Encouraged by her sister’s cancer diagnosis, Cynthia Ingram, BS, RN, HN-BC, COHN-S, animal therapy coordinator, Cancer Treatment Centers of America (CTCA) Chicago, pursued her dream to start an animal-assisted therapy program in her institution.

“My sister was diagnosed with pancreatic cancer,” she shared. “And at that time, I was in a director position. And I was feeling like I needed to be doing something else. And so, she asked me what my dreams were. And my actual dream was to start an animal-assisted therapy program, I just wasn't sure what that would look like. But that was my dream."

Now, nearly 14 years later, Ingram and her therapy dog, Tori, are a vital part of the behavioral health team at CTCA Chicago, providing daily visits to patients with cancer to offer a comforting distraction to the pain, discomfort, or distress from treatments.

After being encouraged by her sister, Ingram spent time volunteering with a dog trainer and gaining experience in the field of animal-assisted therapy. She then collaborated with the director of behavioral health at CTCA in Chicago to establish the program she dreamt of. The program officially began in November of 2008.

The program has 1 dedicated service dog, Tori, an Australian Shepherd. Although a variety of animals can be included in animal-assisted therapy, Ingram’s team “chose to stay with just 1 dedicated therapy dog, because we have patients who are immunosuppressed. And we wanted to make sure that we addressed the safety of our patients.”

For a dog to qualify, they must pass a Canine Good Citizen course. Puppies, like Tori when Ingram started training her, can take about a year to be ready to start working. Tori passed puppy class, obedience class, and advanced obedience class before starting the Canine Good Citizen course. In addition, the pet partners or handler also must complete a written test and demonstrate that the dog will respond appropriately in the hospital environment. Dogs cannot begin working until they are least 1 year old.

Positive Effects in Patients with Cancer, Families

Ingram explained that animal-assisted therapy has been shown to reduce stress and improve energy levels, as well as decrease perceived pain and anxiety. It can also help to combat the feeling of isolation that can accompany numerous procedures or hospitalizations and offer a sense of familiarity and companionship. This is especially potent for patients who travel for treatments and have been separated from their own pets.

“I have so many really fun memories,” she shared. “I mean, 1 thing that I really enjoy is the impact [Tori] has walking down the hall, no matter what's going on, whether it's a patient or a family member, people just stop and engage with her. It’s just beautiful to see that.”

The average day for the duo involves “rounds” to drop in on patients for whom it has been deemed appropriate to receive animal-assisted therapy. Ingram described the effect of Tori as “magic.” All that is needed is for the dog to rest her head on the patient’s bed to make an impact.


“It's really lovely to watch the family witness that because it makes the family feel better, too,” Ingram said.

She recounted 1 instance of a patient whose son had special needs and could not be left at home. He was afraid to be around people, but when he found out about Tori, he wanted to meet her. Soon, he had regular appointments to meet with Tori whenever he came to the hospital. When Tori’s birthday party rolled around, he decided he wanted to attend even though there would be other people there. “He actually came down to the party and actually started talking to other people and throwing the ball for her,” noted Ingram. “He was able to really embrace a party for the first time. And that was a really beautiful thing for his mother.”

Animal-Assisted Therapy’s Impact on Health Care Providers

Tori doesn’t just brighten the day of patients and caregivers. She also has an impact on the health care providers working in the cancer space.

“The people who work here really love Tori,” Ingram shared. “And I think she has provided a real sense of support for them sometimes, [as] working at [the] hospital can be challenging. And sometimes they have some difficulties in their day, and they'll come and see Tori. And they'll just sit down with her, and they might cry with her or just hug her or pet her. Within 5 minutes, Tori comforts them and they're able to return to work and it kind of resolves the issue.”

Starting an Animal-Assisted Therapy Program

Ingram’s advice to those interested in creating a similar program in their own institution is to figure out what type of program they want to have. “Our program is pretty unique,” she said. “We have a facility dog that only works with the patients in this facility. A lot of places have volunteer pet partners, so the pet partner would come in, but they could go to a variety of different places, you know, they might be at an elder care facility 1 day and a hospital the next day. All those volunteers have to be managed to make sure that the pet partner teams have their correct registration through the agency, and [that] they're following policies and procedures, and they have the orientation from the hospital. That's a [very] different way of doing it.”

As a next step, she advised: “I would decide what type of program you wanted to institute, and then talk to somebody within that company to see how you can make that happen.”

She concluded by sharing that “this has really been a wonderful adventure, full of love and joy for me. When we walk in a room, people light up, families light up. And patients and families share secrets with Tori. [They] talk about things that they normally wouldn't have. She allows that when she walks in the room. It gives them a sense of comfort. It’s been a true joy for me to be on the other end of the leash with her.”

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The impact of animal-assisted therapy is felt by more than just patients with cancer, explained Cynthia Ingram, BS, RN, HN-BC, COHN-S. Service animals like her dog, Tori, can also have a positive impact on the well-being of caregivers and health care providers. 

