The New Oncology Care Management Model
We all have a variety of reasons for entering the nursing profession. My wish to be an oncology nurse developed from a desire to be challenged by new situations each day. In the more than 25 years during my tenure as a nurse, I have had the opportunity to interview, hire, and manage hundreds of nurses. During this process, I have been instrumental in encouraging nurses to move toward oncology care management; this is something of which I am proud.
Oncology care management is on the cutting edge of new treatments, improved testing and screening, and continual advancements in research. I am newly energized about this field; for the first time in many years, there has been a true increase in survivors of most types of cancer. Even 5 to 10 years ago we could not make that type of statement, and thus our focus remained on treatment options, side effect management, and transitioning to hospice care. Currently, cancer survivors total 14 million, and this number is growing every year. We have begun to treat certain cancers as a chronic illness. This extraordinary feat does not come without strings though, and this incredible success is fraught with many new challenges for oncology care managers. Following are some of these challenges:
Lasting side effects from cancer treatments:
- Chemo brain (issues with concentration, memory, order, or focus): It can last 6 months to years after chemotherapy; this is a lingering reminder of cancer for patients who are trying to put it behind them.
- Body image changes (related to surgeries or treatments): Patients will deal with physical and physiologic changes that can have long-term effects; as survivors return to daily routines, they will face challenges that remind them of their cancer.
- Changes in lung capacity (shortness of breath, inability to perform tasks previously done with ease): Surgical treatments or medication may reduce patients’ lung capacity. If it affects their ability to return to work, patients may need to find a new job.
- Changes in waste elimination (kidney, bladder, and bowel; appliances): Patients may have surgical treatments that leave them with an external appliance; this will change how they interact with family and friends.
- Changes to the circulatory system (heart, vascular), lymphatic system (edema, lack of circulation), and nervous system (neuropathies): Chemotherapy and radiation therapy can have a devastating and lasting effect on the heart and circulatory system, leaving patients with decreased cardiac function, decreased or poor peripheral circulation, and overall fatigue. This process could render the patient disabled and make them feel “worthless.”
- Depression and anxiety: Underserved areas of cancer management, depression and anxiety are not always outwardly apparent.
Disability: Patients often wonder if they will be permanently or temporarily disabled.
Return to work: Patients are concerned about when they can go back, whether their diagnosis and treatment will affect how they do their job, and if their boss and colleagues will understand. The patient also questions whether to tell his employer or others at the office.
Change in job: Patients often are apprehensive about seeking a new job, and are unsure whether to tell prospective employers about their cancer, fearing it may negatively impact their chances of a job offer. Also, if a new job is secured, patients are concerned about their ability to keep up with scheduled follow-up appointments, screenings, and lab work.
Return to life after cancer treatment: As survivors transition back to life with family and friends, they may be apprehensive about a return to daily activities, transitioning from their oncologist to primary care physician, keeping up with medications and their side effects, and maintaining an active lifestyle.
Assisting patients in making the transition from cancer patient to cancer survivor is critical. To do this we must also change the way we think and how we apply our care management expertise. A small percentage of patients will gladly walk away from cancer; they will attempt to forget it and move on with their lives. We must help them understand that putting cancer emotionally behind them is good, yet maintenance is needed to keep the cancer from recurring. The importance of keeping posttreatment follow-up, blood work, and screening appointments, as well as being aware of signs and symptoms of recurrence, are essential parts of survivorship.
In addition, we must reinforce the need to continue preventive therapies. Approximately 33% of patients with breast cancer on hormone therapy, for example, stop taking their medicine before completing the full 5 years of treatment, even with strong evidence that it can decrease recurrence of cancer not only in the first 3 to 5 years, but over their lifetime. This is an opportunity to educate and advocate for our patients; we need to utilize care coaching skills to keep the door open so patients and families feel comfortable asking questions about side effects, costs, and recurrence.
The key to successful transition from cancer patient to cancer survivor and ongoing education and prevention for patients with cancer rests in our hands. We must continue to strive for better patient and family education, stronger communication and coaching skills, and overall improved engagement with patients and their families.