Specialist Cancer Nurses: Why they matter
Although technology may have changed the role of nurses, what they do for cancer care is more important than ever. By Professor Meinir Krishnasamy, inaugural Chair in Cancer Nursing at the University of Melbourne.
Receiving care from a specialist cancer nurse is the most consistent factor in patients saying their treatment experience was a good one.
That was one of the key findings in the 2013 and 2015-16 Victorian Comprehensive Cancer Centre Patient Experience Survey (CPES). But the same finding has been reported in other countries such as the UK. Is this coincidence or is it, as is often reported about nurses, that they are just kind, caring people?
The answer is neither. It’s because nurses who have committed to developing specialist nursing knowledge through postgraduate education have developed expert understanding of cancer biology. They have studied the risks and consequences of different drugs on vital body organs and the effects of cancer and its treatments on mental health, cognitive and physical function. They focus on family dynamics, ability to work, social integration, and financial concerns.
They educate patients, family and friends about potential side effects of the drugs they are on, the clinical trial they have started. They can help a patient tell their child, parent, sibling or boss they have cancer, or sit and ask a patient and their loved ones what they understand about their cancer. They can communicate what needs to happen next, reassure people that their cancer may not be curable but there many, many things that can be done to ensure quality of life and, where possible, extend quantity of life. They can take all of this information and develop a unique plan of care for and with the person in front of them.
That is a specialist cancer nurse.
Specialist cancer nurses mean the difference between living with cancer and living well with cancer. The knowledge, skills and expertise that come through studying at an advanced level mean that people who find themselves faced with one of the most feared and dreaded of illnesses have nurses who have the latest research at their fingertips.
Specialist cancer nurses are the first line of defence for patients. A specialist nurse who asks to look inside the mouth of a patient undergoing chemotherapy is concerned about the development or presence of mouth ulcers (a common side effect of the treatment).
Why? Because mouth ulcers can become a pathway for infection throughout the body for people who may have little ability to fight infection once their treatment has started. An infection can be life-threatening. The severe pain of mouth ulcers can lead to knock on effects: inability to eat may may lead to weight loss that can reduce ability to respond fully to treatment and may delay or complicate recovery. If left unmanaged, pain may lead to depression and withdrawal from family and friends, which has been shown to impact response to treatment and recovery.
Many things that specialist cancer nurses seem, at face value, to be simple. This is the essence of specialism: the more expert you are, the easier you make things look. Talking to and walking a patient to the bathroom and asking what’s going on in the news are just some examples of how a skilled nurse assesses balance, condition of a patient's skin, their ability to stand and walk independently, whether they are oriented to time and place, their emotional wellbeing, or their motivation to get home, get back to work, and care for themselves ... and that may all happen in the space of five minutes.
These are the skills of many specialist nurses in aged care, paediatrics, and in renal or cardiac nursing. Excellent nursing requires excellent knowledge. But perhaps at no time in the history of cancer care have specialist cancer nurses been more important for people affected by cancer.
Cancer treatments are changing at an incredible pace. Patients benefiting from advances in genomic medicine deserve nurses who understand and can recognise the risks and benefits of these new agents.
They need and deserve nurses who have advanced understanding of what these treatment opportunities mean for side-effects, symptoms and the health outcomes that matter to patients.
And they need nurses who can help prepare and educate patients and their families, so that the investment in the development of these new drugs is fully realised for the people who need them:
- patients who previously could not benefit from radiation therapy because of the limits of technology but are now able to benefit because of the progress in precision delivery;
- patients who previously could not have surgery because of the extent or location of the cancer, but are now able to have surgery because of advances in surgical robotics
- patients diagnosed with a rare or less common cancer, with uncertainty about the hope for cure or long-term control of the disease
Patients need specialist nurses who can assess, anticipate, prevent, manage and treat complex, sometimes multiple interacting symptoms or problems. This requires knowledge of cancer biology, pharmacology, patterns and signs of disease spread, and the physical, emotional, social and spiritual consequences that shape the quality and quantity of life of an individual, and the memories and experiences of those left after the death of a loved one.