Last updated on May 18th, 2022 at 10:00 am
Nursing Study Guide on Oncology Nursing
Oncology nursing is a nursing subspecialty focusing on the care of patients with cancer. Becoming a certified oncology nurse requires advanced education, certifications, and clinical experience, oftentimes more than what a typical BSN program provides.
- Goals of Oncology Nursing
Oncology nursing care can be defined as ensuring the needs of the cancer patient is met on all phases of their disease, with nursing goals that include:
1. Cancer screening and prevention
2. Symptom management – brought about by either the disease itself or the treatment modalities for cancer
3. Rehabilitative and maintenance of normal function as possible
4. Supportive and comfort measures at the end of the patient’s life
Aspects of Oncology Nursing: Management of Cancer
There are numerous treatment modalities when it comes to treating cancer, each with its own risks and benefits. These treatment types can either be utilized in combination with others, or used all throughout the phases of the disease. The different types are as follows:
- Surgery
- Radiation Therapy
- Systemic Anti-Cancer Therapy (SACT): Chemotherapy
- Systemic Anti-Cancer Therapy (SACT): Targeted therapy
- Bone marrow transplantation (BMT)
- Surgery
Surgical management of cancer is a treatment modality that is further subdivided when considering the goal in performing such procedures and they are:
- Diagnostic surgery. Biopsy is the foremost procedure that is done as a form of diagnostic surgery to assess for the presence of cancer cells in the body. Testing a tissue sample obtained from a biopsy is the definitive method for assessing malignancy amd cancer. There are three types of biopsies and they are:
- Excisional biopsy
- Incisional biopsy
- Needle biopsy
- Surgery as primary/ curative treatment. It involves the removal of the tumor, may it be whole or complete, together with corresponding lymph nodes if needed. Categories for these are:
- Excision – could be either local (removal of the tumor only), or wide/ radical (extends to the removal of lymph nodes)
- Video assisted endoscopic surgery
- Salvage surgery
- Electro surgery – the application of electrical currents directly in the tumor
- Cryosurgery – the application of liquid nitrogen directly in the tumor
- Chemosurgery – the application of chemotherapy directly in the tumor
- Laser surgery
- Photodynamic surgery – the use of a light-sensitizing agent given intravenously, that is taken up by cancer cells, followed by exposure to laser within 24-48 hours.
- Radiofrequency ablation – the use of heat for cancer cell destruction
- Prophylactic surgery. This involves removal of non-vital organs that are at risk for developing cancer. Examples of this are mastectomy and oophorectomy.
- Reconstructive surgery. This surgery usually follows after a curative or radical surgery is done so to give the patient improvements in function or for cosmetic effect.
- Palliative surgery. This is a type of surgery done to alleviate the symptoms and complications of cancer.
2. Radiotherapy or Radiation Therapy
Radiation treatment involves the application of radiation to destroy the tumor and its surrounding structures. Radiation therapy can be administered in different ways; however, will depend on the source of radiation used, the location of the tumor, and the type of cancer targeted.
Radiotherapy could either be given externally (Teletherapy) or internally (Brachytherapy). This form of therapy is given in fractionated doses on a span of several weeks, depending on the treatment plan.
3. Chemotherapy
Chemotherapy is the application of anti-neoplastic agents to the body in an attempt to destroy cancer cells. This treatment targets and interferes with the body’s cellular function, including cell replication.
Chemotherapy drugs may directly or indirectly affect the different cell cycle phases, each with a different effect depending on the drug classification. The different classifications are as follows:
- Alkylating agents – alter the DNA structure by misreading the DNA code
- Nitrosoureas – similar to the alkylating agents, but can cross the blood-brain barrier.
- Topoisomerase I inhibitors – induce breaks in the DNA strand by binding to enzyme topoisomerase I, and therefore preventing cell division
- Antimetabolites – hinder the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis.
- Anti-tumor antibiotics – interfere with DNA synthesis by binding DNA and prevent RNA synthesis.
- Mitotic spindle poisons – stop metaphase by inhibiting mitotic tubular formation and inhibiting DNA and protein synthesis
- Hormonal agents – these agents bind to hormone receptor sites and therefore alters cellular growth, inhibits RNA synthesis
4. Targeted Therapy
Targeted therapy is a type of treatment that seeks to minimize the negative effects of conventional cancer treatment on healthy tissues. Its mechanism of action works by disrupting specific cancer cell functions such as malignant transformation, cell communication pathways, processes for growth and metastasis, and genetic coding. Examples of these therapies are:
- Non-specific biologic response modifiers – BCG (Calmette-Guerin) when injected to certain bladder cancers can eradicate malignant cells.
