The following article features coverage from the ONA 2019 Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

PHILADELPHIA — Ensuring that the patient with a central nervous system (CNS) tumor is at least introduced to palliative care at the time of diagnosis is where the neuro-oncology nurse navigator can have a substantial impact, said Marlon Garzo Saria, PhD, RN, AOCNS, FAAS, of the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California, in his presentation at the 2019 Oncology Nurse Advisor (ONA) Navigation Summit.

The scarcity of specialists in neuro-oncology, as well as the complex and unique needs of patients with CNS tumors contributes to the challenge of caring for these patients, emphasized Dr Saria, an advanced practice nurse researcher in neuro-oncology.

Neuro-oncology is a “growing but small, highly specialized, multidisciplinary field,” he explained. Statistics show that there were only 236 board certified neuro-oncologists practicing in the United States in 2018. Furthermore, the Society of Neuro-Oncology groups nursing with allied health, epidemiology, psychology, pharmacology, and statistics under the category of Other, which comprises less than 3% of its membership.

“We really need to grow the neuro-oncology nursing subspecialty if we want to be able to navigate and take care of patients with CNS tumors,” Dr Saria emphasized.

CNS malignancies are a highly heterogeneous group of cancers characterized by an extensive spectrum of disease, age-specific incidences, and highly variable outcomes with vastly different best practice strategies for management, he explained.

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For example, treatment options for glioblastoma, the most prevalent and aggressive CNS cancer in adults, includes only 2 drugs recently approved by the US Food and Drug Administration (FDA) — temozolomide (in 2005) and bevacizumab (in 2009) — and tumor treating fields without and with temozolomide (in 2011 and 2015, respectively). Survival is only 14.6 to 16.8 months after diagnosis. Nevertheless, Dr Saria stressed that a highly-specialized multidisciplinary team including a neuropsychologist, neuropathologist, neuroimaging expert(s), neurosurgeon, radiation oncologist, medical oncologist, and geneticist/genetic counselor is critically important to optimize patient outcomes.  

“I honestly believe that if you suspect that a patient has a brain tumor/CNS cancer that they need to see neuropsychologist,” he commented. “We need to get a baseline before we treat them; before we change or alter their cognitive function or behavioral issues.”

Nurse navigators working with patients with CNS tumors should to communicate to patients that every tumor reacts differently and, regardless of the treatment given, the tumor evolves, and we alter the tumor microenvironment by the treatment given.