What’s HOT in Oncology Nursing?

ONS Treasurer – Tracy Gosselin, PhD, RN, AOCNAssociate Chief Nursing Officer

Duke Cancer InstituteDurham, NC

Shout Out To…..

Rachel Peterson

ONS Scholarship Winner

$1,000

“This book is a history of cancer. It is a chronicle of an ancient disease – once a clandestine,

“whispered-about” illness – that has metamorphosed into a lethal shape-shifting entity imbued with such penetrating metaphorical, medical, scientific, and political

potency that cancer is often described as the defining plague

of our generation.”

Siddhartha Mukherjee

(Author’s Note, xiii)

The New York Times Best Seller

Why do all nurses NEED to know?

• # that have been touched by cancer in their families/ significant others

• # that have supported a walk/run/fundraising event for cancer

• # that have cared for patients with a cancer diagnosis in a nursing clinical experience

• # that expect to care for patients with cancer

Supply and Demand Forcesin Cancer Care

Demand• Cancer is 2nd most common

cause of death • Cancer rates expected to

increase as Baby Boomers age

• Lifetime probability of developing cancer is 1:2 for men; 1-3 for women

• Five year cancer survival rates risen to 64% for adults

Supply• Demand for oncologists

expected to exceed supply• Social worker labor force is

older than most professions• RN shortage projected to be

340,000; By 2020, more RN’s will be in their 60’s than in their 20’s

• Proportion of minorities in the populations outstrips their representation among health professionals MEDSURG Nursing, 2009; Siegel R., et

al. (2013). CA Cancer J Clin, 63, 11-30.

Impact of Cancer Workforce Shortages

• Delays in diagnosis, possibly at later stages of disease• Longer wait times to be seen by a professional• Delays in treatment• Care provided by less experienced or expert professionals• Fragmentation of services• Less frequent interaction with clinical or supportive

services• Delays in the evaluation and management of symptoms• Worsening health disparities• Decreased clinical trial enrollment

http://c-changetogether.org/

Goals: • Increase quantity• Increase quality• Improve value

Cancer Competency Standards

Domain IIICommunication &

Collaborationo Interdisciplinary

Careo Psychosocial

Communicationo Cross-Cultural

Communicationo Ethical/Legal Issueso Grieving

Domain IIBasic Cancer Scienceo Etiologyo Epidemiologyo Clinical Trialso Cancer Surveillance

Domain IContinuum of Careo Prevention o Early detectiono Treatment o Survivorshipo Palliative Care

MEDSURG Nursing, 2009

Hot Topics – Session Overview• Pediatric oncology opportunities

• Better prevention through early detection and vaccination

• Treatment issues and advances

• Survivorship

• Palliative care

Pediatric Oncology

Core Purpose: to support and advance nurses and their practice in order to optimize outcomes for children, adolescents, and young adults with cancer and blood disorders and their families.

Association of Pediatric Hematology/Oncology Nurses

!

Jobs!

Cancer Prevention

Cancer Statistics 2013

• 1,660,290 new cancer cases in 2013– Women: Breast, lung & bronchus, and colorectal

– Men: Prostate, lung & bronchus, and colorectal

• 580,350 cancer related deaths in 2013

• “Although progress has been made in reducing the incidence, mortality rates, and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years of age.”p. 225

CA Cancer J Clin, 2009. Siegel R., et al. (2013). CA Cancer J Clin.

Nurses: How healthy are we?

• Nurses’ Health Study III• Smoking trends – 8%• Obesity

– 37% Overweight – 28% Obese

ACS Recommendations for Early Detection of Cancer in Average-Risk, Asymptomatic Individuals

Breast Cancer BSE -- >20 y ; Instruction required

Mammography -- Begin annually at age 40y

Colorectal Cancer

FOBT – Annually, start age 50

Flexible sigmoidoscopy – Every 5 years OR

Colonoscopy – Every 10y; >50

Prostate Cancer

DRE and PSA

* informed decision making

Cervical Cancer

> 21 y or 3 y after first intercourse

Timing varies based upon age & consecutive negative findings

CA: Cancer Journal, 2011

Cervical Cancer Screening

• Screening 21-65 Pap Smear every 3 years or 5 years with negative HPV combined with cytology

• No screening– < 21 years– 65 > with normal screening history– or hysterectomy with removal of cervix

Human Papilloma Virus Vaccination

• Recommended in 2006 for girls• American Academy of Pediatrics (AAP)

recommends vaccine in adolescents girls and boys – ages 11-12

• Three doses (0,1-2,6 months)• Most effective if administered before

individual begins engaging in sexual activity• Controversy abounds still.....

