As the world celebrates International Nurses Day, oncology clinical nurse specialist Danielle Osmond (now a member of ANZGOG's staff team) sheds light on the important role of nurses in gynaecological cancer research.
"Growing up I loved being around people. As I got older it became a strong passion and ultimately, it’s what led me to nursing. In my early nursing career, I worked in the Haematology ward, where I cared for haematology and oncology patients. I came to understand the importance of building a strong relationship with patients throughout their journey. They came to trust you and were appreciative of everything you did to support them. When my stepfather died from Melanoma, I felt particularly drawn to the oncology patients and wanted to be involved in oncology research. This led me to become an oncology clinical nurse specialist."
Gynaecological cancer nurses are nurses with expertise in caring for patients with gynaecological cancers. It is through the development of the trusting relationships gynaecological cancer nurses have with their patients and their families, that patients often express feeling reassured and supported so that their individual needs are being listened to and met.
Patients often express that they feel more comfortable talking to their nurse about treatment options their doctor has discussed with them, including any available clinical trials. Nurses explain the options to the patient and their carer whilst supporting them in making their treatment decision according to the patient's personal goals. There is a responsibility on nurses to be accessible and knowledgeable and to advocate for the patient to ensure all members of the multidisciplinary team are aware of the patient's individual needs and concerns.
As a clinical nurse specialist, some of the challenges I have seen from patients receiving treatment include the impact the treatment can have on the patient’s quality of life and their family members. Many patients are having to try and balance their treatment needs with their work and home responsibilities, and many patients need to travel long distances to access treatments that are only available in metropolitan areas.
Gynaecological cancers and their treatment affect sexual and reproductive organs which can cause sudden, severe and prolonged symptoms, including menopausal issues, pain management, lymphoedema, continence issues, as well as infertility, all of which can negatively impact a patient’s quality of life. This often leads to emotional distress, and disruption of social and intimate relationships, which may cause low self-esteem and a loss of femininity.
While there are many similarities in the needs of gynaecological cancer patients and patients with other cancers, the needs of a patient with a gynaecological cancer are complex and can change over the course of their cancer journey. The impact on the patient’s reproductive and sexual organs can make them particularly vulnerable both during and following treatment, with some of the symptoms and toxicities experienced causing premature menopause, hot flashes, vaginal dryness, and sexual dysfunction; these can impact the patient’s sense of self and patients may find these issues difficult or uncomfortable conversations to have. A sensitive and holistic approach to caring for these patients is essential, with attention paid to the cultural, ethical, and spiritual preferences of the patient will ensure all the supportive care needs are going to be identified and met.
"It is essential the patient is comfortable having these conversations in a safe physical, emotional and cultural environment as this will optimize the quality of life and outcome of the patient."
There have been many important moments that I have experienced as a cancer nurse caring for patients with gynaecological cancer, many of which have involved being present in the moment to support the patient, listening to the patient’s individual needs, and advocating for the patient. Patients and their caregivers were able to phone me directly to discuss their concerns, whether it was regarding treatment-related toxicities, disease symptom management, or other concerns or supportive care needs. I felt it was very important that I was accessible and available to the patient or her carer when they needed support and that I provided timely counselling and education to the patient on how to manage the symptoms and toxicities she was experiencing, providing the necessary resources or referring the patient onto other members of the multidisciplinary team. I felt it was important to sit with the patient during her consultations with the doctor as she received results or discussed changes in treatment plans, so I could provide the emotional support that was needed. Patients often come out of the consultation room and would be processing the results or the discussion that was had, and needed to talk about it further, or have the information they were given explained again.
"Knowing I was able to provide that support, counselling and reassurance was a very important and meaningful part of my role."
There was one occasion a patient had told me she did not wish to continue treatment as the toxicities were impacting her quality of life, she didn’t discuss this with her doctor, or feel confident in expressing these concerns. The patient trusted me and knew that I would advocate for her, so felt comfortable having this conversation with me. I informed the doctor of the patient's concerns and wishes, which led to the lengthy discussions between the doctor and the patient, to ensure we were respecting the patient’s wishes, and providing her with all the information she needed to make an informed decision which she was supported in, and that all the necessary supportive care measures could be put in place. This is just one example of how important it was for me that I built trusting relationships with my patients, to ensure the patient felt comfortable they were able to have these conversations and that their individual needs would be listened to.
Danielle Osmond is an oncology clinical nurse specialist and ANZGOG's Project Manager – Patient Referral Networks. Danielle's role at ANZGOG is to increase access and participation to clinical trials for women in Australia, particularly in remote and rural areas. To find out more about ANZGOG, click here.