Cancer care and oncology nursing are headed in a new direction, guided by multiple intertwined factors, including the aging of baby boomers and the longer-term needs of patients with cancer. These factors, coupled with general concerns about the nursing profession and healthcare, including the shortage and costs for care, are creating a challenge for oncology nurses. The challenges evolve their roles as educators, case managers and agents of societal change.

Overseeing Care

The Oncology Nursing Society’s January survey of more than 2,800 ONS RN members showed that key concerns of the RN participants included the need for evidence-based practice guidelines and standards and the necessity of ensuring competency of all nurses who provide cancer care, according to Brenda Nevidjon, RN, MSN, FAAN, president of the Oncology Nursing Society. And the bottom line was a top concern for these RNs, including the rising costs of cancer care and the need to increase Medicare reimbursement for cancer care. The current state of the economy is masking another dilemma — an expanding shortage of oncology professionals, including oncology nurses, pharmacists and clinical oncologists, an issue that translates into evolving roles for oncology nurse specialists, according to Nevidjon.

“In the future, we might see oncology specialists performing initial consultations and the plan of care being carried out back in the community by more generalist professionals and practitioners,” Nevidjon says. “Given this trend, oncology nurses will have an important role in mentoring, teaching and overseeing non-oncology nurses who deliver care.”

Care Managing for the Long Term

The increased life expectancy of adults is creating a demand for long-term care management of people with cancer or a history of cancer, according to Nevidjon.
“Over the last couple of decades, cancer has become a predominantly chronic disease,” she says. “Today there are over 10 million people in the U.S. living with a history of cancer. Nurses will need to increase their focus on managing patients’ emotional needs, difficulties accessing care and the delayed effects of cancer treatments, such as fatigue.”

Other challenges include returning to work, financial consequences of treatment costs and concerns about recurrence of cancer.

This will demand the skills of oncology nurses, who will be key to planning long-term care and accessing resources for these patients, according to Nevidjon.

And despite increased survivorship rates for patients with many different kinds of cancer, there are still some types, such as pancreatic cancer and ovarian cancer, which are more acute and are often associated with a shorter life expectancy. Oncology nurses will need to take the lead in accessing evidence-based practices and educating other nurses in other specialties who will be caring for these cancer patients, Nevidjon says.

“My personal belief is that every oncology nurse should be looking at their care and asking, ‘Why are we doing it this way? Is there a better way? What does the research and evidence tell us?’ ” she says.

Higher education also can influence patient outcomes. “An advanced degree is not necessarily required for everyone, but there is research that says the higher the education level of nurses the better the outcomes for patients,” says Nevidjon, who also is clinical professor at Duke University School of Nursing in Durham, N.C.
Research that correlates the RNs’ education levels with patient outcomes includes a well-known 2008 study by Linda Aiken, RN, PhD, and researchers from the University of Pennsylvania, Philadelphia.

Patient Navigators

Ongoing patient and family education will become an even more important element of cancer care as more cancers become chronic diseases with acute phases, because of increasing life expectancies coupled with the potential for recurrences of cancer.
“High acuities and the demands of working in the hospital setting are shrinking the opportunities to spend in-depth time educating patients and families,” Nevidjon says.

This development is creating opportunities for nurses in the oncology patient navigator role, Nevidjon says. Oncology patient navigators help patients to maneuver through system barriers, such as difficulties accessing care from specialists and filling prescriptions. They also facilitate timely access to medical and psychosocial care through all phases of the cancer experience. Nevidjon predicts patient navigators will be important to improving outcomes, containing costs by reducing duplication of services and ensuring continuity and quality of care and improving patient education.

To help address the educational needs of cancer patients, the ONS worked with U.S. Rep. Steve Israel (D-NY) and Rep. Pat Tiberi (R-OH) in 2009 to introduce The Assuring and Improving Cancer Treatment Education and Cancer Symptom Management Act. The legislation supports Medicare reimbursement for time RNs spend educating patients diagnosed with cancer and their caregivers about the disease and effects of treatment. At the time this article went to press, the bill had been introduced in the House with bipartisan support but had not been introduced in the Senate.

Advocates for Societal Change

Another important role for oncology nurses in the future will be in patient advocacy, not only at the bedside, but on a larger scale within the legislative process.
“Nurses have a more powerful voice in representing patients than they realize, because elected officials don’t always know where the system is broken,” Nevidjon says.

For example, the Oncology Nursing Society worked successfully to pass the Family Smoking Prevention and Tobacco Control Act, which was signed by President Barack Obama in summer 2009. The law empowers the FDA to regulate the sale, manufacturing and advertising of all tobacco products, according to Nevidjon, who was in attendance when Obama signed the bill into law.

“Your involvement also benefits your patients when the organization advocates for issues that affect cancer patients, such as financing for cancer care and research and health-related policy and legislation,” she says.

The ONS also was active in advocating for patients and nurses during the development of the Patient Protection and Affordable Health Care Act. For example, Carlton Brown, RN, PhD, AOCN, ONS president-elect, led an ONS delegation to the White House to witness a speech by Obama, who spoke about his plan to reform America’s healthcare system.