As with all patients with cancer, providing care for those with lung cancer involves both physiological and psychological aspects.
Oncology nurses are uniquely qualified to offer a wide range of support to patients with lung cancer, and they play a vital role in caring for this patient population. These highly skilled professionals have a deep understanding of the disease and treatment of adverse effects. As such, they are ideal gatekeepers for the care team, helping patients on the phone, triaging patient concerns, providing education, and performing other critical tasks. A look at how oncology nurses approach caring for patients with lung cancer may provide insight into how to deliver better care.
As with all patients with cancer, providing care for those with lung cancer involves both physiological and psychological aspects. Although there are many factors to focus on, the overarching priority is to educate patients so they know when they should notify the care team. Because oncology nurses are well versed in symptom management and prevention, they are invaluable in guiding patients so they know when to call the clinic. Overall, oncology nurses try to optimize the quality of life for patients to make sure they are achieving their goals during their healing journey.
Although nursing priorities and goals are always patient-specific, a few common priorities can be identified for lung cancer1,2:
Other priorities, which apply to all patients, include the following:
Managing the expectations of patients is always challenging, but this is especially true for those with lung cancer. Although mortality rates are still high, there have been some exciting new developments in treatment, and individuals are living longer with this disease.3 These advancements have brought new hope to many patients, but they have also created some unrealistic expectations. Oncology nurses are uniquely positioned to play a vital role in helping patients navigate the differences between treatment with palliative intent and treatment with curative intent.
Providers must find their own style when it comes to presenting difficult news to patients. I personally am a straight shooter when communicating with patients, and I developed my approach when I was still relatively new to our practice. I shadowed a physician who asked a patient if she could be honest with him about his condition. I knew we were going to be delivering very bad news that would be difficult to hear. It was the first time I had ever seen a provider ask a patient for this type of permission, and I thought it was quite incredible. She was then able to deliver this terrible news in a very direct but compassionate way. I found it to be a very meaningful encounter, and it had a lasting impact on me, as I now ask all patients if I have their permission to tell them what I know.
The development of immunotherapy for lung cancer—which has delivered remarkable results for some patients—has made talking about different prognoses even more challenging. I am open with my patients about this. When discussing immunotherapy, I share my personal experience of caring for 6 people whose diseases were thought to be incurable—who were cured through this treatment approach. I discuss studies that show increased life expectancy with immunotherapy vs chemotherapy, stressing that, of course, everyone is different. I explain that a prognosis is based largely on statistics but that every patient is more than just a number. There is a fine balance between being realistic and remaining hopeful, and oncology nurses are very adept at helping patients strike that balance.
Oncology nurses are highly qualified to identify any gaps in understanding that patients may have about their condition and communicate with them at a level they can comprehend. For instance, it does no good to flood patients with written material only to find out later they cannot read. Nurses who meet patients where they are in their level of understanding help enable informed decision-making about treatment options and ensure patients’ wishes are met.
“Nurses not only educate patients, but also educate physicians about a patient’s condition and suggest when it might be time to initiate end-of-life discussions, said Jason Astrin, DMSc, MBA, PA-C, DFAAPA, senior director of Advanced Practice Provider Services for the US Oncology Network. “Oncology nurses are highly proficient at handling these stressful conversations that guide future care.
Oncology nurses also play a key role in providing comprehensive supportive care for patients with lung cancer in addition to clinical care. Treatment advancements are enabling patients to live longer, creating a growing emphasis on supportive care that preserves or improves a patient’s quality of life during and beyond active treatment. The mental health of an individual is very important, with nurses checking in with patients about issues that can affect their emotional, psychological, spiritual, and social well-being. Nurses sometimes gain information about financial matters, food insecurity, family conflicts, substance use, social stressors, and safety. They can connect patients with resources accordingly.
Can providing high-quality supportive care to patients with lung cancer positively affect outcomes and quality of life? Yes it can, and it has been proven time and time again. One case comes to mind. A patient at Oncology Hematology Care (OHC) with extreme frailty who had just received a diagnosis of metastatic lung cancer had an extended hospital stay because he had malnourishment and cachexia. He was very thin and had spiking fevers combined with other active comorbidities. Consequently, physicians counseled him to consider hospice care.
However, OHC oncology nurses discussed the patient’s care goals with him and provided exceptional supportive care, which helped to improve his condition enough so he was able to be discharged home and eventually start treatment. While the patient was still in the hospital, the OHC team of registered nurses worked in conjunction with a dietician to assist the patient in meeting his immediate nutritional goals. They were the first to identify that he did not have appropriate support at home. Not only did they make the care team aware of this situation, they found resources to help the patient and, prior to discharge, arranged home-care services for him. They also picked up his medications from the hospital pharmacy to ensure he had them when he arrived home.
The patient was assigned a dedicated registered nurse (RN) care manager upon discharge who served as a connection point to the practice. The care manager immediately followed up with the patient by phone to make sure he had what he needed at home. Ongoing services were provided to ensure all of his needs were met. The care manager arranged outpatient referrals to a dietician and a tobacco abuse cessation support program. Help was also provided to secure transportation as needed and to make sure the patient’s medicines were available. His condition greatly improved, and he eventually was able to start treatment on concurrent chemoradiation with carboplatin and paclitaxel, before transitioning to maintenance treatment with durvalumab (Imfinzi). Ongoing support services from the RN care manager and nursing team were provided for several months.
Unfortunately, his disease progressed several months later. He was evaluated by an OHC advanced practice provider (APP). Thanks to her high level of expertise, the APP quickly realized something was amiss and sent the patient to the hospital. It was determined his disease had worsened and that he was starting to have more social issues. After an in-depth conversation with him about his care goals and the social difficulties he was facing, he and his health care team jointly decided hospice was the best choice for him.
This is a great example of someone who initially had many challenges and barriers to treatment that were overcome with excellent support services. This care enabled the patient to receive treatment that ultimately enhanced the quality and length of his life. It is also an excellent example of shared, informed decision-making with the patient, which empowered him to receive the care and quality of life he wanted.
“Oncology nurses are a special breed: highly skilled professionals who wear many different hats,” said Astrin. “Sometimes they are clinicians performing assessments, administering treatments, coordinating care, or helping to develop a care plan. At other times, they are teachers, psychologists, or social workers, providing expertise and emotional support to individuals facing some of life’s most difficult challenges.”
Although lung cancer rates are decreasing,4 more oncology nurses are needed because new treatment advances have resulted in patients living longer. These patients require ongoing care, increasing the need for these vital members of the care team who help survivors live their best lives.
1. Wayne G. Airway clearance therapy & coughing nursing care plan. Nurselabs. Updated July 31, 2023. Accessed August 15, 2023. https://nurseslabs.com/ineffective-airway-clearance/
2. Vera M. 8 lung cancer nursing care plans. Nurselabs. Updated August 13, 2023. Accessed August 11, 2023. https://nurseslabs.com/lung-cancer-nursing-care-plans/
3. Significant advances in lung cancer treatment bring hope. Johns Hopkins Medicine. May 5, 2022. Accessed August 13, 2023. https://www. hopkinsmedicine.org/news/articles/2022/05/ significant-advances-in-lung-cancer-treatment-bring-hope
4. Key statistics for lung cancer. American Cancer Society. Updated January 12, 2023. Accessed August 14, 2023. https:// www.cancer.org/cancer/types/lung-cancer/about/key-statistics. html#:~:text=On%20a%20positive%20note%2C%20the,in%20 early%20detection%20and%20treatment