Listening to feedback from patients is still one of the most important ways providers can assess and plan treatments for patients with cancer.
However, symptom management is never as simple as screening for pain or asking about fatigue: it involves complex decision making, evidence-based interventions, and the support of the entire care team. It’s a central practice to oncology nursing, and it’s paramount to the successful outcomes of patients with cancer.
The Importance of Managing Symptoms
The National Cancer Institute (NCI) reported that anywhere from 20%–50% of patients with cancer experience pain related to their disease or treatment. Beyond that, 14%–96% of patients with cancer report feeling fatigued during their cancer treatments, and 19%–82% of patients report feeling fatigue posttreatment. Those are only two of the most common side effects related to cancer. These numbers don’t tell the story of patients suffering from constipation, anorexia, dyspnea, nausea and vomiting, or the myriad other side effects that pervade cancer treatments.
ONS member and former ONS president Carlton Brown, PhD, RN, AOCN®, NEA-BC, FAAN, oncology nurse consultant and president of Zenith Healthcare Solutions in Portland, OR, knows that oncology nurses are in the unique position to recognize the potential symptoms their patients will face and act accordingly.
“One of the most important aspects of symptom management is being proactive with patients about potential symptoms that they could experience,” Brown says. “At this point in our process of symptom management, we have so much predictive data about symptoms associated with chemotherapy, immunotherapy, radiation, and other treatments—we know from the experiences of millions of patients what symptoms they will experience with their cancer treatment. We need to find ways for nurses to utilize that predictive information for proper symptom management.”
For ONS member Victoria Sherry, DNP, ANP-BC, AOCNP®, oncology nurse practitioner at the Abramson Cancer Center in the Hospital of the University of Pennsylvania in Philadelphia, the benefits of proper symptom management are exponential for patients and caregivers.
“Being on the forefront of patient care, oncology nurses are in a unique position to make a significant impact on a patient’s quality of life; they can decrease distress and improve outcomes through symptom management. Additionally, they impact the success of caregivers in helping their loved ones through the cancer trajectory,” Sherry notes. “The value of oncology nursing in symptom management is becoming increasingly important as treatments become more complex.”
Overcoming Challenges in Symptom Management
Identifying symptom profiles and screening for potential side effects is the just first step toward improving quality of life for patients. Offering evidence-based interventions is key to successful outcomes, but that process can pose known and unknown challenges to the healthcare team, especially as new treatments are developed and approved.
“Oncology treatments have become increasingly complex. With the recent addition of immunotherapy, oncology nurses need to be educated about the immune-related adverse events (irAE) associated with these drugs,” Sherry says. “Early detection is key; therefore, stress to patients that any change from their baseline must be reported to their healthcare team immediately. Oncology nurses need to recognize the signs and symptoms of an irAE, because early detection is crucial to reversing the symptom and keeping the patient on treatment.”
Sherry also notes the potential cost involved with certain interventions important to symptom management.
“Medical marijuana is quickly becoming legalized in many states and is a hot topic among patients with cancer. Obtaining a medical marijuana card can be time consuming and quite pricey for patients,” Sherry notes. “Studies have shown marijuana to be effective for nausea, anorexia, neuropathy, and pain. However, healthcare providers are still trying to identify how to best use this for our patients without hurting their wallets in the process.”
Finding the Best Resources for Symptom Management
Intervening with evidence-based resources can make all the difference to patients plagued with treatment associated symptoms. Organizations like ONS are working diligently to prepare clearly documented information to oncology nurses. The ONS Putting Evidence Into Practice resources are a simple, intuitive, one-stop database for common symptoms associated with treatment. “Other excellent symptom management resources include ONS publications like the Clinical Journal of Oncology Nursing and the Oncology Nursing Forum, ONS textbooks like A Guide to Symptom Management (Second Edition), the National Comprehensive Cancer Network guidelines, and the Cochrane Review website,” Brown says. (See sidebar.)
Sherry also encourages nurses to look within the care team for experienced colleagues and interprofessional assistance. “Never underestimate the knowledge of seasoned oncology nurses—through years of experience they know what works and what doesn’t work, medications that will or will not be covered by insurance, different techniques and approaches, etc. On the flipside, experienced nurses need to take the time to mentor our oncology fledglings in the symptom management arena. The combination of using evidence-based guidelines, personal experience, and thinking outside of the box is a phenomenal thing.”
Interprofessional resources are also readily available to oncology nurses. This includes reaching out to palliative care specialists, occupational therapists, pain management specialists, nutritionists, and more. “Talk with your cancer care team and make suggestion or referrals to these invaluable team members,” Sherry insists.
Using Technology to Move Forward
For Brown, incorporating technology into symptom management could allow nurses to address reported symptoms in real time. He notes technology as a burgeoning area of development where symptom management can take a huge leap forward.
“We are at the point now that we know what symptoms patients with cancer experience during and after treatment, and—for most of the symptoms—we have detailed evidence-based practice interventions. The real challenge for symptom management is arming nurses with those evidence-based interventions that they can use readily,” Brown says. “Part of the issue with symptom management is properly educating nurses about the evidence-based practice intervention process, but the other part is using technology to help deliver those evidence-based interventions to nurses almost immediately for patient care so that nurses can use them to help alleviate symptoms.”
Brown notes that oncology nurses are already skilled at hunting down the necessary interventions for their patients and reporting back to them. However, in the time it takes to do that, symptoms may get worse, change, or otherwise negatively impact care or quality of life. By having interventions at the point of care, symptom management can be more seamlessly integrated into patient care.
ONS’s Qualified Clinical Data Registry (QCDR) offers patient-centered quality measures (see sidebar) and tools to report progress from baseline to continuous improvement. It addresses care issues for people receiving chemotherapy and treatment-related issues for cancer survivors, is appropriate for the inpatient and ambulatory setting, and can be used by all care settings and specialties that provide care to cancer survivors. For more information, visit the ONS QCDR.
Making an Impact With Symptom Management
Ultimately, oncology nurses stand at the forefront of symptom management. Through integrating evidence-based practices into care, they directly improve outcomes and quality of life for their patients.
“Nurses have always been in the perfect situation to help patients with proper symptom management. For nurses in inpatient care, they are with patients virtually 24 hours a day, seven days a week,” Brown notes. “In outpatient settings, and even in the home at this point, nurses have established relationships with patients that potentially gives them better access to patients. And they trust oncology nurses, because nurses are there for patients in difficult times, especially at times associated with the need for symptom management.”
Both Sherry and Brown agree, oncology nurses must continue to adapt and evolve to move symptom management forward.
“Research has repeatedly shown that oncology nurses are the crux of symptom management,” Sherry notes. “Be sure to use your resources, stay current on the literature, advocate for updated guidelines at your institution, educate and empower your patients, spend time with patients and their family members, and build relationships to provide the best possible care for your patients with cancer.”