Oncology nurses have seen medical advances shift the prognosis of cancer from a death sentence to a chronic disease. If you have been on the front lines of cancer treatment long enough, you have seen the emphasis on surgery and radiation evolve into an emphasis on chemotherapy and, most recently, to novel therapies such as targeted treatment and immunotherapy. Some of the brightest minds in research are dedicating their time to the development and testing of medicinal compounds that could one day mean a cure for these now chronic diseases. Due to this paradigm shift, our roles as oncology nurses have changed as well.
When treatment was relegated to chemotherapy for all, understanding the needs and proclivities of each patient was not particularly important. We cared for them and tried to help them through their treatment experiences, but in reality every patient was treated similarly.1-3 We simply needed to know the adverse effects of the chemotherapy agents and how to educate patients in the management of those effects.
Today, understanding the specific characteristics that affect the way patients interact with their treatment is crucial.2,4 A patient on an oral regimen needs a totally different type of support than one on chemotherapy, just as a child may need different support than an adult.3 Oncology nurses have to think about how to ensure that patients understand their treatment, methods of obtaining their medications, managing the health system and its processes, and ultimately, how to persist with this complex and expensive treatment.2 We need to assess people’s social situations, ie, who is available to help them, so they stay motivated and positive over the long term.2 We also need to learn about our patients’ long term goals for their lives, not just the short term goals, because many cancer treatments, especially hematologic agents, are pills that patients will take for the rest of their lives.
As an advanced practice nurse and clinical educator at a cancer center, I have seen patients respond differently to the same treatment based solely on factors that we, their nurses, can influence. Although some efforts go a long way toward promoting treatment success, such as ensuring patients are taking their medication appropriately, assessing their current medication burden, and closely monitoring new patients during the first few weeks of treatment. Other practices require personalized attention to be effective.1,2,4 The most important part of our job as nurses is to identify individual patient factors that can influence adherence to treatment and adjust our care to meet the specific needs created by these unique characteristics.2
What does this look like in practice? In this article, I have outlined a few archetypal patient profiles, identified over the course of many years of working in oncology, and my suggestions for setting each patient up for treatment success.
A New Diagnosis
Nearly every week, I witness patients crumble under the weight of a new cancer diagnosis. Despite all of the safe and effective treatments on the market today, the word “cancer” remains a scary term, especially to those facing it for the first time. While adjusting emotionally to the reality of a new cancer diagnosis, patients are forced to make decisions about treatment options, some of which may continue for the rest of their lives.
One of my patient’s daughters pulled me aside one day, and asked how long her mother would be on the oral treatment the physician had just prescribed. Instead of simply stating that her mother would probably be on the medication for the rest of her life, which would absolutely overwhelm a new caretaker, I broke her mother’s treatment into steps. Often what our patients need is for us to simplify the information from their physicians, by dividing it into digestible pieces.4,5