In today’s COVID-19 pandemic atmosphere, oncology patients and nurses are under added stress. When patients are admitted, the nurse caring for them needs information related to their cancer diagnosis readily available. Online apps can help them in their research. The patient can also log on to the app and view as well as engage with the platform.

I have had numerous patients who were otherwise healthy and then received a sudden diagnosis of cancer which unfortunately had already spread. The primary nurse caring for these patients is a wealth of information regarding their treatment plan. She/he can provide links to patients for these cancer apps. This could be generalized to patients across the board with different types of cancers as well.

As a nurse who has worked many years in the field, there is so much information available that patients can access. In the old days, there were very few resources for RNs, and I don’t remember that much typed written patient information.

On a personal note, I have worked with nursing students in their other role as CNAs (certified nursing assistants), and all their materials are online. In Miami, where I live, there is a Simulation Hospital at Miami Dade College, where nursing students have their virtual patient experience.

Chances are that patients have their phone with them. Using their phone to help patients learn about their cancer is a time saver and very convenient. Patients are overwhelmed with new corona virus information symptom information already. The elephant in the room is their cancer diagnosis. Nowadays current practice has patients tested for COVID-19 before being admitted to the oncology unit. Patients are alone in the hospital now due to visitor restrictions. Accessing these apps is another way they can maintain their connection to the world. These apps will help nurses and patients stay current with information related to their underlying diagnosis.

There are three apps relevant to this trend. They are: CareZone, Belong/Beating Cancer Together, and Cancer.Net. Mobile.

The app that has been downloaded one million times is CareZone (

). Patients can look at it on a phone or a browser and can input and access all their relevant clinical data on either format. There is a convenient storage area where they can list their lab data and meds as well as their current height and weight. Patients can also house a list of their chemo treatments. Clinical staff can also use it to access cancer treatment regimens. This app lets you store photos of meds as well.

) is being promoted as a means of locating support groups and clinicians who can answer patient questions about specific cancers. Family members can also tap into this resource.

In addition, if the patient wants to get information about clinical trials, this is the app for them. Another plus is that medical records can be housed there also, like CareZone. This is a free app and 250,000 people around the world have tried it.

https://www.cancer.net/navigating-cancer-care/managing-your-care/cancernet-mobile

) is the official app from the American Society of Clinical Oncology (ASCO). The goal of this app is to help the patient navigate through the world of cancer, at the onset of their journey, when their physician gives them the news to specific solutions. There are 120 different types of cancers it examines.

The app has a symptom tracker and helps the patient or family member in terms of organization. The patient can list his physicians, when their next appointment is, and all medications taken.

Technology has helped the fight against cancer in so many ways. This is another tool in the arsenal.

Articles

Cancer care and the information around it has moved online. 

The New Normal: Cancer Apps

Nurses, you may have noticed that some of your patients are younger than you. In many cases, patients are decades younger than the nurses taking care of them on the oncology unit. In today’s COVID-19 era, they are alone without family or friends to visit them. The internet is their connection to the outside world. Besides Facebook, Instagram, and Tik Tok to link them to the outside world, there are also cancer websites specifically geared for younger patients with cancer.

The first resource available is called stupidcancer.org (

). It calls itself a “lifeline” to teenage and younger adult oncology patients. It is a link to their cohorts that have cancer and the information given is tailored to their needs. They further characterize their mission as striving to stamp out the isolation that comes with cancer and bringing younger patients together. Part of their website offers a compilation of the best cancer blogs of 2020.

Stupidcancer.org also has their own blog, called Stupid Cancer (

). It offers a 3-pronged approach by linking patients to a cancer social worker, staff members and young adults who have conquered rare cancers.

Another blog is the YSC Blog (Young Survival Coalition) for younger female breast cancer patients (

). It delves into the realm of relationships, and sex while dealing with this disease. Another cancer organization is Breast Friends For Life. This group is concerned with the psychosocial effects of dealing with breast cancer. They are a nonprofit group in Georgia which has a Facebook page that young women can access (

https://www.facebook.com/breastfriendslagrange

Colon cancer is not for those in their 40s, 50s or beyond. It strikes young adults too. The Colon Club has a goal of having younger adults know their risk factors, in terms of family history and learning about symptoms and early detection (

). Furthermore, they want to encourage innovative solutions in their approach to this disease. The older patient mindset is a thing of the past for this group. As their website sates “Let’s talk poop”. They also have a blog called the Colon Club Blog (

https://www.colonclub.com/programs-support/blog

). Writers here are patients who have been impacted by the disease.

