The Role of an Oncology Nurse, with Mary Gullatte, PhD, RN, ANP, BC, AOCN®, FAAN and Cynthia Cantril, RN

May 8, 2014
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In this podcast, we discuss the role of an oncology nurse.



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

In today's podcast, we'll discuss the role of an oncology nurse. This Podcast will be lead by Mary Magee Gullatte and Cynthia Cantril. Ms. Gullatte is the President of the Oncology Nursing Society and the Vice President of Patient Services and Chief Nursing Officer for Emory University Hospital Midtown. Ms. Cantril is the Director of Oncology Service Lines and Patient Navigation at the Sutter Pacific Medical Foundation, a regional healthcare system located north of San Francisco, California.

ASCO would like to thank Ms. Gullatte and Ms. Cantril for discussing this topic.

Mary Gullatte: Hi, my name is Mary Gullatte. I am presently the President of the Oncology Nursing Society. I'm also the Vice President for Patient Services and Chief Nursing Officer at Emory University Hospital Midtown in Atlanta.

Cindi Cantril: And I'm Cindi Cantril, I'm the Program Manager of Cancer Support Services and Patient Navigation for Sutter Pacific Medical Foundation in Santa Rosa, California.

Mary Gullatte: One of the things I wanted to start with is really to describe a little bit of the role of the oncology nurse in caring for patients and their families with the diagnosis of cancer. The oncology nurse has a plethora of different roles that we play depending on the setting, depending on the situation. Primarily, oncology nurses are identified to work in the primary treatment areas of cancer care that is prevention, early detection, that may be the treatment arm, and if it's the treatment arm then we're talking about surgical oncology, medical oncology, radiation oncology. We also have oncology nurses who work in genomics, in cancer genomics. And so depending on the role and the position, the type of care that is provided by the oncology nurse may vary. However, when you think about the roles that the oncology nurse plays, it may be that of navigator, it may be that of care coordinator, nurse researcher or nurse scientist, nurse clinician, who's actually providing hands-on care, a nurse educator or a nurse consultant. As part of all of those roles, it also depends on education preparation. For example, a nurse scientist is someone who has a doctorally prepared degree in cancer nursing research or nursing research. As a nurse educator, if you are working in an academic setting then you may be a professor or a teacher of nurses who are eventually going to be taking care of oncology patients. So whether that is at the baccalaureate level, or whether that is the master's level, or whether that is a doctoral level. Now, the practice is also dictated by the setting that you're in in terms of whether you're working home care, whether you're working ambulatory care, or whether you're working in acute care, or long-term care. There are, again, a number of roles that can be played. We also have roles for advanced practice nurses and that group can be both nurse researchers as well as nurse practitioners. And with those particular roles in mind, a nurse practitioner, for instance, may be someone who is running an independent symptom management clinic through a hospital or through an oncology physician's group. So, again, there are a number of roles and opportunities for oncology nurses as we manage the care of our patients.

Cindi Cantril: Very well stated, Mary. I think it's also helpful to look at not only the practice setting but the patient within the entire cancer trajectory. So, for example, as a navigator I see patients at time of suspicious finding and then follow them through the entire system, no matter whether they're in the inpatient, outpatient, palliative care, survivorship clinic, wherever they may be, I can follow them through the entire system. So there are system-oriented nurses, as Mary alluded to so eloquently. And there's also nurses that follow patients not only within a particular area of, for example, the infusion areas where that hand-off is made to the chemotherapy infusion nurses whereas when I'm visiting a patient in the hospital they're being cared for by the surgical nurses. So it also can be looked at not only as a setting but rather a whole trajectory that the patient might be moving through depending on where they are in their cancer experience. In addition, I think the other role delineation for patients is to understand the certification of oncology nursing through the Oncology Nursing Society, so that there are actually levels of certification whether you're an advanced practice nurse, which is an AOCN versus an OCN which is an Oncology Certified Nurse. And that essentially ensures to the public and the patient and their multidisciplinary team colleagues that they have achieved a significant level of comprehension regarding the full scope of cancer care and nursing standards within oncology nursing.

Mary Gullatte: And Cindi, I think it's very important that you mentioned the certification piece because within the Oncology Nursing Society and the Oncology Nursing Certification Corporation, which is a separate independent arm of the Oncology Nursing Society, one of our subsidiaries, is that their certifications for the Advanced Oncology Clinical Nurse Specialist, as well as the Advanced Oncology Certified Nurse Practitioner, so those initials or acronyms are AOCNS and AOCNP. And sometimes our patients can get very confused, but what I would like to encourage our patients to do is ask the questions. And many organizations are now permitting nurses to have those credentials prominently displayed either on business cards, or on their name badges, or their lab coats. And so with that in mind, I think it's important that patients have an opportunity to dialogue and ask questions of their care provider in terms of what do all of those initials behind your name mean. It's an opportunity to get to know your provider a little bit better and know what skill set as well as what education and preparation and development that this person who's providing your care has. Cindi, anything else on that one?

