ONS Foundation Can Help You Celebrate Oncology Nurses Day and Month

Now is the time to recognize an important member of your team, organization, specialty, and profession: an oncology nurse. ONS announces the eighth annual Oncology Nurses Day, Thursday, April 18, 2002, and Oncology Nurses Month, April 18 to May 18, 2002. The theme this year is "Proud to be an Oncology Nurse." This celebration is designed to encourage the recognition of oncology nurses worldwide, and to celebrate their accomplishments. A recent report published in the British medical THE MAMMOGRAM CONTROVERSY: Tojournal, receive The a freeLancet celebration, concluded kit, thatsend no an scientific email to: support [email protected] exists for breast cancer and screening list your name,with mammography. address, telephone number, andONS email RESPONDS: address, plusThe theONS, number along ofwith kits 18 you other need. major Up cancer to five organizations,kits can be ordered including per organization.the American Cancer Society, had a letter published in the February 3, 2002, New York Times responding to the controversy this article generated. ONS urges women to Thefollow ONS the Foundationadvice of their has physicians produced andan array obtain of mammogramsproducts in honor per ofcurrent the 2002 guidelines. celebration Paula of Rieger,Oncology President Nurses ofDay ONS, and writes:Month. Wonderful“Healthcare gifts professionals such as "Proud must tocontinue be an Oncologyto educate Nurse" the public t-shirts, and mugs, their patients. and lanyards Although are availablemammography to present is not a perfect tool, it is effectiveto friends in and detecting associates. breast An cancers order early,form is which, enclosed in turn, within allows the 2002many celebration women to havekit, or breast-conserving contact Michelle at surgery. the ONS Further Foundation studies byshould email: be [email protected] initiated to examine this or bycontroversy phone (412) more 921-7373, thoroughly. Extension Until research 231. conclusively proves otherwise, ONS stands by its position that every woman has the right to make an informed decision about her need for mammography screening. The Society Allurges proceeds women from to discuss sales help the appropriatenessto support ONS Foundation'sof mammography continued for their efforts age toand promote risk factors the effective with their care healthcare and treatment providers.” of patients To withread cancerthe letter through and other scholarships, information awards, about publicthe study education see http://www.ons.org/xp6/ONS/News.xml/Mammography.xml projects, and research. News from the Mother Ship… National Headquarters

It’s getting closer! ONS 27th Annual congress “The Many Faces of Oncology Nursing” April 18-22, 2002 Washington, DC

**April 18 is Oncology Nurses Day! **

Certification News LAST MULTISITE OFFERING OF PAPER-AND-PENCIL CERTIFICATION TESTS IN SEPTEMBER September 28 is the last date for paper-and-pencil administrations of the OCN®, AOCN®, and CPON tests at more than one location. Beginning in 2003, paper-and-pencil versions of these tests will be administered only once per year. The OCN® and AOCN® tests will be administered in conjunction with the ONS annual Congress, and the CPON Test will be administered during the annual meeting of the Association of Pediatric Oncology Nurses. Computer-based OCN®, AOCN®, and CPON tests will be administered at more than 300 locations during several one-week intervals in 2003. Early applications for the Sept. 28, 2002 tests are due June 21, 2002, and will save $75 off the application fee. The final application deadline for the September test is July 5, 2002. For application information, call toll free 877-769-ONCC.

ONCC ALLOWS MORE TIME TO ACCRUE POINTS The ONCC Board of Directors recently voted to expand the time period during which candidates may accrue points to be used for certification renewal by the Oncology Nursing Certification Points Renewal Option (ONC-PRO). Beginning in 2002, candidates may apply points earned until the date the ONC-PRO application is submitted. This provides renewal candidates with an additional 2-6 weeks to earn points for their ONC-PRO applications. Information will be mailed to candidates due to renew in 2002. Details are also available online, or by calling the number above. What We Do: An Interview with Chris Egan, RN, MS, ANP, AOCN

