The personalized oncology revolution hinges importantly on determining and monitoring tumor and patient genetics and molecular biomarkers that can guide targeted therapy. The oncology nurse is frequently responsible for collecting, preparing, and often, managing, the biospecimens needed for these analyses.
As molecular tests have proliferated, the “complexity, required knowledge, and expectations of the oncology nurse have changed dramatically over the past decade,” says Sharon Kaufman, MS, a research protocol specialist at the Mayo Clinic Cancer Center in Rochester, Minnesota.
“Many cancers are caused, at least in part, by several different genetic mutations along several different metabolic pathways,” Kaufman and coauthors noted in a recent review on oncology biospecimen collection and processing.1 These mutations and their gene products can be inhibited by targeted molecular therapies, at least temporarily.1 A goal of personalized oncology is to develop such targeted therapies and deploy them strategically against tumors with specific vulnerabilities. Toward that end, and to develop better risk-stratification tools, myriad prognostic biomarkers derived from blood and tumor tissue exist and are under development.1,2
Educating patients about the purpose of these tests, and collecting and preparing biospecimens with which to perform them, frequently fall within the responsibilities of the oncology nurse. “Oncology nurses used to monitor vital signs and administer chemotherapy,” Kaufman tells Oncology Nurse Advisor. “Now, they [also] need to be experts in collecting and processing blood and tissue; dissecting clinical trial protocols to determine the details of collecting and processing; helping guide patients through their treatment options, clinical trial options; and then monitoring vital signs and administering chemotherapy.”
Oncology nurses must familiarize themselves with biomarker analyses relevant to their patients, biospecimen collection techniques for biomarker analysis, and not least, institutional policies, standard operating procedures, and laboratory manual guidance.
Increasingly, effective treatment planning and monitoring require detailed insight into the tumor’s molecular biology and genomics. Circulating tumor cells can now be captured and isolated for genetic analysis and determination of a tumor’s suitability for targeted therapies, a process sometimes called liquid biopsy.
“A few decades ago, a drop of blood was used to determine blood type, biopsies were believed to enhance the likelihood of metastases, and nursing assessment for a person believed to have cancer was limited to palpation and examination of [radiographs],” noted Kaufman and coauthors.1 Those ideas have changed. Today, that drop of blood provides much more information; it essentially opens a window into a person’s genetic makeup and risk profile.
Biopsy specimens can be subtyped not just by histology, but tumor genetics and epigenetics for targeted therapy and stored for future research use as well. Nurses are expected to coordinate the correct collection of blood and tissue; mediate the overlapping needs of the clinical and research teams; then navigate patients through a maze information systems that will help them understand risk, diagnosis, and treatment data at an individualized level.1