The myriad changes that oncology physicians have experienced in the last 20 years are certainly applicable to oncology nurses, in particular, the technology explosion and its effects on diagnosis, treatment, and survivorship; the emergence of cancer as a disease of the elderly; challenges posed by shortages of health care workers; and the fact that almost all cancer patients today are treated as outpatients. Recent therapeutic innovations and management approaches have been keenly felt by oncology nurses, who typically play a major role in patient education.
When I was doing clinical work about 23 years ago, patients receiving cisplatinum often would be in the hospital 2 to 3 days for hydration, followed by a couple of days for their treatment and then a few more days for post-therapy hydration. Many were patients with brain tumors and were inpatients for the entire 6 weeks of their course of radiation, and that's unheard of today.
Of course, treatment choices have changed radically, with increasing attention given to chemotherapy (even for cancers that used to be treated primarily with radiation), as well as biotherapy and molecular-targeted and genetics-based treatments, and new challenges have emerged as a result of these improvements in care.
Many medical advances over the last few decades have occurred in areas in which oncology nursing has traditionally been strongest: symptom management, survivorship, and detection and prevention. In symptom management the oncology nurse has tremendous influence on outcome, by using a variety of techniques to improve patients' functional status, keep them moving, and ease them back into family or community roles, while providing psychological support.
The relatively recent availability of agents to manage nausea and vomiting, as well as anemia and fatigue, has enabled us to significantly improve cancer patients' quality of life.
Better Informed Patients
Another dramatic change is that patients are much better informed, because they have used the Internet to educate themselves about their disease. You can talk with patients at length, and they ask intelligent questions about their treatment options. This is very positive.
The other side of this, however, is that often patients have received some bad information, so the oncology nurse has to help them wade through all of it and direct them to good resources. Patients also ask about clinical trials, and often they have thoroughly researched the various available studies. Here is where patient advocacy groups have had a major influence, again, with patients being much more knowledgeable about appropriate treatment.