Cancer treatment is shifting from intravenous to oral formulations, and the evolution in therapy administration could change the way oncology nurses take care of their patients. As pharmaceutical companies develop more cancer treatment alternatives, the trend toward oral chemotherapy will grow, according to Pamela Ginex, RN, EdD, OCN, nurse researcher, Memorial Sloan-Kettering Cancer Center, New York City, who, in her current research, is looking at factors that promote patient adherence and those that deter it. Oral chemo has been around for years, but were seeing a significant increase [in its use], Ginex said. This has a lot to do with the development of more targeted therapies.
Thats good news for patients. [Patients] dont have to come into the clinic as often since they dont need IV access, she said. Oftentimes, the oral cancer treatments have a lower side effect profile.
While all of these changes are positive, there is a potential drawback: patients become more responsible for their own treatment.
New duties for nurses and patients
Adherence is a real concern. Ginex said its not always easy for a patient to take the oral cancer treatments as prescribed. These often complicated regimens rarely involve taking one dose a day. Rather, the patient might have to take several pills in the morning and at night. He or she might be on this schedule for a week or two and then off oral chemotherapy for the next week. If youre older, if you have metastatic cancer or if you have a lot going on, you can forget, said Ginex.
The use of oral cancer treatments and the fact these treatments can be administered at home mean oncology nurses roles will need to evolve, according to Ginex. Nurses will have to look at how they manage their time. [Nurses] obviously educate patients about the treatments, but they also assist in obtaining the oral chemotherapy treatments, Ginex said. They call the specialty pharmacies; they take care of insurance issues. Nurses will spend a lot of time and effort on the front end, making sure patients are set up with the oral chemotherapy.
Follow-up care even more important
Oncology nurses still need to follow patients throughout treatment, monitoring them for side effects and adherence, assessing how theyre tolerating treatment and educating them in the process. They also need to coordinate future appointments with their physicians or with specialists in dermatology, nutrition, psychology and other fields depending on the patients needs. We very well may have to set up standard follow-up practices, she said. So once they go home with the oral agent, we would have established when we are following up with them, whether it be in the clinic or by additional phone calls, and how often.
Best practices for nurses involved in oral cancer therapy are in the works, Ginex said, but will involve reconsidering how nurses practice. For example, according to Ginex, centers with IV clinics might need oral clinics. And although the traditional role of the IV chemo nurse will remain an integral one, the advent of more oral cancer treatments prompts a reevaluation of how to manage patients needs.
Well have to look at our current practices from a new perspective and see how we can best care for these patients, she said. An example would be documentation how do we document oral chemo adherence? How do we fit this into our electronic medical records?
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