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Oncology Nursing and Cancer-Related Distress: A Conversation with Dr. Lisa Kennedy Sheldon

By Kim King

During Oncology Nursing Month, Blue Note Therapeutics had the opportunity to discuss cancer-related distress with Dr. Lisa Kennedy Sheldon, oncology nurse practitioner, cancer care advocate, and former CCO for the Oncology Nursing Society.

Oncology Nursing and Cancer-Related Distress: A Conversation with Dr. Lisa Kennedy Sheldon

Thanks for joining us, Dr. Sheldon! Before we get started, would you share a little bit about your background for our readers? What led you to a career in nursing, and further into the oncology nursing field?

The desire to become a nurse began early in life when I worked with the elderly and listened to their life stories about love, health, relationships, and success. Each person was unique and their struggles and victories were the foundation of how they dealt with declining health and functioning, and sometimes impending death. I thought that being a nurse might allow me the opportunity to make a difference in their lives. In my first job as a nurse, I witnessed the fear and anxiety caused by a cancer diagnosis and focused my training and later graduate and doctoral education on the psychosocial impact of cancer on people and their families, and the communication between patients and oncology clinicians that relieves distress and anxiety.

As a nurse and nurse practitioner for more than four decades, I have had the privilege of working with many people facing cancer and witnessed their struggles and resilience. Communication between patients and clinicians is key to understanding the needs of patients and improving their quality of life. As former faculty, I had a platform to help address this need and developed a program of research regarding how clinicians communicate with people with cancer and respond to their cues of distress. I came to the conclusion that every person with cancer needs careful, focused assessment of cancer-related distress and, if detected, access to timely and effective psychosocial care. Both assessment and treatment are needed to detect distress and provide the focused interventions that improve quality of life and outcomes after a cancer diagnosis.

It sounds like you’ve really found your calling! It’s well known that nursing can be a very rewarding but also very demanding career. Even on those more difficult days, what gets you out of bed in the morning?

Sometimes working in cancer care is challenging. What does my patient need today? Do I understand what the patient is feeling? How can I help? Did I say the right thing? Can someone else help? It is remarkable to be part of the oncology team as it truly takes a team to provide complex cancer care. Ultimately, being an oncology nurse and nurse practitioner requires leaving your other concerns at home and coming to the clinic fully “present” – that is being yourself with patients and families. Mostly, it is a privilege to be a nurse - the most trusted profession for 19 years in a row - a trust that I strive to earn every day.

Working in the oncology nursing field for more than 40 years, I’m sure you have a very insightful perspective on this next question. How has the treatment of cancer-related distress evolved over the course of your career? Has the COVID-19 pandemic had an impact on cancer care?

For decades, we have known that a cancer diagnosis can cause anxiety and fear but we did not assess that distress with tools. Anxiety and depression were treated with medications such as benzodiazapines and later tricyclics and SSRIs as well as comforting conversation and patient education. Psychological treatments, if available, were often performed outside of the cancer clinic mostly by social workers or sometimes by psychologists; many centers simply lacked specialty psycho-oncological care. There continues to be an enormous gap in the cancer care workforce creating inequitable care and patient outcomes, particularly in community settings.

Since the COVID-19 pandemic began 15 months ago, cancer care has had to transform to meet the needs of patients. Early in the pandemic we saw a rapid decline in patients getting cancer screening, an issue we will need to pursue for years to come. However, we also saw remarkable changes in care delivery including the rapid escalation of telehealth and home-based cancer care and relaxation of clinical trial requirements. These important pivots in health care delivery will most likely continue in some version after the public health emergency. These changes will allow clinicians to reach people in their homes for cancer care, clinical trial enrollment, and symptom management including the delivery of interventions for distress, anxiety, and depression. 

As you know, Blue Note is working to address the distress associated with cancer diagnosis, treatment, and survivorship. Would you mind explaining what the role of an oncology nurse is in identifying the signs of, and helping to treat, cancer-related distress?

Oncology nurses spend the most time with patients, often detecting cancer-related distress and pursuing further care. In addition, oncology nurses are the largest workforce in cancer care and, due to their numbers and time with patients, have the opportunity to make a large difference in the detection and alleviation of distress and anxiety related to the diagnosis and treatment of cancer and improve quality of life from diagnosis and into survivorship.

What an important role it is! You mentioned earlier the advancement of home-based care. What excites you most when you think about the possibilities with prescription digital therapeutics?

Digital therapeutics offer the opportunity to reach people at home, where they may feel most comfortable and secure. Cancer care settings such as ambulatory care centers and acute care facilities are not always conducive to the private and meaningful issues that patients are going to deal with throughout their diagnosis and treatment. For example, a simple curtain may be the only thing separating patients in an infusion center, not allowing for private and sensitive conversations. In fact, the impact of the cancer experience may be felt after consultations or treatments in healthcare settings when patients are in the safety of their home with their loved ones. Prescription digital therapeutics offer patients the opportunity to receive supportive care on their devices anywhere, when it’s convenient for the patient, not just in a healthcare setting or office.

You’ve been very successful in your career and as a cancer care advocate. Is there a time that stands out to you when you felt most proud?

Talking with oncology nurses from many countries around the world has shown me that nurses everywhere share the same passion: a great respect for their patients and desire to help restore health and functioning, reduce suffering, and, sometimes, find meaning and a peaceful death. To be allowed to share these moments with patients and their families is a great honor.

Before we wrap up, it’s Oncology Nursing Month. Are there any parting words you’d like to share with the nursing community?

Oncology nurses are the backbone of cancer care delivery. With their extensive contact with patients during educational sessions, treatment delivery, follow-up care, and telehealth for triage of symptoms and concerns at home, they can assess and pursue further care for significant problems including cancer-related distress. I continue to practice as an oncology nurse practitioner and marvel at how oncology nurses work in the interprofessional team to ensure safe, seamless care for people with cancer – from screening and diagnosis into treatment and survivorship. It is an honor to work with nurses and the team.

Thank you, Dr. Sheldon! This has been very meaningful. We greatly appreciate you - and oncology nurses everywhere - for all that you do for patients living with cancer. 

Lisa Kennedy Sheldon, PhD, ANP-BC, AOCNP®, CGNC, FAAN, is an oncology nurse practitioner, educator, author, speaker, and certified Global Nurse Consultant. As a leading advocate for quality cancer care and oncology nursing training, Dr. Sheldon is sought as an expert on cancer trends, oncology nursing, education and research, and psychosocial issues in cancer care. She collaborates with professional organizations, patient advocates, researchers, and policy makers to elevate cancer care, advocate for nurses, and improve patient outcomes. Dr. Sheldon has served as the Chief Clinical Officer at the Oncology Nursing Society, Editor of the Clinical Journal of Oncology Nursing, and as a tenured Associate Professor at the University of Massachusetts-Boston. Nationally, Dr. Sheldon has served the National Academies (NASEM) National Cancer Policy Forum (NCPF) in Washington DC, cochairing NCPF Workshops on topics such as navigation, survivorship, the cancer workforce, and adverse events of cancer treatment. She continues to practice as an oncology nurse practitioner and is honored to work with the interprofessional team and care for people with cancer and their families. A frequent guest for interviews, articles, presentations, and podcasts, Dr. Sheldon is the recipient of numerous honors and awards including induction as a fellow in the American Academy of Nursing (FAAN).