Taussig Cancer Institute

TON May 2015 Vol 8 No 3

The Taussig Cancer Institute, part of the Cleveland Clinic, is one of the National Cancer Institute’s designated comprehensive cancer centers in the United States, offering care for patients with all types of cancer.

Each year, more than 250 doctors, nurses, and other healthcare professionals provide advanced cancer care to more than 14,000 patients with cancer.

At the Taussig Cancer Institute, clinical trials and research efforts ensure that patients have access to the latest advances in cancer treatment. Many support programs are available to help patients navigate the changes and challenges associated with cancer. Special services include patient education and support and wellness and prevention.

The Oncology Nurse-APN/PA interviewed Kimberly Hamilton, MSN, CNP, about her role as a nurse practitioner at Taussig Cancer Institute.

What is your role at the Taussig Cancer Institute?

Kimberly Hamilton (KH): I am a nurse practitioner [NP] working in an independent practice that follows patients with multiple myeloma and chronic leukemias. Patients are first seen by a hematologist/oncologist, diagnosed, and treatment initiated, and then we become part of their team. Patients are often seen monthly—one month by NPs and the next by the hematologist/oncologist. We also see patients for symptom management while they are here for treatment.

Patients with monoclonal gammopathy of undetermined significance (MGUS) are the exception. We see them independently and provide monitoring. We have created an algorithm of when to refer them to an oncologist that includes when they meet criteria for multiple myeloma or other disorders related to MGUS.

I see about 8 to 12 patients per day, and this includes bone marrow biopsies.

Part of the role of NPs at Taussig is to staff the Cancer Associated Thrombosis (CAT) clinic. This is a separate clinic where patients can be evaluated if they are suspected of having a deep vein thrombosis or venous thromboembolism—they are treated the same day if necessary. These patients were previously sent to the emergency department. The CAT clinic is a new and unique aspect of our cancer institute that was started about a year ago.

What are the challenges of your job?

KH: In general, our main challenge is to make sure that patients who are living with a chronic cancer take care of their general health. That includes visits to the primary care physician, screening for second cancers, immunizations, and treatment for high cholesterol, hypertension, and diabetes. Cancer patients already have to have medical appointments and treatments and may feel that seeing a primary care doctor is one more doctor appointment that is burdensome, or they may assume that because they see us once a month that we are taking care of their general health, which is not the case. We encourage our patients to maintain a good relationship with their primary care provider.

What are the rewards of your job?

KH: It is gratifying to treat cancer patients and see that their overall function and symptoms are improved by our recommendations and that they can resume activities of daily life. We help them with their side effects from treatments, and other cancer-related symptoms that can include fatigue and bone pain.

What are you excited about in the field of oncology right now?

KH: I find cancer research exciting because it is a rapidly evolving field. Here at Taussig we are involved in clinical trials of newer targeted therapies and other therapies. Recently
panobinostat—a drug with a unique mechanism of action—was approved for the treatment of relapsed/refractory multiple myeloma in combination with Velcade [bortezomib]. We are now involved in clinical trials of panobinostat, as well as elotuzumab and newer compounds in multiple myeloma.

What inspired you to become an oncology nurse?

KH: In college I decided that I wanted to be a nurse, and I worked as a nursing assistant in the hospice wing of a hospital, where I assisted with hospice and rehabilitation. These patients touched my heart, and I was encouraged by seeing that I could help meet their needs.

What advice would you give to someone entering the field of oncology nursing?

KH: Oncology is a specialty that encompasses all of the body’s systems and there are diverse types of cancer. I think that is part of what attracted me to the field—the diversity and the chance to learn about it. Diversity keeps things exciting and new. Oncology is a rapidly evolving field and there is a lot to keep up with. I think it is important to join professional organizations and to further one’s education.

How has the role of the oncology nurse/NP changed in the past 5 years?

KH: The roles of the oncology nurse/NP and physician assistant [PA] have evolved, and we are now recognized and appreciated as independent practitioners who provide care for cancer patients. NPs and PAs are in the frontline of care. We are the eyes and ears and we identify important issues that need to be addressed.

What would you do if you won the lottery? Would you still be an oncology NP?

KH: Yes, I would continue my work. But I have 1-year-old twins, so I would hire a full-time maid and lawn care personnel.

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