Current trends in Oncology Nursing

Most practices now utilize electronic health records. Electronic communication is becoming ever more widely used to monitor patients and communicate with them.
"Reports show that many practices are bringing on advanced practice practitioners (APPs) and giving them greater responsibility, which streamlines workflow." [Representational Image]
"Reports show that many practices are bringing on advanced practice practitioners (APPs) and giving them greater responsibility, which streamlines workflow." [Representational Image] Flickr [Creative Commons]

Nursing has always been a pivotal for efficient delivery of healthcare and gas evolved into many specialised branches over the years. As a nursing specialty, oncology nursing requires attention to detail and is fundamental for driving patient-centred 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.

Evolving Roles, Enduring Value of Nurses

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

Most practices now utilize electronic health records. Electronic communication is becoming ever more widely used to monitor patients and communicate with them.

It may only be a matter of time until everything is digital. All healthcare workers, from oncology nurses to hospital pharmacists need to be tech-savvy moving into the future. Tele-health may become a new paradigm even for cancer care, during COVID and beyond.

Although COVID-19 has had some negative impact on clinical trials, reports showed that they were only increasing in 2019. In the decades beyond COVID-19, it's likely that clinical trials for antineoplastic drugs will once again be in full swing.

As we learn more about cancer and hazardous drugs that can treat it, safe medication administration will always be important. closed-system transfer devices (CSTDs) help to ensure safe handling of drugs for both oncology pharmacists and nurses, no matter the treatment modality.

Oncology nurses are experiencing increased diversity in their roles and responsibilities. And this shows no signs of letting up. More and more oncology nurses are using, doing, and leading research in their field. Nurse researchers are key members of their teams, working hard towards improved cancer treatments and patient outcomes.

Reports show that many practices are bringing on advanced practice practitioners (APPs) and giving them greater responsibility, which streamlines workflow.

Such nurses are also performing more invasive procedures that may not have been within their scope just decades ago. Nurses can advance their degrees by becoming nurse practitioners, specialized nurses, professional care navigators, or advanced practice nurses (APNs).

As the landscape of healthcare evolves, there will be even more opportunities for oncology nursing.

Innovation and the use of precision medicine is steadily increasing in the oncology field. Precision medicine is a way of devising an individualized treatment plan, by considering genetics, lifestyle, and environmental factors.

This is an area where nurse researchers are important within their interdisciplinary teams, seeking to improve cancer treatments through personalized medicine. Whatever treatment is used, it's important to optimize drug preparation.

With increased research and innovation, novel anti-cancer therapies such as checkpoint inhibitors are on the rise. These novel therapies are expected to make a large impact.

In the next few years, oncology nurses will have to stay up-to-date in their knowledge of varied cancer therapies and safe handling of drugs, whether monoclonal antibodies, chemotherapy, or other hazardous drugs.

There's also been an increase in the use of performance incentives for achieving quality goals. With the growth of participation in merit-based incentive payment systems (MIPS), it's important for oncology nurses to do their jobs as effectively and efficiently as possible. Nurses can help their organizations decrease costs by delivering medications safely and effectively. With high quality medical devices that will support oncology nurses in the safe handling of hazardous drugs.

Given the landscape of cancer care, the demand for oncology nurses shows no signs of stopping. A vast workforce of nurses is needed to meet oncology goals for the future. Nursing shortages, perceptions about oncology being demanding or hazardous, and burnout are all roadblocks to a healthy workforce.

Now and into the future, oncology nurses will not only care for patients in an oncology ward, but also in patients' homes. When nurses are doing home care, they can't control the environment they're walking into. But it's still important to practice universal precautions and safe treatment administration.

Beyond the Job

When it comes to nursing, one thing will never change. Nurses learn many technical skills during their careers and work in an extremely task-oriented world — but empathy and compassion will always be vital parts of nursing.

Oncology nurses care for all demographics of patients going through the most difficult times of their lives. Nurses help patients to heal, not only with the medical treatments they give, but with the compassionate care they bring to the table every day.

It's clear that managing cancer care during the COVID-19 pandemic and beyond will never be the same as it was just decades ago. But this is a good thing. New research and advances in medicine will likely save countless lives going forward.

Oncology nurses will only grow in their roles and continue to be indispensable members of their teams

The Specialized Oncology Nurse has a combination of expanded education focused on cancer care and experience, such as two years in a setting where the primary focus is cancer care delivery.

This nurse has enhanced specialty knowledge , skill, and practices in an environment where the majority of individuals has a diagnosis of cancer or is at risk of developing cancer.

The Specialized Oncology Nurse has a combination of expanded education focused on cancer care and experience, such as two years in a setting where the primary focus is cancer care delivery.

This nurse has enhanced specialty knowledge , skill, and practices in an environment where the majority of individuals has a diagnosis of cancer or is at risk of developing cancer.

Nurses are uniquely positioned to have an impact on the quality of patient care. In the field of oncology in particular, nurses not only provide patients with complex medical care, they also offer crucial psychosocial support and education at a difficult time in patients’ lives.

