The following article features in Issue One of the ST BREAST magazine.
Oncology nurse practitioner Gill Kruss first worked on a cancer ward as a graduate nurse in the 1990s and it was there she discovered her own natural affinity for oncology nursing and supportive care. After 20 years as an oncology nurse, a chemotherapy nurse, a breast care nurse and an oncology research nurse, she is now an oncology nurse practitioner with Melbourne Cancer Care, predominantly looking after patients with breast and gynaecological cancers. Oncology nurse practitioners are specialist nurses who provide vital support to cancer patients, by “filling the gaps” in cancer care and helping patients cope with their diagnosis and treatments. Here, Gill outlines how an oncology nurse practitioner can assist breast cancer patients and why she is so passionate about her job.
“The role of an oncology nurse practitioner in breast cancer is so broad, and so varied. We are there to provide all kinds of support to patients – whether it is physical, psychological, spiritual, social or practical. As nurse practitioners, we can work both collaboratively and independently and are empowered to take the initiative and make decisions. It’s not uncommon for us to devote up to an hour to an individual patient, assisting them with whatever it is they need help with. On any given day, this could be counselling patients, educating those women who want more information about their disease and treatments to help them make informed choices, administering injectable anti-cancer therapies, or providing practical support, such as helping complete paperwork required to access their superannuation or life insurance.
Clinically, as a nurse practitioner, I am trained to have a more advanced scope of nursing practice. My work consistently involves assessing and monitoring cancer patients who may have side effects from their anticancer treatments, or symptoms of their disease. I can determine if there is a need for more medication or dosing changes. I can prescribe a variety of medications and order some diagnostic tests. I can also make referrals to other health care professionals, services and community resources.
I also work very collaboratively with the oncologists at Melbourne Cancer Care and with the breast care nurses at the hospital. We communicate well and keep each other well informed about the condition of our patients and any significant changes to their management plans. We have many people on oral anticancer therapies these days who need that advanced monitoring and management.
As an oncology nurse practitioner, I have the scope to make decisions on whether a patient needs dosing changes, or whether other medications need to be prescribed to help manage any side effects. I am also a point of contact for outpatients via phone and email, so I can answer any queries and provide advice over the phone or decide whether the best place to manage their symptoms is in the hospital, or by the GP, or whether they need to come in to the private consulting rooms to be assessed by myself or one of the oncologists at Melbourne Cancer Care.
Working with patients and being able to support them is a real passion. You develop a rapport over time with many patients, particularly with the metastatic breast cancer patients. Because our treatments can be a lot more effective these days, those women with stage IV breast cancer are often living for longer. I think most breast cancer patients will experience some anxiety.
Those with early breast cancer worry about how they will cope with the variety of treatments they may need and many fear a relapse of their cancer. Those with metastatic disease have more complex supportive care needs associated with the uncertainty of having a life-limiting illness, and many worry about those close to them or want information on how to stay well for as long as possible. Their symptom management needs will vary depending on where their metastases are and what treatments they are on. The goal for these women is to prolong their life, but also to preserve their quality of life for as long as possible. And there is so much we can do these days to help women manage disease or treatment symptoms.
I also support those patients who are approaching the end of their life by having the necessary discussions with them and their families to help them prepare better for what is ahead and ensuring they are linked into the palliative care and supportive services that they may need.
It’s not always an easy job and there can be some sad days, but you get a lot of satisfaction when you see the impact your care can have. You know that you are making a difference when you can help women cope better with their disease and their treatments.”