Training new geriatric oncology nurses
Aaron Begue - The James Cancer Center, Ohio, USA
The geriatric oncology nurse has a variety of roles; it’s very unique to even countries around the world. So in the United States, for example, the geriatric oncology nurse may be a bedside or clinic nurse that works very closely with the physician team to help co-ordinate care as it relates to the geriatric patient. In Europe and other countries they have very, very specially trained nurses who are highly skilled in understanding the geriatric patient as they progress through their oncology treatment. They too provide co-ordination but then they also focus on teaching other nurses, who maybe don’t have that specialised training, really how to understand the complexity of the patient who is elderly and going through cancer treatment.
What are your needs as a geriatric oncologist?
The needs of the geriatric oncology nurse are many; I don’t know that I could mention them all. The main focus is on getting the patient what they need, oftentimes that means being an advocate in terms of working with insurance companies to maybe get a drug approved that requires consultation directly with the insurance company to truly discuss the complexity of that particular patient. So it’s very unique to each individual patient. Some of the other challenges are making sure that our role is understood by the multidisciplinary team, certainly we look toward the leadership of our physicians to help diagnose and develop the plan of care for these patients but then as that changes it’s the nurse’s particular role to say, ‘I think perhaps this person is getting a toxicity related to treatment,’ or ‘I think that this person is not doing as well as they were last visit. How can we work together as a team to identify those things early and make adjustments to treatment plans as the team sees fit?’
Tell us about your involvement in the SIOG taskforce.
Two years ago I was asked to help work with the SIOG planning team for the Manchester meeting and put together a nursing taskforce at that time. That group met in Manchester, SIOG was kind enough to even give us a meeting room for half a day where just nursing and allied health were together. We were able to really all meet for basically the first time in person and work through some of the similarities that each of our countries faces in terms of providing care to these patients but then to also understand differences in terms of what have certain countries already accomplish that we can copy or mimic in other areas. So that’s been fantastic. This is now my second year working with the taskforce and I think our focus now is going to be to put out some collaborative nursing guidelines on effective care of the oncology patient as it relates to nursing care and other supportive care measures that nurses and the allied health groups really have an expertise in and focus on.
When will these guidelines be published?
We hope to develop them over probably the next year; my vision would be that those would be presented next year at the SIOG meeting. And then we’re also going to look at what research opportunities are out there that we can collaborate with, even internationally as nurses, to provide more awareness to how nursing can impact the quality and outcomes of the elderly oncology patient.
What can you tell us about Allied Health?
The allied health groups that have worked with us here at SIOG have been social workers, dieticians, patient navigators, pharmacists, radiology technicians, and I’m probably missing a few but so many different groups of people impact the day-to-day care of the geriatric oncology patient and so many of them also have such an interest in how to provide that patient with the absolute best care possible. That’s what’s evidenced by the SIOG nursing and allied health group is it’s not just one occupation, it’s not just nursing, it’s nursing and all of those other groups that I mentioned that have a common interest in how do we give that patient the best experience possible and not so much how do I, as a nurse, only worry about my job or my plan or focus. But really how do I, as a nurse, work best with the social worker and how does the social worker work best with me and how do I work best with the pharmacist and so on and so forth, so that I recognise what their expertise is and I utilise that and vice versa. In the end the patient is the one who comes out with the optimal outcome.
What about the importance of nutrition in geriatric patients?
The nutritional session at SIOG this year is focussing on the cachectic patient which has been a challenge. There is still very little hard evidence to address the patient with nutritional deficits; certainly dieticians have probably the most extensive experience in how to work with these patients but nursing as well needs to be able to identify not just that the patient may be losing weight but understand the entire scope of what the patient is dealing with. Can the patient get to the grocery store? Can the patient cook their food if they have food in the house? So it’s not as simple as just saying they don’t want to eat, it may be that they can’t physically make a meal for themselves and how do we co-ordinate with, again, other groups and professionals to make sure that we address the needs of getting to the store, the needs of maybe financially even affording groceries, to focussing on things like certain cancer treatments alter the taste of food and recognising that if a patient is on that treatment perhaps we suggest different food types that won’t taste so different or bad. We find a lot of patients don’t want to eat because the foods they loved don’t taste the way they used to, which is a challenge. So I think the nutritional piece is something that has been on-going for a long time, probably still will be a challenge in the future, but I think this is really an area where the nursing and allied health teams can help optimise the patient’s nutritional status.