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.

Cancer does not stop progressing because of a pandemic. Although the COVID-19 coronavirus does not recognize that someone with leukemia has been fighting for months, even years, for remission to receive a lifesaving blood and marrow transplantation (BMT), a new program is ensuring that marrow products are available when patients need them. 

Oncology nurses must advocate for prevention and control of the COVID-19 coronavirus to minimize the risk to themselves and the patients with cancer in their care, the International Society of Nurses in Cancer Care (ISNCC) announced in its April 2, 2020, COVID-19 Position Statement. ONS is a full member of ISNCC.

Because of weakened immune systems and prolonged treatment courses, patients with cancer have a higher chance of developing sepsis. Once acquired, sepsis puts patients at risk for hospitalization and increased morbidity and mortality. Prevention and prompt management are essential to improve outcomes. 

As part of a larger understanding of the social determinants of health, geography—whether it’s rural or metropolitan, urban or suburban—plays a huge part in how patients understand, receive, and access care. Regardless of zip code, community, or travel distance, patients have a right to receive the best possible care for their cancer diagnosis. As staunch patient advocates, oncology nurses are primed to help patients navigate geographic disparities and overcome challenges they face in treatment. 

Cancer is a global health problem. According to the American Cancer Society, cancer incidence is expected to continue to grow to nearly 27 million new cases around the world by 2040. In 134 of 183 countries, cancer is the first or second leading cause of premature death for people aged 30–69 years, and it ranks third or fourth in an additional 45 countries. Although cancer is a major health issue across the world, outcomes differ depending on a patient’s country of origin.  

Jamie is completing her last cycle of carboplatin and paclitaxel for stage I ovarian cancer. The oncology infusion nurse notices that Jamie appears withdrawn and nervous, so he takes time to ask her how she is feeling about completing treatment. Jamie responds, “I feel as frightened about finishing treatment as I did when I was diagnosed with cancer.” She also shares that she doesn’t want to ring the cancer center’s bell to ceremoniously signify the end of her treatment because she doesn’t want to “jinx it.”

Throughout the country, Americans have seen the effects of opioid abuse. Rising numbers of overdoses have sent shockwaves through communities from Miami to Seattle and everywhere in between. As such, addressing the national opioid epidemic is still a major priority for the Trump administration.

As groundbreaking yet high-cost cancer treatments make their way into clinical practice, the effects of financial toxicity can put a damper on the profound effects that new, lifesaving medications can have on patients with cancer. It’s a problem that even Washington, DC, hasn’t been able to address—so what can oncology nurses do about it?

At a recent conference I attended, a presenter asked the audience to choose the best treatment option for a case study review. The choices were introduced as three separate viable treatments with the fourth option being “or just refer to palliative care.”

For years, the human papillomavirus (HPV) vaccine has been promoted for its potential role in cancer prevention. In a study released in August 2019 by the Centers for Disease Control and Prevention (CDC), the agency estimated that nearly 92% of all HPV-related cancers could be prevented through proper vaccination.

With the 2020 presidential election cycle in full swing, some Democratic candidates are pushing an aggressive proposal to combat the rising costs of prescription drugs by potentially ending patents for high-cost medications. Breaking the patent of an existing drug to allow competitors to make a cheaper version is a bold step to combat the drug pricing issue, but the potential proposal doesn't seem to be getting much negative push back from either side of the aisle. Many see it as a way to keep the industry in check, and the provision makes for great political fodder on the campaign trail.

Found along the expansive Appalachian mountain range in the Eastern United States, Appalachia is legally recognized as an economically disadvantaged area that’s home to a unique population of patients requiring special considerations.

The cancer prevention conversation is tricky for providers to navigate. Not surprisingly, people want to do everything it their power to prevent cancer. But sometimes conversations involve uncomfortable elements of health care—like sex or sexually transmitted diseases—that can quickly derail the discussion. Despite this, the human papillomavirus (HPV) vaccine is one case where prevention efforts have a led to huge increases in participation, especially among children. Following that thread, the Centers for Disease Control and Prevention (CDC) have committed to spearheading the cancer prevention conversation by encouraging people to discuss cancer prevention early in their children’s lives.

Global radiation oncology research has seen an increased commitment to addressing disparities in the world and at home. The more radiation oncology proves and improves itself as a therapeutic modality, the more we are faced with the reality that the odds for survival are related to geography, poverty, education, and race.

