Navigating the Shift to Chronic Care in Advanced Lung Cancer Management

The landscape of thoracic oncology is undergoing a fundamental transformation, shifting from the management of acute terminal illness to the navigation of a chronic, long-term disease. Pamela Plasket, RN, BSN, CHPN, OCN, an oncology nurse navigator at Wellstar Health in Georgia, highlights that advanced therapies are significantly extending survival times, requiring oncology nurses to adapt their clinical and supportive care strategies.

With over 11 years of experience in navigation, Plasket now focuses on specialty treatments, including bispecific T-cell engager (BiTE) therapy for patients with small cell lung cancer (SCLC), lymphoma, and multiple myeloma.

Redefining survivorship

As early detection efforts expand and treatments become more effective, the traditional framework of cancer survivorship is being challenged. Plasket, who serves on the Academy of Oncology Nurse & Patient Navigators (AONN) survivorship committee, noted that the historical categories of acute, extended, and permanent survivorship may not accurately capture the reality of modern lung cancer patients.

"For the most part, they're going to be living with lung cancer and receiving treatment pretty much the entire time," Plasket explained. While some early-stage non-small cell lung cancer (NSCLC) patients may reach a point of surveillance only, many SCLC patients remain on treatment for the duration of their disease management. This "living with cancer" paradigm has resulted in NSCLC survivors reaching 20-year milestones and SCLC survivors increasingly living beyond five years.

For the oncology nurse, this necessitates a focus on long-term quality of life and the maintenance of daily activities over decades, rather than months.

Managing advanced BiTE regimens

The introduction of complex regimens like BiTE therapies introduces specific educational and symptom management hurdles. Plasket emphasized that the "front end" of these treatments requires intense nursing surveillance. During the initial cycles, nurses must monitor closely for cytokine release syndrome (CRS) and neurotoxicity.

Plasket noted that patient education is vital during this phase; patients are often reassured that if they can successfully navigate the first cycle, these specific acute side effects typically diminish as the body adjusts to the drug. However, as treatment continues over extended periods, oncology nurses must guide patients through more persistent "quality of life" symptoms.

Fatigue remains a primary concern, affecting an estimated 80% to 90% of lung cancer patients. Nurses must also manage appetite changes, altered taste, and significant weight loss, which can impact a patient’s overall nutritional status and stamina.

Addressing financial toxicity

One of the most pressing concerns for long-term survivors is financial toxicity. Because patients are remaining on treatment for much longer durations, the cumulative cost of care can be devastating. Plasket identified finding resources for co-pay assistance and grants as a critical responsibility for navigators. This includes securing local or national funding to defray the costs of basic necessities, such as groceries, gas cards, and transportation, to ensure treatment adherence over the long haul.

The psychosocial burden: Stigma and PTSD

Beyond physical symptoms, the oncology nursing team must address the unique psychosocial challenges associated with lung cancer. Despite the shifting demographics of the disease — including younger patients and non-smokers with environmental exposures like radon — a heavy social stigma persists.

Patients often grapple with guilt or "survivor’s guilt," fueled by the public assumption that their diagnosis is the result of personal smoking history. "They do need support," Plasket said, emphasizing that even non-smokers feel the need to defend themselves against these assumptions. Oncology nurses play a key role in facilitating these conversations and referring patients to oncology psychologists to help them process this emotional distress.

Furthermore, Plasket highlighted a rising incidence of post-traumatic stress disorder (PTSD) among cancer survivors, with studies suggesting that 10% to 20% of patients may be affected. This requires the entire multidisciplinary team to remain vigilant and utilize ongoing distress assessments to identify patients who need specialized psychological intervention.

The path forward for oncology nursing

As lung cancer transitions into a chronic condition, the role of the oncology nurse is expanding from acute clinical provider to long-term care coordinator. This evolution requires a multidisciplinary approach that integrates physical symptom management, financial advocacy, and psychological support. By understanding the nuances of advanced therapies like BiTEs and the long-term needs of survivors, oncology nurses can ensure that patients not only live longer but maintain a high quality of life throughout their journey.