Oncology nurses are key players when it comes to managing adverse events (AEs) for patients with breast cancer, explained Debu Tripathy, MD, professor and chairman of the Department of Breast Medical Oncology, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center in Houston.
Tripathy, who is also the editor in chief of CURE, recently sat down at the Miami Breast Cancer Conference to discuss the importance of oncology nurses in breast cancer care and offered insight as to how they can keep up-to-date with the constant advancements in the field.
What role does the oncology nurse play when it comes to managing AEs in patients being treated for breast cancer? Are there any AEs that are particularly worrisome that they should look out for?
Oncology nurses are such important components of our care. They interact directly with patients in a way that allows them to monitor what's going on at a granular level. Oncology nurses are great at making sure they are staying on the pulse of patient symptoms, not only when they're in the clinic, but when they call in with symptoms. More and more people are using telemedicine to report their symptoms.
Oncology nurses are trained to recognize the common side effects that we see, and even some of the less common ones. To intervene early is so important. Things like diarrhea and dehydration—we need to know about those and monitor them early. Things like complications of chemo that are also common with low white blood cell counts and infections or fevers, those need to be intervened right away.
And then there are more chronic things that might not be as urgent, but we still want to know about them, [such as] developing neuropathy in patients who are getting targeted drugs. With immunotherapy, we are seeing a lot of different side effects that we need to monitor, things like skin rashes, diarrhea due to colitis, or even some of the side effects on the endocrine organs, where the adrenal glands aren't making enough corticosteroids or thyroid deficiencies. Those need to be picked up quickly as well.
The oncology nurse can intervene in not only assessment, but also in recommending the types of supportive care approaches that would be critical to keep patients out of trouble.
What kind of conversations should patients on CDK4/6 inhibitors have with their oncology nurses and healthcare team?
We want to know particularly how they are tolerating it in terms of their overall wellbeing. Fatigue is a common symptom, and there are things we can do, sometimes even modify the dose. So these are things we want to follow with them every time they are visiting the clinic. Things like fevers are very important to notify the team about more urgently with a phone call because those can sometimes be more problematic. They're very uncommon with CDK4/6 inhibitors but still an important thing to know.
Other side effects that patients may have [include] mouth sores that we would treat with a variety of different palliative approaches, loss of appetite, [and] hair loss, [but] we don't have a good treatment for that. Usually it's mild, but sometimes patients want to make sure it's not something else, and they may want to report something that may not be life-threatening, but they want to make sure it's not, so we want to make sure we're listening to every single one of their symptoms.
Those are the common ones. And then of course, many times the other symptoms of the endocrine component of the therapy may be indistinguishable, so the myalgias, the muscle soreness, can also be managed, and we certainly want to attend to those as well.
How can oncology nurses keep up with the evolving treatments and research?
There are many ways that oncology nurses can keep up. Many modalities are targeted for oncology nurses, which I think are excellent opportunities because they are selected for that particular profession. There are many online courses. The Oncology Nursing Society really has a wonderful meeting every year, and many other special offerings.
But also, I find that it's good to be in mixed company with colleagues on the medical side as well—physicians, including medical oncologists [and] surgical oncologists. Coming to these large meetings that also have programming for oncology nurses is also important because then you get to see the questions that come up in the context of the team approach, where you have physicians, RNs, APRNs, genetic counselors, nutritionists, and a whole mix of the supportive team. A lot of questions come up about patient management that crosses what the different team responsibilities are. Meetings like the Miami Breast Cancer Conference are one of those.