Pet Therapy Touches Lives Beyond Patients With Cancer, Including Caregivers and Providers 

A privilege. This is how Christina Kirk, RN, MSN, AOCNP, feels about her experience as an oncology nurse, with 20 years of experience in the cancer space.

Kirk knew she wanted to be an oncology nurse when she was still in nursing school, because of the incredible compassion she felt for the patients.

However, nursing was not her first career. She had worked as a nurse’s aide in oncology for many years before deciding to go to nursing school. In the 20 years since becoming a registered nurse, she has worked as a hospital oncology nurse, participated in oncology nurse research, and currently works as a nurse practitioner at UC Irvine Health.

Kirk chose her current position because she wanted to work with clinical trials. Passionate about academic research, Kirk believes that the opportunity to participate in clinical trials is very important for the patients. Her background in academic medicine was celebrated by her coworker, Susan O’Brien, MD, UCI Health, who shared that “Christina has a firm grasp of not only the treatments for these malignancies but of the evolution of therapies and major advances in small molecules. More importantly, she has a wonderful way of explaining treatments to patients, which describes not only the expected efficacy, but the drug side effects. She does this in a very clear and straightforward way that makes it easy for patients to grasp.”

Part of what draws Kirk to clinical trials is that they do not discriminate. She explained that “we take all patients, regardless of education level or their familiarity with health care.” One of the biggest daily challenges in her role is teaching people how the trials work and ensuring that patients understand that they are not “guinea pigs,” but rather, that they have the opportunity to participate and receive a treatment option that may be the best therapy option available for them.

She also shared that it is very important for both the patient and their family to understand how these trials work. “A lot of times, the patients are very stressed, and they're relying on their family members to take in that information or help them process it,” Kirk said. She sees it as the oncology nurse’s responsibility to talk with patients and answer the questions they might have so that they are able to make an informed, educated decision. Kirk does not want a patient to say “No, I'm not going to do this,” simply because they don’t understand the process.

Kirk shared that some of her patients have written to her over the years. One patient even wrote her a note saying, “Thank you for never making me feel stupid.”

This was a powerful moment in her career. It emphasized how, often, when confronted with such complex concepts and medical jargon, patients feel overwhelmed and inept to tackle the journey. The ability to help patients feel educated enough to make their own informed decisions and navigate their cancer journey with confidence has been both a moving and rewarding aspect of her career.

In addition, Kirk emphasized the importance of meeting a patient “where they are.” As she explained, sometimes a patient has a third-grade education level, or only knows English as a second language, and it is important to find a way to effectively engage those patients just as much as a patient with advanced degrees and their own vision regarding their treatment. Every patient comes from a different background and understanding, and to Kirk, the flexibility required to meet each patient’s different needs is how an oncology nurse can truly determine the level of excellence in the supportive care.

O’Brien commended Kirk’s efforts, saying “Christina is always ready to go the extra mile and it is not uncommon to have patients who have an acute issue just show up in the clinic without an appointment because they know Christina will always squeeze them in to give them all the support they need. She has intervened on patient denials and spent long amounts of time to get the patients the treatment they need. She is also always looking out for their psychological needs and provides a great deal of support herself as well as referring to other professionals.She worked every day through COVID-19 pandemic and was always there for the patients during those difficult times. She is a real hero to me.”

In Kirk’s view, the goal isn’t solely to provide patients the care they need but with the knowledge they need as well.This includes discussing all aspects of treatment with patients. She noted the importance of explaining a symptom management plan with patients. Lots of treatments have side effects, so explaining to a patient that there is a plan in place to address those symptoms and not leaving them to suffer is an important aspect in alleviating stress. The other consideration is ensuring that patients are taking their medicine. If the oncology nurse has frank, open conversations with their patients about topics such as drug costs and medication fears, it can help empower the patient to navigate their journey without added anxiety. The rapport between nurses and patients is critical.

Christina Kirk’s message to fellow oncology nurses is this: “Between the education, the knowledge, and the experience, there is such a value in what we provide. We learn from our patients, and we use those experiences to help the next patient. That role is so important to healthcare. Oncology nurses should know that they are very valuable and remember that the role they play is very important. At the end of the day, it is a privilege.”

“It’s a Privilege, I feel very honored to be helping patients.”

Oncology Nurse Champion: Christina Kirk

Oral cancer therapies can be appealing to patients, particularly during the COVID-19 era, because they can be taken at home. However, at-home medication can also pose a threat to adherence. Oncology nurses therefore need to remain diligent in educating their patients and monitoring their adherence.

“You avoid intravenous infusions; I’m all about that. And patients feel empowered [taking their medication at home], but we have to give them the tools to succeed,” said Patricia Jakel, MN, RN, AOCN, a clinical nurse specialist in the Solid Tumor Program at UCLA Medical Center, at the 5th Annual School of Oncology Nursing Annual Meeting.