An award-winning website that has created a community approach is Planet Cancer. It has several ways for patients to connect with each other. They offer a retreat in person as well as online forums run by those who have fought in the trenches of this battle. It was founded by Ewing’s Sarcoma survivor Heidi Adams and is a huge presence on the web. (

). It has a nickname of “Myspace on prednisone.” It is now part of the Livestrong network founded by Olympian and cancer survivor Lance Armstrong. The website bills itself as the first online presence for young adults with cancer.

This list is not exhaustive by any means. It is meant to be shared with your patient who has time on their hands. Resources that helps them cope while recovering from surgery or while getting chemo are worthwhile.

Besides Facebook, Instagram, and Tik Tok to link them to the outside world, there are also cancer websites specifically geared for younger patients with cancer.

Resources for Young Patients With Cancer

Your patient had a mastectomy and chemotherapy and is recovering on the post-op surgical oncology unit. She has 1 or 2 JPs (Jackson Pratt’s) which are drained on a prn basis and a surgical bra. The physical part of her recovery is in progress, but what about body image issues?

A patient once told me that she was not concerned about turning grey. At that point in her journey, multiple rounds of chemo and radical surgery, hair color was not on the top of her to-do list. Does this ring true across the board for all patients with breast cancer? The jury is out on that one. Everyone has their own opinion on how important it is to look good after a mastectomy or a prophylactic double mastectomy for a BRCA 1 /2 positive patient.

A major drug store chain, Walgreens, has their own approach to this dilemma. Their program “Feel More Like You” has beauty consultants available to help patients deal with issues such as dry skin and hair loss after chemotherapy. These consultants also are familiar with battling the brutal effects of being in the sun as well as nail changes of the hands and feet. In Florida, sun damage is a major concern. Couple this with a mandatory face mask due to COVID-19, and you have a challenge for this patient.

There are also pharmacists ready to help patients cope with the effects of chemotherapy such as the classic adverse event of nausea and emesis, as well as skin rashes, dry mouth and mouth sores. Incidentally, the “Feel More Like You” program was created between the resources of the Cancer Support Community (cancersupportcommunity.org) and “Look Good Feel Better”

There is a program called “Battle Beautifully” which is a podcast dealing with the diametrically opposed concepts of beauty and cancer. Currently, there is a five-part series which Walgreens has created to help cancer patients. The first episode looks at the concept of beauty. Episode two features an interview with noted TV broadcaster Joan Lunden who discusses her battle with breast cancer. Episode three has a visit to Gilda’s Club which highlights patient coping mechanisms. Finally, episode four discusses mouth problems and episode five rounds out the series with a discussion on tattoos. There is a visit with a breast surgeon and two tattoo artists who gives insight to this trend among breast cancer patients.

As a nurse and patient advocate, helping the patient find the right self-care balance after breast cancer treatment is vital to helping a woman maintain her self-image. Looking in the mirror should not be a stressful experience and these issues can be mitigated with knowledge.

Helping Breast Cancer Survivors Deal With Body Image Issues

All too often, I get off the elevator to work on the surgical oncology acute care unit and am witness to an increasingly familiar scene. I see relatives preparing to say goodbye to their loved one who have terminal cancer. This backdrop of death and dying extends to the corridors outside the hospital room. Big families have large groups meeting in the hall when. Smaller families, in contrast, have one or two relatives present. Also, there are patients suffering alone with their pain. All these scenarios are present in this extended canvass of death and dying.

Working as an RN on this 30-bed unit has given me a ringside seat to the random cruelties of this disease. I have seen the sadness and despair of patients facing their own mortality. I have also seen patients go home and continue their extended journey.

The case of parents watching their adult children fight cancer is extremely difficult. I have watched older parents who might not be in the best of health end up caring for their adult children. This unfortunately has also become a common occurrence.

Giving an elderly mother reassurance or hope as she cares for the child who by rights should be on the other side of the bed is also stressful for the nursing staff. The thought usually crosses your mind that they, themselves, could easily become the patient if stressed to their breaking point. Figuring out how to support the relatives becomes a delicate balance between trying to pretend that all is well and helping them negotiate their “new normal.” Getting up in the middle of the night to monitor their son or daughter’s vital signs and taking their own medication while watching them decline has become a familiar scene.

