The 2019–2022 ONS Research Agenda mentions LGBTQ patients with cancer among ONS’s research priorities for the very first time. A panel discussion at the 44th Annual ONS Congress focused on this underrepresented patient population, so we are making progress. In the past few years, our field has given a little more attention to LGBTQ patients with cancer, although I suspect that many of the issues are still pervasive.

Like most nurses, my shifts as a new nurse functioned as consistently as clockwork. I would begin my afternoon shift by reviewing the assignment list. The previous shift’s nurses would handoff the patients, and I would head out to the unit to report to my assistive personnel and review the patients’ medication administration records. Every hour was dedicated to a different task, including my dinner break. That is, until a monumental moment jostled me from my systematic routine.

Recognized by the National Academies of Medicine as a population vulnerable to health disparities, people who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) experience specific health disparities, including limited access to health care, increased risk for certain disease types, and an inherent bias in the health system.

As early detection, treatment modalities, and symptom management advance in oncology care, we are seeing an increase in the number of adult and childhood cancer survivors. Added to the unique challenges of comorbid conditions in an aging population, oncology nurses have a lot to juggle in the spectrum of patient care. The relatively new role of the oncology nurse navigator was developed to enhance care coordination in patients with cancer.

Many say that love is the universal language. I agree, but I’ve found that care is also universal.   

We are oncology nurses. We don’t shy away from hard discussions. We have the skills and tools to help others. But this pandemic is different. The COVID-19 coronavirus has changed the rules. It’s ushered in social distancing, limited contact, and induced a new level of panic. COVID-19 doesn’t care if you are a nurse or a patient. It is an equalizer between us all. 

“I don’t want to die.”  “What is my prognosis?”  “Is this a death sentence?” 

As oncology nurses, heart-wrenching questions like these are part of our day-to-day work. So how do we address patient concerns in a compassionate yet professional way? How do we respond to a patient with stage IV cancer who exclaims they only have two more cycles of treatment until they’re cured? How do we explain to patients with cancer that their journey is not short term?  

“It’s going be okay.”

That common phrase is full of meaning, yet so vague. Often, it’s a patient’s response when they’re first diagnosed or are told that all of the treatments have failed and they only have a few months to live. Other times, a family member will voice the remark when holding a patient’s hand as they provide comforting hope or temporary relief from distress. Sometimes an oncology nurse shares the phrase in an attempt to calm the agony their patients face each day.

In nursing school I was always taught to maintain professional boundaries with patients, including never sharing any personal information like my address or contact information. No matter how many times faculty members said it, we never role played scenarios with that situation. I was unprepared for the moment, six months into my nursing career, when a kind, gentle, nonthreatening woman asked me for my address so she could send me a Christmas card.

I remember my first day as a student nurse technician at an academic medical center as if it was yesterday. It was a Saturday afternoon shift in May 1996 on 10 Green at Harper Hospital in Detroit, MI, on a hematology unit that cared for patients with either malignant hematology (i.e., leukemia and lymphoma) or benign hematology conditions (e.g., sickle cell disease).

At the heart of patient-centered cancer care is communication and understanding, and oncology nurses have a responsibility to ensure that their patients have all the information they need to successfully navigate their cancer journey. But what happens when language barriers inhibit the flow of information between patient and practitioner? 

As people age, their risk for cancer increases, and so too does the complexity of their cancer care. Older patients with cancer typically present with age-related conditions like comorbidities, functional problems, falling, and polypharmacy, which are not as widely discussed in the oncology space as they should be. Age-
related concerns can influence outcomes for patients with cancer and their caregivers, including treatment toxicity, hospitalization, and even early mortality. 

“Two heads are better than one” is an idiom so old and often used that it borders on cliché. But as with most colloquial sayings, a kernel of truth is buried underneath. Combining forces to solve problems, overcome obstacles, and coordinate efforts is the key to nearly every successful endeavor, and it’s especially true for patients and providers navigating the cancer journey. 

Genomic testing—identifying variants, like mutations, in tumor cells to inform patient treatment options—occasionally comes with unanticipated results that clinicians have to address with their patients. Clinicians and patients alike are often hopeful that tumor genomic testing will identify a personalized cancer treatment. Indeed, many patients have benefited from being candidates for new targeted therapies identified through genomic testing. 

