By Arushi Sinha

“Oncology nurses are people who aren’t afraid to care‚” says Alan Kindler‚ 29‚ of Wauwatosa‚ Wisconsin.He should know. As a survivor of Ewing’s sarcoma‚ Kindler‚ who was diagnosed in January 1997‚ has been treated in many different settings across the nation‚ undergoing chemotherapy‚ a bone marrow transplant‚ and other surgery.

“I have been treated in hospitals‚ clinics‚ even at the National Institutes of Health (NIH)‚ and meeting the right oncology nurse can make a difference‚” says Kindler.

Oncology nursing combines art and science‚ requiring nurses to be skilled in many aspects of care‚ medical as well as the personal. While physicians diagnose‚ stage‚ and treat cancer‚ the oncology nurse is instrumental in teaching the patient about the disease‚ including potential side effects of treatments‚ symptom management‚ and the emotional effects of cancer on the patient and his or her family.

“The difference between a physician and a nurse is that physicians deal with the disease itself‚ and oncology nurses help patients and family members learn to live with the disease and with the treatment process‚” explains Judy Lundgren‚ RN‚ MSN‚ AOCN®‚ president of the Oncology Nursing Society.
The OCN® certification offered by the Oncology Nursing Certification Corporation is a two–year process that trains the nurse in all aspects of oncology nursing. The nurse takes a written exam testing his or her knowledge of the cancer disease process‚ prevention‚ genetic risks‚ chemotherapy‚ radiation therapy‚ and a whole host of other issues. Upon passing the exam‚ the nurse is identified as an OCN or Oncology Certified Nurse. A nurse with an AOCN designation after his or her name has a master’s degree in nursing (MSN) and has successfully passed the advanced certification exam.

Oncology nurses who work in chemotherapy programs administer medication‚ monitor vital signs‚ and teach patients about potential side effects and how to deal with them. Radiation oncology nurses understand the principles of radiation therapy and its side effects. Their work may include everything from assessing nutritional status to providing psychosocial support for patients and their families.

For those patients who find the side effects of radiation therapy overwhelming‚ the radiation oncology nurse refers patients to various resources and makes sure they are able to maintain good health. Oncology nurses who work on clinical trials protocols teach patients about how trials are conducted and about informed consent procedures.

Before clinics begin‚ the oncology nurse prepares charts for clinic‚ ensuring that they are complete with the latest updates: laboratory results‚ prescription updates‚ disability or insurance information‚ X–rays‚ and all of the other information that may be needed by the oncologist to help decide the appropriate treatment.“Once the clinics begin‚ a nurse might see a patient every 15 minutes‚” explains Kimberly Ivester‚ RN‚ BSN‚ OCN‚ MS‚ an oncology nurse at Iowa Cancer Care‚ Cedar Rapids. The nurse reviews the patient’s vital signs and medical history‚ discusses any medication changes with the patient‚ and may also accompany the patient to the next part of his or her treatment in the infusion room.

Ivester says one crucial interaction is teaching patients about chemotherapy‚ which brings to bear all of the specialty training. The nurse will pull drug information cards for particular chemotherapy drugs‚ and discuss side effects‚ treatment options‚ and new drugs on the horizon. The nurse will also answer any questions the patient might have and discuss which potential side effects might be cause for concern.

“Oncology nurses do a phenomenal amount of teaching‚” agrees Lundgren. “They train the patients about when to be concerned‚ when to pick up the phone‚ when to panic‚ when not to panic‚ what dietary adjustments need to be made.”

The oncology nurse listens to particular complaints in relation to cancer treatments‚ says Lundgren. For instance‚ a rash may be just a simple skin rash or it may be something that is the result of treatment.
“There are things that can wait‚ but there are also things about which a patient needs to call a medical professional immediately‚ no matter the time of the day or night. We help teach patients the difference‚” explains Lundgren.

Teamwork
Oncology nurses focus on the patient and his or her needs and concerns. Cancer is unique because treatments can happen over several weeks or even months‚ which gives the oncology nurse a chance to develop strong bonds with the patient and his or her support network. “The best part of my job is getting to know the families‚” says Ivester.

Ivester’s own family was crucial to her becoming a nurse. Her grandmother was a nurse. “I’ve always wanted to be a nurse‚” says Ivester. “There just wasn’t much question.”

Ivester says she enjoys being part of the healthcare team that cares for patients every day‚ even weekends‚ and develops long–lasting relationships with patients and their families. She jokes‚ “I see my patients more than I see my family. The patients are here even on weekends!”

Treating cancer is a team effort involving many healthcare professionals‚ patients‚ friends‚ and family. Ivester reassures her patients‚ “Whatever happens‚ we will get through it together.”

Oncology nurses also help match patients to community agencies‚ counseling‚ and support groups. The oncology nurse might discuss familial or hereditary risks with patients. Oncology nurses may also counsel patients on the spiritual aspects and the larger “Why me?” questions that patients have in dealing with a cancer diagnosis.

“People are so immobilized by the word ‘cancer’ that they may think that they have no choices‚ but they do‚” says Lundgren. She encourages patients: “Never hesitate to ask a question. The answer is always ‘No’ if you don’t even ask.”
“The best part about my job is learning from the patients about how they deal with a potentially life–threatening illness‚ how they deal with adversity‚ and how they deal with happiness‚” says Lundgren. “The biggest challenge is not always being able to make patients as comfortable as you would like. That is terribly frustrating.”

“It can be a very big challenge for the oncology nurse when the best doesn’t happen for all patients‚” says Kindler.

Kindler recounts a recent episode of praising the oncology nurses for what a wonderful job they had done while he was under sedation. “I didn’t even remember telling them these things‚” he says. “They only told me what I had said after I woke up. That is how important their efforts are to me.”

Even when at home‚ it is hard not to think about the patients from the clinic. Ivester says‚ “It’s hard to leave work at work.”

Editor's Note: Alan Kindler passed away Sept. 6‚ 2002. His family tells CURE that he was very excited to have contributed to this story. We are proud to honor his memory.