At cancer’s frontline

These nurses play a vital role in caring for patients as they experience one of life’s toughest challenges. 

This year alone, an estimated 124,910 new cases of cancer will be diagnosed in Australia, a figure which is set to rise to 150,000 a year by 2020.

Excluding non-melanoma skin cancer, the most common cancers diagnosed in Australians are prostate, colorectal, breast, melanoma and lung.

According to Cancer Council Australia, nearly 15,000 more people on average die each year from the disease than 30 years ago. The survival rate for many of these common cancers, however, has increased by 30 per cent during the past two decades.

For this edition, we spoke to four nurses providing cancer care about their specific area of practice, their day-to-day clinical responsibilities and what it’s like working in this important field.

NURSE 1
Melanoma CNC
Tracy King, Institute of Haematology, Royal Prince Alfred Hospital Sydney

Tracy maintains a dual role: clinically as the myeloma CNC in the haematology department at RPA and as a clinical research fellow managing a program of research into supportive care in the Cancer Nursing Research Unit under the supervision of Professor Kate White at Sydney Nursing School, University of Sydney.

Tracy’s clinical role predominantly focuses on the provision of tailored information, explanation and interpretation of complex therapy regimens, common toxicities and management of such, plus the provision of treatment schedules and general coordination of care.

As a clinical researcher, she manages a program of research into the supportive care needs of those affected by myeloma. This includes better understanding of patient experience, the information needs and development of resources to meet those needs.

“The most rewarding aspect of my role is the ability to help patients and their families better manage their life with myeloma through the provision of tailored information and having the ability to be a single point of contact for them within the complex environment that is the cancer health system,” she says.

One of the biggest challenges in managing those affected by myeloma is increasing heterogeneity on all levels. She believes the term “many multiple myelomas” is coined with good reason! Myeloma affects people in very different ways; the morbidity associated with the disease and the toxicity of increasing lines of therapy over increasing lengths of time challenge patients and clinicians to seek the best ways to improve survival outcomes as well as supporting the broader question of quality of life.

“The most enjoyable aspect of my job is its duality,” Tracy says. “To maintain contact with patients while I’m undertaking mentored clinical research that I can then translate back into clinical practice – it’s the ideal nursing job!”

NURSE 2
Nurse Practitioner Neurosurgery
Kate Becker, Royal North Shore Hospital

The role of nurse practitioner in neurosurgery at Royal North Shore Hospital is that of a clinical leader and care coordinator.  One aspect of the role is the care of patients with a neuro-oncological diagnosis.

This unique cohort of patients requires complex planning of care, intervention and assessment to ensure that cognitive, physical and social challenges are identified and assessed and appropriate interventions made. This ensures that their adjuvant treatment can proceed following an acute neurosurgical admission with minimal disruption.

Many of these patients are not able to advocate effectively for themselves due to cognitive impairment and many struggle with adjuvant treatment regimens due to dysexecutive syndrome. This role works with carers who may need to provide 24-hour supervision or care for patients with a new diagnosis of brain tumour.

Education of patients and carers is a priority in this role. The NNP also performs medication review and prescription, and requests and interprets radiological imaging.

The role works collaboratively with the neurosurgical interdisciplinary team and the oncological interdisciplinary team.

In providing holistic patient-centred care, it is a pivotal and dynamic role that combines the fascinating clinical areas of neurosurgery and oncology. Its challenges include obtaining appropriate resources for a population of patients that are relatively young and where carer fatigue is significant due to the physical impairments and personality changes experienced by many patients.

“I’m fortunate to work in a team of clinicians and therapists who are also dedicated to providing comprehensive care and clinical intervention in order to optimise the patient’s quality of life following what can be a devastating diagnosis,” Kate says.

NURSE 3
Case Manager in Thoracic Surgery
Jocelyn McLean, Royal Prince Alfred Hospital

Jocelyn’s main role is to provide patients with pre-operative information, clinical support when in hospital, and troubleshooting and support after discharge.

At RPAH, she contributes to policy development, participates in research, conducts support groups and is responsible for patient and nurse education.

This at times includes coordination of oncology services following surgery or, in some cases, before surgery, as well as the coordination of admissions of country patients and care in liaison with rural cancer care nurses.

The case manager also enters the details of surgical cancer patients onto the lung surgical database and attends meetings of the lung multidisciplinary team, collating and entering surgical patients for discussion.

Jocelyn offers support to patients with a new diagnosis of  mesothelioma, and then gives intimate support to patients who proceed to trimodality therapy that involves extrapleural pneumonectomy. She also facilitates a support team for this unique group of survivors and carers.

She was nominated by a number of patients for the 2013 NSW Health Excellence in Nursing and Midwifery Awards and won in the category of Excellence in Partnerships with Patients, Families and Carers.

She has also recently co-authored a book titled Diagnosis and Treatment: the journey of a patient with malignant pleural mesothelioma. This is a handbook of information for patients about mesothelioma covering presentation, diagnosis and treatment, and specifically addresses the needs of patients contemplating radical surgery as part of their treatment.

NURSE 4
Colorectal Cancer Care Coordinator
Sonia Khatri, Concord Repatriation General Hospital, Sydney

The role of the colorectal cancer care (CCC) coordinator is to provide information, support and coordination of services for patients diagnosed with colorectal cancer and their families. 

Many patients with bowel cancer often receive complex care in multiple settings from several healthcare providers. The CCC coordinator assists patients and their families navigate the healthcare system and provide a focal point of contact throughout their cancer journey.

The care coordinator tailors care to meet patient’s individual needs by working collaboratively with members of the multidisciplinary team. A bowel cancer support group is facilitated by the CCC coordinator to provide a forum where people with bowel cancer can keep up-to-date with information and share their experience with others. The CCC coordinator is also involved in survivorship clinics where colorectal cancer survivors are seen in a MDT setting for provision of information on living well after cancer.

As a result, patients receive more coordinated delivery of quality cancer care. The CCC coordinator tailors care to meet patients and their families’ informational and psychosocial needs.

“I feel I make a positive difference for patients and their carers by contributing towards a more streamlined continuity of care throughout their cancer journey,” Sonia says.

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