Ambulatory oncology began to gradually evolve in the mid-2000s to include multiple aspects of the care continuum. Then suddenly, a pandemic skyrocketed that growth as institutions Raced to develop their ambulatory infrastructure to meet new and changing needs.

Simon is a 72-year-old patient diagnosed with myelodysplastic syndrome and acute myeloid leukemia. He underwent an HLA-identical sibling peripheral blood stem cell transplantation with fludarabine and melphalan as conditioning chemotherapies before the procedure. Simon is now more than 12 days posttransplant but still neutropenic with an absolute neutrophil count of 0. He has no signs of engraftment, is on total parenteral nutrition, and requires multiple blood transfusions and electrolytes through his central line catheter daily.

Thrust into the mainstream in 2020, telehealth has transformed how patients with cancer receive some of their care, substituting certain traditional in-person office or clinic visits for phones, videos, and apps and devices that monitor patients’ health. It’s improved access to care in areas previously considered at risk for disparities: for example, patients in remote locations can be managed in an acute-care setting using television monitors, cameras, and call buttons to contact specialists. 

Only 19% of strategies to implement clinical practice guidelines are fully effective and the majority (43%) are not effective at all, according to the findings from a clinical review in the European Union. Effective guideline implementation requires teamwork, interprofessional engagement, and selecting the most appropriate tool for the job. 

The COVID-19 coronavirus pandemic is unchartered territory with many unknowns, especially a new reality that nurses may be experiencing for the first time: virtual patient care. Even at a distance, the team at Jefferson Health New Jersey Sidney Kimmel Cancer Center in Sewell wanted to ensure we offered the same level of care and encouragement to patients in all phases of the cancer continuum, so here’s what we found worked for us.

The Oncology Care Model (OCM) is a value-based payment system that the Centers for Medicare and Medicaid Services is piloting. OCM focuses on decreasing the cost of cancer care while continuing to provide high-quality care, including a high level of care coordination and navigation and adherence to national guidelines for care. Part of OCM requires implementing certain practice changes, including documenting a 13-point care plan for each patient.

Better care. Smarter spending. Healthier people. Those are the three hallmark goals of the Oncology Care Model, a value-based payment system developed by the Centers for Medicare and Medicaid Service’s Center for Innovation.

The preliminary outcomes for performance in the first year of the Oncology Care Model (OCM) have shown modest but interesting results for the value-based payment model. Centers for Medicare and Medicaid Services’ year-one evaluation examined the initial impact of the new payment model on practice in terms of outcomes related to total cost of care per practice, unplanned hospital and emergency department visits, hospital visits, and patient-reported satisfaction with care for six-month episodes of chemotherapy for beneficiaries from July 1, 2016–June 30, 2017.

After years of confusion, discussion, debate, and dedicated advocacy work, lawmakers are finally understanding what palliative care is—symptom management, not hospice—and how it’s employed in care. The benefits of early palliative interventions for many diseases, including cancer, can improve quality of life for patients as they navigate their diagnoses. To increase awareness and availability of palliative care in practice, Senators Jacky Rosen (D-NV), John Barrasso, MD (R-WY), Deb Fischer (R-NE), and Tammy Baldwin (D-WI) launched the bipartisan Senate Comprehensive Care Caucus on July 31, 2019.

In divisive times, fewer congressional bills find their way to the president’s desk without considerable bipartisan support. The dance of legislation is complex. Maneuvering through the legislative terrain and avoiding political landmines requires partnerships, expert data, and—at times—a little bit of luck. In the case of the Cancer Care Planning and Communications Act (H.R. 3835), that’s the story so far.

As genetic and genomic testing become more common—and complex—in cancer diagnosis and treatment decisions, more efficient and accessible ways of providing comprehensive genetic care are needed. In their article in the February 2019 issue of the Clinical Journal of Oncology Nursing, Pierle and Mahon discussed the findings from their literature review, specifically pertaining to genetics care services across the cancer continuum, patient and system barriers to accessing care, new service delivery models, and oncology nurses’ role in providing comprehensive cancer genetics care services.

Patients with cancer are living longer, embarking on complex treatment regimens, and experiencing more complications associated with care. As a result, a large volume of patients with cancer require urgent or emergency visits throughout their disease trajectory. Although the need remains constant, what has evolved over time are the chief complaints that bring patients in, the care associated with complications, and new options to lower the burden and cost of care.    

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.

