Cancer in Older Adults: The History of Geriatric Oncology, Part 3
Geriatric Oncology Nurses in the Care of Elderly Patients With Cancer
In the preceding two issues of The ASCO Post, we explored the overall history of geriatric oncology from 1980 to 2020. In this concluding part of the series, we focus on the invaluable contributions made by oncology nurses to the field.
Silvio Monfardini, MD
Lodovico Balducci, MD
Janine Overcash, PhD, APRN-CNP, FAANP, FAAN
Matti S. Aapro, MD
Over the past several decades, geriatric oncology has gained increasing recognition as a medical specialty, and the integration of geriatric oncology into cancer care has led to the improved care of older adults with cancer and better outcomes for these patients.1,2 Nursing care for older adults with cancer is complex and requires the integration of knowledge from multiple disciplines that combine the expertise of geriatrics, oncology, and nursing to address the needs of aging patients, including the presence of comorbid medical conditions and psychosocial factors related to aging, and to improve patients’ quality of life.
“Nursing care for older adults with cancer is complex and requires the integration of knowledge from multiple disciplines that combine the expertise of geriatrics, oncology, and nursing….”— Silvio Monfardini, MD, Lodovico Balducci, MD, Janine Overcash, PhD, APRN-CNP, FAANP, FAAN, Matti S. Aapro, MD
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It was the integration of myriad medical professionals, including nurses, physicians, social workers, pharmacists, dieticians, physical therapists, and chaplains, in the performance of comprehensive geriatric assessment in geriatric oncology that was the catalyst for establishing the field of geriatric oncology nursing. In 1988, the Oncology Nursing Society (ONS) recognized the need for specialty nursing care of older adults with cancer and created the Gerontology/Oncology Focus Group to promote networking among its group of academic and clinical nurses who were interested in combining gerontology with oncology.3 The Gerontology/
Oncology Focus Group remains active today and holds annual meetings at the ONS Congress.
The Evolution of Geriatric Oncology Nursing
Since the early 1990s, oncology nursing has recognized the importance of addressing the unique needs of older adults with cancer, incorporating gerontologic principles into oncology nursing education and practice, and developing evidence-based strategies to understand how aging and cancer treatment influence outcomes and affect patients’ functional status and psychosocial well-being. Over the ensuing decades, oncology nursing has made great strides in these areas, and many oncology nurses, including clinicians, educators, and researchers, have contributed to the expansion of the field.
Here we detail some of the important milestones in the evolution of geriatric oncology nursing:
1992—The Oncology Nursing Society published its first position paper on cancer and aging, which was pivotal in establishing a mandate for geriatric oncology nursing and in moving the field forward.4 That same year, Nurses Improving Care for Healthsystem Elders (NICHE) was founded by Terry Fulmer, PhD, RN, FAAN, who wanted to improve education for nurses working in health-care facilities in the United States and Europe.5
1993—The H. Lee Moffitt Cancer Center & Research Institute opened the Senior Adult Oncology Program to offer care to older patients in Florida. Geriatric oncology nursing was central to patient care, research, and the education of medical and nursing students. As a result of this pioneering work, in 2003, Lodovico Balducci, MD, and Janine Overcash, PhD, APRN-CNP, FAANP, FAAN, published The Older Cancer Patient: A Guide for Nurses and Related Professionals (Springer Publishing Co).
1996—The Hartford Institute for Geriatric Nursing (HIGN) at New York University’s Rory Meyers College of Nursing is founded to support nursing students, faculty, and nurses at all levels of care. Many of the providers trained by HIGN are focused in oncology nursing and are associated with academic medical centers to advance gerontology practice and research in caring for older adults with complex needs.6
Also in the 1990s, geriatric oncology ambulatory care clinics were developed to adequately treat older patients with cancer.7
2000s—In the early 2000s, leaders in the field of nursing, including Deborah Boyle, MSN, RN, AOCNS, FAAN, and Sarah Kagan, PhD, RN, FAAN, called for additional gero-oncology nursing research and established updated research agendas focusing on older adults with cancer.3
2005—The National Comprehensive Cancer Network® (NCCN®) published its first Senior Adult Oncology Clinical Practice Guidelines, now called Older Adult Oncology, which addresses risk assessment and screening, risk-reduction strategies, and treatments for older adults with cancer. Until recently, the expert panel for the NCCN Guidelines® for Older Adult Oncology has not included nursing representation. Today, a nurse with expertise in cancer and aging serves on the NCCN expert panel.3
Geriatric oncology nurses now also have a voice in other oncology organizations, including ASCO, the International Society of Geriatric Oncology, and the European Organisation for Research and Treatment of Cancer, as well as the Gerontological Society of America.
Today, the practice of geriatric oncology nursing continues to develop and evolve to meet the needs of older people with cancer in health-care settings worldwide. The profession is particularly attuned to unraveling and managing the complexity of aging and cancer, and nurses will continue to be on the forefront of developing geriatric expertise in cancer care.
DISCLOSURE: The authors reported no conflicts of interest.
1. Rao AV, Hurria A, Kimmick G, et al: Geriatric oncology: Past, present, and future. J Oncol Prac 4:190-192, 2008.
2. Lichtman SM, Hurria A, Jacobsen PB: Geriatric oncology: An overview. J Clin Oncol 32:2521-2522, 2014.
3. Bond SM, Bryant AL, Puts M: The evolution of gero-oncology nursing. Semin Oncol Nurs 32:3-15, 2016.
4. Boyle DM, Engelking C, Blesch KS, et al: Oncology Nursing Society position paper on cancer and aging: The mandate for oncology nursing. Oncol Nurs Forum 19:914-933, 1992.
5. Fulmer T, Mezey M, Bottrell M, et al: Nurses Improving Care for Healthsystem Elders (NICHE): Using outcomes and benchmarks for evidenced-based practice. Geriatr Nurs 23:121-127, 2002.
6. New York University Rory Meyers College of Nursing: Hartford Institute for Geriatric Nursing. Available at https://nursing.nyu.edu/innovation/hartford-institute-geriatric-nursing. Accessed October 22, 2020.
7. Overcash J: Integrating geriatrics into oncology ambulatory care clinics. Clin J Oncol Nurs 19:E80-E86, 2015.
Dr. Monfardini is Director of the Geriatric Oncology Program at Instituto Palazzolo, Fondazione Don Gnocchi, in Milan, Italy. Dr. Balducci is Professor of Oncology and Medicine at the University of South Florida College of Medicine and Chief of the Division of Geriatric Oncology, Senior Adult Oncology Program at H. Lee Moffitt Cancer Center & Research Institute. Dr. Overcash is Professor of Clinical Nursing and Co-Director of the Academy for Teaching Innovation, Excellence and Scholarship. Dr. Aapro was a Member of the Board, Genolier Cancer Center in Genolier, Switzerland, and of the International Society of Geriatric Oncology (SIOG) until September 2020.