The entire staff sometimes gets acclimated to a particular patient, and if they are on your floor long enough with multiple admissions, they become part of the fabric of the unit. Sometimes you admit a patient and the first thing out of their mouth is, “you were my nurse last year.” They remember you and your name even if you can't remember them at first.

Cancer care has become more complex. This part of care has stayed the same. We sometimes know the probable outcome of this doomed boxing match. You cannot help but to wonder what is going on with the patient on your days off. I have learned that none of us come with a date stamped expiration tag.

All too often, I get off the elevator to work on the surgical oncology acute care unit and am witness to an increasingly familiar scene.

The View from the Hall of the Oncology Unit

Three 3 things that inspire me at work, are the support I get from my co-workers, the resilience of my patients, and the advantages of working in a teaching hospital.

In my practice setting, the surgical oncology step down unit, I see patients waking up after surgery with an ostomy, their bodies changed forever. Finding out that a patient’s cancer has metastasized makes me feel sad and I wonder about how life can be so cruel. When new scans and biopsies reveal that a patient’s cancer has spread, you realize that it takes a special kind of nurse to do this job. Working on this unit is not for the faint of heart. You must be a tough cookie, as the saying goes, and able to withstand the devastating losses these patients endure. To say that this backdrop is suitable for every nurse would not be accurate. Patients receiving blood transfusions and total parenteral nutrition are commonplace scenarios every night. My coworkers and I support each other by listening to each other vent about difficult situations. They are able to endure long shifts with constant calls from patients who are facing terminal illness. I have tried to incorporate their caring attitude into my care also. We often have long-term patients with multiple physical and emotional needs. Therefore, we take turns with difficult patient care assignments. 

I often see patients with stage IV cancer. My patients’ resilience frequently surprises and impresses me. Prior to working on this unit, I thought that a cancer diagnosis signaled the end. But patients have shown me that on the contrary, it is possible to return to college or go back to work during and after cancer treatment. My patients are determined to fight and stay optimistic. Many do plan for the future. Seeing these patients has inspired me to keep trying to find solutions to my own challenges. I have learned that we can bounce back from adversity. I try to apply the “one-day-at-a-time” mindset to my life as well. 

Working in a teaching hospital has its advantages, and that also inspires me. The fact that I have on-site support from a doctor 24/7 is invaluable. I have encountered residents who will insert IVs and place nasogastric tubes for decompression on busy nights. In my experience, the chances of this happening in a non-teaching hospital would be slim to none. Working in a teaching hospital give me continued learning opportunities every night. The residents work as a team with the nurses which motivate them to provide better care. The surgical resident is only a phone call and an elevator ride away. 

I have been an RN for a long time. My mind is at ease with the knowledge that these 3 things

are available to me at work and serve as my inspiration.

Being an oncology nurse is not always an easy job, but here are 3 things that keep me inspired.

3 Things That Inspire Me at Work

After a busy night on the surgical oncology step-down unit, I finally sat down to catch up on my computer charting. When I looked over, I was surprised to find my co-workers engrossed in a YouTube video showing the latest in plastic surgery. This was an actual case showing 

. They were learning about it online, for free, at their convenience.

Many student nurses consult YouTube to help them learn how to do clinical procedures and to help them brush up on their skills. It is an invaluable resource. While many of my fellow nurses are new or recent grads, I am learning that nursing school is radically different now than when I attended, and that it has changed for the better.   

Since that busy night, I have discovered a variety of YouTube channels that are available for nursing care. The channel 

 boasts more than 450,000 subscribers and covers a range of topics like diagnosis of clinical conditions such as shock, how to survive in nursing school, and how to prepare for nursing entrance exams. There are also videos explaining the pathophysiology, management, and nursing interventions for different types of shock. We discussed these same topics decades ago

Since I wanted to find out about YouTube in relation to oncology nursing, I discovered that the 

 has a YouTube channel featuring videos by Donna Wilson, RN, a clinical nurse specialist who is also a personal trainer at the Integrated Medicine Center at Memorial Sloan Kettering Hospital, showing  nurses how to get patients moving in order to avoid fatigue and muscle weakness associated with cancer. Other videos feature archived videos of full sessions given at the annual congress and more.

