also works as a legal nurse consultant, said the more knowledgeable the oncology care team, the less risk of malpractice lawsuits from breach of duty because they’re not meeting acceptable levels of care or negligence because they’ve deviated from acceptable levels of care.

Nurses that are knowledgeable and witness unacceptable levels of care can become change agents at their institutions, according to Dell.

In addition to having the knowledge, oncology nurses should be able to work independently, as well as have effective communication skills.

“You need to be able to explain pathology reports to your patients,” Dell said. “There are many nurse-driven protocols. You have to be a person who shows initiative and can function independently.

Dell also said a nurses has to be a good communicator “because you’re the person that the patient and family or caregivers see the most. You’re the person who is communicating with the interdisciplinary team coordinating care for the patient.”

Oncology nurses also need to be critical thinkers able to anticipate and prevent problems, she said.

Oncology education always a good thing

Nurses in all settings encounter oncology patients and cancer survivors and should be up to date on how cancer care has changed.

For example, Dell said, it’s a problem when emergency room nurses and doctors don’t realize when a cancer patient presents to the emergency room. That patient should be separated from other sick people and cared for quickly. Many of today’s providers also don’t recognize common side effects of immunotherapy drugs.

“Patients come in and they look like they’ve had pneumonia and they’re treated with antibiotics when it’s really pneumonitis and they needed steroids,” Dell said. “I don’t think ER nurses need to come to an oncology certification course, but they certainly need to understand general principles.”

Many of today’s immunotherapy patients carry information cards that help providers know in advance what might be going on, she said.

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