Patients may be burdened with complicated medication schedules, that could include taking 1 drug to ensure that another works properly, as well as adverse event management. Add chemotherapy-related cognitive impairments – commonly referred to as “chemo brain” – and clinicians may be surprised to see how many patients are struggling with their medications. Jakel admitted she has struggled with chemo brain.

“I’m a breast cancer patient [who was] on treatment for the last 4 years. Oral adherence was not the best for me, so I have personal experience with it,” Jakel said. She joked, “I used to be smart. I used to be really smart, and chemo brain has really affected me. It doesn’t matter if you’re taking oral agents, IV agents, or anti-estrogen agents. [Chemo brain] is really real to patients.”

Cancer treatments can affect memory, executive functioning, and a patient’s ability to organize their thoughts. Their ability to pay attention or processing speed may be affected, too. Jakel said that cognitive training, which could be as simple as doing puzzles or keeping up to date on the latest news in an area of interest, can help curb the effects of chemo brain, as can complementary treatment methods such as acupuncture.

“Poor adherence decreases clinical benefits and overall effectiveness of the healthcare system,” she said. “It not only affects the patient, but these patients who are non-adherence actually end up back in the hospital and end up with other complications.”

Strikingly, 20%-30% of medication prescriptions are never filled. And according to Jakel, there are factors besides chemo brain that contribute to non-adherence.

In her experience, Jakel has seen patients stop taking their medications once they start to feel better or that the drug is working. Others may be experiencing cost barriers or psychosocial issues that prevent them from taking their medication as prescribed. “Make sure you talk to your patients about … the reasons why they’re not taking [their medication.]”

There are steps that clinicians can take to help their patients improve medication adherence. Some are simple, like calling and checking in on them, asking them to keep a drug diary, or conducting pill counts. Doctors can also encourage patients to use apps or alarms on their phone that reminds them to take their drugs.

When discussing medication adherence, clinicians should be careful of their word choice, Jakel said.

“What I say [to patients] is ‘Tell me how you’re taking your medication.’ I don’t say ‘Are you taking it?’” Jakel said. “I think that’s very important to have them talk to you.”

Additionally, caregivers should be educated on proper drug handling, scheduling, and potential drug-drug interactions.

“Make sure that education is done for the family and the caregiver,” Jakel said. “Hopefully the patient has a caregiver or a friend or family member helping them, because that’s critical for adherence.”

Ultimately, when patients do not take their cancer drugs properly, it can lead to a barrage of other complications that will have negative consequences both for the individual with cancer and the healthcare system.

Jakel P. Breast Cancer Supportive Care in 2021. Presented at: 5th Annual School of Nursing Oncology. August 6-7, 2021. Virtual.

With a newfound abundance of available oral cancer therapies, it has become necessary for oncology nurses to ensure that their patients are adhering to treatment. 



Oncology Nurses Must Stress Importance of Medication Adherence 

Cancer Treatment Centers of America’s Oncology Clinic at Home is a pilot program which allows qualifying patients to receive their chemotherapy treatments in their own home.

Chevon Rariy, MD, medical director of Endocrinology and the Telehealth Program director for the Cancer Treatment Centers of America (CTCA) Chicago, recently spoke to Targeted Oncology

, sister publication of Oncology Nursing News

,about the launch of the In-Home Infusion Program and what the shift in care represents for the nurses supporting these patients.

The Oncology Clinic at Home Program, which is currently based in Atlanta, Georgia, delivers oncology care to patients so long as they are in good enough health to not require a hospital visit, can tolerate their medication in an in-patient setting, have reliable internet service, own a mobile device such as a laptop or mobile, and have insurance policies which cover the treatments. The program currently treats breast, lung, prostate, head and neck, colorectal and some genitourinary cancers.

“I certainly think it is an opportunity to improve the nurse-patient relationship.”  

At-Home Infusion Program to Change Nurse-Patient Relationship

Making lunch for a patient might not be the first task one envisions when thinking about oncology nursing. Luckily, that didn’t stop one nurse from helping a patient who was unable to prepare lunch for herself during chemotherapy.

That nurse is Kathleen Lutz, RN, NP-BC WH, and she addresses a variety of tasks every day to make the journey for her patients a little more comfortable. After 23 years at NYU Langone Health in New York, New York, as a nurse practitioner (NP), Lutz has seen cancer care develop dramatically during her career.

“I started practicing nursing in 1988 after graduating from Molloy College in Rockville Centre, New York. In 1997, I earned my post master’s nurse practitioner (degree) in women’s health from Stony Brook University. By 1998, I was the third NP credentialed to practice as a nurse practitioner at NYU Medical Center and the first NP in ob/gyn at the center, so I basically paved the way for the future of APN within the department of ob/gyn,” she said in an interview with 

Lutz knows that oncology nursing is her calling. Despite some hesitancy moving to her current practice, on her first day working in outpatient gynecologic oncology she fell in love with the facet of nursing. She loved the level of care, the level of involvement with the patients, and the amount of relationship building that comes from helping a patient across the entire spectrum of cancer.

