Trends in Oncology Nursing: A Retrospective of the Past 10 Years

Throughout the emergence of new treatments, novel delivery systems, and challenging new roles and practices, one thing has remained constant: Nurses are still the most trusted healthcare provider in the country. For that the publishing staff of ONA celebrates out 10 years with you, and looks forward to more years together.

In honor of Florence Nightingale’s 200th birthday, the World Health Organization designated 2020 the Year of the Nurse and Midwife to recognize the critical impact nurses make on the communities in which they work.¹ Oncology nurses play a vital role in improving the patient experience, from improved clinical outcomes to better qualitative experiences.

As a nursing specialty, oncology nursing requires attention to detail and is fundamental for driving patient-centered care and integrating shared decision-making into the cancer care continuum. Furthermore, oncology nurses’ consistent implementation of standardized administration of cancer therapies can improve the safety, reliability, and overall patient experience, particularly as the treatment landscape of cancer evolves and changes rapidly.²

Evolving Roles, Enduring Value of Nurses

The oncology nurse has traditionally been involved in multiple aspects of patient care, including patient assessment, patient education, coordination of care, supportive care, symptom management, and often direct patient care during chemotherapy treatment.³ Oncology nurses also frequently operate as members of multidisciplinary care teams and may serve as patient advocates.⁴

Although many fundamentals of oncology nursing remain constant, technology has brought changes to the clinic. With the greater abundance of data and implementation of electronic health records and other technologies in recent years, skills and education in nursing informatics and telemedicine have grown in importance.^5-7 Telemedicine continues to widen the opportunities for patient care, especially in more remote areas, and ongoing challenges include improving patient examination techniques and addressing policy barriers.⁷

Nurses consistently have been rated at the top of an annual Gallup poll of the most trusted professions in terms of honesty and ethics.⁸ Knowledge and commitment to dialogue have been shown to contribute to patient trust in nurses, and patient trust in healthcare providers may have a modest association with health outcomes.^9,10 In a recent study from Italy, oncology nurses were found to demonstrate a high level of clinical competence, even in cases where oncology competence was less developed.¹¹ In a 2018 survey in England of patients with cancer, 88% of respondents felt that their clinical nurse specialists mostly or always provided answers to important questions in terminology patients could comprehend.¹² Additionally, nurses can play a critical role in shaping patient attitudes around the acceptance of dependence on care providers.¹³

Key Trends in Clinical Practice

Oncology nurses have worked in a changing therapeutic landscape. In the past, chemotherapy, surgery, and radiation therapy formed the mainstay of cancer treatments, but the emergence of newer types of therapies has fundamentally changed cancer care.¹⁴ Newer paradigms of treatment include targeted therapies and immunotherapy.^14,15

In the field of immunotherapy, the past decade has featured the approvals of checkpoint inhibitors for the treatment of a variety of cancer types, leading to improvements in survival and reduced rates of adverse events in comparison with conventional treatments.¹⁶ In 2011, the US Food and Drug Administration (FDA) approved the checkpoint inhibitor ipilimumab, a cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitor, for the treatment of advanced melanoma. This therapy has since expanded into the treatment of other cancers.^16,17

Soon to follow in FDA approvals were several treatments directed at programmed cell death-1 (PD-1) proteins or PD-1 ligands, PD-L1 or PD-L2, beginning with the PD-1 inhibitor nivolumab, first approved in 2014 for treatment of melanoma.^17,18 Nivolumab has since been approved for the treatment of kidney cancer, lung cancer, head and neck cancer, follicular lymphoma, and bladder cancer.¹⁸ These checkpoint inhibitor therapies have also been joined by pembrolizumab, atezolizumab, avelumab, durvalumab, and others, extending PD-1/PD-L1 inhibitor options for patients with a variety of cancer types and mutational loads.^17,18