As technology and scientific discovery accelerate to meet the growing needs of healthcare providers, cancer treatment and prevention are being redefined. The paradigm is shifting in care, and precision medicine is ushering in novel, individualized ways of treating patients with cancer.
By targeting the specific pathways of cancer and looking on a molecular and genetic level, precision medicine works to tailor which treatments are used and how they are delivered to provide the best possible outcomes for patients. Although many of these techniques have been developed over the past 25 years, President Obama during his 2015 State of the Union Address provided the spark necessary for precision medicine to spread like wildfire across the healthcare industry. NIH created the Precision Medicine Initiative (PMI) with a goal of collecting genomic data from more than one million U.S. participants for research use and the advancement of precision medicine.
As the field continues to rapidly expand throughout oncology, precision medicine and the bounty of new information it supplies will demand a higher level of education, understanding, and coordination from oncology nurses. With precision medicine comes precision nursing.
Changing the Current Landscape With Precision Medicine
The effects of precision medicine are already being felt throughout institutions across the United States. ONS member Marilyn Hammer, PhD, DC, RN, director of research and evidence-based practice in the department of nursing at Mount Sinai Hospital in New York City, recognizes the change. “At this stage, education, publications, and discussions are well under way. Additionally, patient care is already starting to shift with the growing evidence from research findings generated through PMI,” Hammer says.
Sandra Kurtin, RN, MS, AOCN®, ANP-C, nurse practitioner at the University of Arizona Cancer Center in Tucson, identifies the shift toward precision medicine as a new perspective in cancer care. “The biggest change right now are educational initiatives that try to refocus away from standard chemotherapy,” she explains. “It’s helping people understand that precision medicine implies analyzing the individual patient’s disease as a molecular signature.”
Arriving at a signature profile for patients comes in part through genomic testing, both nurses explain. Nurses are in the unique position to educate patients about the use of genetic testing and how it will affect their treatments. Moreover, the collective genomic analysis for certain tumor types leads to the evolution of targeted drugs that block specific biochemical pathways. These treatments are tailored for patients to create a more exact response based on their genetic data.
Currently, targeted therapies and immunotherapies in precision medicine have required healthcare providers to adjust the way they deal with symptoms and other facets associated with treatment. But that’s not all. “These new treatments will require updated protocols for short—and ideally—very long-term management,” Hammer says.
Preparing for the New Paradigm
As the focus of care shifts from traditional dose-intense treatments to precision medicine and individualized care, oncology nurses will likely see numerous changes to the healthcare landscape. According to Hammer, “Individual genome sequencing will likely one day become standard practice. This will unveil not only perturbations in DNA that increase the risk for cancer and provide genetic information for truly tailored treatments but will also lend insights to other health risks, some of which may have similar underlying threads.”
The National Institute of Nursing Research has put its support behind PMI, encouraging patient-centered research to push precision nursing forward. Currently, nurse scientists are working to improve symptom outcomes through the information PMI collects. Throughout oncology, nurse scientists are identifying common biologic elements—otherwise known as biomarkers—that exist in patients suffering from adverse treatment effects. In a study done at the P30 Center of Excellence for Biobehavioral Approaches to Symptom Management, nurse scientists looked at the relationship between psychological states and symptoms while also examining the relationship between symptoms and nerve signaling chemicals. Through the use of pooled symptom data, researchers found a strong correlation between perceived stress and symptoms. However, they noted the relationship was much weaker between nerve signaling chemicals and symptoms, calling for further research in the area.
For Kurtin, one certainty exists as the paradigm shifts toward precision medicine: “Things are only going to get more complex. There’s a shift in care from ‘one-size-fits-all’ to a very tailored, individualized approach. Nurses have to know more about individual patients and their specific disease profile—not just their general diagnosis.”
Oncology nurses will need to prepare themselves through education and collaborative learning. Moreover, Hammer notes that a focus on the “omics” sciences—genomics, proteomics, and metabolomics—will be paramount as health care continues to move toward precision treatments. Staying current on these topics through information supplied by the PMI, NINR, and NIH will prepare oncology nurses for future wave of precision medicine.
Embracing Individualized Care
Precision medicine, as futuristic and advanced as it sounds, still needs to overcome obstacles before it can be fully adopted into all healthcare settings. According to Kurtin, one of the biggest issues facing the change toward precision medicine is time.
“It takes time, and time is difficult—because nobody has enough of it,” Kurtin says. “It takes time to make the diagnosis. It takes time to go over all that material and select the best therapy, then get the targeted therapy approved and set the patient up for tailored treatment. There’s a level of precision in the process itself, and that takes time.”
Hammer notes that personalized treatments will not only allow healthcare providers to tailor their care for individual patients, but it will engage patients to be a part of the process. “Patients are becoming partners in their care and in research studies. The collaborations between patients, researchers, healthcare team members, and the community at large are integral in this process.”
To personalize care and educate patients on precision medicine, oncology nurses must stay up to date on information, education, and resources. “One of statements that bothers me more than anything is, ‘Oh, nurses don’t need to know that,’ ” Kurtin says. “Yes they do! If you don’t understand it, you can’t explain it to a patient, you can’t do your best in supporting the patient, and if we don’t take a stand, we’ll be doing ourselves a disservice. So, let’s embrace it, be part of it, and learn it so we can do the work of supporting and treating patients.”