Measuring and improving cancer care: Nursing leads the way

Written by: Christopher R. Friese and Alex J. Fauer

 The challenge is daunting: The latest statistics suggest that nearly 1.8 million Americans will receive a cancer diagnosis in 2020 and over 600,000 will die from cancer in the same period. Despite impressive advances in cancer detection and treatment, far too few Americans receive high-quality, evidence-based cancer care, according to a National Academy of Medicine report. Even more concerning is that outcomes are often worse for members of racial/ethnic minorities, rural residents, individuals facing poverty, individuals with multimorbidity and those who identify as LGBTQ+. Oncology nurses make up the largest health care workforce for patients with cancer, however only 1 percent of all nurses hold research-focused doctorate degrees. Nurses are well-suited to understand and improve the care experience for patients diagnosed with cancer and their caregivers.

Students and faculty at the University of Michigan School of Nursing practice clinically in addition to leading research efforts. For example, Alex cares for adults diagnosed with cancer receiving cellular therapies, including hematopoietic stem cells and the novel Chimeric Antigen Receptor - T cell therapies (CAR-T). These treatments offer patients the opportunity to remedy complex blood cancers such as leukemia, lymphoma and multiple myeloma. However, cellular therapies are often highly toxic and costly. Chris cares for adults with blood cancers before their transplants, in addition to other patients with advanced cancers who are hospitalized to manage their symptoms.

In both of these settings, patients struggle to manage cancer treatment-related side effects, such as pain and digestive symptoms, and frequently return to the clinic, visit an emergency department or become hospitalized for symptom control. Their caregivers, often family members or spouses, frequently miss work and report strain in managing the complex array of tasks that caring for adults with cancer entails.

Here’s the good news: Nurse researchers at the University of Michigan are leading efforts to address these vexing problems. The Center for Improving Patient and Population Health (CIPPH) at the U-M School of Nursing provides support for students, faculty, and research teams to measure and improve the quality of care received by patients with cancer. Examples of studies led by CIPPH investigators include:

• Outpatient clinics that administer chemotherapy treatments have struggled to implement electronic health records, which has weakened clinician-to-clinician communication and threatens patient safety (Patel, et al, 2019).
• Adults diagnosed with cancer are increasingly prescribed gabapentin and pregabalin — two risk-prone, antiseizure medications — in the hopes of controlling their pain, despite unclear evidence of clinical benefit (Fauer, et al., 2020).
• Compared with placebo, Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor antidepressant, was a safe and effective treatment for patients who experienced neuropathic pain due to chemotherapy treatment (Smith, et al. 2013).
• An interdisciplinary team has successfully implemented a low-cost, evidence-based FOCUS program in a community setting to improve outcomes for cancer caregivers (Titler, et al., 2017).
• Nurses and pharmacists who participate in a team-based workshop focused on chemotherapy safety report high satisfaction, and over half implement clinical practice changes (MOSST Workshop Website).

We enter 2020 inspired by the remarkable advances in cancer treatment. Indeed, the latest data suggest that novel cancer treatments have notably reduced cancer-related mortality. We are humbled by the obligation and the opportunity to ensure that nursing science addresses the needs of the most vulnerable patients with cancer. As scientists, we are excited by the Cancer Moonshot Goals to accelerate discoveries in cancer care. As nurses, our proximity to patients and families inspires us to lead the discovery of effective interventions to reduce the burden of cancer on our society.

About the authors:

Christopher R. Friese, Ph.D., RN, AOCN, FAAN, is the Elizabeth Tone Hosmer Professor of Nursing and director of the Center for Improving Patient and Population Health at the University of Michigan School of Nursing. He is also professor of health management and policy in the U-M School of Public Health and associate director for cancer control and population sciences at U-M's Rogel Cancer Center. You can follow him on Twitter at  @ChrisFriese_RN.

Alex J. Fauer is a Ph.D. candidate, Hillman Scholar and Jonas Scholar at the University of Michigan School of Nursing, where he earned his Bachelor's of Science in Nursing degree in 2017. Fauer also works as a staff nurse at U-M's Rogel Cancer Center. You can follow him on Twitter at @Al_Fau.