The H. Lee Moffitt Cancer Center, Tampa, FL, is 1 of 47 National Cancer Institute–designated Comprehensive Care Centers in the United States, and is the only center based in Florida. Care at Moffitt is centered around the patient, and focuses on treating individuals with more common conditions compared with those with rare malignancies. As a center of excellence, Moffitt addresses patients’ needs starting with diagnosis, through cancer treatment, and on to survivorship, offering individualized therapies based on a patient’s unique genetic fingerprint. Moffitt is also an active research center, covering basic science, prevention, and clinical research with the goal of translating discoveries into improved patient care. Moffitt is committed to Total Cancer Care—a research study that is changing the way healthcare providers prevent, detect, and treat cancer.
The Oncology Nurse-APN/PA (TON) spoke with Stephanie Andrews, MS, ANP-BC, about her role at the Moffitt Cancer Center.
TON: Can you describe your role and responsibilities at Moffitt?
Stephanie Andrews: I am an adult medical oncology nurse practitioner in the internal hospital medical department. I work as part of a team with hospitalists, pharmacists, a social worker, physician assistants, and advanced practice nurses. There are 3 services at our hospital—a teaching service (resident and hospitalist), and 2 teams with a hospitalist, pharmacist, social worker, and advanced practice professionals. We reach out to medical oncologists and other specialties as needed.
My responsibilities are to admit patients to the hospital, work with physicians to formulate a medical treatment plan, order diagnostic testing, perform rounds, discuss results, monitor inpatient chemotherapy, and ensure safe discharge planning. We admit all patients with solid tumors, and, typically, admission is prompted by adverse events or disease progression. Adverse events requiring hospitalization can be caused by immunotoxicity, new-onset small bowel obstruction, and other problems.
TON: What are the challenges of your job?
Ms Andrews: Mainly, the challenging aspects of my work have to do with patient volume and not having enough time to accomplish the educational and caring aspects of nursing.
For example, we do end-of-life care, and discussions with patients and families can be quite difficult, depending on the level of the patient’s and family’s understanding. Our discussion may take place after chemotherapy, or if other treatments stop working and there is no better treatment. This may be the first time that a patient and family hear this. It can take multiple discussions for this news to sink in. The discussion can happen in small doses, dropped into the conversation at visits by different staff members until patients and their families can acknowledge the situation. The sands have shifted for these patients, and it is a hard time for them.
TON: What are your biggest rewards?
Ms Andrews: When you have limited time with patients, it feels like a great accomplishment if you can make them laugh for the first time that day, or if an educational session has been successful.
TON: What have you learned through your research on immunotoxicity?
Ms Andrews: I became interested in immunotoxicity when I worked in the outpatient setting with patients who had metastatic malignant melanoma and were being treated with immune checkpoint inhibitors. When I moved to the inpatient setting, I saw patients with immune-related adverse events that required hospitalization. Although these events are relatively uncommon, they occur across all tumor types. Immune-related adverse events are managed in consultation with the individual medical oncologist. Once we formulate a treatment plan, we consult an organ specialist if that is appropriate, depending on the organ system involved and the grade of adverse event.
Immunotoxicity can be difficult to manage. Colitis is a problematic event, because it tends to reflare. We can control it, but it takes a long time to do this. Endocrinopathies are also serious events, and patients may not recover from these.
We withhold immunotherapy for serious adverse events. Depending on grade and toxicity, immunotherapy may be permanently discontinued.
TON: What are you currently most excited about regarding cancer therapy?
Ms Andrews: I am very excited by the effectiveness of immunotherapies in multiple tumor types, as well as the durability of response that we are seeing. For bladder cancer, immune checkpoint inhibitors are the first new therapy in 30 years, and in melanoma, the first in 20 years.
TON: How did your career path lead you to your
Ms Andrews: I had a summer placement in an oncology unit when I was in nursing school. At first I felt like I had drawn the short straw, because the emergency department looked like a more exciting place to be. I was worried that oncology would be depressing. But it turned out that I loved working with patients with cancer. They were so appreciative of anything I did for them. Also, I found that I really connected with their problems. For example, the first time I had to ride in an ambulance with a patient with bone metastases who required radiation in a separate building, I held her hand throughout the trip. This was an educating moment, and I continued to have those moments. Since then, there has been no other choice for me but oncology.
My first job at Moffitt involved screening for breast, prostate, gynecologic, and skin cancers. I obtained an associate degree, then a bachelor of science degree in nursing, and then I decided to become a nurse practitioner. I’ve been at Moffitt for 18 years. I worked in the outpatient setting for many years, and 4 years ago, I started working in the inpatient setting.
TON: If you won the lottery, would you continue to do what you’re doing now?
Ms Andrews: I am fascinated by medical care in other cultures, and would love to continue to learn more about that through hands-on experiences. I recently went to Nepal on a medical mission trip and it was interesting, exciting, and fulfilled my love for travel. I also went to Spain where nurses don’t have special oncology training. It would be wonderful to educate oncology nurses in different countries.