Use of oral therapies requires healthcare teams to monitor patients for issues such as unreported side effects, medication nonadherence, and incorrect administration of medications. Although many patients do very well with this form of treatment, some patients, even with a significant amount of education before starting therapy, may have challenges. 

Although care coordination and interdisciplinary collaboration are essential components of every oncology nurse’s role, oncology nurse navigators (ONNs) take that work even farther by helping patients and caregivers navigate a complex healthcare system and access much-needed resources. By ONS’s definition, ONNs are key in meeting patient and caregiver needs while providing evidence-based, cost-effective, and quality cancer care by eliminating barriers to timely care.

What makes a great oncology nurse? Is it opportunity and experience? Is it passion? I’ve worked with managers who’ve held wildly different opinions on these hiring characteristics, but I would argue they’re all critically important.

Oncology nurse navigators (ONNs) fill a critical, ever-growing role in cancer care settings across the country, providing patients with the resources, education, and care coordination they need to successfully navigate their cancer journey. By reducing barriers and burdens on patients and their caregivers, ONNs help lead patients from initial diagnosis, during treatment, into survivorship, and often through end-of-life care. 

As improved screening, diagnosis, and treatments lead to cancer’s classification as a chronic disease, people with cancer are surviving longer than ever before. However, with lengthened survival comes long-term physical and emotional symptoms and other sequelae that require ongoing surveillance and management. Advanced practice registered nurses (APRNs) are essential to delivering quality survivorship care.

The cost of cancer care and the quality of patient services has always been a top priority in health care. However, the Centers for Medicare & Medicaid Services (CMS) Innovation Center has been working to strengthen both elements of care. CMS, through its Oncology Care Model (OCM) division, works with cancer care providers to develop payment strategies and performance categories in treatment plans for patients with cancer.

Even for medical professionals working in health care every day, the U.S. healthcare system can be incredibly complex. Understanding where to obtain information and how to connect patients to resources can be difficult. For patients, navigating their treatment journey can be—at times—downright impossible. Coordinating care for patients with cancer is a crucial component to successful outcomes and quality cancer care.

When I worked in the clinical setting, like many of you, I guided patients through treatments, prepared them for managing their care at home, celebrated the completion of treatment, and grieved the deaths of many. I coordinated patients’ care. 

Well-coordinated care by knowledgeable healthcare providers improves patient-centered care, supports shared decision making, reduces fragmentation of care, and decreases readmissions and emergency room visits. However, patients with complex care needs are often lost in the very systems designed to support them.

Guidelines regarding healthcare provider communication about immunotherapy do not currently exist. Researchers sought to determine patient and provider preferences for this type of information and to identify barriers to communication about immunotherapy. The study’s findings were presented at the 2017 ASCO Annual Meeting.

Nurses in the intensive care unit (ICU) generally see patients with cancer only when they are extremely sick—not throughout the extensive cancer journey they go through before they get to the ICU. Educating and familiarizing ourselves, as ICU nurses, with a patient’s oncology plan, goals, and history can improve overall care. Learning at which points in the process of cancer treatment certain issues are more likely to arise, such as tumor lysis syndrome during high-dose induction, when a patient is most likely to be neutropenic during a stem cell transplant, and other general facts about oncology, can help improve the care we give. It helps us understand our patients as a whole. The oncology population is a huge part of medical intensive care, and encouraging critical care nurses and oncology nurses to collaborate can help improve the continuity of care and eliminate errors in the ICU.

Based on the results of the oncology nurse navigator (ONN) role delineation survey and feedback from ONS membership, ONS evaluated and updated its ONN Core Competencies. Several significant changes were made.

Oncology institutions across the United States are implementing big change in the way nurses and physicians deliver care to patients with cancer. By highlighting quality care and smart spending, facilities are reimagining the way cancer is treated in America. New procedures, research, and technology have redefined the way cancer is treated, so a new system for delivery and reimbursement is vital to ensure that quality care can be delivered at a reasonable cost.

Oncology care is a complex, expensive, and often-fragmented area of medicine. To understand the potential need for a new payment model in oncology care, a thorough evaluation of all the data was important. By reviewing the oncology literature associated with costs and quality, we discovered that there were wide variations in the costs associated with the treatment of advanced cancers, but little variation in the outcomes of patients. We also identified gaps in patient care that we thought could be improved.

More than ever before, oncology nurses are required to provide multifaceted care when it comes to managing patients with cancer. As the population of patients with cancer continues to age and cancer becomes more of a chronic condition, oncology nurses are seeing more patients who exhibit comorbidities during their cancer journey.