A provider develops a partnership with a patient and negotiates behaviors to reach an agreement to adhere to oral chemotherapy medication. This is an example of which strategy?

a. Reinforcement

b. Operant conditioning

c. Motivational interviewing

d. Partnership   

Oncology nurses interact with other staff, patients, and families, each of whom have various cultural and personal preferences. A person’s culture encompasses race, ethnicity, spiritual practices, social habits, and so much more. 

When patients with cancer also suffer from psychiatric diagnoses, it can present unique challenges to healthcare professionals. Because oncology nurses build relationships with patients while addressing issues, understanding the obstacles to practice is key to providing the best possible care. By having a keen understanding of symptoms, assessment procedures, and necessary response skills, oncology nurses can work together with the mental health team to provide holistic care throughout the cancer journey. 

Nearly 20% of Americans experience mental illness in a given year, according to the National Alliance on Mental Illness. With diagnoses such as schizophrenia, bipolar disorder, or major depression, about one in every 25 Americans suffers from a serious mental illness that directly affects major life activities. The prevalence of mental illness in the United States can have a downstream effect on cancer care and patient outcomes, and with these statistics, oncology nurses may encounter patients with cancer who have pre-existing psychiatric disorders. Healthcare providers in fields outside of psychology need to be prepared to address the unique needs and individualized care required to support this patient population during and beyond cancer treatment. 

Public opinion surveys from respected groups such as Gallup serve as a barometer on certain topics and issues. In Gallup’s 2019 poll assessing ethics and honesty, nurses were again ranked the most-trusted profession in the United States for the 20th year. In 2019, 84% of respondents said they rated nurses “very high” for honesty and ethical standards, leading the pack by a wide margin. Patients, families, and caregivers know firsthand that nurses are driving patient-centered care. For that very reason, they rank nurses higher than physicians, clergy, police officers, and educators. It’s a position that commands respect.

During the morning shift change, Charlie, an RN, receives a report on Ellis, age 52, who was admitted three days ago for severe abdominal pain and persistent diarrhea after cycle 3 of high-dose ipilumumab and nivolumab.

When Charlie and the certified nursing assistant (CNA) enter Ellis’s room, the patient is sitting up in bed caressing hands with a woman of similar age. Ellis requests help getting into the shower, so Charlie says to the CNA, “Please, help him shower, and I will finish introductions.” 

Ellis interrupts Charlie. “I am not a he!” 

Practice reflection is a critical element of self-care for an oncology nurse, and one way to reflect is through storytelling. Whether it’s sharing your own stories or your patients’ stories, writing them down and speaking them aloud to yourself, your family, a small group, or more can be a healing self-care experience.

As a direct line to the oncology team, the phone conversations between nurses and their patients can help address symptoms, foster valuable patient education, provide useful interventions, encourage side effect reporting, and identify potentially life-threatening situations. Ultimately, successful telephone triage requires a unique skill set for oncology nurses to communicate with their patients and recognize underlying issues.

Advance care planning (ACP) is a process for patients and their families to discuss their wishes and goals of care for treatment and end-of-life care, clarify related values and goals, and state preferences through written documents and medical orders. In situations where a patient’s decision-making capacity is limited, healthcare providers turn to family members to make decisions. When no ACP conversations have occurred between patients and their families, family members are left to make decisions regarding life-sustaining treatment without input from the patient or with little knowledge of the patient’s wishes.

One of the biggest challenges in medical practice is finding a way to spend enough time with each patient amid all the regulatory paperwork. To streamline workflows and encourage better provider-patient relationships, the Centers for Medicare and Medicaid Services (CMS) proposed new reforms to roll back certain regulatory efforts that were saddling clinicians with cumbersome paperwork. As part of those efforts, CMS reevaluated some of its reimbursement methods to improve efficiency with its required paperwork.

The medical terms for living with and beyond a cancer diagnosis identify patients as entering the survivorship phase of their cancer journey. However, as science continues to develop new treatments responsible for extending patients’ lives, new levels of survivorship are being determined.

One of your patients is enrolled in a clinical trial and is scheduled to receive an investigational drug today. She reports a cracked tooth and asks if it’s okay to get dental work. What should you tell her? 

