By representing perspectives from the entire cancer care team, collaboration with interprofessional colleagues is one way for oncology nurses to influence the delivery of high-quality patient care.

Implementing a standard guideline for nursing management of patients receiving new U.S. Food and Drug Administration–approved chemotherapy, immunotherapy, and biotherapy decreased 1:1 patient–nursing hours by nearly 65% and saved more than $100,000 per year at one health system in south Florida, a team of nursing leaders reported in a poster presentation at the 49th annual ONS Congress^® in April 2024.

More than 40% of patients receiving antibody-drug conjugates (ADCs) will experience ocular toxicities during treatment, ONS members Caroline Clark, MSN, APRN, OCN^®, AGCNS, EBP-C, and Ikuko Komo, MSN, CNS, NP, AOCNS^®, AOCNP^®, reported in an article in the April 2024 issue of the Clinical Journal of Oncology Nursing.

Innovation—a proactive effort to create or build on ideas—is something that oncology nurses and advanced practice providers (APPs) do every day. This month’s 49th Annual ONS Congress^® reminds us to “ignite the extraordinary” and recognize how we can use our strengths to blaze new trails for oncology and health care. Step by step, we all have opportunities to innovate in oncology nursing through evidence-based practice, quality improvement, the development of new products and technology, and research.

Infection with Clostridioides difficile (commonly referred to as C. diff; formerly Clostridium difficile) is an extreme example of a type of gut microbiome dysbiosis that can occur in patients with cancer. C. diff is a gram-positive, anaerobic, spore-forming, toxigenic bacterium, and infection is acquired via fecal-oral transmission and can cause symptoms ranging from uncomplicated diarrhea to pseudomembranous colitis and toxic megacolon. Because of many common risk factors (e.g., use of antibiotic therapy, advanced age, exposure to healthcare environments, immunosuppression), the hematology and oncology population is at high risk for C. diff colonization or infection.

Our gut microbiome—the diverse community of microorganisms, including bacteria, archaea, viruses, and eukaryotes such as fungi, that inhabit the gastrointestinal (GI) tract—can affect our entire body’s health. Most people’s microbiomes have a healthy balance of organisms that stay contained in the GI tract because of the lining’s tight epithelial cell junctions. But from the gut, bacteria are capable of generating a range of vitamins, synthesizing amino acids, and breaking down and metabolizing indigestible carbohydrates. And a growing body of evidence—including studies conducted by oncology nurse scientists—is uncovering how the gut microbiome can influence a patient’s response to cancer treatment and their overall outcomes.

Type 2 diabetes has been linked to an elevated risk for liver, endometrial, pancreatic, and other cancers. Furthermore, patients with diabetes and cancer have higher disease-related mortality and are at a greater risk of infections. Evidence also supports an inverse association between serum HDL cholesterol and cancer risk. To lower their blood sugar and cholesterol levels, some patients use dietary supplements such as berberine. 

Venous access devices are ubiquitous in nearly every direct care nursing setting. But as technology becomes more complex and new evidence emerges, nurses must evaluate it against their current practice: Should I use saline or heparin to flush this access device? Am I placing this peripheral venous catheter correctly? What does the latest evidence say? Do I need to implement a practice change? 

Many patients with cancer experience sleep disturbances, including insomnia, that can persist for years if not appropriately managed. The resulting increased risk for infections, anxiety, and depression can take a toll on patients’ quality of life.

Pharmacologic treatments for insomnia may contribute to adverse effects such as performance problems, memory disturbance, falls, and driving accidents, leading many patients to seek alternative or complementary therapies.

On September 14, 2023, the U.S. Food and Drug Administration (FDA) approved new labeling for temozolomide (Temodar^®) under Project Renewal, an Oncology Center of Excellence (OCE) initiative that updates labeling information for older oncology drugs to ensure it is clinically meaningful and scientifically current. This is the second drug—both anticancer agents—to receive a labeling update under the pilot program. The first was for capecitabine (Xeloda^®).

Less than 20% of National Cancer Institute Community Oncology Research Program practices routinely report collecting sexual orientation and gender identity data, limiting the available evidence to support recommendations for oncology nursing care of a vulnerable LGBTQ+ population that faces biases, stigma, cultural insensitivity, inequities, and disparities. In a 2022 Clinical Journal of Oncology Nursing article, ONS member Georgina T. Rodgers, BSN, RN, OCN®, NE-BC, and colleagues evaluated the latest studies to identify best practices and care considerations for LGBTQ+ patients with cancer.

A multimodal nursing education intervention using ONS resources, didactic teaching, and small group discussions grew one institution’s advance care planning (ACP) documentation rates from 0% to 63%, according to a report published in the February 2023 issue of the Clinical Journal of Oncology Nursing. Nurse participants also reported increases in ACP discussions and a clinically significant improvement in their overall comfort level with ACP conversations.