Oncology nurses help their patients through an avalanche of challenges. It is difficult for Lutzwhen she sees patients without a support system at home. “One of the big challenges is when we have a patient with no social support,” she said. “It means getting creative and finding the resources to get them back and forth to appointments and getting them medications.” She explained that patients without support systems need daily phone calls and more frequent home care visits to ensure that somebody is checkingin on a regular basis.

Lutz believes in an interdisciplinary team. She consistently reaches out in the community to see what resources can be provided for patients. This includes getting social services and nutritionists involved, as well as informing the regular staff nurses to ensure they know which patients need this extra level of support.

“I bring [the patients without support] in a little bit more often since they don’t have anybody, and I help coordinate their rides and such,” Lutz said, adding that she also arranges services such as Meals on Wheels for these patients and allows them to call her on the weekends.

Her enthusiasm for the patient’s well-being is clear to all who know her. Bhavana Pothuri, MD, who works at NYU Langone with Lutz, said, “Kathleen is extraordinary in her commitment to the care of the gynecologic oncology patient and is most deserving of this [recognition]. I have worked with her for 15 years and can say she is undoubtedly the most dedicated nurse I have ever worked with.”

This is not the first time Lutz has been spotlighted for being an excellent oncology nurse. At the end of 2014, Lutz received the Advanced Practice Nursing Excellence Award from NYU. Her colleague, Erin Reese, RN, NP-BC WH, nominated her, citing an example of a patient for whom Lutz made lunch every time she came in for chemotherapy. This award served as a pivotal moment for Lutz, causing her to consider the positive impact of her actions. She explained, “Getting that award helped me realize that I am making a difference. I am making things better for patients and I am doing the right thing….I am on the right path.”

Her role as an advanced practice nurse also lends itself to an emphasis on excellent supportive care. Lutz cares for complex gynecologic patients during diagnoses, surgery, and chemotherapy treatments. Along the way, she supports them by providing an environment where they can go through the journey successfully. She also deals with end-of-life issues when appropriate, working closely with the supportive oncology team to help transition patients who go from active treatment for cancer to best supportive care. This entails working closely with the patients and their families.

Lutz said she is always inspired by the evolution of new drugs and successful treatments. A special moment in her career was recognizing that today she can say that patients are living longer, better, quality lives with cancer. She enjoys knowing she can make a difference in women’s lives and looks forward to what the future brings in cancer care, including the different trials and drugs that will arrive.

During the COVID-19 pandemic, Lutz helped orchestrate infusion appointments locally when going to New York City was not feasible for patients. This involved spending many hours on the phone with patients to arrange for them to receive their chemotherapy in 1 of the 2 satellite centers on Long Island. Step 1 involved a telehealth visit where her team would make all the necessary assessments. On the day of the treatment, she would check in with the laboratories, look at the numbers, and ensure all the orders were set and signed so the patient would have a seamless appointment experience.

For approximately 9 months, the team worked tirelessly to help patients navigate the system so they could receive their treatment without traveling to 1 of the major epicenters of the pandemic. Lutz reminisced that “it was a challenge, and an exciting one, and I hope never to go through it again.”

When Lutz thinks about excellence in oncology care, she finds herself repeating the importance of having “big shoulders.”

“You need a lot of wiggle room,” she said. “It is important to recognize that patients are facing the most stressful event of their lives. One needs to allow [patients] multiple chances. Sometimes a patient might get angry, and that’s okay. You can’t get mad at your patients.”

Her message to other oncology nurses is to take a step back, put yourself in the patient’s position, allow them room to express themselves, and support them along the way.

Lutz understands that oncology nurses have to be 100% vested in what they do to be successful. She knows it is that level of commitment that makes her team what she calls “a successful family” and is happy to say she loves being an oncology advanced practice nurse.

From orchestrating local infusion appointments to making lunch for a patient, Kathleen Lutz, RN, NP-BC WH, constantly strives to provide an excellent level of supportive care.

Oncology Nurse Champion: Kathleen Lutz

A recent study showed that, among patients with limited-stage small cell lung cancer (LS-SCLC), patients of color had longer overall survival (OS) than White patients, suggesting race is associated with survival in this disease, according to data analysis published in 

Among patients with stage I disease, no significant difference across races was observed (

= .54). The median OS in Hispanic patients was 27.7 months (95% CI, 19.4–not reached [NR]) vs 22.0 months (95% CI, 21.3-22.7 months) in White patients. Among those with stage II disease, Asian patients had a median OS of 20.4 months (95% CI, 15.0-28.0) compared to 17.5 months (95% CI, 14.8–NR) in Hispanic patients. Again, no significant difference was observed across races (

However, in patients with stage III disease, survival did differ significantly across the races, with a median OS of 12.7 months (95% CI, 12.6-12.9) in White patients vs 13.6 months (95% CI, 13.2-14.1) in African American patients, 13.4 months (95% CI, 10.3-16.9 months) in Hispanic patients, 13.9 months (95% CI, 12.6-15.2 months) in Asian patients, and 13.5 months (95% CI, 11.3-16.7 months) in Native American patients.