I remember my early days of nursing school. I wish YouTube had been around then to help vanquish my fear. YouTube can only enhance the nursing school experience and one’s career down the road.  

For more information on YouTube videos that 

 has to offer, visit our sister publication, 

YouTube videos can help oncology nurses learn how to do clinical procedures and brush up on their skills.

YouTube Training for Nurses

Oncology nurses working in hospitals can do a lot to help patients prepare to adhere to their treatment regimens. For example, they can encourage patients to communicate freely with their physicians, help them remain hopeful, and recommend that they use tools to stay organized and on top of their follow-up appointments.

Meeting new physicians during a postoperative stay requires a patient to have an open dialogue with all of their doctors. Patients frequently ask me when they will see their physician, what test results mean, or simply, when they will be allowed to go home. By achieving an open dialogue with their healthcare provider, patients can stay connected to the specifics of their care.  This means giving patients contact information for their physicians. I also let the patient know when physicians are expected to make rounds. Making sure patients can 

 openly with their physicians is the first step to ensuring that they adhere to their treatment.   

Being resilient in the face of a devastating diagnosis can be difficult. Not everyone has the same mindset. I am not advocating that patients have long-range goals if that is not their wish. But 

 can play a real role in a patient’s journey. Narrow down the approach to hope to an hour, or a day. Diversions like soothing music, an entertaining website, book, or movie, can help patients hold on to a hopeful mood, even if they only work for a brief chunk of time. Hope gives patients a reason to adhere to their treatment. Show the patient how to use the TV in their room, or help them access the hospital library, if there is one.

It is also important to maintain a positive attitude when talking with the patient. Your behavior can have an effect on how the patient feels about how their care is being managed.

Patients are usually discharged from hospitals with several appointments pending to see specialists they may have met over the course of their most recent hospitalization or a physician they are already seeing. There might also be pending scans, such as follow-up MRIs, PET or CT scans. Physical therapy and home health care visits might also have to be arranged. A patient may be dealing with pain management issues. If possible, provide patients with a printout with all pending appointments, as well as physician names and phone numbers. Encourage patients to record dates of new appointments in their calendars or smartphones. Staying organized gives the patient the ability to adhere to their treatment regimen. 

Oncology nurses can implement these ideas while their patients are still in the hospital to help their patients stay on track with their care after they leave.

Here are some things nurses can do to prepare patients to adhere to their treatment regimens once they leave the hospital.

Three Ways Nurses Can Ensure Patient Adherence to Treatment Regimens

This year, I’ve made 3 New Year’s resolutions that I know can help make me a better nurse. They are small things, but I believe they will make a difference in the way I feel about myself and my work.

I work three 12-hour night shifts per week on a 30-bed, step-down surgical oncology unit. I have to keep going for long stretches of time. Sometimes, I don’t sit down for 5 or 6 hours. To sustain myself both physically and emotionally, I plan to: eat healthier, stay connected with my friends, and spend time with my dogs.

When I was younger, I could get through the night shift with one small bag of potato chips or pretzels, and lots of coffee. That was back in the days of 8-hour shifts. Hospitals have eliminated the early evening shift now. Nowadays, I end up bringing lots of food to get through the long nights. My resolution is to bring more vegetables, like a salad with carrots, radishes, and tomatoes, to fuel me.

I realize that fuel in the form of nutrient-packed food, like proteins and carbs will get me through long stretches of time and keep my hunger satisfied. I usually bring vegetables, plus a can of tuna in olive oil, and of course, pretzels and Diet Pepsi. Bringing my favorite comfort foods to work makes me feel like I’m taking care of myself.

I also resolved to make sure to connect more frequently with my best friend from social work grad school. She works in the morning, so frequently, we catch each other when she is going to work and I am going home. We are both sleepy. In the evening, if I talk to her, it is when I am battling rush hour traffic to go downtown, and she is going in the opposite direction. We are both in stressful jobs, so connecting early in the morning and in the evening gives us the means of putting our day or night in perspective. 

I have several rescue dogs ranging in age from 7 to almost 15 years. Spending time with them brings me joy. Caring for these dogs also makes me feel connected to the animals I had when I was younger. I truly miss those dogs and I have found peace of mind by putting those experiences into caring for the animals I have now. 

I think my New Year’s resolutions for self-care will make me stronger, relieve stress, and add joy to my life. I hope other nurses can identify the things that give them strength, make resolutions, and focus more on them to help offset tough times on the job.  

