Personalized Medicine and the Role of the Oncology Navigator

Personalized medicine is treatment that is tailored (personalized) to the individual characteristics of each patient. The sequencing of the human genome, completed in 2003, opened the door to understanding the genetic makeup of many diseases, including cancer. Because of the availability of molecular testing, many cancers are now treated with agents that target a specific genetic mutation or rearrangement pathway. Molecular testing has become standard of care for many cancers. Nurse navigators must understand which patients require molecular testing to ensure tissue collection and testing, timely results reporting, and education of patients as to the significance of testing results for treatment planning. The navigator may have to manage patient anxiety and expectations as they wait for testing results. Chemotherapy and targeted agents differ in mechanism of action, administration, and toxicity profiles. Targeted therapies include small molecules, monoclonal antibodies, and checkpoint inhibitors.  Nurse navigators can learn naming conventions of the drugs to quickly identify how the drug works and what are the expected side effects to be managed. Toxicity profiles are different among the types of targeted therapies as well. Small molecule drugs are usually given orally, therefore requiring attention to patient adherence and a more chronic approach to patient care. Drug/drug and drug/food interactions may also occur. Monoclonal antibodies are given by intravenously and infusion reactions are common. Patients must be prepared for what to expect in prevention and management of reactions. Checkpoint inhibitors modify the immune response and have a unique toxicity profile. At times the immune response may cause a tumor to seemingly grow larger. The nurse navigator coordinates the care of the patient during the diagnostic and treatment decision making phases of care to manage expectations and ensure efficiency and timeliness in completing tests and procedures. The education and emotional support provided is critical to patient care.

Key Points

· Personalized medicine utilizes therapies that target specific mutations and pathways.

· Molecular testing is standard of practice for multiple cancers to ensure evidence-based treatment decisions.

· Nurse navigators can ensure timely diagnosis and treatment planning as well as educating patients and managing expectations.

Read more of Oncology Nurse Advisor‘s coverage of the 2017 ONA Navigation Summit by visiting the conference page.