HPV Vaccination

Opportunity to eradicate 3 cancers:

Cervical cancer

Anal cancer

Oropharyngeal cancer

Treatment Advances

Cancer Treatment

• Surgery – from more is better to less is better; adjuvant with chemotherapy before and after– VATS

– Robotic

• Chemo/ Biotherapy – targeted therapies– Oral agents

– Combination regimens

• Radiation Therapy – highly specific– IMRT

– IGRT

Genetics & Genomics

What every oncology nurse needs to know

• Relationship between cancer and genetics

• Testing for hereditary cancer syndromes

• Pharmacogenomics

• Issues– Genetic Information Nondiscrimination Act– Direct to Consumer DNA testing kits– Access to genetics professionals

Genetics & GenomicsProfessional Nurse Responsibilities

Essentials of Genetic & Genomic Nursing, 2009, 2nd ed

Symptom Management:Putting Evidence into Practice

http://www.ons.org/Research/PEP

Oncology Nursing Society, 2008?

Symptom Management

ONS Putting Evidence Into Practice Resources

Anorexia Fatigue Prevention of Bleeding

Anxiety Lymphedema Prevention of Infection

Caregiver Strain MucositisSleep / Wake Disturbances

Constipation Nausea & Vomiting

Diarrhea Pain

Dyspnea Peripheral Neuropathy

Drug Shortages

• ...a national healthcare crisis – mostly generic meds

• Why?– Lack of adherence to

manufacturing standards– Up to 80% of raw

materials obtained outside of US

– Mergers and acquisitions

...causing treatment delays, compromises, and unknown clinical outcomes for patients

Survivorship

• 11.7 million people living with cancer in 2007– Breast cancer 22%– Prostate cancer 19%– Colorectal cancer 10%

• 54% are women

• Survivorship care plan

• Survivorship treatment summary

Survivorship

• Multi-disciplinary approach to care– Counselors – Dietitians– Social workers– Child life specialists– Pharmacists– Physical and occupational therapy– Exercise physiologist

Palliative Care

ONS and AOSW Position on Palliative and End-of-Life Care

• Palliative and end-of-life care is integral to oncology and indicative of the importance of alleviating physical, psychological, social, and spiritual pain and suffering whether or not cure is an option.

• People with cancer and their family members should receive care that reflects the principles of excellent palliative care across various settings (home, hospice, hospital, or residential facility) from the time of diagnosis through the end of life.

• Such care should ensure that patients and families are not abandoned at the end of life. A proactive and integrated approach to palliative care will improve quality of life across the care continuum.

2010 Hospice Stats

• % deaths that occurred in hospice = $41.9%

• ½ of hospice patients received care for more than 3 weeks

• 35.7% of hospice patients were discharged within 7 days of admission to a hospital

NHPCO Facts & Figures on Hospice Care, 2012

ONS Position: Nurse’s Responsibility to Patients Requests for Assistance in

Hastening Death

Although ONS does not support procedures or actions whose direct and immediate purpose is to cause a person's death, it recognizes the intellectual and psychosocial contributions of nursing care, supports continued efforts to improve compassionate, evidence-based care for the dying, and encourages continued dialogue on any and all ethical dilemmas.

ONS Position: Nurse’s Responsibility to Patients Requests for Assistance in

Hastening Death

• In those jurisdictions where patients are allowed to hasten their own deaths by taking legally prescribed medication, nurses have the right, on moral and ethical grounds, to refuse to be involved in the care of patients who choose hastened death as a course of action.

• When a request for hastened death is made, nurses opposed to participation in such activities must listen compassionately, resist the inclination to abandon (i.e. withdraw physically or emotionally from patients), and explain that they are unable to provide assistance. This does not constitute abandonment. In those circumstances, however, care must continue until alternative sources of care are available to patients (Oregon Nurses Association, 2001).

EOL Education =

End-of-Life Nursing Education Consortium (ELNEC)

• Nursing care at EOL• Pain Management• Symptom Management• Ethical Issues in Palliative

Nursing• Communication

• Cultural Considerations in EOL care

• Loss, Grief, Bereavement• Achieving Quality

Palliative Care• Preparation for and Care

at the Time of Death

Information about ELNEC Courses: http://www.aacn.nche.edu/ELNEC

www.ons.org

Resource

Thank you & questions…