Thanks to significant scientific and technologic advancements in the past 15 years, the majority of cancer care—an estimated 80% or higher—is being delivered in the outpatient setting.
For patients, ambulatory oncology care offers comfort, flexibility, and a sense of normalcy during their difficult cancer journey while maintaining the highest-level treatment and care for optimal outcomes. Oncology nurses are key to successful outpatient care, serving as caregivers, educators, advocates, and patient champions from diagnosis through treatment and into survivorship.
Ambulatory Oncology Nursing Roles
No matter the setting, flexibility is crucial when caring for patients. According to ONS member Xenia Downey, BSN, RN, OCN®, Northeast Florida ONS Chapter member and chemotherapy nurse supervisor at the Mayo Clinic’s Hematology/Oncology Ambulatory Chemotherapy Infusion Clinic in Jacksonville, FL, the role of an oncology nurse can cover a wide spectrum of responsibilities, depending on the institution and patients’ needs.
“My department is strictly dedicated to infusion, which allows our nurses to focus on becoming experts in administration and practicing at the top of their licenses. We have other nurses who handle navigation and administrative duties,” Downey says. “But in many ambulatory settings, nurses serve both roles. They have their infusion hat on and work in care coordination and navigation by helping to organize with physicians or other providers, manage patient schedules, and more. They take a lot of other responsibilities under their wings.”
ONS member Jonathan Morgan, RN, registered nurse at the AtlantiCare Cancer Care Institute in Egg Harbor Township, NJ, and Southern Jersey Shore ONS Chapter member, adds another ambulatory oncology nursing role: patient champion.
“Besides administering treatments, we support patients and their family through the stress and uncertainty of cancer treatment. We constantly educate patients, ensuring they receive and comprehend all the information they need to understand their treatments, manage their side effects, and follow up with the appropriate providers,” Morgan says. “We also help them and their families navigate the complicated healthcare system, and we must make sure they remain psychologically healthy while dealing with their disease.”
Benefits of the Ambulatory Setting
A cancer diagnosis will upend a patient’s life. Receiving treatment in an accessible location, close to home, can empower patients to find some semblance of familiarity in an unfamiliar, postcancer world.
“The biggest benefit of receiving treatment in an ambulatory setting is convenience and comfort,” Morgan says. “The comfort that can be achieved in an outpatient setting is far superior to any that could be achieved in the inpatient setting. We’re also able to make the care more personal and individualized. This helps reduce the amount of anxiety patients have to endure when receiving their treatments.”
Quality of life is a key component for ambulatory oncology care. Instead of being defined by their cancer, patients can simply factor it into their lives.
“Ambulatory oncology units help our patients keep their lives moving forward. After a diagnosis, being able to receive treatment in an outpatient facility can give patients some amount of normalcy in their lives,” Downey says. “It can certainly cut down on the potential for hospital-acquired infections, and it provides a sense of flexibility for patients. But even if the only benefit they get is from keeping themselves out of the hospital and moving forward—that’s literally life changing.”
Ambulatory Nursing’s Changing Landscape
Prevention and early detection successes have helped to stem the tide of late-stage cancers, leading to a direct increase in early treatment for patients—many of whom receive their care in the outpatient setting.
“The biggest change in ambulatory oncology practice over the past few years has been the advancements in diagnostics and treatments, including immunotherapy. Patients’ diseases are being diagnosed and treated earlier than ever, allowing us to help them transition from patient to cancer survivor,” Morgan says. “Our palliative therapy patients are staying on and tolerating their treatments for a longer period with fewer and less-severe adverse effects. It doesn’t seem uncommon to have a patient on a regular treatment for years. We are giving people a better quality of life during treatment for a longer period of time.”
With new movements in oncology best practices and more treatments making the way to practice than ever before, nursing responsibilities in the ambulatory setting are growing at an unprecedented rate.
“Ambulatory nursing care is constantly evolving, and new technologies have changed the way we track, assess, and care for our patients. The switch to electronic health records has definitely seen to that,” Downey says. “But also, there’s a better focus on caring for caregivers as well as patients. Understanding burnout and compassion fatigue is huge, especially in an ambulatory setting and when working with family members and other colleagues. Beyond caregiver support, we’re also seeing new treatments—historically given in an inpatient setting or hospital—being approved for safe administration in an outpatient setting, and that’s adding a new complexity to the care we give.”
Challenges for Ambulatory Nursing
Both Morgan and Downey agree, part of ambulatory oncology nursing is being adaptable and flexible to overcome whatever practice challenges exist. The best way for nurses to do so is to ensure they’re up to date on the latest treatment options.
“Because so many treatments are moving from the inpatient to outpatient setting, we’re seeing a lot of different modalities of care, including concurrent chemotherapy, targeted therapy, and CAR T-cell therapy. These treatments are much more advanced than what we’ve seen in the past. There’s a new level of knowledge needed to ensure that patients are receiving the best possible care,” Downey says.
“New treatments mean new side effects, new educational materials to communicate, more medications, and more complicated care trajectories. Knowing how to decipher what patients are experiencing and how new therapies are affecting them is crucial so we can get them the interventions and support they need to be successful.”
Away from larger academic institutions and fully staffed hospitals, oncology nurses in ambulatory clinics must also navigate some limitations in practice.
“Working in an outpatient setting, we don’t require the same amount of nursing staff needed in a hospital setting. This often leaves us working in small teams, and that means fewer nurses to rely on for support or to discuss specific patient care issues,” Morgan says. “Ambulatory nurses don’t always have access to the same resources as those in an inpatient setting. Patients requiring testing—even when STAT—can face obstacles such as scheduling, transportation, or insurance authorizations. And when a patient experiences an adverse reaction, we rely on 911 when necessary. We don’t have the same resources or staff as an acute care setting to deal with a severe medical emergency.”
What the Future Holds
The demand for ambulatory oncology nursing continues to grow, and nurses will have to rely on education and resources to keep up (see sidebar).
“We’re diagnosing and treating sooner, and many patients are staying on treatments longer. There’s a move to do as much in health care as possible in the outpatient setting, and there seem to be fewer and fewer infusions being done on an inpatient basis,” Morgan says. “Nurses are great at adapting to change—which seems to be the only constant in health care anymore. The treatments we give are constantly evolving, and we must stay up to date on the latest therapies. Professional nursing organizations such as ONS are a great resource to see the latest trends in a specialty, while also helping us touch base and talk with members on a national or global scale.”
Ambulatory oncology nurses will also have to grow to accommodate their patients’ needs as patient care becomes more complex in the future.
“Part of ambulatory oncology nursing’s future is understanding patients’ evolution. As they grow and change, we need to grow and change with them,” Downey stresses. “New treatments will continue to emerge, and our patients are also becoming savvier and more involved in their care. The patient experience is becoming more complex—their lives are getting more complex—and ambulatory oncology care is positioned to help make sure they aren’t defined by their cancer diagnoses. We’re here to get them through it and back to their lives.”