Cindi Cantril: No, I think it helps everyone speak a common language with respect to if you know you're being cared for by an oncology certified nurse. You, as a patient, can have a confidence that that nurse has achieved a significant level of education and preparation.

Mary Gullatte: Exactly. And I think when we're talking about being able for our caregivers to be able to communicate with our patients, and our patients and families to be able to communicate better with the care team, it really is about not being shy of any questions that you may have. There's no such thing in my book as a dumb question. Or even if you think we told you about it before, then I think it's important for the patient or family member to ask the question again, it's okay, because the better educated and knowledgeable the patient is about what the plan of care for their cancer treatment and throughout the cancer care trajectory, the better they're able to comply with our plan that we have made together. Because they are not just the provider plans of care, they really are a partnership between the patient and family and the healthcare provider or the oncology healthcare team. Even to the point of writing down your questions, we recommend that patients or families with the patient keep a journal so that you can keep up with the medications that you're on, keep up with what works well for you as antiemetics or analgesics, things that we use for nausea and vomiting, or things that we use to help with your pain. So those are the kinds of things that are very important for you as a patient and family to be able to communicate with us and to ask us those questions. And to keep a journal so that when you're at home two or three weeks after you've finished your treatment, things come up that aren't urgent or don't require you having to call in that you think, "Well, I'm going to see my doctor next week or my nurse practitioner next week. And so these are some questions that have come up that I have for them, so I don't forget to ask them." So what do you think, Cindi?

Cindi Cantril: I think one of the most important things that has happened in the healthcare community with respect to patient and professional or patient and provider communication is that capability within many systems electronic health records or online services that you can directly communicate via email with your provider. I think that that's made a huge difference in clarifying questions that patients have that help the communication be more comprehensive and collaborative within other members of the cancer care team. And I always recommend patients to take a recorder or a cellphone recorder capability device with them when they visit their physician on their first consultation with respect to outlining what their treatment regimen is going to be. Or at any point in time there's a change in a treatment recommendation it's very important for, as you said Mary, for patients to understand it's really a partnership. It's really a patient-centered focus in terms of being able to care for the patient in a collaborative way, not only with the professionals, but one-on-one with your provider. I always tell patients it's kind of like putting together a personal board of directors. It's various members of your care team including your community, your friends, your loved ones, your family, become part of your care team in a different way and everybody has a particular role. And it's really a good way to approach the whole comprehensive nature of what patients need to get through their cancer care experience. Also, I think that the addition with respect to now so many-- over 12 million cancer survivors in this nation and growing, thankfully. I think one of the other real great strategies are the free American Cancer Society tools and cancer managements. There's CANCER 101 Planners. There's communication that gives you long-term calendars in terms of what your follow-up visits should be. Every patient who ends up completing treatment should really have a established at that time of treatment completion, a survivorship care plan that looks at what their follow-up should be, what drugs they got, what side-effects they might anticipate long-term, when their return scans or when their return visits should be. So that it's still a very active part of the process. It's not just at the moment of diagnosis, it's actually at the end of treatment as well.

Mary Gullatte: Very well said, Cindi. And I think a couple of tools that I would like to encourage patients and families to ask for when they go in for their treatments. One is a treatment care plan, and many cancer centers are offering a treatment care plan to the patients that is in language that patients can understand. That has a listing of all the medications that they're on, the cancer chemotherapy drugs that they're receiving, as well as something that can go back to the community from their initial referring primary care physician. The other one is as the patients finish and complete their treatment, a survivorship care plan that the patient that is very interactive between the oncology care team, the primary care provider, and the patient and family. So that what are those follow-up care needs now that you have received a clean bill of health, so to speak, from your oncologist that everything looks good, your cancer is in remission, and now we just need to do some long-term follow-up. So that's also helpful. So the treatment care plan and the survivorship care plan are a couple of tools that I would recommend that patients and families request when they go in to see their oncology care team.