- Monoclonal antibodies – allow the sparing of normal cells while facilitating the destruction of atypical, malignant cells
- Cytokines – produced by the body during an inflammatory response and are used to enhance the body’s response in eradicating cancer cells
- Retinoids – some cancer cells have retinoid-dependent cell receptors in the cell nucleus; the use of retinoids therefore affect the cell cycle
- Cancer vaccines – used to mobilize the body’s immune system to recognize and attack cancer cells (e.g., HPV vaccine for cervical cancer)
5. Bone Marrow Transplantation
Bone marrow transplantation or BMT is administered with the goal of replacing the diseased marrow of the patient with the new, healthy cells. These cells may either be sourced through an allogeneic donor (related relative or matched unrelated), autologous (from the patient him or her self), or syngeneic (from an identical twin).
The role of BMT as adjunct treatment for cancer has been long established, especially for leukemias.
Roles of an Oncology Nurse
The oncology nurse plays a vital role in cancer care. There are various roles that the oncology nurses assume, and they are as follows:
- Direct caregiver – implies mastery of the nursing process and the ability to provide, guide and evaluate nursing practice delivery to individuals with cancer, their families and community
- Coordinator – works expertly with a multi-disciplinary oncology team to achieve realistic goals for an individual or for an entire community
- Consultant – provides expertise about oncology to colleagues, allied health personnel and healthcare consumers.
- Educator – devoted to teaching nurses who work in healthcare facilities the skills and knowledge needed to provide the best possible care to their patients; provider of health teaching to patient and their caregivers
- Researcher – identifies or investigates research problems and evaluates and applies research findings that affect cancer care nursing
- Administrator – creates environment conducive to the optimum health of the public and professional nursing practice
Nursing Care Plan for Oncology Nursing
Possible Nursing Diagnoses
- Risk for Infection (Neutropenic Sepsis) related to systemic anti-cancer therapy (e.g., chemotherapy, immunotherapy, and targeted therapies)
- Fatigue related to cancer treatment
- Impaired Skin Integrity related to radiotherapy
- Disturbed Body Image related to side effects of systemic anti-cancer therapy (e.g., alopecia or hair loss) or because of surgical treatment (e.g., mastectomy, prostatectomy)
- Imbalanced Nutrition: Less than Body Requirements related to side effects of systemic anti-cancer therapy
- Risk for Fluid Volume Deficit
- Risk for Altered Oral Mucous Membranes
- Anxiety
- Hopelessness
- Risk for Constipation/ Diarrhea
- Risk for Altered Sexuality Patterns
- Anticipatory Grieving
- Pain (acute or chronic)
- Situational Low Self-Esteem
- Self-care Deficit
- Risk for Falls
- Deficient Knowledge related to the treatment’s purpose, benefits, and risks
Nursing Assessment
| Interventions | Rationales |
| Complete pre-cancer treatment assessment using the form provided by the hospital/ institution. The assessment should include: Name identification (check name band) Diagnosis Past medical history Family history Current medications Allergy status Baseline vital signs History of cancer treatments if there’s any | To confirm the indication for the pre-cancer treatment (systemic anti-cancer therapy, radiotherapy, and/or surgery) and to prepare the patient for it. |
| Assess patient’s knowledge about the cancer treatment when verifying consent. | To ensure that the patient is fully aware of the details of the cancer treatment he/she will be receiving. |
| Allow the patient to express his/her thoughts and feelings about the cancer diagnosis and treatment. Re-assure the patient that the healthcare team is always ready to address his/her concerns. | Patients with new or recurrent cancer may feel helpless, afraid, and anxious about their diagnosis and treatment. The nurse should stand as a client advocate and establish rapport to help the patient cope with the situation. |
| Check for the status of peripheral veins prior to cannulation and administration of intravenous medications. Assess for the presence of central venous line/s and access aseptically if needed for the treatment. If administering oral medications, assess the patient’s mucous membranes and his/her ability to swallow. | To check for any potential problems with administration, hydration, and absorption. To ensure that the right form of medication is given through the right route. |
| Obtain a list of current medications and their doses from the patient or caregiver. | The patient’s current medications should be reviewed, especially those that might interact with the SACT drugs or symptom-relieving drugs that will be used during the treatment. |
| Obtain blood samples and monitor blood counts, especially red blood cells, hemoglobin, WBC and neutrophil counts. | To check for any risk of bleeding or anemia, and to assess for presence of an infection. |
