Vanderbilt University School of Nursing is affiliated with Vanderbilt University School of Medicine and the Ingram Cancer Center, one of the National Cancer Institute (NCI)–designated Centers of Excellence. The School of Nursing, located in Nashville, Tennessee, values excellence and innovation in advancing the art and science of nursing. The school has a 4-fold mission in the areas of academics, faculty practice, research, and informatics. Committed to evolving in response to innovations in these fields, the school is committed to transactions that integrate technology and embrace cultural and academic diversity.
The Oncology Nurse-APN/PA spoke with Sheila Ridner, PhD, RN, FAAN, the Martha Rivers Ingram Professor of Nursing at Vanderbilt University School of Nursing, about her research interests and the role of the oncology nurse/advanced nurse practitioner.
What is your role at the school of nursing?
Sheila Ridner (SR): Eighty percent of my time is spent on research in oncology symptom management in 2 areas: lymphedema, primarily in patients with head and neck cancer (HNC), and biobehavioral science.
Can you give me some examples of your research projects?
SR: Chemotherapy and radiation commonly cause damage to the lymphatic system and soft tissue structures in patients with HNC, although this was not well known or well described in the United States until we started doing our studies. We have done studies on techniques for measuring the lymphatic changes and blood flow in the arms of patients with breast cancer, and have pioneered work on self-measurement of lymphedema with bioelectric impedance devices. In HNC, we are looking for genetic markers and biomarkers associated with lymphedema and fibrosis.
Our studies have shown that HNC patients swell internally as well as externally, and in fact, these patients appear to develop lymphedema sooner in the course of treatment and go through progression faster than breast cancer patients. We have found that surgeons or ENT [ear, nose, and throat] physicians who use endoscopy to look for tumor regrowth can actually visualize internal lymphedema. At first, these physicians thought that patients were not swelling internally because they were focused on looking for tumor regrowth; when they were asked to assess internal swelling on nasal endoscopy, they were surprised to see that it was relatively common.
We are measuring and recording physical findings in these patients, and drawing cytokine levels to see if there is an inflammatory component with the lymphedema.
How do you treat lymphedema in patients with HNC?
SR: We are doing a small pilot study to evaluate the effect of standard massage therapy on the movement of internal fluid in HNC. This is the only therapy known to help lymphedema. Our preliminary findings suggest that massage can help. We plan to look at the effect of preemptive therapies in patients with HNC undergoing chemoradiation.
What are the trends in HNC?
SR: We are seeing more women and more younger people with HNC due to HPV [human papillomavirus] infection. It is not well known in the US that lymphedema occurs in these patients. However, we have clearly identified lymphedema as a problematic adverse event associated with treatment of HNC.
What type of biobehavioral research are you doing?
SR: We conducted a randomized controlled trial to determine the benefits of expressive writing in breast cancer survivors with lymphedema. We just received funding from NCI to conduct a 2-year randomized trial in HNC patients using a tailored yoga program to help with the musculoskeletal complications and swelling due to treatment.
SR: Diaphragmatic breathing helps to move the lymphatic fluid. We plan to study an 8-week program that includes several yoga postures, breathing techniques, and meditation techniques and compare outcomes with a non-yoga control group. We will videotape the program for patients to use in their home yoga practice.
What are you excited about in the field of oncology?
SR: I am excited about raising awareness of the problem of lymphedema in HNC patients. If lymphedema is not controlled, patients can end up in the ICU with tracheotomies. The ability to identify, measure, and treat lymphedema in HNC will ultimately lead to better quality of life for patients and wiser use of healthcare resources. Another avenue of research is use of laser therapy during radiation for HNC, which has been helpful with arm lymphedema in breast cancer patients. Investigators in Tasmania report that laser therapy helps mucositis and also reduces internal swelling in HNC.
The goal is to help people with HNC who develop lymphedema—the so-called “throwaway children in cancer care.”
How has the role of the oncology nurse changed in the past decade?
SR: Advanced practice oncology nurses are assuming growing responsibility for management of symptoms during and after treatment. Symptom management clinics are becoming more common. These advanced practice nurses can follow patients and measure their symptoms, order endoscopies, and make referrals to lymphedema therapists when indicated.
Non-advanced practice nurses are also assuming a growing role in gathering information on the types of symptoms that patients have and assessing them, beyond their vital signs.
The specialty of oncology is leading the way for broader responsibilities for nurses, and I think this will happen in other types of medical practices.
What inspired you to become an oncology nurse?
SR: In nursing school, I did a 2-year stint as an oncology assistant and I learned more about life in that job than I could have learned by simply living for 10 years. I was moved by the strengths that people have in facing terminal illness, and that was part of my inspiration. I still learn from my patients every day.
After nursing school, I lived with my husband in Europe and worked with mental health patients. I eventually enrolled at Vanderbilt to get my PhD, and my dissertation was on lymphedema in breast cancer survivors.
Those experiences led to my interest in lymphedema and biobehavioral research.
What advice would you give to people who are thinking of entering the field of oncology nursing?
SR: I would say that your patients can teach you how to live your own life. Patients may not always acknowledge you, but they need you and appreciate you. In order to enter this field and remain in it, you have to care about people. Many people try it and leave because they have trouble facing death and dying on a daily basis. You also need to set personal boundaries so you can tolerate the sadness and stress.
If you were not an oncology nurse, what else would you be doing?
SR: I would be a veterinarian in a rural area. I grew up on a farm that I now own and where I spend every weekend. I have seen how much help a rural veterinarian can provide to the community. People make a living from their animals, so keeping them healthy is vital to their livelihood.