A. To Set up an appointment with her dentist between treatment cycles. 

B. To check with her research team before setting up a dental appointment. 

C. Not to have any dental work done since she’s on a clinical trial.  

D. Have her tooth fixed right away and let the research team know if you have any problems. 

On March 6, 2018, 23andMe—an at-home genetic testing company—announced their direct-to-consumer genetic test (DTCGT) would include DNA results for the three common founder BRCA mutations commonly seen in people with Ashkenazi Jewish ancestry. This was big news because DNA results for the BRCA mutations had been previously available on the 23andMe panel report until the U.S. Food and Drug Administration removed them in 2013.

Despite groundbreaking treatments, novel medications, fast-tracked drug approvals, and cutting-edge science, a terminal diagnosis is still a reality for many patients with cancer. Having end-of-life discussions with patients and their family members is a difficult part of oncology nursing, but it’s necessary to provide the highest quality of care and education possible. With more news reports emerging about states introducing—and passing—medical aid in dying legislation, oncology nurses will face questions about the process from patients and caregivers.

Imagine being in a hospital, unable to verbally communicate and having to find a way to get across your basic human needs. As oncology nurses, we take care of a variety of different patients: some able to make their needs known and some who unfortunately cannot.

More than 13,000 children are diagnosed with cancer every year in the United States. Because treatment options continue to improve, more than 80% of those children will survive at least five years after their diagnosis.

Roxanne, a blood and marrow transplant certified nurse, has been taking care of Jerome, a 20-year-old man diagnosed with acute myeloid leukemia. Jerome is the eldest of seven children; his mother works full-time, and with younger children at home has not been able to make the trip across country to be with her son.

Writing images from one’s memory and imagination can be a healing act. According to a recent study on expressive writing and patients with cancer, some individuals may benefit from participating in expressive writing as part of their supportive cancer treatment. The writing act can be a form of healing for patients struggling with their cancer diagnoses.  

Direct-to-consumer genetic testing (DTCGT) has entered the prime-time stage. It’s difficult to watch TV without seeing ads touting the simplicity of DTCGT and what it can tell you, and it even made Oprah’s 2017 Favorite Things List.

The MeToo movement, an online campaign where women from all walks of life shared their stories of personal sexual assault and harassment, went viral in October 2017. The goal of their stories was to demonstrate the prevalence of sexual misconduct, especially in the workplace. Victims of sexual violence and harassment often go unnoticed and unheard, even though the World Health Organization (WHO) estimates that it affects approximately one third of women worldwide. In a 2017 poll of American women, 54% reported “unwanted and inappropriate sexual advances” and 95% said it goes unreported.

Christina is a 29-year-old African American woman with a strong family history of breast and ovarian cancers and a personal history of benign ovarian fibroids. She was referred to your office because of a suspicious lump in her left breast. Because of her family history, Christina is especially worried. You are concerned that Christina could have a hereditary family cancer syndrome, and you know that a comprehensive family history must be obtained.

American author Kurt Vonnegut once wrote, “Laughter and tears are both responses to frustration and exhaustion. . . . I myself prefer to laugh, since there is less cleaning up to do afterward.” Humor has the ability to sooth and heal, and humor often makes grim situations feel brighter and less daunting. Moments affixed with tragedy, grief, loss, and terror can often soften in time, allowing for understanding, acceptance, and sometimes even laughter.

I just finished writing a sympathy card to the family of “Beth.” For the past five years, Beth was in a support group that I facilitate for individuals with advanced cancer. Beth is an example of why I am an oncology nurse. She was an amazing woman. A deliberate thinker, she collected information and made decisions about her health that fit her goals. She once asked me, “How can you continue to care for folks with cancer year after year? It must be hard.”

I arrived at work on Tuesday morning to find my charge nurse handing out blue ribbons, beads, and bracelets to staff.

"March is National Colon Cancer Awareness Month,” she said. “Put on the blue, we're promoting awareness and encouraging people to get their screenings!" I stared at some of my coworkers with ribbons tied neatly in their hair.

It’s important to know that I routinely have to field the question, "Are you sure you're old enough to be a nurse?" I had a feeling the ribbon wasn't going to help my credibility. This was also my second day of caring for a patient struggling to cope in a very tough fight against colon cancer. Would she mind? Would it be insensitive?