Although it’s impossible to predict what can lead to cancer in any individual, researchers look at data compiled over many years to make confident decisions that certain behaviors, characteristics, and factors increase the risk of developing cancer. By discussing these factors with patients, oncology nurses can potentially reduce or identify their chances of developing future cancers.
Whether you’re speaking with a patient, caregiver, or extended family, explaining risk factors can help reduce the chances for developing potential diseases and treatment comorbidities. Many risk factors can be lessened by altering certain behaviors, which means that education and guidance are key components in cancer prevention.
Opening a Dialogue About Cancer Risk Factors
For many patients, knowledge of cancer risk factors may come from any number of sources, be it television, news, or entertainment. One of the most commonly misunderstood factors for cancer is hereditary risk. For ONS member Sharon K. Byrne, DrNP, APN, NP-C, AOCNP®, CNE, advanced practice nurse for the Cancer Screening Project at the University of Texas M.D. Anderson Cancer Center at Cooper in Camden, NJ, clear communication is key for her patients.
“Even though we as providers or nurses think people know about heredity and cancer risk related to the media coverage of the topic, in reality a large majority still appear misinformed,” Byrne says. “As nurses, we need to use lay terminology to discuss that the genes our patients are born with may contribute to their risk of developing certain types of cancer, including breast, ovarian, colorectal, and prostate cancer. We also have to allay fears and point out that only about 5%–10% of cancers are caused by harmful mutations that are inherited from a person’s parents.”
ONS member Julie Eggert, PhD, AGN-BC, AOCN®, FAAN, Mary Cox professor and coordinator of the healthcare genetics doctoral program at the Clemson University School of Nursing and advanced genetics nurse at St. Francis Cancer Center in Greenville, SC, says it starts with asking questions and creating a dialogue with patients.
“It’s always a question-and-answer discussion about their family and personal history of cancers and environmental risk factors encountered over their lifetime,” Eggert says. “I use the high-risk National Comprehensive Cancer Network guidelines for breast, ovarian, or colon cancer. The American College of Medical Genetics and Genomics and the National Society of Genetic Counselors also have referral indications for cancer predisposition assessment, which are very helpful as well.”
Unfortunately, misinformation can lead to uncertainty and misunderstandings between patients and providers. Discussing certain risk factors, especially those related to family history, can be helpful in dispelling myths that your patients believe.
According to Eggert, “I find people who think if their mother had breast cancer—whether at age 35 or 92—they are at high risk. With regards to the age of the patient or family member, they didn’t think that was an issue and the history of mother with breast cancer was important to them.”
This can lead to troubling recommendations and unnecessary screenings. “I’ve seen mammography screening initiated in patients’ 20s because mother was diagnosed at 72,” Eggert said. “This was when no one else in the family had breast cancer.”
Byrne notices misconceptions around breast cancer risk as well. “Patients may at times think that only the maternal side of the family is important, especially for breast cancer genes,” she says. “For those that are red-flagged as being at risk, a prudent provider will refer to the clinical genetics counselor or service at their respective institution, so they can make informed decisions about risk and the option of testing.”
When approaching misinformed patients, it’s best to answer their questions head on. “I think nurses as providers need to use an evidence-based approach to the information they share with patients, make sure they speak at a level the respective patient will comprehend, be willing to repeat information, and above all be truthful,” Byrne says.
Addressing Modifiable Risks
Although patients aren’t able to change things like age and heredity, they can still be active in reducing their risk for cancer by understanding their behaviors and environmental factors (see sidebar). According to Byrne, “Patients probably know about the purported risk that tobacco, sun exposure, high-fat diet or obesity, and some hormones play in increasing cancer risk, but they might be unaware of industrial carcinogens and chronic inflammation.”
To address modifiable risk factors with patients, Byrne and her colleagues at the University of Texas M.D. Anderson Cancer Center at Cooper have been working on the Cancer Screening Project. Through this project, “providers and staff use a variety of resources to share knowledge about modifiable risk factors with our patients,” Byrne explains.
“Patient education pamphlets and handouts come from a variety of sources, such as the American Cancer Society, National Comprehensive Cancer Network, American Congress of Obstetricians and Gynecologists, and the National Ovarian Cancer Coalition,” Byrne says.
The Cancer Screening Project also works to actively engage patients through games and activities. “One of the biggest resources is our own M.D. Anderson Cancer Center at Cooper Cancer Outreach, Education, and Screening Program’s ‘Educational Parties,’” Byrne notes. “Through the use of gaming strategies such as Bingo and RISK, we promote cancer risk and prevention awareness in various community settings, including homes within our catchment area.”
Understanding Risk Through Genetics
Genetic testing is constantly evolving, making new strides to help identify mutations that could lead to diseases such as cancer. Although tests are becoming more popular, many patients might not fully understand the science behind the genetics. If genetic testing is recommended, oncology nurses could receive a number of questions.
“I’m commonly asked, ‘Can I be tested?’ or ‘Should my children be tested?,’ even if it’s before the parents have been tested,” Eggert says. “When explaining genetics to patients, I’ve noticed that many aren’t aware that only 50% of genes are inherited from each parent—which also means that 50% are not. If the gene mutation is not in the inherited 50%, then the patient is not at risk.”
Genetic testing is already becoming a common part of cancer care. It’s important to support your patients by educating them, answering their questions, and connecting them with a genetic counselor who can help, Eggert says. “My patients also talk about us being their advocates for insurance issues related to genetic testing and risk identification.”
“Be the best advocate you can be for your patients, their families, and the community in general related to cancer risks,” Byrne summarizes. “Education can go a long way!”