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The Oncology Nurse Practitioner: A Unique Provider for the Follow-Up for Early-Stage Breast Cancer

Oncology Nurse Practitioner Program, University of Pittsburgh School of Nursing, Pittsburgh, PA

To the Editor:

The findings of Grunfeld et al¹ evaluating the family physician versus specialist care for long-term breast cancer care are provocative. The main outcomes (recurrence-related serious clinical events) are rare and usually easily recognized. It is not surprising that the family physicians are not significantly different from the cancer care specialty providers in the recognition of those selected outcomes. The general scales used to measure the quality-of-life outcomes (the Medical Outcomes Study Short Form and the Hospital Anxiety and Depression Scale) do not measure some of the unique concerns of breast cancer survivors. As the companion editorial by Khatcheressian and Smith² suggests, the study that now needs to be completed is an evaluation of the best provider for the more subtle long-term effects of breast cancer and breast cancer therapy such as altered body image, estrogen deprivation, and fears and uncertainty of recurrence. The appraisal of the best provider for long-term cancer care should not be limited to physicians.

An important trend in cancer care within the United States is the increased use of advanced practice nurses,³ specifically nurse practitioners in oncology specialty practice.⁴ Use of nurse practitioners alone or in collaboration has a long history of equivocal or superior patient outcomes in primary,⁵ specialty,⁶ and cancer care.⁷ Improved outcomes have been documented in quality of life and cost, especially in breast cancer care.⁸ Oncology nurse practitioners are prepared at the master's or doctoral level with a combination of generalist and specialty oncology content. Particular strengths of nurse practitioners are patient education, communication, and adherence to evidenced-based practice guidelines.⁹

Oncology nurse practitioners are uniquely educated to provide quality specialty care within a comprehensive health promotion framework. Within an oncology practice, it would be appropriate for the nurse practitioner to maintain a breast cancer care follow-up clinic, addressing survivorship and wellness issues, while physicians and medical trainees evaluate women with new diagnoses of breast cancer, recurrence, progression, or refractory symptoms. This appropriate use of education, skills, and expertise allows cost-effective, quality follow-up care and allows the patient to remain within a cancer specialty practice. This model of care should be tested.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Grunfeld E, Levine M, Julian J, et al: Randomized trial of long term follow up for early stage breast cancer: A comparison of family physician versus specialist care. J Clin Oncol 24:848-855, 2006[Abstract/Free Full Text]

2. Khatcheressian J, Smith T: Randomized trial of long-term follow-up for early-stage breast cancer: A comparison of family physician versus specialist care. J Clin Oncol 24:835-837, 2006[Free Full Text]

3. Druss B, Marcus S, Olfson M, et al: Trends in care by nonphysician clinicians in the United States. N Engl J Med 348:130-137, 2003[Abstract/Free Full Text]

4. Lynch MP, Cope D, Murphy-Ende K: Advanced practice issues: Results of the ONS Advanced Practice Nursing Survey. Oncol Nurs Forum 28:1521-1530, 2001[Medline]

5. Mundinger MO, Kane RL, Lenz ER, et al: Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. JAMA 283:59-68, 2000[Abstract/Free Full Text]

6. Hoffman L, Tasota F, Zullo T, et al: Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. Am J Crit Care 14:121-130, 2005[Abstract/Free Full Text]

7. McCorkle R, Strumpf NE, Nuamah I, et al: A specialized home care intervention improves survival among older post surgical cancer patients. J Am Geriatr Soc 48:1707-1713, 2000[Medline]

8. Ritz L, Nissen M, Swenson K, et al: Effects of advanced practice nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncol Nurs Forum 27:923-932, 2000[Medline]

9. Gawlinski A, McCloy K, Jesurum J: Measuring outcomes in cardiovascular APN practice, in Kleinpell R (ed): Outcome Assessments in Advanced Practice Nursing. New York, NY, Springer, 2001, pp 131-188

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  Eva Grunfeld, Mark N. Levine, and Jim A. Julian
  JCO 2006 24: 3711-3712 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rosenzweig, M. Q. Search for Related Content PubMed PubMed Citation Articles by Rosenzweig, M. Q. Related Articles Related Reply Social Bookmarking                            What's this?