Cindi Cantril: And I think it's important for patients to really be clear about who is the contact person for their care planning and who's the contact person throughout their whole experience. In other words, when patients enter into a cancer care team, as Mary pointed out, there's surgical oncology, medical oncology, radiation oncology. So patients may move through different care settings, and it's important to know who is the oncology nurse advocate for them within that particular setting. So who is their radiation oncology nurse assigned to them, who is their chemotherapy infusion nurse assigned to them. So that that is a wonderful touchpoint for the patient and the caregiver in terms of communication because we all speak to each other in terms of a multidisciplinary team, but the patient can often wonder, "Well, who is the best person for me to call?" So a tip with respect to how to better communicate is to make sure you know who your oncology nurse is at that particular care setting that you can call. One of the most wonderful models I saw many, many years ago was actually at a Cancer Care Center in Texas where when the patient entered the cancer center they were assigned an advocate, and that person was the one person that the patient or caregiver could call to identify answers to their particular questions. It may be a question related to financial support, it may be a question related to nausea and vomiting, but that one call was then triaged appropriately. Now that was way before, there's now an electronic record where we can look at multiple provider notes or care team notes. But many patients often get their care in different settings. They may get there-- particularly in northern California, they may be getting their radiation therapy at one facility and their infusions in another facility. So, again, going back to finding out who is the important person at that particular care setting that is their contact person is critically important.

Mary Gullatte: Yes it is. And another important aspect of communicating with the nurse, for the patient and family, has to do with making sure that they know any other health problems or health issues that are not related to your cancer diagnosis that those providers need to know about including different medications that you may be taking whether prescribed or unprescribed. Something that you can purchase over-the-counter such as a number of the different vitamins, and herbs, and things like that. We really want to partner with our patients and not have them feel that they cannot tell us about some of the over-the-counter medications that they may be taking because it's important for us to know because there may be interactions between the medications that we're prescribing for them and the medications that they may be taking over-the-counter. And I think of some in particular that may cause blood thinning, if you will, and so if the patients are also on some medication that we're giving them that's going to cause their blood counts to drop, that it would interfere with platelets or blood clotting, then we don't want them also taking something over-the-counter that's going to cause the same issue. So, again, it's important that the patients and families communicate with us as the oncology healthcare team, partners with them, to let us know about additional medical conditions, as well as medications that they may be taking that are not related to their cancer treatment and symptom management.

Cindi Cantril: Very well said, Mary. And in addition to that, what else helps is for the patient to organize everything in one notebook or everything in one place, those folders that I alluded to, the Cancer 101 or the Lance Armstrong Foundation, has a wonderful planner, or The American Cancer Society, or individual, for example, I know at Sutter we have our, for example, a breast notebook where I put-- when I tell the patient their pathology results, I give them a copy of their pathology report and go through it, and encourage them to take all of their test results with them all the time, wherever they go. Because it's important for the patient to have a copy of everything, every result that we have. It's really about, as you alluded to, Mary, that partnership between the provider and the patient. A way to organize your care is a very rewarding part of this, in the sense that it's one thing that patients can control and be very active in their own treatment and outcomes.

Mary Gullatte: Yeah, and I think kind of a final message that I would like for our patients and families to understand, is that the oncology nurse team member is a partner with you on your journey. And so, there's nothing too big or too small for you to share with us or to disclose to us. And we're really your navigator and that just happens to be Cindi's position title. But we really are your care coordinator to make sure that things are going well, that you are getting the best out of your treatment and that if you're having any issues and problems that we're addressing those with you both from a preventive standpoint as well as a comfort measure. If you are going home after your treatment and two or three days later you're having issues with nausea and vomiting, we need to know that. Don't just expect that that's-- I just have to suck it up and I just have to deal with it. Let us know because we have too many wonderful pharmacy medications that we can share with you, and try to make sure that you are as comfortable as possible both from a symptom management standpoint, which includes the nausea, vomiting issues as well as pain. And peripheral neuropathy or that's something when you have the numbness in the fingers, and in the toes, and in the feet, you need to let us know when that first starts and not think that, "Oh well, this is something I should expect." Let us know any changes that you have in your physical condition, regardless of how big or how small you think they are so that - it may be an early warning sign of something that we need to jump on or change direction in something - so that we can make sure it doesn't get any worse. So I just really want to express that we're here for you, we're here to help provide the best care outcomes for you that we can as you navigate and go through your cancer journey. Cindi, any last words?

Cindi Cantril: No, you and I have often talked about our mutual hero, Dr. Harold Freeman [laughter], who is-- every day when I wake up I'm reminded of his words, and Mary's heard me say this is that, "No patient should spend more time fighting the health care system than they do with their disease." And I think that that's the pivotal role that oncology nurses have, is that we really are your voice and your advocate.

Mary Gullatte: Absolutely. Very well said. Thank you.

ASCO: Thank you Ms. Gullatte and Ms. Cantril. More information on the role of an oncology nurse can be found at

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