Tell me why you went into Nursing, specifically Oncology Nursing. I started nursing school at Lehman College in the Bronx in 1986, after having had four children. I had always wanted to be a nurse-but never had the opportunity to go to school. I chose Oncology Nursing because I believed that cancer (AIDS hadn’t become the epidemic yet that it is now) was the most terrible disease that one could get, and so caring for cancer patients embodied to me the ultimate in nursing. I didn’t choose cancer because of any personal experience, my only exposure to cancer was through a Great Aunt who died of head and neck cancer, but by that time I had already made my decision. I also think that I was somewhat afraid of cancer and I wanted to confront my fears by learning more about this horrible disease. Even before I started nursing school, I was a volunteer at Calvary Hospice. How long after graduating did you go into Oncology Nursing? While I was in nursing school, I worked as a tech at Memorial Sloan-Kettering. After I graduated, I started in the Bone Marrow Transplant Unit there. Ironically, while I was in school, I had done a research program wherein I determined that bone marrow transplant wasn’t a good job for a new grad--it’s very complex and there are a lot of patient issues--but there I was, and I stayed for three years. After my first year there, I started a Master’s program as a Clinical Nurse Specialist. Well, you didn’t waste any time. Many of my bedside colleagues at Sloan-Kettering had Master’s degrees or were in the process, so it seemed the thing to do. What was it like to work at Sloan-Kettering, the “Mecca” of Oncology Nursing? Yes, it is. I credit Sloan-Kettering for establishing the foundation of my nursing career, and my love of Oncology nursing. I can’t recommend it enough. Nurses and physicians alike respect nurses at Memorial. They truly fostered a collegial atmosphere. Another great thing about Memorial was a strong belief in education. Their orientation for nurses was excellent - 2 weeks didactic, classroom orientation, and then practical orientation, concluding with a written exam. Altogether it was three months before I began to work completely on my own. And then I took the OCN exam as soon as I was eligible. They had covered everything I needed to know for it. There were great professional development opportunities available to staff RNs; for example, you could present at “Nursing Grand Rounds” or lead a patient care conference. Continuity of patient care was another major aspect of nursing at Memorial. You partnered with another nurse and mirrored each other’s schedule. Patients always had the same nurse when they were readmitted. We were a self contained (closed) Unit. You were actually on call in case a colleague called in sick. I owe a lot to Memorial - it was the perfect beginning to a successful career in oncology nursing. Where did you go next? After working at Memorial for six years, my family and I moved to Northern Westchester County. The commute into the city became too much. So after a year of commuting, I took a staff position at what was then named the Westchester County Medical Center on their Bone Marrow Transplant Unit, while I completed my Master’s Degree as a Clinical Nurse Specialist. I then took a position at Vassar Brothers Hospital as a CNS, Oncology. During those years, I went back to school and completed an ANP (Adult Nurse Practitioner) certificate program. My time at Vassar broadened my Oncology experience considerably. There, I was fully integrated in a complete Cancer program. Whereas at Memorial, the departments were separated, for example, the Head & Neck, the Bone Marrow, the Urology Floors--you were an expert in only one thing there--at VBH I became an expert in many things. For example, I learned a lot about Radiation and Surgical Oncology—I was involved in many more facets of Oncology there.

And after Vassar? After Vassar, I went into industry. I worked for two years as an Oncology Nurse Educator for a pharmaceutical company (Alza) that marketed two oncology drugs. Another company bought Alza and the nurse educator position was dissolved. But it couldn’t have worked out better. Right now, I have three jobs, and I love it. I have a full time job (40 hours) as an Oncology Nurse Practitioner at St. Agnes, and I have two contracts as an independent Nurse Educator/Consultant for the companies who bought the two oncology drugs (Doxil and Ethyol). What do you do as an Oncology Nurse Practitioner? At St. Agnes, I admit and discharge patients, do their H&Ps, and order medications, lab tests, consults and x-rays etc. I also order and monitor their chemo in collaboration with the attending Oncologist. During the patient’s admission I am the “eyes and ears” of the Attending, who works in the Outpatient Cancer Clinic. I round daily with the attending; I write daily progress notes and I am available on the Unit when patients have medical complications and oncological crises.

And for the drug companies? I present and develop in-services and CEU programs for nurses; I help write drug protocols and documentation policies. I help to develop patient education pieces. I teach sales reps about the clinical aspects of drugs, I’ve flown all around the country. I’ve spoken at national conferences and at large cancer centers. I’ve done teleconferences, and I’ve written educational monographs. And - getting paid to travel is a huge perk, as well as getting to meet some of the nurses whose books and articles I’ve read. I’ve also had the opportunity to meet some of the most important “thought leaders” in Oncology.

How do these two different job areas compare? My jobs are very different. The hospital is a non-profit, patient focused institution and I love taking care of patients. I also enjoy the autonomy of working as a Nurse Practitioner and having my own patient caseload. The consulting jobs are more Nurse-focused, and the companies are for-profit (so the pay is better!). I get to travel and see different cancer centers and I get to enjoy all of the beautiful landscapes and different geographies in this country. It’s nice to get out of the hospital environment once in a while! I meet many doctors and RNs all over the country so I am able to get new ideas to bring back home (to the hospital). I work 3 12-hour shifts at the hospital and when I am off (traveling around the country) my caseload is handled by another Nurse Practitioner with whom I job-share. This is the best time of my career; I have the best of both worlds. I feel truly blessed.

What are some of the down sides to these jobs? The autonomy of the hospital job is sometimes stressful. I worry about the decisions I make, and their possible consequences for the patients. And it’s also stressful juggling my traveling—getting to places on time, etc. I’ve been driving, not flying, since Sept. 11.