Disparity. Inequity. Futility. Barriers. Miscommunication. Unacceptance of the inevitable. Ethical and moral challenges perpetuate throughout practice for today’s healthcare workers, particularly oncology nurses in cancer care. As those burdens build up, nurses struggle to sustain their resilience and risk developing burnout or even leaving the profession entirely.

Whether it’s through conferences, podcasts, or journals and other articles, an oncology nurse’s quest for continuing their cancer care learning is ever extensive. Innovative educational methods like gamification can keep training fresh and encourage teamwork.

In your day-to-day conversations with patients, colleagues, or even friends and family at home, are you merely hearing what others tell you or are you actively listening to them? When we actively listen to what someone is saying, we intreat curiosity about their words and the emotions they are communicating with their tone and body language. Active listening engages a whole-person connection, whereas passive listening relies on the brain’s ability to catch the main points of a conversation.

Equalizing the quality of patient-provider communication for Black versus White patients is one way to reduce the systemic racial disparities prevalent in cancer care, researchers reported in study findings published in the November 2022 issue of the Oncology Nursing Forum. They identified critical opportunities for oncology nurses to improve interpersonal communication with Black patients. Nurses are key drivers to affecting change and cancer outcomes for all patients, they reported.

The White House Office of Science and Technology Policy updated policy guidance in August 2022 to allow the average American easier access to publications. The new guidance applies to taxpayer-funded research studies and makes the results publicly available for free.

As a term, sexuality is linked to sexual functioning—the ability to engage in sexual behaviors and the body’s physiologic response—as well as sexual reproduction and fertility. But those biologic aspects are just a small part of a person’s overall sexuality. Sexual health is a state of physical, emotional, mental, and social well-being and requires a positive and respectful approach to sexuality and sexual relationships.

Some people may be overjoyed at the prospect of completing their cancer treatment and returning to normal life, but for many others, fear and anxiety can overshadow feelings of elation. The survivorship phase of a cancer journey can be confusing and uncertain. Comments like, “I don’t know what is next” and “The responsibility for care is now up to me” can alert oncology nurses that patients need additional communication and strategies to transition into healthy survivorship.

Regular, light-intensity exercise and activity has been shown to reduce the risks of fractures, heart disease, and death. Substantial evidence also indicated benefits for cancer-related outcomes, including fatigue, depression, and quality of life. Additional observational data suggested that sustained physical activity may help reduce cancer recurrence and improve overall survival.

President Joe Biden released the National COVID-19 Preparedness Plan in March 2022, enabling the United States to move forward with goals to protect against and treat COVID-19, prepare for new variants, prevent economic and educational shutdowns, and expand vaccinations.

Does hearing a certain song suddenly energize you or make the day seem brighter? There’s a reason for that. Music can have a powerful effect on our well-being and is a tool nurses can use to help take care of their mental health.

Among their many benefits in practice, ONS Guidelines™ arm oncology nurses with the evidence to advocate for their patients’ care, according to findings from a fall 2021 focus group ONS conducted with nurses practicing at all levels of direct care.

Immune checkpoint inhibitors (ICIs) enhance immune response against foreign antigens, such as cancer, by manipulating checkpoints that have stopped the body from fighting them. In doing so, they also increase risk of the immune system attacking healthy cells and producing inflammatory side effects, resulting in immune-related adverse events (irAEs).

As cancer care delivery changes, oncology nurses step up to the challenge: they adapt and develop solutions to fuel the future of nursing education, certification, and practice. During the November 2021 ONS Hackathon™, launched in partnership with the Oncology Nursing Certification Corporation (ONCC), teams were tasked to identify methods that address issues in the delivery of cancer care and prepare the future nursing workforce to care for patients with cancer anywhere.

To reduce the disparities affecting maternity health outcomes, the U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH) launched the Maternal Morbidity and Mortality Data and Analysis Initiative, an $8 million contract with Premier, Inc., the agency announced in December 2021. The initiative is rallying a network of hospitals to deploy evidence-based best practices in maternity care.

The Oncology Nursing Society (ONS) launched its third ONS–ONCC Hackathon™ in November, designed to create innovative solutions for current and future nurses in the delivery of high-quality, evidence-based cancer care in all possible settings.

As a clinical nurse specialist (CNS) with a cardiovascular background, I have seen the evidence-based benefits of exercise in a variety of settings. However, several years ago, when I was working as a CNS on an acute inpatient oncology unit, I noticed that exercise was not regularly included in care plans. As I learned from staff, this was done out of concern that patients needed to rest to save their energy. 

We have an approximately 14- to 17-year gap between the inception of research discovery and the implementation of findings into clinical practice. As a profession, nurses have a shared responsibility to address the challenge of identifying and overcoming barriers to evidence-based practice (EBP) implementation to provide the best possible clinical care for patients. My primary area of focus as a researcher is on using EBP to improve patient, staff, and organizational outcomes through the Science and Practice Aligned Within Nursing (SPAWN) model, a framework for applying EBP to clinical nursing care.