“The findings of this cohort study that race is associated with survival of L-SCLC, because Asian and African American patients had better survival compared with White patients,” Kexun Zhou, MBBS, Division of Hematology and Medical Oncology, of Mayo Clinic, and colleagues, wrote. “In addition, our results confirmed that female sex, higher median annual income (≥63,000), private insurance, diagnosis confirmation by positive cytological analysis, larger increase in number of sampled regional lymph nodes examined, and earlier stage at diagnosis were associated with prolonged survival in L-SCLC.”

Along with clinical characteristics and medical care, data have suggested that economic status, medical insurance, sex, and age were linked with occurrence and cancer outcomes. Race has also been considered to be a factor, mostly due to disparities in access to cancer prevention, early detection, and treatment.2,3 Some studies have attributed higher morbidity in African American patients to socioeconomic factors, and others have indicated that race is not an independent predictor of survival when controlling for confounding variables.4-7

Most of these studies were limited by institutional experiences or statewide databases and mainly focused on non–small cell lung cancer and extensive-stage SCLC (ES-SCLC). Because of this, the validity of race, among other factors, for LS-SCLC is not well understood.

For the study, investigators identified patients who had been diagnosed with LS-SCLC between 2004 and 2014. Participants were put into 5 cohorts based on race/ethnicity, as reported by patients in the National Cancer Database. Additionally, residential region was categorized as urban, metro, and rural, and median annual household income was divided into the following categories: less than $38,000, $38,000 to $47,999, $48,000 to $62,999, and $63,000 or more. Moreover, education level was grouped by the percentage of adults with no high school degree in the residential region (less than 7.0%, 7.0% to 12.9%, 13.0% to 20.9%, and 21.0% or greater). Insurance categories included no insurance, government insurance, and private insurance. Diagnostic confirmation was broken up into either histological or cytological analyses, and facility type was classified as non-academic or research program, and academic or research program.

A total of 72,409 patients were included in the analysis. Among these patients, the median age was 67.0 years (range, 23.0-90.0) and just under 60% (55.6%) were women. Moreover, 74.7% were diagnosed with stage III disease, 14.7% had stage I disease, and 10.6% had stage II disease. Regarding racial groups, 90.4% were White, 7.9% were African American, 1.1% were Asian, 0.3% were Hispanic, and 0.3% were Native American.

African American patients were found to have lower income and education levels compared with White and Asian patients. Moreover, African American patients were the largest racial group in the low-income group of less than $38,000 (stage I, 47.1%; stage II, 47.8%; stage III, 50.8%). The same trend was noted in the lower–education level group. Here, African American patients comprised 35.8% of those with stage I disease, 37.2% of those with stage II disease, and 38.7% of those with stage III disease. More than 90% of patients across all races had some form of medical insurance coverage, and the majority had government insurance.

“Eighty-three percent of patients [59,962 patients] were diagnosed according to positive histological findings, and 74% of patients [53,551 patients] were treated at non-academic or research programs across all races,” the study authors wrote. “The exception to this was noted when patients were analyzed by stage, showing that 65% of Hispanic patients [26 patients] with stage I SCLC were treated at academic or research programs. However, the overall number of Hispanic patients remained low.”

Among those with stage I disease, African Americans were found to have lower rates of undergoing surgery for the primary site. No significant differences among races were noted among those with stage II or III disease regarding tumor and treatment characteristics. No difference in the administration of radiation therapy was observed among racial subgroups for any of the disease stages. Although chemotherapy was given to most patients, the proportion was not significantly different among the racial groups except for those with stage II disease. Here, more Hispanic patients received chemotherapy than White, African American, Asian, or Native American patients.

Multivariable analysis revealed that sex, income, education, insurance type, diagnostic confirmation method, number of sampled regional lymph nodes, and disease stage at diagnosis were significantly associated with survival in patients with LS-SCLC. Moreover, African American patients (HR, 0.92; 95% CI, 0.89-0.95; 

 < .001) and Asian patients (HR, 0.83; 95% CI, 0.77-0.91; 

< .001) appeared to be less likely to die from their disease compared with White patients.

