Welcome to Oncology as a Nurse Practitioner!

Transcription

1 Welcome to Oncology as a Nurse Practitioner! As a nurse practitioner in cancer care there are many resources that can help orient you to the care of the patient and family with cancer. The members of the Oncology Nurse Practitioner Special Interest Group have developed an outline of resources for you that may help you do self study for cancer care. We encourage you to work with your local mentors and preceptors to apply this information to your particular cancer setting. There are some online and academic resources for which you may want to negotiate purchase or access that will help orient you to cancer care practice. Many academic centers will have these available to you. If these resources are available at your institution ask if you can be oriented and get the appropriate access to these applications, on line or personal access device resources. Some examples of these on line resources are: The Johns Hopkins POC_IT Antibiotic guide The Sanford Guide to Antimicrobials Up To Date Evocates If you have no experience at all in cancer, The Fundamentals of Cancer Course from the Oncology Nursing Society may be of benefit. You may want to inquire if the practice or health care administration of your setting will absorb the cost of the online course. ( Some books that may be helpful: 1. Washington Manual of Oncology: Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO (2007) 2. Cancer Symptom Management, Third Edition Yarbro,Frogge,Goodman (2004)

2 Some information overall that can be helpful to you I. Resources for information about cancer and specific information initial workup and treatment according to tumor and stage. i. i As you think about the patient with cancer you can be overwhelmed. It is better to think about the patient as having a specific cancer at a specific stage of cancer. This helps you narrow the focus of what you need to know for diagnosis, treatment and symptom management. II. Cancer diagnosis and staging When a patient presents to the cancer center, they generally have some workup completed that has indicated that they have cancer. The traditional history and physical and patient presentation used in general medicine is amended for the patient with cancer to include the pertinent diagnostic history and physical, radiology and pathology with pertinent markers A. Presenting the history for a new patient with cancer - 1. The "story" of the cancer workup and diagnosis thus far 2. Diagnostic Radiology - what radiology has been performed, results? i. sandprocedures/medicalim aging/medicalx-rays/ucm htm 3. Pathology - Specific factors (tumor size, lymph nodes) indicative of disease seriousness as per tumor i Companion Diagnostics - Specific to each tumor tumor markers for prognosis and prediction of response to therapy. i Metastatic work up - Specific to each tumor

3 6. Staging: Specific to each cancer i Other relevant components of the history III. Cancer treatment While the physician will usually decide the treatment for the specific cancer at one specific stage, it is important that the nurse practitioner understand the decision making and participation in the discussion of the implications of the treatment for the patient and family. These resources will outline the evidence based care for patients according to cancer type and stage. A. Discussion with patient and family regarding prognosis and treatment i. i iv B. Surgery C. Radiation D. Chemo/Biotherapy i. Writing Chemo Orders - chemoregimines.com E. Oral Therapies i. Adherence Issues ii Specific considerations E. Clinical Trials i. ncipoet.cancer.gov/docs/thebasics.ppt

4 IV. Symptom management during cancer treatment A. Review of systems for patients undergoing treatment You should ask - and the patient should respond to all of the following signs and symptoms the use of a symptom checklist using a 10 point scale for intensity is recommended so that symptom assessment can be done more easily and efficiently. Patients can complete these if they are able. The Oncology Nursing Society Putting Evidence into Practice (PEP) is an efficient way for you to apply assessment and intervention with an evidence base. There are many resources for patient education regarding symptom management. No matter what the resource, patients respond best to one on one counseling. i. Oncology Nursing Society: PEP Resources a. b.. National Cancer Institute The symptoms to be assessed can be amended to specific cancers and side effects of therapy of the individual patient. 1. Nausea 2. Vomiting 3. Pain 4. Fatigue 5. Neuropathy 6. Constipation 7. Diarrhea 8. Dyspnea 9. Mucositis 10. Dry Mouth 11. Myalgia 12. Hot flashes

5 13. Depression 14. Anxiety 15. Skin Rash 16. Overall cancer related distress B. Common Oncologic Emergencies - Recognition and Intervention I. C. Survivorship Issues I. Review of systems for patients in follow-up i Surveying for recurrence Specific follows up testing as per malignancy V. Metastatic Cancer A. Treatments I. People living with Cancer; plwc.org patient education B Indications of Disease Recurrence C. Symptom Assessment and Management with Metastatic Cancer I. D. Common Oncologic Emergencies - Recognition and Intervention E. End of Life Care 1. Pain Management I Symptoms specific to end of life care I.

6 VI. Communication A. Empathetic Communication B. Difficult conversations in cancer care 1. Breaking Bad News 2. Angry patients and families VII. Professional Issues A. Certification I B. Ongoing continuing education I. VIII. Specific Disease Information A. Breast Cancer Staging, prognostic and predictive factors and Treatment According to Stage a. Common Symptoms during Treatment b. Survivorship and Follow up Issues B. Lung Cancer Staging, prognostic and predictive factors and treatment according to stage I..

7 a. Common Symptoms during Treatment b. Survivorship and Follow up Issues C. Cool-Rectal Cancer Staging, prognostic and predictive factors and treatment according to stage Professional/page1 a. Common Symptoms during Treatment b. Survivorship and Follow up Issues D. Gynecologic/Ovarian Cancer A. Staging, prognostic and predictive factors and Treatment According to Stage Professional/page1 B. Common Symptoms during Treatment C. Survivorship and Follow up Issues E. Pancreatic Cancer A. Staging, prognostic and predictive factors and Treatment According to Stage Professional/page1 B. Common Symptoms during Treatment C. Survivorship and Follow up Issues F. GU Cancers - Prostate/Renal/Bladder Cancer A. Staging, prognostic and predictive factors and Treatment According to Stage

8 Professional/page1 B. Common Symptoms during Treatment C. Survivorship and Follow up Issues G. Non- Malignant /Malignant Hematology Evaluation A. Thrombocytopenia B. Neutrogena C. Anemia D. Bone marrow procedure - Checklists for procedure "sign off" i. Examples of procedure &playnext=1&videos =M7nNG2VdHuY