As innovators and leaders, oncology nurses and advanced practice providers are increasingly collaborating with engineers to create or expand the use of technology to improve cancer outcomes.

A template-based standardized ambulatory oncology nurse orientation process substantially reduced turnover rates at a large academic comprehensive cancer center, ONS member Christina M. Matousek, MSN, RN, OCN^®, reported in an article in the June 2024 issue of the Clinical Journal of Oncology Nursing. Additionally, the standardized training ensured new nurses built consistent, disease-specific experience across 17 different interprofessional disease teams.

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.

Complex cancer treatments like bispecific antibodies and chimeric antigen receptor T-cell therapy are associated with equally complex side effects and complications. When patients experience signs and symptoms back home away from their dedicated cancer care team, how should they seek intervention? Should they go to the emergency room? The local urgent care facility? Call 9-1-1? And, if they do any of those things, will the healthcare providers in those settings know how to care for them?

Using a formal framework for a team debriefing after an emotionally challenging critical event can create a positive learning experience, initiate process improvements, and ultimately offer nurses and other healthcare professionals psychological support that reduces burnout and compassion fatigue, ONS members Molly Joyce, MSN, APRN, OCN^®, and Joanne Itano, RN, PhD, reported in an article published in the February 2024 issue of the Clinical Journal of Oncology Nursing.

My husband is a geriatrician.

My oldest daughter first became a music therapist and then completed an accelerated program in nursing. She is passionate about caring for older adults, just like her father. She completed her master’s degree in nursing and is now working as a palliative care nurse practitioner in a very busy urban university trauma center.

The winter holidays are marked with traditions. Although we may most often think about them in terms of family or community, celebrating traditions with our colleagues helps build feelings of community and may contribute to a positive work culture, both essential to our well-being as oncology nurse.

Nearly 65% of oncology advanced practice providers (APPs) say they want to have a larger role in clinical research. Although research has often been a part of the APP role in academic institutions, providers now have the potential to engage in its expansion into community practice settings. Here are some of the key contributions APPs can bring to community-based clinical research. 

Central line-associated bloodstream infections (CLABSIs) can cause serious harm or even death to patients and significantly increase healthcare costs. Nurses are critical contributors to infection prevention in any healthcare setting, particularly for oncology’s often-immunocompromised patient population, ONS member MiKaela Olsen, DNP, APRN-CNS, AOCNS^®, FAAN, clinical program director for oncology at the Johns Hopkins Hospital and Johns Hopkins Health System in Baltimore, MD, said. 

For patients and their care teams, transitions are an integral part of the cancer journey. Patients may be moving from inpatient to outpatient care, an acute care setting to a community-based setting, hospital care to nursing home care, or even active treatment to ongoing survivorship. Care transitions can be times of intense information overload for patients, caregivers, and the healthcare team. 

As an oncology advanced practice provider, I saw a need to enhance the scheduling process for transplant and cellular therapy nurse coordinator visits at my institution. In response, I developed and implemented the following quality improvement project and successfully reduced scheduling error rates by 95%.

Remote educational outreach involving oncology nurse–developed videos and follow-up navigator phone calls increased breast, cervical, and colorectal cancer screening adherence compared to usual care in females obtaining community care in rural Ohio and Indiana locations, according to study findings published in JAMA Network Open.

A multipronged approach that incorporates all disciplines on the interprofessional cancer care team resulted in a 34% improvement in antibiotic initiation within 30 minutes of a neutropenia diagnosis on a 24-bed blood and marrow unit, according to study findings presented at the 48th Annual ONS Congress® in April 2023.

Collaborative, interprofessional care for hematopoietic stem cell transplantation recipients improves time to electrolyte repletion; reduces cardiac adverse events, oral mucositis severity, and bloodstream infections; and improves use of patient-controlled anesthesia, researchers reported in study findings presented at the 48th Annual ONS Congress® in April 2023.

Clinicians have an implicit—if not explicit—obligation to advocate for their patients. However, as health care’s complexity increases, independent advocates can help patients navigate systematic challenges throughout the continuum. Independent advocates follow the patient, not the reimbursement constraints, a chief distinction between us and clinical, facility, or agency case managers.

Ambulatory oncology began to gradually evolve in the mid-2000s to include multiple aspects of the care continuum. Then suddenly, a pandemic skyrocketed that growth as institutions Raced to develop their ambulatory infrastructure to meet new and changing needs.

Since the first checkpoint inhibitor was approved in 2011, we have made tremendous leaps in immunotherapy in a short span of 10 years. Now we see immunotherapy combined with a variety of options, including chemotherapy or other oral and IV targeted therapy.