With our heads held high, Michelle Santizo, RN, PHN, MSN, and I walked right into Capitol Hill, ready to tackle meetings with important members of the U.S. Congress. On that day in July 2019, we spoke with staff members working for the offices of both Kamala Harris (D-CA) and Diane Feinstein (D-CA).

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 health care advances, so too does our understanding about the numerous conditions affecting patients, including their mental health and well-being. Messaging from federal agencies like the Centers for Disease Control and Prevention (CDC) about mental health is taking an inclusive, wholistic approach to the many aspects of mental health. CDC presented new educational applications for providers to consider when talking to their patients about mental well-being and their continued success in treatment.

While representing ONS in June 2019 at the National Institute for Nursing Research in Bethesda, MD, I met with my state’s congressional delegation to introduce ONS’s health policy legislative agenda to their offices on Capitol Hill. Despite it being one of the hottest days on record for the nation’s capital, the congressional offices offered a cool place for health policy discussions.

It’s more than just four walls and a roof. Home is where most people find comfort, solace, and a sense of familiarity. It’s where the heart is, and there’s no place like it. With advancements in cancer therapies, treatment care modalities, and technology, many of today’s patients are finding they can receive a large portion of their care in the home. Home care is not a new concept—rather it’s likely the oldest healthcare setting in human history—but it can be a complex and intricate care environment, especially when addressing specific needs related to cancer treatment. At its heart are expert oncology nursing professionals who safely deliver the best possible care for their patients—in the comfort of their own homes.  

The word advocacy comes from the Middle English word “advocacie” or “intercession” and the Anglo-French word “advocassie,” meaning “pleading.” As a profession, I believe nurses pride ourselves as being advocates for our patients and their families. I can easily say that most nurses—myself included—think of advocacy in terms of daily practice. We’re always making sure patients have the right resources and knowledge and have their basic needs met to get through their daily treatments.

For many RNs working in oncology settings, certification might seem like the next step for their career and their commitment to patient-centered care. It’s important to understand the process of certification, along with what resources are available to help them succeed. ONS believes that oncology nursing certification benefits everyone in the cancer care continuum—from patients to family members to the nurses themselves and their employers. Certification shows that a nurse has voluntarily met the rigorous requirements for gaining cancer-based knowledge and experience and is prepared to provide high-quality, competent care to patients with cancer. It acknowledges a nurse’s commitment to career development and dedication to patient care in a constantly changing healthcare environment. 

Oncology care is a complex field in a constant state of paradigm shifts, where new information and research affect clinical practice in countless ways. Amid rapid developments in treatments, technologies, and patient-care modalities, oncology nurses must show they’re up to date with emerging knowledge in their field. Oncology nurse certification is one way nurses can demonstrate their commitment to the art and science of patient-centered oncology care.

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 an oncology advanced practice nurse and administrator for cancer services, every day I care for patients and caregivers coping with cancer. I mentor nursing staff in best practices to deliver care, and I create a work environment conducive to advancing quality cancer care. However, my commitment to supporting people with cancer does not end at the walls of my workplace.  Oncology nurses are called to be a visible change agent in our communities—and beyond—to continue the worthy work of championing quality care for people diagnosed with cancer, along with spreading prevention and early detection information.

The U.S. Food and Drug Administration’s (FDA’s) mission is primarily to protect the American public by regulating the sale and development of consumer items like cosmetics, food, tobacco products, medication, and much more. However, a lesser known arm is FDA’s Oncology Center of Excellence, established to further prevention, detection, patient-centered research, and cancer-specific education.

Developed to combat the nation’s opioid crisis, a comprehensive opioid addiction bill has finally made its way to the president’s desk. On October 25, 2018, President Trump signed the opioid package into law. The new law allots more than $8 billion to address addiction, drug trafficking, and recovery issues. 

As the Affordable Care Act is challenged in court, 12 Republican Senators signed a letter insisting that pre-existing conditions be covered in any new healthcare laws moving forward. Despite initial praise for the GOP, many patient advocacy groups, including the American Cancer Society Cancer Action Network, have voiced concerns about the efforts being far too little and far too late. On September 4, 2018, more than 25 patient advocacy groups came together and released a statement condemning a recent Republican bill stating it didn’t provide enough protections for pre-existing conditions, compared to what’s currently covered under the ACA. The advocacy groups noted the bill's outlying weaknesses and pushed for stronger reassurances.