Several other factors were found to be associated with longer survival, including female sex (HR, 0.84; 95% CI, 0.83-0.85; 

 < .001), a median annual income of $63,000 or higher (HR, 0.94; 95% CI, 0.90-0.98, 

 < .001), higher education (HR, 0.94; 95% CI, 0.91-0.98, 

= .002), and having private insurance (HR, 0.88; 95% CI, 0.81-0.94, 

 < .001). Patients who had their diagnoses confirmed by positive cytological findings (HR, 0.96; 95% CI, 0.94-0.98; 

 = .003), had an increase in number of sampled regional lymph nodes (HR, 0.99; 95% CI, 0.98-0.99, 

 < .001), and who were diagnosed at an earlier disease stage were all linked with longer survival.

“Given that there is a complex interaction among several factors, more studies are warranted to formulate strategies to overcome the disparities that we have highlighted,” the study authors concluded.

Zhou K, Shi H, Chen R, et al. Association of race, socioeconomic factors, and treatment characteristics with overall survival in patients with limited-stage small cell lung cancer. 

. 2021;4(1):e2032276. doi:10.1001/jamanetworkopen.2020.32276

Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. 

. 2004;54(2):78-93. doi:10.3322/canjclin.54.2.78

Bach PB, Schrag D, Brawley OW, et al. Survival of blacks and whites after a cancer diagnosis. 

. 2002;287(16):2106-2113. doi:10.1001/jama.287.16.2106

Gadgeel SM, Severson RK, Kau Y, et al. Impact of race in lung cancer: analysis of temporal trends from a surveillance, epidemiology, and end results database. 

. 2001;120(1):55-63. doi:10.1378/chest.120.1.55

Tannenbaum SL, Koru-Sengul T, Zhao W, et al. Survival disparities in non-small cell lung cancer by race, ethnicity, and socioeconomic status. 

. 2014;20(4):237-245. doi:10.1097/PPO.0000000000000058

Videtic GMM, Reddy CA, Chao ST, et al. Gender, race, and survival: a study in non-small-cell lung cancer brain metastases patients utilizing the radiation therapy oncology group recursive partitioning analysis classification. 

. 2009;75(4):1141-1147. doi:10.1016/j.ijrobp.2008.12.022

Kiswas T, Walker P, Podder T, et al. Effect of race and insurance on the outcome of stage I non-small cell lung cancer

This article was originally published on OncLive as 

“Disparities in Race and Socioeconomic Factors Linked with Outcomes in LS-SCLC”

African American, Asian, and Hispanic patients with limited-stage small cell lung cancer displayed superior survival outcomes compared with White patients, indicating that race might be linked with survival in this disease.

Race, Socioeconomic Factors May Impact Survival Outcome in Limited-Stage Small Cell Lung Cancer 

An Unplanned Journey That Led to a Lifelong Career as an Oncology Nurse

Lisa Cusaac, MSN, RN, OCN, began her nursing career running away from oncology. In fact, that specialty was the last thing on her mind.

“I never wanted to be an oncology nurse,” Cusaac shared. “My grandma always told me you should help out oncology patients, but I think I ran the furthest away from it.”

Cusaac had prior experience caring for someone with cancer, and she wasn’t ready to commit her life to working in that field. When Cusaac was about to start college, her grandmother was diagnosed with pancreatic cancer. Her grandmother needed help changing her dressings following a painful procedure to treat the cancer. Cusaac, who was on college break, would go to help her, but she recalls how difficult it was to see her grandmother in so much pain and agony.

“I respected the oncology nurses,” she said. “I got to know some of them, and I respected them, but I never thought I wanted to have anything to do with cancer. That was my first introduction and I saw it as painful and certainly not comforting.”

However, something rather unexpected happened when she signed up for the Nurse Tech Program at Georgetown. She was placed in the endoscopy department, where she cleaned the scopes used for colonoscopies and upper endoscopies. She would also interact with patients, some of which were receiving a diagnosis of cancer.

Across the hall from the endoscopy department was the bone marrow transplant unit, and there was a need for a nurse tech. Cusaac volunteered, and that’s where everything changed. She fell in love with the practice. She recognized that the patients needed so much care, and she was inspired by the cutting-edge science with which she would be working alongside. Surrounded by diverse patients who all needed a high level of support, she reminisces on how she knew she was in a position where she could make a difference. And so, she began her career there as a recent graduate.

Cusaac has now been at MedStar Georgetown for 25 years, working in many different facets of oncology. She has cared for bone marrow recipients, patients with hematologic malignancies, and patients with breast and other solid organ cancers. Some of Cusaac’s previous roles included serving as the Inpatient Assistant Manager of the Bone Marrow Transplant and Hematology Unit, as well as the Manager of the Outpatient Chemotherapy Infusion Center and Clinical Trial Infusions Centers. She currently oversees the nursing delivery of care and the supportive delivery care in the Lombardi Comprehensive Cancer Center.

Addressing Biases and Being a COVID-19 Vaccine Ambassador

Last spring, Cusaac spent time addressing racial biases in the workplace following the murder of George Floyd. The incident made her reflect on her own biases. She participated in the Equity, Diversity and Inclusion (EDI) taskforce. The work of this group sparked conversations within the hospital. The task force shared books and links to useful articles, addressed topics such as microaggressions and, most importantly, provided everyone with a safe place to speak.