This year, I’ve made 3 New Year’s resolutions that I know can help make me a better nurse.

An Oncology Nurse's New Year's Resolutions

There are 3 things that nurses can do to improve the patient experience: listen, anticipate the patient’s needs, and be flexible.

As a nurse on a surgical oncology step-down floor where patients are battling severe post-operative 

, I find listening to what patients say is vital to providing optimal care. Oncology nurses must

 listen to patients when they say that their pain is not under control

. Calling the surgical or other specialty resident is always an option for more pain medication.

Listening to patient feedback about their comfort level is also important. For example, if the TV in the room doesn’t have sound, the bed is not comfortable, or it is too cold in the room, the patient experience suffers.

Anticipate your patient’s physical needs. Don’t wait for a patient to buzz for things you know they should have and will need. For example, patients with abdominal surgery usually start off drinking clear liquids. Make sure ice and water are readily available. Also, have apple juice, tea, and chicken broth on hand. If the floor is out of Jell-O, getting in the elevator and going to another floor to find it is always an option. Having extra blankets and pillows on hand is crucial as well.

If you know that it may take an hour for extra pain medication to be approved, suggest that the patient alert you to their rising level of pain before it reaches an unbearable level. Some patients want to tough it out until they can’t stand the pain, but if they wait until that point to let you know about it, they may suffer unnecessarily longer until you can provide them with relief.

Being flexible may be the key to getting through a shift. The world doesn’t revolve around the nurse’s schedule. A patient’s severe pain may necessitate a change in priorities. Sleep is not on a set schedule. Sometimes, patients sleep for hours at the beginning of a shift and wake up at midnight. If that is the case, medications may have to be given later if the patient is too drowsy. Going the extra mile to be flexible is important to this patient who needs reparative sleep.

Another way to be flexible may involve keeping family members comfortable. Many times, they are your key to keeping the patient calm during the shift, especially if this is a patient who is not used to being in the hospital. Remember that this may be a challenging experience for the family member also. I always ask the family member if they need something to eat or drink. I also offer extra blankets and pillows. Providing the doctor’s phone number in case they don’t already have it is another way to keep them in the loop regarding their family member’s care.  

These may seem like simple measures, but they go a long way toward improving the patient experience.

Listening to a patient carefully, anticipating their needs, and being flexible in your responses to their care schedule are 3 ways oncology nurses can help improve the patient's experience during a hospital stay. 

Three Things Nurses Can Do to Improve the Patient Experience

Three things I wish I had been told when I started my career as a nurse would have been to become computer literate, that great footwear is essential, and that communication is key.   

When I started my career as a nurse in the late ‘70s, there were no computers in the nurses’ station. The medication cart was not on a workstation on wheels.  You were the workstation on wheels. You carried the meds on a tray and everyone had a small card with their instructions. You wrote your notes by hand. There was no computer with checklists in a grid that you checked off. There was a Kardex that contained the patient’s care plan that you kept up to date with a pencil. I wish I had been told to start learning computer skills early on.

The second thing I wish I had been told is that great footwear is essential. Your feet are the key to staying in this business for decades. Nursing shoes have gone from lace ups to high-end designer sneakers. Now, I wear black leather walking shoes with non-slip bottoms because there always seems to be a puddle on the floor. Spills occur often in patients’ rooms, with urine or emesis, or in the hallways, with ice water or coffee from food trays. When nurses are rushing from one proverbial fire to the next, the dangers of slipping and falling are real.   

Many of my coworkers wear thrombo-embolic deterrent (TED) stockings, which are elastic graduated compression hose that help with venous return. Personally, I can’t stand the elastic, but others find them useful.

The third thing I wish I had been told is to work on my communication skills. Since I began working in oncology nursing, the demographics of my coworkers have changed. I am not always working with fellow baby boomer nurses. Nowadays, my coworker might be a 20- or 30-something RN. They may not get my references to not wearing gloves when I was a young nurse or to Carly Simon, and I may not get their references to an app they used to learn EKG rhythms or to Cardi B. Well, I used the app my colleagues told me about and aced my EKG exam, and I found out who Cardi B is. As a tradeoff, they listened to my no-gloves story and learned who Carly Simon is. Communication is key to working well with others and to developing a more efficient working environment.

I think these 3 things would have come in handy, but it’s never too late to try new ways of thinking and living.    