| Perform a physical assessment before and after treatment. Using the Common Terminology Criteria for Adverse Events (CTCAE), assess for the presence of SACT-specific side effects, which may include:Vital signs, noting any changes in temperature, breathing, and circulationSigns of allergic reaction or anaphylaxisThe oral mucosa for stomatitisThe skin for any radiation or chemotherapy-associated skin changesGastrointestinal upset, nausea and vomiting, acid reflux, constipation, or diarrhea | Many SACTs can cause oral mucositis and stomatitis. Radiotherapy can cause skin changes known as radiation dermatitis that usually show up within 2 weeks post radiation treatment. Chemotherapy and other SACTs may cause skin changes such as rashes. Severe rash may indicate allergic reaction/ anaphylaxis towards the SACT. |
Nursing Planning and Intervention
| Interventions | Rationales |
| Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking SACT medications and symptom relievers. Instruct the patient on how to self-administer oral medications. | To inform the patient on the basics of medications, as well as to empower him/her to safely self-administer the medication. |
| Collect bloods and check for complete blood count, renal and liver function. Collect urine samples as needed. Check the patient’s urine for any signs of infection or profuse bleeding. | To check for any signs and symptoms of excessive bleeding or infection. Cancer patients with active SACT regimens are prone to infections. Some of these SACT medication may cause renal and/or liver dysfunction or low platelet counts. |
| Administer the appropriate supportive medication as prescribed. | To provide relief of side effects of SACT or radiotherapy, such as pain, skin changes, mucositis, nausea and vomiting, constipation or diarrhea. |
| Place the call bell within patient’s reach during treatment. Always have an emergency trolley nearby. | To ensure patient’s safety and to perform proper wound care post-surgery while at home. |
| In the event of anaphylaxis or adverse reaction to SACT, stop the infusion immediately, call for help, report to the oncology resident on duty, and administer appropriate medications. | To promote patient’s safety and prevent complications by treating the adverse reaction as soon as possible. |
| Post-surgical treatment: Educate patient and caregiver about follow up care, proper wound care, and take-home medications if discharging to home. | To ensure patient’s safety and to perform proper wound care post-surgery while at home. |
| If the patient has central venous access device/s (CVAD), teach the caregiver on its proper management, such as changing dressings and flushes if competent to do so. If unable to perform skin cleansing and dressing changes, schedule the patient for routine CVAD care. | CVADs must be properly managed as they can be entry sites of infection. CVADs can be managed by the patient’s caregivers if they show competence after the nurse has demonstrated the procedure. Another option is to have the CVAD dressing changes done in a cancer unit or a competent nurse to visit the patient at home to perform the procedure. |
| Perform scalp cooling procedure as indicated and as consented by the patient during SACT treatment. | Many SACT treatments cause alopecia or hair loss. This can be sometimes minimized through the use of scalp cooling |
| Complete nursing documentation prior to transfer to another clinical area or before discharge to home. | To update patient’s medical records which is important in providing continuous holistic care. |
| Administer GCSF as prescribed. | To prevent neutropenic sepsis. |
| Refer the patient to another healthcare team as required and as consented by the patient:Oncology dietitianPhysiotherapy / occupational therapy teamComplementary therapyPsychiatric servicePain specialistOther medical teamsHair services that specialize in making wigs for cancer patientsCancer support groupsPalliative or end-of-life care serviceClergy | To provide specialized care for the patient and to help him/her achieve optimal quality of life |
Nursing Evaluation
| Interventions | Rationales |
| Ask the patient to repeat the information about SACT regimen and supportive medications. | To evaluate the effectiveness of health teaching on medications. |
| Monitor the vital signs and neurological status of the patient after cancer treatment. | To ensure that the surgery or administered medications did not cause any adverse events to the patient. |
| Monitor complete blood counts, kidney and liver function through blood tests. | To check for the presence of neutropenia. To ensure that the surgery or administered medications did not cause any adverse events to the patient. |
| Advise the patient to inform the healthcare team of any new or worsening side effects of SACT or radiotherapy. Remind the patient to always carry the card provided that contains important details such as full name, allergy status, diagnosis, current SACT treatment, and contact number of the cancer unit where he/she is being treated. | To ensure patient’s safety and to deal with any emergent complications. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
Disclaimer:
Please follow your facilities guidelines, policies, and procedures.
The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.
This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
the table part is so nice because it helps people know the different types of nurses and what they do