She also became a COVID-19 vaccine ambassador at MedStar Georgetown. As she tells it, the hospital was about 75% vaccinated (vaccinations although not required, were strongly encouraged). Part of her job included talking to staff members who had not yet been vaccinated, many of which were minority members, and taking the time to dispel some myths surrounding the vaccine as well as to emphasize the importance of getting vaccinated.

John Marshall, MD, who works with Cusaac at Medstar Georgetown stated that, “Without Lisa, we would not have managed the pandemic. Without Lisa, we would not be managing the nationwide oncology nursing shortage. Lisa leads by example. She knows how to do, and often finds herself doing, most all the jobs we ask of nursing.”

Cusaac epitomizes a health care champion. She notes how she strives daily to embody the MedStar Georgetown University Hospital’s mantra of 

, or care of the whole person. Sometimes this means taking care of a patient’s family and providing supportive care throughout the cancer journey. Other times, it includes taking a moment to ask the patient about how they’re doing and what they truly want.

Cusaac remembers a powerful moment that forced her to stop and think. A child who received a bone marrow transplant and experienced countless hospitalizations, remissions, failed treatments, and therapies, said to her that “death is not defeat for me.” The boy then went on to say that he would never have another CT scan, never have another injection, and never have to be hospitalized and separated from his family. That has stuck with Cusaac forever. That conversation helped her realize that a patient’s quality of life is more important than the quantity of days. Oncology nurses always want to extend the days, months, and years of their patients, but, in her words, “if our patients are miserable, then what are we doing?”

She makes it her personal priority to always advocate for the patient. And, according to Marshall, she always does it with a kind smile on her face.

As for what she would say to fellow oncology nurses, it is this: “As a nurse we have to be present, and we have to be flexible. Each patient has their own journey, and each patient responds and reacts differently. No two patients are alike. I have to be patient, I have to be flexible to their individualized treatment plan, and being present in the moment is most imperative. I can’t be so task oriented, I have to remember that there is a person in front of me. They are not a name and a date of birth, not a number or medical record. They are a human being.”

Lisa Cusaac never planned on being an oncology nurse. However, 25 years later she has spent her entire career providing care for patients with cancer and being an Oncology Nurse Champion. 

Oncology Nurse Champion: Lisa Cusaac

A new qualitative study will determine what behaviors, communication techniques, and relational practices are vital in the videoconferencing telehealth era. This study will attempt to explore practical guidelines for relationship building and establishing rapport between patients and oncology nurses through screen-to-screen communication.

Data collection is set to begin in the summer of 2021 and the researchers anticipate results by winter of the same year. Researchers well-versed in qualitative methodology will perform a conventional content analysis using the first--and second-level codes extracted from the transcribed text data.

“A strong and supportive nurse-patient relationship is especially important for persons with cancer,” Paula D. Koppel, MS, RN, GNP-BC, AHN-BC, NBC-HWC and Jennie C De Gagne, PhD, DNP, RN, NPD-BC, CNE, both from Duke University School of Nursing, argue. “Looking at how the movement toward videoconferencing visits during the COVID-19 pandemic affects the nurse-patient relationship and the capacity to maintain high quality, supportive cancer care is essential, given the likelihood that telehealth videoconferencing visits will become an enduring component of cancer care.”

Researchers will conduct a series of semi-structured narrative interviews with both patients with cancer and oncology nurses to facilitate an understanding of rapport building via telehealth videoconferencing. Interviews themselves will be conducted on videoconferencing platforms to abide by COVID-19 safety protocols and restrictions. Nurses and patients will be interviewed separately in order to ensure that insight gained is honest and to allow for comparative analysis of the different perspectives.

Recruiting will be conducted at the oncology clinics at the ambulatory care center through a combination of efforts including, but not limited to, nursing staff meeting announcements, web-based postings on message boards, and study brochure distribution. Informal caregivers will be allowed to be included in this process in an effort to reduce the recruitment process burden on patients with cancer.

The study will not discriminate on the basis of age, self-reported gender, identity, race or ethnicity, except for in cases where it is necessary to meet the inclusion and exclusion criteria. While there certainly is legitimate concern regarding the question of laying further burden upon the patients, literature suggests that patients with cancer are often able to find meaning in the disease by participating in such research.

By concentrating exclusively on nurse-patient rapport in oncology-ambulatory settings, this study aims to not only accurately describe but better understand the challenges, barriers and experiences that one faces in these computer-mediated encounters. Such unique barriers might include nurses’ uncertainty regarding patient privacy, a lack of sensory input due to the limited view of peripheral spaces, and full visualization of body language, as well as a lost sense of physical connectedness. One unsurprising challenge reported to have a negative impact on rapport is technological difficulties.

