Episode 221: Surgical Interventions for Patients With Cancer

“Our goal in surgical oncology is, of course, to treat the cancer for a cure, but to do it in a safe manner so the patient is able to recover and resume their normal living activities that they had before their surgery,” ONS member Lisa Parks, MS, APRN-CNP, ANP-BC, inpatient nurse practitioner of hepatobiliary surgery at the James Cancer Hospital and Solove Research Institute, Division of Surgical Oncology, at the Ohio State University Wexner Medical Center in Columbus, OH, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a discussion on prehabilitation and preoperative assessments for patients with cancer undergoing surgery, implications of and advancements in cancer surgery, and the interprofessional collaboration that takes place in this scenario. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below. 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Oncology Nursing Podcast episodes: Episode 58: The Power of Cancer Rehabilitation Episode 66: Updates in Surgical Oncology—ONS Congress Episode 185: Surgical Oncology: Where We’ve Come and Where We’re Going Episode 212: When Cancer Care Gets Complex: Those Other Oncologic Emergencies ONS Voice article: The Power of Prehabilitation Clinical Journal of Oncology Nursing articles: Perioperative Care Implementation: Evidence-Based Practice for Patients With Pancreaticoduodenectomy Using the Enhanced Recovery After Surgery Guidelines Use of Robotics in Oncology Surgery Oncology Nursing Forum article: Cancer Prehabilitation Programs and Their Effects on Quality of Life ONS books: Surgical Oncology Nursing Gastrointestinal Cancer Care for Oncology Nurses Cancer Basics (second edition) ONS’s Get Up, Get Moving Dana-Farber Cancer Institute article: How ‘Prehabilitation’ Can Benefit Cancer Patients American Journal of Physical Medicine and Rehabilitation article: Cancer Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity, Increase Cancer Treatment Options, and Improve Physical and Psychological Health Outcomes Journal of Human Nutrition and Dietetics article: Nutritional Screening in a Cancer Prehabilitation Programme: A Cohort Study National Cancer Institute article: Surgery to Treat Cancer Enhanced Recovery After Surgery Society guidelines To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email [email protected]. Highlights From Today’s Episode “Prehabilitation for surgery is probably one of the most underutilized areas of the surgical process. The goal of prehabilitation is to initiate coordinated, preoperative, optimized strategies. During the patient’s preoperative assessment by the oncology nurse in the clinic, as well as the provider, risk factors are identified that can be addressed for a better surgical outcome.” Timestamp (TS) 02:27 “Any solid tumor patient that is having an oncological surgery can benefit from prehabilitation. It really depends on their overall assessment preoperatively. . . . And certainly, any lengthy surgery that is going to require the patient to be under anesthesia for prolonged time, the patient would benefit from being optimized prior to a surgical procedure.” TS 07:43 “When a patient is initially seen by a surgical oncologist in a pre-op setting, all of these assessments are completed by the oncology nurse, as well as the advanced practice oncology nurse, for the patient. And in order for the patient to go through the surgical process, prehabilitation is started immediately after that initial visit. The patient will be brought back in and reassessed periodically while going through prehabilitation.” TS 09:03 “Our goal in surgical oncology is, of course, to treat the cancer for a cure, but to do it in a safe manner that the patient is able to recover and resume their normal activities that they’ve been living, that they had before their surgery.” TS 10:51 “I think [one] of the greatest challenges that I hear from nurses are family support. The family needs to understand the whole process of prehabilitation and the fact that the patient is not going to come to harm by waiting a couple weeks to optimize themselves to undergo a major cancer operation, and to make sure that they’re providing transportation and assisting their family member if they need to go to outpatient physical therapy, occupational therapy, pulmonary rehab, things like that, that the provider may, based on assessment, refer these preoperative candidates for.” TS 12:18 “I think that people always think of surgery as being curative, but a lot of times, some of the procedures that we do are to sustain a quality of life for the patient at the end of their life.” TS 20:41 “Now, what I’m seeing is that the majority of the time, robotic surgery is utilized more often than an open surgery. Of course, any time there is uncontrolled bleeding, any time they’re unable to really visualize the surgical field well, they may start out robotically, and then go to an open procedure, but certainly I’m seeing them starting the cases and scheduling them as robotic or robotic-assisted. . . . I just think that robotic-assisted surgery continues to really grow, and I don’t think we’ve reached the full potential of what surgeons can do with the surgeries. There is a great learning curve for these surgical oncologists.” TS 28:10 “Surgical oncology nurses are trained in post-operative care, preoperative care, and for nurses that are in the OR, perioperative nursing, as well as oncology. They have to be competent, not only in surgical care, but in oncology care, too. . . . This specialty is very different than a medical oncology nurse, or a hematology nurse, who is mainly giving chemotherapies, CAR T’s, immunotherapies. The surgical oncology nurse needs to understand what chemotherapies, treatments, radiation therapies, anything like that, that has been done with that patient, because that would certainly impact that patient’s outcome, but also to understand the whole surgical process.” TS 31:28