University of Arizona Cancer Center

The University of Arizona Cancer Center, located in Tucson, was founded in 1976 as a division of the University of Arizona’s College of Medicine. In 1990, the University of Arizona Cancer Center was designated as a Comp rehensive Cancer Center by the National Cancer Institute (NCI). As such, the center is not only focused on patient care, but also conducts translational and clinical research into the development and delivery of therapies to reduce the morbidity and morphology of cancer. It is only 1 of 2 comprehensive cancer centers in the 5-state region of Arizona, Colorado, Nevada, New Mexico, and Utah.

With the mission of preventing and curing cancer, the University of Arizona Cancer Center carries out its research across several programs, including cancer biology and development, cancer imaging technology, gastrointestinal cancer, therapeutic development, and cancer prevention and control. A newly developed program conducts research into the biobehavioral and social sciences to identify and evaluate interventions to improve the quality of cancer care and implement effective supportive strategies in caring for people with cancer.

Sandra Kurtin, RN, MS, AOCN, ANP-C, is a hematology/oncology nurse practitioner at the University of Arizona Cancer Center and a clinical assistant professor at the University of Arizona colleges of medicine and nursing. She answered our questions about the profession of oncology nursing.

What are you excited about right now in the cancer field?

Sandra Kurtin (SK): I am excited about the progress being made in diagnostic technologies and their application to the clinical management of patients with cancer. For example, high-resolution MRI with phases of arterial and venous contrast (functional MRIs) can now suggest certain malignancies and often exclude other potential diagnoses prior to any tissue biopsy or surgical intervention. This allows more effective treatment planning and eliminates unnecessary invasive procedures in some cases. In other cases, functional imaging and tissue analysis can predict early response or lack of benefit to treatment within days of the first dosing, potentially eliminating exposure to treatments that have limited potential benefit but considerable potential toxicity. This does present challenges to the healthcare team and to the patient—requiring very individualized treatment plans that may change based on these techniques.

Similarly, tissue diagnostics have provided a number of new therapies with activity in specific populations. Whether we call them targeted therapies or tailored therapies, these treatments have particular benefit in patients with a specific tumor profile. For example, patients with wild-type KRAS are known to have improved benefit from EGFR inhibitor agents, patients with ALK-1+ lung cancer may benefit from a new drug targeting this marker. Similarly, profiling cytogenetic and molecular markers in the hematologic malignancies allows risk stratification and risk-adapted treatment selection. The diagnostic process, both imaging and tissue analysis, will dictate the treatment plan. Thus, precision in the diagnostic process is critical to making the best treatment decisions.

What approach does your institution take to treating people with cancer?

SK: Each patient is approached as an individual as opposed to a diagnosis or suspected diagnosis. This individualized approach to care is critical to building a sense of trust and confidence on the part of the patient and his or her family. The initial interactions with the patient and his or her caregivers are critical to building a partnership for ongoing management of the disease and any possible adverse events as a result of treatment. Careful review of the diagnostic evaluation, in some cases by multidisciplinary tumor boards, is routine in our institution. As mentioned previously, the diagnosis drives treatment selection. Discussion with the patient and his or her caregivers about the diagnosis, implications for survival, available treatment options, the risks and benefits of the treatment, and how the disease and potential treatment will affect their daily life is a critical step in creating trust and is the foundation for the patientprovider partnership. As patients move through their cancer experience, continued open and honest communication is key to helping the patient live within the constraints of his or her diagnosis. This support is best achieved with a multidisciplinary approach including providers, advanced practitioners, dietitians, social workers, pharmacists, genetic counselors, and others.

How does that translate to better outcomes for your patients?

SK: Open communication, and partnership with the patient and his or her caregivers allows for effectively setting expectations for treatment, potential adverse events, and reportable signs and symptoms. Early identification of adverse events and prompt intervention will reduce the severity of these events. An individualized multidisciplinary approach to the diagnosis, treatment planning, and ongoing support of patients improves patient outcomes.

How has the role of the oncology nurse changed over the past 5 years?

SK: The continued and robust scientific discoveries in the diagnosis, risk analysis, and risk-adapted treatment selection of cancer presents challenges to all healthcare professionals. It is imperative that oncology nurses remain engaged in the discussion of these advances as well as maintaining a working knowledge of key aspects of each development. The complexity in the diagnosis and treatment of cancer will continue to grow. Oncology nurses are often the most common longstanding contact for patients and their caregivers. They must develop the knowledge and skills that will allow them to safely treat and support the patient, including educating the patient on these complex concepts. This is most effectively done when the nurse has a good working knowledge. The majority of oncology care is provided in the outpatient setting and the majority of patients with cancer are older, which requires an understanding of the needs of the older adult and effective strategies for safe outpatient management.

What inspired you to enter the field of oncology nursing?

SK: The courage, grace, resilience, and humor the patients exhibit each and every day is my inspiration. The continued progress being made and the excitement of offering new therapies to patients, in essence providing hope, is extremely rewarding. Knowing that I make a difference every day provides a sense of accomplishment. Being able to do something I love every day is priceless.

Any advice for nurses just entering the field?

SK: Be thankful. Oncology nursing is a unique area. There are many challenges and there will be difficult times. You must be willing to feel, but be cautious in allowing boundaries to be too open. Ask for assistance, seek out mentors, and be kind to your colleagues—we are all in this fight against cancer together. Read something every day, attend local meetings, visit websites, talk to members of the multidisciplinary team—this will make the challenge of staying current much more manageable. Oncology nursing is a gift, so Pass the Passion!

Any advice for nurses just entering If you weren't working in this field, what would you be doing?

SK: My plan in retirement is to be in charge of the mud puddle and the sandbox at my daughter’s future preschool.