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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…