Caring for Cancer Patients
Vicki Norton, MHA, RN, OCN
Clinical Nursing Director, Park Nicollet
Methodist Hospital
Director-at-Large, ONS Board of Directors
Working with Cancer patients: what you
need to know
How many cancer patients are there?
What healthcare settings will I find oncology patients?
What is some basic information to know about cancer?
What are my resources to care for cancer patients?
How would I know if I’d be a good oncology nurse?
Why do all nurses NEED to know about cancer?
• # 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
The New York Times Best Seller
“This book is a history of cancer. It
is a chronicle of an ancient disease –
once a clandestine, “whisperedabout” illness – that has
metamorphosed into a lethal shapeshifting 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)
2014 Statistics
• All Sites New Cases = 1,665,540
Male = 855,220
Female = 810, 320
• Deaths = 585,720
Male = 310,010
Female = 275,710
• Percent Surviving 5 Years = 66.1%
2004-2010
www.cdc.gov/cancerfacts
Top four causes of death in U.S.
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Heart disease (24.5%)
Cancer (23%) Percent Surviving
Years
Chronic Respiratory 5Disease
(6%)
Stroke (4%)
www.cdc.gov
Top 4 causes of cancer deaths
Male
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Lung
Prostate
Colon/rectum
pancreas
Female
• Lung
Percent Surviving
5 Years
• Breast
• Colon/rectum
• Pancreas
www.cdc.gov
What % of Americans will get cancer?
• Lifetime Risk of Developing Cancer:
Approximately 40.4 % of men and women will
be diagnosed with cancer at some point
Percent Surviving
during their lifetime.
5 Years
• Prevalence of cancer: In 2015, there will be an
estimated 14.5 million people living with
cancer in the United States (~5% of
population).
www.cancer.org
Healthcare settings with
oncology patients
• Primary Care Clinics
• Rehabilitation Facilities
• Women’s Health
• Home Care
Percent Surviving
Centers
5 Years
• Long-term Care
• Cancer Centers
• Palliative Care
• Infusion Centers
• End-of-Life Care
• Rural & Metro Hospitals
Hot Topics in Cancer Care 2015
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•
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Genetics
New treatment
Percent modalities
Surviving
5 Years
Palliative Care/End of Life Care
Assisted Suicide
Survivorship
Oncology Nursing: The Application of Cancer Genetics
and Genomics Throughout the Oncology Care
Continuum
“Advances in the understanding and
application of cancer genetics (i.e., single gene
hereditary disorders) and cancer genomics (i.e., the
identification of multiple
genes,
DNA
sequences,
Percent Surviving
and proteins and their
interaction
with one
5 Years
another) have dramatically changed the practice
and implementation of cancer risk assessment, risk
reduction, prevention, screening, diagnosis,
therapeutics, and options for personalized health
care.”
www.ons.org/positionstatements
End of Life Issues
The American Nurses Association, in its position
statement Registered Nurses’ Roles and
Responsibilities in Providing Expert Care at the
End of Life states:
“Respect for persons is a fundamental principle
of bioethics; ensuring respect for persons
includes honoring their wishes regarding
treatment decisions.”
www.nursingworld.org
Assisted Suicide
• The Hospice and Palliative Care Nursing Association (HPNA)
has a position statement called Legalization of Assisted
Suicide:
Surviving
We.. “Affirm the value ofPercent
end-of-life
care, which includes
5 Years
aggressive and comprehensive
symptom management; open
and honest communication about prognosis, treatment
options and the dying process; ongoing discussion about
patients’ goals of care; and psychosocial and spiritual support
for patients and their families; and bereavement services.”
www.hpna.org
Survivorship Statement
“Many survivors face distinct and serious health
care issues. CancerPercent
survivors
are at increased
Surviving
5 Years and premature
risk for long-term morbidity
mortality, related directly to the cancer itself, to
preexisting comorbidities, and to exposure to
therapy.”
jco.ascopubs.org
Cancer Basics
• Cancer starts when cells in a part of the body start to
grow out of control.
• In normal cells, when the cell DNA changes for any
reason, the cell either repairs or dies
Percent Surviving
• In cancer cells, the cell
does
not repair or die but starts
5 Years
to replicate the damaged cells
• Grows into a tumor in an organ or multiplies in the
blood or lymph systems
• Cancer cells travel (metastasize) to other parts of the
body through the bloodstream or lymph system
• Cancers are named based on the place that it
originates, not necessarily where it is found
Percent Surviving
5 Years
Cancer Risks
•
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Age
Smoking
Sun Exposure
Percent Surviving
Previous radiation
exposure
5 Years
Diet
Genes
Infections
Other – chemicals
www.cancer.org
7 signs of cancer
C-A-U-T-I-O-N
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•
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Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Percent
Surviving
Thickening or lump
in the
breast, testicles, or
5 Years
elsewhere
• Indigestion or difficulty swallowing
• Obvious change in the size, color, shape, or
thickness of a wart, mole, or mouth sore
• Nagging cough or hoarseness
www.cancer.org
Other Symptoms
• Persistent headaches
• Unexplained loss of weight or loss of appetite
• Chronic pain in bones or any other areas of the
Percent Surviving
body
5 Years
• Persistent fatigue, nausea, or vomiting
• Persistent low-grade fever, either constant or
intermittent
• Repeated infection
www.cancer.org
Treatment
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Prevention
Early diagnosis
Surgery
Percent Surviving
5 Years
Radiation
Bone Marrow and Stem Cell transplants
Chemotherapy/Biotherapy
Targeted Therapies
ONS Clinical Practice Resources
www.ONS.org
Clinical Inbox
• Do you have a hands-on question for the ONS education
team? Email our experts at clinical@ons.org.
Putting Evidence into Practice
• Learn which treatments are most effective for patients with
cancer—and which aren’t. Visit the PEP webpages to learn
about interventions for more than 20 different cancer topics.
ASCO/ONS Chemotherapy Safety Administration Standards
• The gold standard for chemotherapy administration,
applied by institutions everywhere to ensure the safest care
for nurses and their patients.
P u t t i n g
Evidence into
P r a c t i c e
20 topics
• Anorexia
• Constipation
• Depression
• Diarrhea
• Fatigue
• 15 more
ONS Resource
Percent Surviving
5 Years
Survivorship
• What does that mean for nursing care?
– All healthcare settings
– Long term effects
of treatment
Percent Surviving
5 Years
– Symptom management
– Reoccurrence
– Anxiety for patient
– Advanced Care Planning
Palliative and End-of-Life Care
• Symptom Management
• Quality of Life discussions
• Ethical Issues
• Family dynamics
• Comfort Care/Hospice
End-of-Life Nursing Education
Consortium (ELNEC)
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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
Oncology Nursing as a Profession
• What does it take?
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Knowledge
Critical thinking Percent Surviving
5 Years
Technical skills
Psychosocial skills
Compassion
Empathy
Self care
Called
Life-long learning
Oncology Nursing Society
• Student discounts on membership
• Scholarships through
ONS Foundation for
Percent the
Surviving
5 Years
education
• Resources and educational offerings on caring
for oncology patients
• Leadership and volunteer opportunities
Free Membership