Studies have shown that increased nursing specialty certification is associated with improved patient outcomes and decreased adverse events in acute care settings.

Oncology nurses are registered nurses (RNs) who specialize in helping to treat patients with cancer, aid in administering radiation and chemotherapies, and provide follow-up monitoring.

As an oncology nurse in training, they might study psychology, nursing skills, social sciences, nutrition, and more.

The CONNECT intervention was developed to address the shortage of palliative care clinician specialists by training oncology infusion room nurses to provide primary palliative care in the infusion room setting.

Nurses participating in the CONNECT intervention receive training from an experienced palliative care provider as part of a 3-day course, as well as ongoing support from CONNECT nurse coordinators. Although an ongoing randomized study is evaluating the impact of the CONNECT intervention on patients and caregivers.

An analysis of participant responses revealed several themes including:

Increased personal fulfillment as well as greater emotional attachment to patients Enhanced ability to communicate with patients Feelings of increased stress, frustration, and guilt related to less time spent on task-oriented care that were minimized through support from coworkers and the CONNECT nurse supervisor.

Oncology nurses practice in a variety of settings including acute care hospitals, ambulatory care clinics, private oncologists' offices, radiation therapy facilities, home healthcare agencies, community agencies.

They practice in association with a number of oncologic disciplines, including surgical oncology, radiation oncology, gynecologic oncology, pediatric oncology and medical oncology.

Brachytherapy is a type of internal radiation therapy in which seeds, ribbons, or capsules that contain a radiation source are placed in the body of the patient , in or near the tumor. It is a local treatment and treats only a specific part of the patient's body. It is often used to treat cancers of the head and neck, breast, cervix, prostate, and eye.

Brachytherapy may cause fewer side effects than external beam radiation, and the overall treatment time is usually shorter with brachytherapy.

Most brachytherapy is put in place through a catheter, which is a small, stretchy tube. Sometimes, brachytherapy is put in place through a larger device called an applicator. The way the brachytherapy is put in place depends on type of cancer. doctor will place the catheter or applicator into patients body before beginning of treatment.

Techniques for placing brachytherapy include:

Interstitial brachytherapy, in which the radiation source is placed within the tumor. This technique is used for prostate cancer, for instance.

Intracavity brachytherapy, in which the radiation source is placed within a body cavity or a cavity created by surgery. For example, radiation can be placed in the vagina to treat cervical or endometrial cancer.

Episcleral brachytherapy, in which the radiation source is attached to the eye. This technique is used to treat melanoma of the eye.

Once the catheter or applicator is in place, the radiation source is placed inside it. The radiation source may be kept in place for a few minutes, for many days, or for the rest of life.

How long it remains in place depends on the type of radiation source, type of cancer, place of cancer , health of the patient , and other cancer treatments the patient had.

There are three types of brachytherapy:

Low-dose rate (LDR) implants: In this type of brachytherapy, the radiation source stays in place for 1 to 7 days. Patient is likely to be in the hospital during this time. Once treatment is finished, doctor will remove the radiation source and the catheter or applicator.

High-dose rate (HDR) implants In this type of brachytherapy, the radiation source is left in place for just 10 to 20 minutes at a time and then taken out. Patient may have treatment twice a day for 2 to 5 days or once a week for 2 to 5 weeks. The schedule depends on patients type of cancer. During the course of treatment, patients catheter or applicator may stay in place, or it may be put in place before each treatment.

The patient may be in the hospital during this time, or may make daily trips to the hospital to have the radiation source put in place. As with LDR implants, doctors will remove the catheter or applicator once treatment has finished.

Permanent implants

After the radiation source is put in place, the catheter is removed. The implants remain in patients' bodies for the rest of life, but the radiation gets weaker each day. As time goes on, almost all the radiation will go away. When the radiation is first put in place, patients may need to limit time around other people and take other safety measures. Be extra careful not to spend time with children or pregnant women.

Less exposure to radiationShorter treatment timeReduced side effectsImproved cosmetic outcomesDespite its potential benefits, brachytherapy is not standard of care for breast cancer after lumpectomy.

Doctors are not yet sure who gains the most from having brachytherapy instead of standard whole breast radiation therapy, or if certain populations are more likely to have negative side effects.

To learn more, researchers compared medical records of women treated with brachytherapy after lumpectomy, standard whole breast radiation therapy after lumpectomy, and lumpectomy alone.

The analysis showed:

Brachytherapy lowers the risk of future mastectomy compared with lumpectomy alone, but not as strongly as does traditional whole breast radiation therapy Brachytherapy led to a higher risk of negative breast side effects and post-surgery issues overall A study was conducted in 2017 by Ingham B, Orton A, Boothe D, Stoddard G et al to evaluate the survival benefit of adding vaginal brachytherapy (BT) to pelvic external beam radiation therapy (EBRT) in women with stage III endometrial cancer.

It was concluded that in this population of women with stage III endometrial cancer the addition of BT to EBRT was associated with an improvement in survival for women with end cervical or cervical stromal invasion.

The author is Principal Syed Mantaqui Memorial College of Nursing and Medical Technology, Islamic University of Science and Technology

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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