Where Oncology and Transplant Care Intersect: A Nurse’s Perspective

I spent my first 6 years of nursing working in oncology. At the bedside, I cared for patients with solid organ cancer. In the infusion clinics, I administered treatment for all types of cancer. I educated patients and families on what to expect with their treatment. I provided emotional support as they navigated the unknown and celebrated with them upon the completion of treatment.

I eventually moved into a kidney transplant coordinator role. In this position, I witnessed the unique impact that a cancer diagnosis has on a patient who is also on the kidney transplant waitlist. This gave me a better perspective on caring for complex patients. It increased my clinical knowledge and patient communication skills.

Kidney cancer could be considered the most “expected” cancer, out of all cancers, to be discovered during a kidney transplant evaluation. Many kidney transplant candidates already receive dialysis. The longer the time on dialysis, the higher the risk of developing kidney cancer.

Renal cell carcinoma is the most common type of kidney cancer. Many patients do not even know they have it until they present to their doctor with hematuria, flank pain, and/or a fever. In contrast, patients undergoing a kidney transplant evaluation might be diagnosed with cancer before they develop symptoms.

Identifying kidney cancer early, rather than late, is preferable. However, this news can still be overwhelming for the recipient. For kidney transplant candidates, this diagnosis also delays their goal of receiving a new kidney.

The most common treatment for renal cell carcinoma is a partial or full nephrectomy. Patients might receive targeted therapy, chemotherapy, and/or radiation. Throughout this process, nurses support each patient through their journey.

As a kidney transplant coordinator, I witnessed the emotional rollercoaster kidney transplant candidates navigate. A diagnosis of kidney disease requires diet and lifestyle adjustments to protect kidney function. Dialysis affects patients’ ability to work, travel, and their overall energy level. A kidney transplant offers the hope of more independence and freedom. A diagnosis of cancer adds another layer of changes and restrictions.

I know from professional and familial experience that receiving a cancer diagnosis is devastating for anyone. Even with a good prognosis and multiple treatment options, it forces significant life changes. Patients who are on the kidney transplant waitlist and receive a cancer diagnosis face two long journeys. Kidney transplant candidates usually go through a monitoring period before they are activated on the transplant waitlist. This is typically a 2-year wait, but could be 0-5 years depending on the staging.

Oncology nurses provide critical support during patients’ surgical and monitoring stages. They provide education about treatment and answer family members’ questions. They provide active listening. They address the extra layer of anxiety that patients experience related to how cancer treatment affects their kidney transplant status.

As an inpatient oncology nurse, I monitored urine output and labs following a patient’s nephrectomy. I rounded with the oncologists and surgeons. Working in kidney transplant expanded my understanding of patients' additional concerns about cancer treatment.

Supplemental treatment, such as chemotherapy, requires special considerations. The oncologist reviews the pros and cons of nephrotoxic chemotherapies. The oncologist might order a lower dose to avoid further kidney damage and other side effects. For patients on dialysis, chemotherapy administration must be timed immediately after their dialysis session. This prevents the chemotherapy from being filtered out of their system too soon.

I now better understand why kidney transplant candidates are hesitant to receive blood products. Chemotherapy and kidney cancer itself can lead to low red blood cell counts. They need to be replaced through transfusion. Blood transfusions can increase a person’s Panel Reactive Antibodies (PRA). People with higher PRA levels are statistically limited in kidney matches. Therefore, these patients prefer to avoid blood transfusions.

Today, I work with patients remotely. Many of these patients have a history of cancer and/or renal disease. Working in kidney transplant enhanced my understanding of patients’ complex needs, compared to my early oncology days. Each patient has a unique journey. Somemight be waiting to “restart” another medical journey after completing cancer treatment.

With this understanding, I approach patients differently. When I notice that a patient is anxious or hesitant about a routine treatment, I take time to explore the root concern. Sometimes the patient will share new details. Sometimes their concerns are medical; sometimes they are social.

Even though cancer treatment can seem like a priority to me, patients might be prioritizing something else. They might have been envisioning a future with fewer restrictions and more freedom through a kidney transplant. A cancer diagnosis and treatment put that on hold.

Understanding patients who are going through more than one health journey leads to better care. During my first meeting or introduction with a new patient, I try to allow extra time (if possible) to explore their medical and social history. This helps to paint a broader picture of their priorities. Understanding their motivations helps me, as a nurse, support patients in reaching their goals.

Anne Denk, RN, BSN, is a registered nurse and freelance writer with over 15 years of nursing experience, including oncology, kidney transplant, and case management. Anne writes about health, medicine, and the nursing profession.