“The nurse’s technological competency is seen as another way of caring. From this vantage point, videoconferencing visits can be a way to maintain human connectedness during the pandemic or even beyond,” the researchers wrote.

This study hopes to create a foundation for developing such interventions and guidelines so as to facilitate smoother screen-conference experiences. Learning to successfully navigate the world of telehealth videoconferences will most likely continue to be vital to nurses as the potential benefits to patients, providers and health care systems indicate that the use of virtual communication will continue to exist even after the pandemic subsides.

Koppel P, De Gange J, Exploring nurse and patient experiences of developing rapport during oncology ambulatory care videoconferencing videos; protocol for a qualitative study. 

“Looking at how the movement toward videoconferencing visits during the COVID-19 pandemic affects the nurse-patient relationship and the capacity to maintain high quality, supportive cancer care is essential…”



Descriptive Study to Explore Nurse-Patient Videoconferencing Relationships in Oncology Ambulatory Care

Monumental strides in cancer treatment have been made in recent years, though there is still far more work to be done when it comes to cancer screening and diagnostic procedures, according to the American Cancer Society’s “Blueprint for cancer research: critical gaps and opportunities.”

“With only 4 of the 20 most common cancer types in the United States having a proven screening method to reduce mortality by identifying early-stage lesions, developing such tools for other high-incidence malignancies is urgently needed,” the 

The American Cancer Society worked with experts in the field to establish research opportunities that could lead to the development of better screening approaches in the future. They included:

Better understanding the molecular makeup of early-stage cancer and premalignant disease

Determining how the tumor microenvironment leads to the transition of premalignant to preinvasive to invasive disease

Creating better technologies for screening, early detection, and risk stratification

Improving the ways that biomarkers are analyzed and detected with a limited amount of fluid

Establishing how public health genomics can affect precision public health when it comes to cancer screening and earlier detection

Find ways to use artificial intelligence or machine learning and next-generation technologies (wearable devices, etc) to help in cancer screening and early detection.

Despite the existence of these major gaps, there have still been significant strides in diagnosing cancer and better understanding the disease biology.

For example, thanks to the advent of liquid biopsy, patients can undergo a blood test that provides vital information about circulating tumor cells, free tumor-derived DNA or RNA and cancer-derived exomes.

“A liquid biopsy offers many advantages over a traditional biopsy,” the report says. “It is minimally invasive, not generally limited in terms of sample accessibility and availability, and practical for repeat sampling, which could help clinicians during screening and surveillance as well as postdiagnosis to better understand the molecular changes occurring in a tumor over time.”

Additionally, every year researchers learn more about cancer biomarkers, and these discoveries continue to serve as the backbone for more personalized, efficacious cancer treatment.

Authors of the report hope that advances in genomics, proteomics, metabolomics, and lipidomics will further be used to develop better cancer screening as well as improve the cancer screening methods that are currently available — though those efforts have not yet been fruitful.

“With the advancement of metabolic profiling technologies, there have been notable efforts over the past decade to clinically exploit cancer-specific metabolism to aid in cancer detection,” the report says. “Thus far, translation and clinical utility have been somewhat disappointing.”

Ultimately, while 2020 did have scientific discoveries that will improve cancer treatment, there is still plenty of work to be done in 2021 and beyond.

Only 4 of the 20 most common cancers have a proven screening method.
 

Better Cancer Screening Is Needed: Hopes for 2021 and Beyond

Each month, we take a look back at the most popular 

 stories. Here are the top 5 stories from July 2020.

5. Dexamethasone Is Affordable and Promising in Treating COVID-19

As the coronavirus 2019 (COVID-19) pandemic continues, research efforts have revealed a potential weapon to add to the treatment arsenal against the virus, a drug that has historically played a crucial role in oncology treatment: the inexpensive, and widely accessible, 

4. Why Be an Oncology Nurse? A Patient Perspective 

Like many people, Jane Biehl, PhD, thought she knew what the field of oncology was all about — 

. Here, she details how her own experience as a patient with cancer has taught her all about the compassion and love found in oncology nurses.

3. Immunotherapy Does Not Increase Death Risk in Patients With COVID-19

According to new findings presented during the 2020 AACR Virtual Meeting: COVID-19 and Cancer, treatment with 

 did not increase the risk of mortality in patients with COVID-19 and cancer. Learn more in this recap.

2. Cancer Organizations Advocate for US to Remain in the World Health Organization

Leading cancer organizations and members of Congress recently wrote a letter to the White House advocating that the 

United States remain in the World Health Organization

 (WHO) after President Trump stated earlier this month that the US will withdraw from WHO.

1. Mental Health Treatment May Improve Cancer Outcomes

 may want to encourage patients to seek help, according to a recent study published in 

. Read more about these findings in this web exclusive.

Each month, we take a look back at the most popular Oncology Nursing News® stories. Here are the top 5 stories from July 2020.

Supportive Care