National Cancer Institute NCI Cancer Bulletin: A Trusted Source for Cancer Research News
January 12, 2010 • Volume 7 / Number 1

Guest Commentary by Brenda Nevidjon

Oncology Nursing
This is the second article in a series of stories related to oncology nursing. Look for the symbol on the left in an upcoming issue for the next article in the series.

Health Care Changes: How Cancer Care Initiatives Can Help

Brenda Nevidjon

New year’s greetings from the Oncology Nursing Society (ONS). Depending on your perspective, 2010 is either ending a decade or beginning a new one. Nevertheless, we have begun a new year and one that brings hope that Congress will indeed come to consensus regarding health care reform.

In the discussions, debates, and deliberations about reform, nursing organizations, including ONS, have actively communicated with Congress and the White House about meaningful solutions to health care reform. As health care providers who spend the most time with patients, nurses know what their patients need and want and recognize that all of the health care disciplines must work together to increase access, ensure quality, and contain cost.

Five initiatives in cancer care could model solutions to challenges in the health care system: interdisciplinary care, patient navigation, survivorship planning, advanced practice nurse-led services, and expanding the science and its translation into care. ONS and our more than 37,000 members are focused on these initiatives.

Cancer care is built on a foundation of interdisciplinary respect and collaboration at the personal and organizational levels. Every day, physicians, nurses, pharmacists, social workers, and other professionals contribute their expertise to develop and deliver care plans. At the organizational level, ONS, along with the American Society of Clinical Oncology (ASCO), American Society for Therapeutic Radiology and Oncology, Association of Community Cancer Centers, Association of Oncology Social Work, and many other cancer professional organizations find common ground in advocating for people with cancer, in developing collaborative projects, and in educating our future oncology health care specialists.

The complexity of care and insurance coverage policies can be overwhelming to patients and families. Thanks to Dr. Harold Freeman’s vision, patient navigation is evolving and being integrated into many organizations. Other specialties are viewing this model as well. At a recent meeting of specialty nursing organizations hosted by ONS, the idea of navigators made sense to many whose members care for patients with chronic diseases. So, too, does a focus on survivorship, and the cancer community is leading the way in developing approaches to living with, through, and beyond a cancer diagnosis. Integral to survivorship is attention to the psychosocial care of patients that is often lacking because of insurance issues or the lack of staff with expertise. Nurses have a holistic approach to patient care, but a recent survey conducted by ONS shows that nurses do not have the time to spend with patients to provide psychosocial support. Whether the mental health parity legislation that has been passed will help people with cancer is yet to be determined.

The goals set by the National Priorities Partnership reflect the heart of nursing and provide opportunities for advanced practice nurses (APN), both nurse practitioners and clinical nurse specialists, to lead a transformation in cancer care delivery. APNs are not only partnering with oncologists in their practices but are leading specialized clinics, such as survivor follow-up, or services, such as palliative care or pain management. ASCO’s study, funded by Susan G. Komen for the Cure, on how nonphysician practitioners (such as nurse practitioners and physician assistants) can provide services to patients with cancer has the potential to confirm what APNs can offer as we face an increasing shortage of oncologists. This study is an example of translating health services science into practice just as basic science is translated into clinical care. Since 1981, the ONS Foundation has provided nursing research funding so that our nurse scientists can continue to seek new knowledge and innovative solutions to gaps in caring for patients with cancer.

In the next 10 years, health care is going to change and so will cancer care. What will not change is the need for highly qualified, well-educated, and compassionate oncology nurses. ONS will continue to provide the resources for nurses caring for patients and will collaborate with our colleagues to ensure that health care changes deliver quality and access for all with a cancer diagnosis.

Brenda Nevidjon
President, Oncology Nursing Society