Jeff is a 60-year-old patient with myeloproliferative disease. After his care team secured a 9/10 match, he received an allogeneic hematopoietic stem cell transplantation with a conditioning regimen of fludarabine and melphalan. Neutrophil engraftment occurred at day 20, and he was discharged to home shortly after engraftment. One month later, he presented to the clinic with abdominal pain and a new diffuse erythematous rash, which his care team initially treated with corticosteroids. However, his abdominal pain persisted, and Jeff was admitted to the hospital a few days later for further workup for suspected acute graft-versus-host disease (GVHD). A computed tomography scan of his abdomen demonstrated worsening enterocolitis because of Yersinia enterocolitica. What would you do?

Effectively treating a cancer diagnosis requires an immense amount of collaboration. Clinicians are equipped with the clinical knowledge to provide the best care possible, and sharing that crucial information with each other and patients is essential for optimal patient outcomes. 

Our understanding of cancer’s genetic components is constantly growing, with new cancer susceptibility genes discovered every year that change how we screen for and treat cancer. Genetics specialists keep up with the latest information and implications of genetic results is and can be a great addition to comprehensive oncology teams.

Nutrition impact symptoms (NIS) involve any barrier to a patient’s nutritional status. Cancer and its treatments often lead to complex side effects that develop rapidly and change in character and intensity throughout treatment. Barriers to eating and drinking, digesting, and absorbing nutrients lead to negative clinical outcomes for patients with cancer, including malnutrition. Prompt assessment and interventions are key to helping patients avoid treatment holidays and dose reductions while also promoting the best possible quality of life during their cancer journey. In fact, a weight loss of just 5% is an indicator that a patient will likely not receive all of his or her prescribed cancer treatment.

U.S. Pharmacopeia (USP) chapter <800> provides safety measures for all healthcare workers in any setting where hazardous drugs (HDs) are used in the health system. For situations from the initial delivery of the drug to the institution through administration and disposal, USP <800> provides a vast number of safety measures intended to minimize risk and potential exposure to HDs. To meet the new requirements, medical institutions and pharmacies have had to make significant changes in various systems.

As of February 2019, only 160 institutions across the United States are certified to administer CAR T-cell therapy, meaning many eligible patients may need to be referred to a treatment center outside of the local ambulatory or community cancer center where they had previously received treatment. The transition from primary oncologist to certified center and back again requires careful coordination to ensure important steps and information aren’t lost.

The old saying, “it takes a village,” comes to mind. Many team members are needed to help a patient through one of the most critical times of their lives. Blood and marrow transplant (BMT) nurses play a large role, along with BMT physicians. However, we also depend on our BMT pharmacist, BMT dietician, and BMT social worker as part of the interprofessional team. Our patients not only need excellent nursing and medical care, but they also need care from members of the team to support them physically, psychologically, and nutritionally from transplant prep through the transplant itself and into the recovery phase.

When faced with a difficult problem, it’s human nature to seek different perspectives, to work together with others facing similar issues to accomplish a common goal. Compromise, collaboration, and communication are essential to successful teams—whether it’s your daughter’s basketball team, the U.S. government, or any group in between. In oncology, teamwork is no different. Bringing together professionals from different disciplines can yield tremendous results for patients with cancer.

Patients with cancer experience many feelings: they’re frightened and they’re hopeful, but mostly they’re in a new world. Symptoms associated with cancer and its treatment are taxing on patients’ physical, emotional, and spiritual well-being. In some cases, cancer-related symptoms and side effects are so debilitating that providers struggle to manage them just to get patients to a point where they can continue their treatment. Oncology nurses can lead the interprofessional care team to work together to proactively manage symptoms to ensure patients can endure treatment and come out as themselves on the other side. Proper symptom management doesn’t just promote quality of life but the best possible chance for patient survival.

Nurses in the intensive care unit (ICU) generally see patients with cancer only when they are extremely sick—not throughout the extensive cancer journey they go through before they get to the ICU. Educating and familiarizing ourselves, as ICU nurses, with a patient’s oncology plan, goals, and history can improve overall care. Learning at which points in the process of cancer treatment certain issues are more likely to arise, such as tumor lysis syndrome during high-dose induction, when a patient is most likely to be neutropenic during a stem cell transplant, and other general facts about oncology, can help improve the care we give. It helps us understand our patients as a whole. The oncology population is a huge part of medical intensive care, and encouraging critical care nurses and oncology nurses to collaborate can help improve the continuity of care and eliminate errors in the ICU.

Five to Ten Percent of patients with cancer will need to visit the intensive care unit (ICU) for a life-threatening condition. In fact, estimates suggest that nearly 30% of patients with esophageal cancer or acute leukemia and those undergoing allogenic stem cell transplantation will need ICU care.

More than ever before, oncology nurses are required to provide multifaceted care when it comes to managing patients with cancer. As the population of patients with cancer continues to age and cancer becomes more of a chronic condition, oncology nurses are seeing more patients who exhibit comorbidities during their cancer journey.