As an oncology nurse, I’m grateful to work alongside so many colleagues who bring dedication, grace, and skill to their work. No other industry in the world shares the same frustrations or emotional tolls as nursing, but we continue to bring enthusiasm, optimism, and devotion to our daily work. Nurses strive to ensure the best for their patients. It’s the call to patient advocacy that is at nursing’s core.

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.

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.

Financial toxicity in cancer care is an increasingly recognized burden for many patients. Driven by many factors, financial toxicity is often a combination of a patient’s individual characteristics, the costs associated with care, and the overall impact of the illness on a patient’s ability to work throughout the cancer journey. Financial toxicity negatively impacts patient outcomes, and many patients struggle with costs regardless of whether they’re covered by health insurance—this includes undocumented immigrants. Currently, more than 11.1 million undocumented immigrants live in the United States, and they aren’t immune to cancer diagnoses.

On May 7, 2018, the White House told the Department of Health and Human Services to overturn Kansas’s new lifetime limit restrictions on Medicaid. Kansas has been leading the way for states looking to implement restrictions to federal benefits. The state previously implemented work requirements for Medicaid recipients and was trying to impose time limits for how long recipients could receive Medicaid for some time. Had its efforts stood, this would mark a fundamental shift in how the federal program is implemented at the state level.

I was selected to represent ONS as a panelist at the Cancer Innovation Coalition meeting held in Washington, DC in February 2018. The meeting, “Integrating Patient Perspective into Clinical Pathways: A Dialogue Between Stakeholders,” brought together patient advocates, healthcare professionals, and technology stakeholders to address and identify the importance of patient-centered care and involving patients in clinical pathways. The National Patient Advocate Foundation released an article outlining the topics covered in our discussion.

It’s beneficial to think about financial toxicity in terms of issues adhering to treatment. Mounting evidence suggests that patients with financial toxicity aren’t adhering to their cancer care. It’s becoming a common side effect of cancer treatment, and patients might be less likely to take treatments their medical team prescribes because of it, leading to substandard care.

The cost of health care in the United States has been the source of debate for years. Questions range from the extent of Medicare and a Medicaid coverage, how—or if—the government should regulate drug prices, who deserves coverage, and how Institutions collect payments from insurance companies. But often, one important aspect is missing from the numerous conversations on health care, treatments, and financial reimbursements: the patients.

Specialized Knowledge: Quality Care. This is my ONS presidential platform. In several columns, I have discussed how ONS resources can provide you with the specialized knowledge and expertise to provide quality care. This issue, I’d like to focus on quality care.

After failing to garner support for the GOP’s healthcare bill in the Senate—known as the Better Care Reconciliation Act of 2017—Senate Majority Leader Mitch McConnell (R-KY) noted that the next strategy for repealing and replacing the Affordable Care Act (ACA) would be to repeal the legislation without any concrete healthcare bill to replace it. In 2015, the Senate already successful voted to repeal the ACA, but it was vetoed by former President Obama. According to McConnell, the 2017 repeal effort would provide a two-year window to ensure a stable transition.

Earlier in 2017, a group of 12 nurses traveled to Cuba to learn about cancer care and the healthcare system there. Cubans are very proud of their healthcare and educational systems, which are offered without charge to their citizens. We learned so much on this trip, but my take-home message from this experience was the importance of prevention and early detection.

Two members of the House of Representatives have put political party differences aside and introduced bipartisan legislation that requires health insurers to cover traditional chemotherapy, along with oral medications associated with cancer treatment. U.S. Representatives Leonard Lance (R-NJ) and Brian Higgins (D-NY) have proposed the Cancer Drug Parity Act (H.R. 1409). The intent of the bill is to ensure appropriate oncologic treatments are affordable and covered for patients with cancer.

Imagine a situation where a patient’s tumor cells were used for countless scientific experiments—without the patient’s informed consent. Safeguards are in place today to prevent such an ethical breach, but in 1951 Henrietta Lacks and her family weren’t as lucky. Author Rebecca Skloot shared Henrietta’s story in a 2010 nonfiction book, The Immortal Life of Henrietta Lacks, that was adapted into a movie released on April 22, 2017.

As an ONS member, I participate in the Bipartisan Policy Center and represent oncology nursing in dialogue and advocacy regarding health policy topics that are at the forefront of cancer care.