ONCOLOGY Nurse Edition.
No. 2
Integrating Genetics and Genomics Into Oncology Nursing
By Dale Halsey Lea, MPH, RN, CGC, FAAN
Health Educator, National Human
Genome Research Institute
Kathleen A. Calzone, MSN, RN, APNG, FAAN
Senior Nurse Specialist, Research, National Cancer
Institute, Center for Cancer Research—Genetics Branch
National Institutes of Health, Bethesda, Maryland |
February 16, 2010
You and the team reinforce to the patient that these are difficult choices, none of which should be rushed into. You tell her that, at a minimum, intensive cancer screening should begin, and you arrange those appointments for the patient. You also discuss the fact that consultations with a breast surgeon and a gynecologic oncologist are important, to facilitate her decision-making and so that she can learn more about risk-reducing surgical options. The patient agrees to those consults, which you also arrange. Lastly, you provide her with summary of all the options reviewed during the appointment, your contact information, and instructions to call with any questions, and you schedule a follow-up appointment with the team in
1 month. You also mark your calendar with a reminder to call the patient in 2 to 3 days to check in and see whether she has any questions or concerns.
The patient returns with her husband for the 1 month follow-up appointment. She informs you and the oncologist that she has decided to undergo risk-reducing surgery for removal of her breasts and ovaries so she can do “whatever I can to prevent getting cancer.” You help your patient to get scheduled for her surgery and prepare for the sudden onset of menopause. Preoperatively you also schedule the patient for a baseline bone density scan and provide her with education about bone health, including the benefits of weight-bearing exercises and taking calcium and vitamin D. Your patient does well postoperatively but continues to struggle with hot flashes.
When you see your patient in follow-up after her surgery, she tells you that she is feeling well except for the hot flashes. However, she states that she is “still anxious about the cancer” and “worried about my two sons who are in their teenage years and their risk for cancer,” adding, “I wish that I had someone to talk with who has gone through this before.” To provide support to your patient, you give her information about a local support group for women at increased risk for cancer. You also refer her to the team social worker for additional support and assessment to be sure that she does not need to be referred to a behavioral health specialist.
In addition, you give her information about the Genetic and Rare Diseases Information Center (GARD). You explain that she can talk to a GARD information specialist about her questions and needs, and assure her that the GARD specialist will work to identify someone who can talk with her.[37] You also suggest that she can follow up with the genetic specialist to whom she spoke originally, to discuss both how to approach her sons with their risk information and at what time the sons should consider genetic education and counseling, to learn more about the BRCA gene mutation that runs in their family and about genetic testing.
Conclusion
Genetic and genomic research discoveries are transforming healthcare through earlier diagnosis, more effective risk management and treatment of disease, and avoidance of drug side effects. This new era of healthcare, personalized healthcare, is rapidly being realized in the field of oncology. Genetic and genomic testing and technologies are increasingly being used throughout the cancer care continuum—from prevention, to screening, diagnosis, treatment, and prognosis of many cancers. These discoveries have important implications for oncology nursing practice. The Essentials of Genetic and Genomic Nursing was created in recognition of the important role of genetics and genomics in nursing care. The Essentials provides a foundation for oncology and for all nurses as they integrate genetics and genomics into their daily practice.
Financial Disclosure: The authors have no signifi cant fi nancial interest
or other relationship with the manufacturers of any products or
providers of any service mentioned in this article.
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