The Gibbs Cancer Center, part of the Spartanburg (South Carolina) Regional Healthcare System, is 1 of 21 National Cancer Institute (NCI)-designated community cancer centers. Recognizing in 2007 that 85% of all cancer patients receive their care in the community, NCI set benchmarks for elevating cancer care in the community setting. The Gibbs Cancer Center and other NCI-designated community cancer centers have to meet standards on reducing healthcare disparities, enhancing community outreach for cancer screening and follow-up, collection of high-quality biospecimens, improving quality of cancer care, research, and expanding information technology, survivorship, and palliative care. Approximately 1700 cancer patients are diagnosed and treated at the Gibbs Cancer Center each year, many of them underinsured or uninsured, with low levels of literacy.
The Oncology Nurse-APN/PA spoke with Lucy Gansauer, RN, MSN, OCN, director of the NCI Community Can-cer Centers Program at Spartanburg Regional Healthcare, about cancer care at the Gibbs Cancer Center and her role as an oncology nurse.
What is the approach to cancer care at your center?
Lucy Gansauer (LG): We have a personalized and multidisciplinary approach to our patients. We have nurse navigators who are the point of entry to our system: 1 for prostate/GU [genitourinary] cancer; 1 for hematology/head and neck/CNS [central nervous system] and brain cancer; 2 for breast cancer; 1 for thoracic cancer; and 1 for colorectal cancer. The nurse navigator identifies cases and connects patients to the system at the time of diagnosis. He or she helps navigate patients through the system and answers any questions. The nurse navigator identifies special needs or problems, such as the need for social support, low literacy, education, or insurance barriers—in an attempt to eliminate barriers and ensure equity of care. At our center, we focus on eliminating disparities in care due to race, ethnicity, or rural location; we provide outreach to help patients have access to quality care. Many of these patients are uninsured and unemployed, and we facilitate free screening for breast, colorectal, and prostate cancer for early detection.
How does your approach improve outcomes?
LG: Our approach has reduced diagnosis of breast cancer at a late stage among African Americans. Thirty-six percent of the men we screen for prostate cancer are African Americans, who have worse outcomes if not diagnosed early. We can identify men early, who often can be treated with active surveillance, and we educate those who need treatment about their choices.
What are you excited about at your center?
LG: We are serving a larger proportion of adolescents and young adults with cancer, and we have expanded our services for this group, including support groups, survivorship clinics for those at risk of second cancers, and onco-fertility. We are partnering with fertility specialists at the Piedmont Reproductive Endocrinology Group to encourage patients who either have not had families yet or who plan to expand their families to preserve eggs and sperm. Genetic counselors meet with patients for a free consultation in person or over the telephone and give them information about fertility services. This has been a wonderful collaboration that has allowed us to apply for LiveStrong discounts and free fertility drugs.
How has the role of an oncology nurse changed over the past 5 years?
LG: We have become accountable now for patients’ outcomes. This is new and difficult for some nurses to adjust to. We need to make sure that patients understand their treatments, and nurse navigators are now accountable for reducing avoidable emergency department and inpatient stays. For example, patients with diabetes or past psychological problems are at greater risk for rehospitalization, and we have to risk-stratify these patients and manage them proactively. Nurses are now equal partners with doctors in accountability for outcomes.
What inspired you to become an oncology nurse?
LG: I always wanted to be a nurse. When my father was diagnosed with colorectal cancer, I witnessed how overwhelming the diagnosis was. He had to meet with a medical oncologist, surgeon, and radiation oncologist within 1 week. He ultimately needed a colostomy. I became his de facto manager. Then I got an opportunity to become an oncology nurse, and I took it. In the era of personalized medicine, I find it fascinating and rewarding to match the treatment with the patient’s specific genetic markers. There is no other nurse specialty that requires such a high level of learning and expertise.
What advice would you give to an oncology nurse just entering the field?
LG: You need to ground yourself by working in an oncology unit and seeing how patients deal with cancer emotionally and physically. You need certification and an advanced degree to be an oncology nurse. An entry-level degree does not prepare you for the evolving science and clinical care. You will always be learning.
What would you be if you weren’t an oncology nurse?
LG: I would be a cancer researcher. I find it fascinating how research can improve patient care; for example, developing less toxic regimens or being involved in new drug development. It is amazing what we can learn about the human body and its response to cancer and to cancer treatment.
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