You’ve done a lot of things in your career! What is Chris going to do next? My next aspiration is to teach in a Nursing Program as an adjunct professor. And to continue with the ONS: I’m coordinator of the Psychosocial SIG for ONS, and I’m coordinating a session for the National ONS on Psychosocial Oncology Standards.

What is your proudest accomplishment? Actually I have two accomplishments that I am equally proud of. They are easily two of the most rewarding things that I’ve ever done during my nursing career. First, helping a group of excellent Oncology Nurse colleagues get excited about becoming certified by the ONS, and second, helping to organize and start our Mid-Hudson Chapter of the ONS. I had never done anything like that before (I wasn’t even a former Board Member of another ONS Chapter!), but I knew that the Mid-Hudson Valley had too many excellent Oncology Nurses and we needed the support of a local ONS Chapter. I had a lot of help – from local nurses, hospital administrations, pharmaceutical companies and the National ONS. Our Chapter was chartered within 12 months of our first planning meeting! We were a CHIP (Chapter In Progress) during that first year and now we have been an official Chapter for two years. We are now just starting our third year! It is hard to believe – how quickly the time flies! As a group – I know that we are totally committed to Oncology Nursing and we are very proud of all we have accomplished. I didn’t know there was so much to know about our first President! Very impressive career. Thank you, Chris.

Farewell to an Oncology Colleague

It was with profound, unspeakable sadness that many of our members stood together on Sunday, March 03, 2002 to honor and remember a colleague – Dr. Jeffrey Perchick. Our worlds were shaken by the senseless, incomprehensible murder of a man who dedicated his life to caring for oncology patients. Dr. Perchick maintained a solo practice in Poughkeepsie since 1978 and was known for his honesty and straightforwardness when dealing with his patients. Those of us who worked with him might remember his jokes (he loved a good one), his impatience with incompetence, his commitment to improving the quality of life for his patients and his outspokenness. He will be missed greatly by all who knew him. Chapter Meetings: Highlights and Sound Bites On Dec. 12, we met in the conference room at the recently dedicated Dyson Center for Cancer Care at Vassar Brothers Hospital. Sherry Greifzu, RN, MSN, OCN spoke on “Skin Cancer and Melanoma.” She spoke about risk factors, types of skin cancers, treatment, and the importance of screening. She stressed that we are all at risk for skin cancer, not just the fair-haired and fair- skinned. Avoid sunburn and use sunscreen: “Age spots are really sun damage.” Sun exposure causes the skin to lose elasticity, causing wrinkles. “If you take good care of your skin, it’ll age gracefully; if you don’t, it’ll look like leather.”

In 1935 the lifetime risk of developing malignant melanoma was 1:1500, in 2000, 1:75. There are three types of skin cancer: basal cell (1 million new cases/year), squamous cell (100,000 new cases/year), and cutaneous melanoma, the least common (44-50,000 new cases/year, but accounting for 85% of deaths). Risk factors include three serious (blistering) sunburns prior to 10 years of age, and UV light exposure (yes, including tanning beds!).

With an array of slides, she described the ABCD&Es of melanoma: lesions that are Asymmetrical, with an uneven Border, two or more shades of Color (dark, red, even light blue and white), Diameter (6 mm or less is usually benign), Elevation and Erythema (lesions don’t have to be black; they can resemble a wart or just be a little red). There are many hard to recognize, easily ignored presentations of melanoma. Other things that may signal melanoma but are often overlooked include dark spots under the fingernails, areas that resemble fungal infections on toes and fingers, lesions that may appear on a person’s heels—and can be mistaken for a foot ulcer. Uncommon presentations include ocular melanoma (use sunglasses: skiing, snow blindness, burning eyes through welding are also risk factors); mucosal melanoma (black, blue gums). “Anything you find on your body that does not belong there, get it checked.”

Treatment starts with an excisional biopsy, then a wide local excision: 1 cm of surrounding tissue for each 1mm of melanoma. Skin grafts are often required. She also spoke of the importance of sentinel lymph node mapping, dissection, and prognostic factors. Treatment also includes chemo and immunotherapy; vaccines, monoclonal antibodies, and gene therapy are also being tested.

Screening was also stressed. Nurses need to teach self-examination for skin cancer as much as self-examination for breast cancer. She recommends an annual skin screening—with ALL your clothes off, not just a check of exposed areas. The entire body must be checked—front and back, under arms, palms, backs of legs and neck, between toes, the scalp (she suggested using a blow dryer to part your hair to see your scalp, or ask your hair dresser). All areas must be checked; melanoma can even present rectally. “I hope that you go home, look in the mirror, and examine your family.” I know I did!

Thank you, Shering!

On Feb. 13, we again met in the conference room at the Dyson Center for Cancer Care at Vassar Brothers Hospital for a General Business Meeting. See our message from the board, front page.

“If you do not care for each other, who will care for you?” - from Buddha’s Little Instruction Book