The Johns Hopkins Kimmel Cancer Center and Sibley Infusion Center

TON - December 2012, Vol 5, No 11 — December 20, 2012

The Johns Hopkins Kimmel Cancer Center, located on the campus of Sibley Memorial Hospital, provides medical oncology services to cancer patients in the Washington, DC, community. The joint venture of Johns Hopkins Kimmel Cancer Center and Sibley Infusion Center offers patients access to expert, disease-specific oncologists from Hopkins. Patients are seen by a multidisciplinary team, which may include surgeons, radiation oncologists, social workers, nutritionists, physical therapists, and pastoral care counselors. In addition, patient cases are frequently presented at tumor board reviews at the main Hopkins campus located in Baltimore, Maryland. Also, patients have access to the diverse portfolio of clinical trials available at Hopkins.

In 2016, a new hospital with an integrated, comprehensive cancer center will be completed. This new facility will provide even greater access to services for many cancer patients in the Washington, DC, area.

Catherine Bishop, DNP, NP, AOCNP, answered some questions from The Oncology Nurse-APN/PA about the programs and services of the Johns Hopkins Kimmel Cancer Center and Sibley Infusion Center.

What are you excited about right now in the cancer field?
Catherine Bishop (CB): My enthusiasm in the field of oncology comes from the many clinical and pharmaceutical advances available to patients today. The new drug combinations, molecular targeted therapies, and markers allowing for the identification of treatment sensitivities move forward the goal of cure for some, longer disease-free intervals and overall survival for others. Understanding the drugs that provide the least response for specific tumors minimizes toxicities and undue costs for treatments. The plethora of clinical trials ongoing here at Johns Hopkins allows us to understand what treatments yield the most benefit, and which treatments don’t work.

With the advent of many oral chemotherapeutic and targeted agents, patients have more freedom to stay at home to receive their therapy. I think this may result in patients feeling they have more control over their treatment course and thus their personal and professional lives. It also may alleviate the burden on caregivers to make frequent trips to the clinic.

What approach does your institution take to treating people with cancer?
CB: The Johns Hopkins Kimmel Cancer Center and Sibley Infusion at Sibley Memorial Hospital are truly the finest of both institutions. Local Washington, DC, metropolitan patients have access to Johns Hopkins experts in their own community. This translates into convenience for patients who gain the disease-specific expertise from the physicians associated with Johns Hopkins without having to make the trip to Baltimore for every visit.

Our clinical approach is team based. Teams are comprised of the oncologist, the oncology nurse practitioner, and the primary oncology nurse. Every patient is at the center of this team.

How does that translate to better outcomes for your patients?
CB: Patients feel well cared for, knowing that a group of individuals are current on their plan of care. Here at Johns Hopkins Kimmel Cancer Center/ Sibley Infusion there is never a time when one of the providers is not in the clinic. Whether a patient calls or comes into the clinic in an unscheduled appointment, one of the team members is present and available to address his or her needs. This availability will often preclude an emergency room visit.

This team approach translates into comprehensive, quality care, as patients have access to each discipline. The team works together to create a cohesive, patient-centered environment.

What is your role?
CB: I am the oncology nurse practitioner (NP) within the practice, caring for a variety of cancer patients with varied types of cancer diagnoses. Before joining the medical oncology group here at Johns Hopkins Kimmel Cancer Center/Sibley Hospital, I was part of a community oncology practice and therefore had the opportunity to gain experience with many types of cancer diagnoses. This has proved to be beneficial, because while the physicians in this practice are specialists and disease specific, I have the ability and experience to cross over to many cancer diagnoses and to care for these patients alongside my physician partners.

How has the role of the oncology nurse changed over the past 5 years?
CB: Oncology staff nurses have more autonomy than in the past. I think the hierarchy way of managing patients is in the past. Staff members in each discipline have their area of expertise and are recognized and respected for their knowledge. Oncology nurses have professional commitments to furthering their understanding of the disease process and treatment protocols. They have a clear understanding of, and embrace, evidence-based practice. Oncology RNs are direct care providers working with patients on a daily basis who understand how to manage the side effects of chemotherapy. Medicine and nursing within oncology have led the way in creating and maintaining the exemplar of the intradisciplinary team. It truly takes a team to care for one patient.

Oncology NPs are integral members of both the medical and nursing team within oncology. Oncology NPs work collaboratively with oncologists. They often see patients at their initial visit, and many see follow-up visits as a routine in their daily schedules. Oncology NPs frequently are performing procedures such as bone marrow biopsies/ aspirations and intrathecal chemo­therapy and are practicing at advanced levels within community, academic, and hospital cancer centers.

What inspired you to enter the field of oncology nursing?
CB: My mother died of a brain tumor in 1992. This personal experience drew me to oncology. When the opportunity presented itself in 1994, I jumped at the chance to rotate from internal medicine to the outpatient cancer center at a large academic institution. I felt I could relate to the cancer patients and their families in a special way because of my recent experience with my mother. Oncology nursing is such a rewarding specialty. It allows closeness with patients (and their families) at a fragile time in their lives. There are so many opportunities to provide help and understanding—after all, this is one reason people choose the healthcare profession. I hear from others outside of oncology, “Your job must be so difficult.” To which I respond, “The work of oncology is one of the most rewarding jobs—I cannot think of doing anything else.” Our patients give us so much. Their courage, strength, and resilience inspire us to continue the work we have been called to do. It is truly an honor to do this work.

Any advice for nurses just entering the field?
CB: Oncology nursing is an incredibly rewarding area of practice. The opportunity to understand the science behind the quickly advancing subspecialty is both challenging and exhilarating. It demands consistently reading the literature to keep abreast of new drugs, new advances in local control of disease, and predictive and prognostic tools. The qualitative data we gather from our patients in terms of preferences related to psychosocial aspects and palliative and end-of-life care enable us to understand the type of care they want during this time in their lives.

If a nurse is thinking about entering or changing to the field of oncology, my suggestion would be to spend some time with an oncology nurse. Almost every oncology nurse I know welcomes a new nurse, or an experienced nurse entering oncology, into his or her environment to mentor or speak with about what it is like to work with the oncology patient population. Most, if not all, oncology nurses feel they get more than they give.

If you weren't working in this field, what would you be doing?
CB: I would be involved in the design field. I have always had a passion for space design, which spilled over to esthetic design. They go hand in hand for me. I like my personal and professional environments to be organized and functionally friendly. This translates into more efficient production—whether that is in the kitchen at home or in the oncology clinic.

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