The Frontier of Care: How Oncology Research Nurses Drive Clinical Excellence

As oncology care continues to advance through novel therapies and complex clinical trials, the role of the research nurse has transitioned from a supporting player to a central leader in trial execution and patient safety. Christina Klawitter, MSN, RN, OCN, RN, Team Lead at the Clinical Trials Research Unit (CTRU) at Mayo Clinic in Phoenix and a member of The Arizona Clinical Oncology Society (TACOS), recently shared insights into the intricate balance of scientific rigor and compassionate care required at the "frontier" of oncology in an interview with Oncology Nursing News.

With over 13 years of experience ranging from inpatient hematology to hospice and breast cancer infusion, Klawitter has spent the last three years focusing on the treatment side of clinical research. Her unit was born out of a necessity to provide dedicated attention to investigational protocols that were previously integrated into standard infusion centers.

"Our unit, particularly, started as a little small sliver of a really large standard of care infusion center, and we were finding a 'Swiss cheese effect,' so to speak, where a lot of things were getting missed just because it wasn't given the attention that it deserved," Klawitter explained.

The art of pre-planning and protocol adherence

Managing the rigid requirements of a clinical trial alongside the unpredictable needs of an oncology patient requires what Klawitter describes as "finesse." Success begins long before the patient arrives, involving a deep dive into protocols that can exceed 100 pages. The research team at Mayo Clinic conducts extensive safety checks and reviews each planned treatment with the assistance of principal investigators (PIs) and research coordinators.

"We review the protocol thoroughly ... making sure that each day a patient is coming in for treatment, we have reviewed thoroughly the protocol, what's planned, and the treatment that is planned," Klawitter said. This pre-planning phase also includes strategic staffing assessments to ensure the unit is prepared for the specific side-effect profiles of novel therapies.

A foundation of vigilance

While all oncology nurses are trained in safety and side-effect management, Klawitter noted that research nursing requires an added "layer of vigilance." In the Phase 1 or novel setting, the unit often employs a one-to-one nurse-to-patient ratio to ensure maximum safety during the administration of investigational products.

"We're already pretty vigilant people. And then I think adding the novelty of a new drug, we try our best to anticipate how a drug might behave," Klawitter noted.

Beyond monitoring for acute reactions like anaphylaxis, research nurses must track subtle, late-emerging side effects. Every symptom reported by a patient — from sleep disturbances to minor rashes — is meticulously documented to provide valuable data for the study.

Interdisciplinary synergy

A hallmark of the CTRU at Mayo Clinic is its high level of collaboration across departments. Klawitter highlighted a specific example involving nuclear medicine, where treatment nurses must coordinate with nuclear medicine technicians to administer radioactive study drugs. This process requires precise timing for pre-medications, vital signs, and EKGs.

"The nurse is really at the center of that, once that patient's in a different department, where the timing is so crucial," she said. This coordination ensures the unit functions as a "well-oiled machine," even when moving patients between different specialized areas of the hospital.

Effective delegation within the research team is also vital. Licensed medical assistants (MAs) play a critical role by performing time-sensitive tasks like venipunctures and EKGs, allowing nurses to focus on complex assessments and the "psychosocial needs that are so hallmark to the cancer world."

Advocacy and education in research

For patients, participating in a clinical trial can represent a high-stakes emotional journey. Klawitter emphasized that informed consent is an ongoing process, not a singular event. Nurses must frequently reiterate the requirements of the protocol, as patients often struggle to retain information during the initial diagnosis or when a treatment plan changes.

"We’re often holding space for patients to have hope, and also to have that fear," Klawitter said. She noted that it is essential for patients to understand the "tedious" nature of trials, which often involve more frequent appointments and longer hours on-site than standard care.

The future of nursing in research

Klawitter believes that research offers a unique path for nurses who wish to engage with the academic and legal sides of medicine without necessarily pursuing an advanced degree like a nurse practitioner. Nurses now have a "seat at the table" when determining the feasibility of a study in an outpatient setting, ensuring that research remains patient-centered.

Her advice for units looking to expand into research is to integrate nursing insights early in the planning stages. "No one silo gets the job done," she said, emphasizing that collaboration between PIs, pharmacists, and nurses is the key to success.