Evidence-based practice is dual sided: nurse scientists conduct research, and clinical nurses implement those findings into practice. Working together, they improve care by developing cancer survivorship programs, reducing cancer risk, and assessing cancer care in vulnerable populations. The University of Washington School of Nursing’s (UW SoN’s) partnership with Confluence Health, one of the largest healthcare providers in north central Washington, built a novel program to identify gaps in research and implementation and elicit projects that influence healthcare outcomes.

Most nurses have not received formal training in quality improvement (QI) methodology, and many workplaces lack the resources to efficiently implement evidence-based practice (EBP), which results in delays in translating science into practice. But ONS members are overcoming those barriers and leading the way in effectively developing, implementing, and sustaining practice changes.

When ONS reached out and asked me to participate in the inaugural ONS Hackathon, I wasted no time in confirming my interest. I had heard of hackathons before but never a nursing-specific one. It was an exciting experience full of growth for me and the other oncology nurses who participated.

Efficiently running an ambulatory infusion clinic is a complex process that requires evolving strategies to equip staff to provide high-quality cancer care. During the June 2021 ONS Hackathon^TM, oncology nurse innovators created solutions to address ineffective nursing resources in infusion centers across the United States.

As Americans reduce tobacco use and treatment and diagnosis advance, lung cancer survivorship rates are improving; however, it still remains the second most common type of cancer. The growing population needs appropriate survivorship care.

My team’s current project to understand communication in ambulatory oncology settings stems from more than a decade of research (Kamimura et al.), in which we have tried to uncover the factors that facilitate high-quality cancer care for patients and a satisfying practice environment for care teams (Friese).

Dance/movement therapy is a complementary modality that may help patients manage cancer and its treatment-associated symptoms. Based on the concept that mind, body, and spirit are interconnected, it combines the communicative elements of dance and movement with other body-focused activities—such as guided imagery, mindfulness, breath awareness, and play—to create an emotionally inviting environment where participants can share feelings and experiences. 

I believe that every nurse is a leader, and we need leaders in all areas of our profession, from academia and research to clinical practice. Nurses must lead from the future and reinvent themselves to achieve their desired career path. Practice in the now, but lead from anticipation of what will happen based on healthcare trends.

Guidelines give oncology nurses an evidence-based, standardized approach to cancer care. But guidelines are most effective used when they’re used as a regular part of practice—a process referred to as implementation. 
With several oncology societies releasing new guidelines in 2020 and 2021, including ONS and the American Society of Clinical Oncology (ASCO), the implementation process requires nurse managers and leaders to facilitate staff education, maintain a high quality of care, and answer the all-important question: “Why are we doing this?”

Cancer-related fatigue is a serious, debilitating symptom that affects nearly 90% of patients following treatment, with the majority reporting the adverse event at moderate to severe levels. It can prolong hospital stays and limit patients’ ability to complete their treatments and resume daily activities, ultimately affecting quality of life and survival. Despite high prevalence rates, cancer-related fatigue was reported as “inadequately addressed” in findings from a large multisite study.

Oncology nurses hold a unique position in improving symptom management and health outcomes in people with cancer, and their contributions to the body of symptom science are critical. In support of that work, ONS embarked on a landmark partnership with the National Institute of Nursing Research and National Cancer Institute's Center for Cancer Research to present the inaugural Colloquium on Symptom Science Advances in Oncology Nursing on February 4–5, 2021.

When they launched in 2020, oncology nurses recognized the first five ONS Guidelines™ for cancer treatment-related symptoms and adverse events as the evidence-based standard for patient care. Now, the ECRI Guidelines Trust, a national evaluation organization, has given them that distinction as well, including all of ONS’s current guidelines in its repository.

Imagery is a mind-body practice with deep historical roots. It uses imagination to recreate mental images, sounds, smells and even tastes to help achieve relaxation and to promote healing. Guided imagery can be learned in an interactive manner from a licensed practitioner or from books and self-help tapes. Repeating the practice results in a conditioning effect that can empower the individual to use it whenever needed.

When a patient comes to the doctor’s office with a generalized symptom such as an ongoing cough or chest heaviness, they are bound to have anxiety. In Wayne’s case, a patient with a lung mass that was identified unexpectedly, his anxiety was further compounded by feeling alone: his wife has dementia and his grown children live out of state. He also lives in a rural area and must drive a significant distance to get to a center for testing and diagnosis.

Clostridium difficile infection is a dangerous and sometimes deadly adverse event in immunocompromised patients with cancer. Although transmission risk is high in the hospital setting, even with isolation precautions, oncology providers can use a variety of prevention techniques to reduce the chance for infection in their patients.

Leading organizations like ONS develop nationally recommended, evidence-based cancer care guidelines to inform practice, unify and standardize the way patient care is delivered, and ensure successful outcomes. By clarifying gray areas and codifying practice, guidelines enable providers to deliver efficacious, safe oncology care for patients and all care providers.