Straight from the Lab: Oncology NP Students Learn the Latest Cancer Therapies

When master’s student Daniel Billings considers what moved him to choose a career as a nurse practitioner, he recalls a close friend, Joe*, who died of non-Hodgkin’s lymphoma. Joe’s mother wanted her son to continue receiving treatment despite his terminal prognosis, and she wasn’t getting support, except from the nurses and nurse practitioners. “They did such a good job of helping her through the process,” Billing recalls. From the beginning of Joe’s hospitalization to the end, they there there for him. “That experience changed my life,” he adds. Specifically, it inspired Billings to augment his NP studies in adult gerontology and primary care with a sub-specialty in oncology. “I want to help patients and families manage and navigate through the illness,” he says. “The oncology subspecialty is giving me the knowledge and confidence I need to play an integral role in patient care.”

            Nurse practitioners (NPs) have long played pivotal roles in caring for cancer patients, from administering chemotherapy to monitoring side effects to helping patients and their loved ones let go when death is imminent. Columbia Nursing prepares future NPs for even broader roles through its oncology sub-specialty. The program introduces them to a world where research and technology are revolutionizing cancer treatment and where they, as NPs, will form the backbone of patient care.

            “The nurse practitioner’s role has really changed,” says Oncology Subspecialty Program Director Maura Abbott, PhD. Indeed, NPs have become a critical link in every team of physicians, nurses, phlebotomists, social workers and research coordinators at the Herbert Irving Comprehensive Cancer Center at the Columbia University Medical Center. In addition to providing treatment, comfort, and to serving as patient advocates, NPs are essential conduits between the patients they see daily and physicians,. “We know these patients,” Abbott says. “We’re the ones who see them and their families in the emergency room and who manage the acute side effects of treatment or disease. We’re the ones who get the phone calls and the e-mails. We’re the ones who are there all the time.”

Abbott attributes the change in the NP’s role and education to scientific and technological advances in oncology that have transformed cancer treatment. “Chemotherapy is not the only therapy anymore,” she says. “Tumors may be different due to different genetic mutations or genetic sequencing, and  researchers are developing therapies––immunotherapy, targeted therapy, precision medicine––that target individuals’ immune systems and genetic profiles.”

In response to these advances, Columbia Nursing is training its NP students to not only partner with top oncologists, but also to serve as the primary caregivers––and educators––of patients who are increasingly sophisticated about medicine. “It’s imperative that we as nurse practitioners understand what a tumor is telling us, what we’re looking for and why we’re doing what we’re doing,” Abbott explains. “How do we explain why patients are getting certain therapies if we don’t understand the information behind them?”

The oncology sub-specialty, which takes 15 months to complete (three semesters), has two tracks: adult and pediatrics. The first two semesters comprise scientifically rigorous classwork. Students learn about all forms of cancer, cancer treatments and their side effects, as well as the latest findings from research and clinical trials. “We’re teaching more basic science, more genetic sequencing and cancer genetics. We’re really focusing on the immune system at a basic level,” said Abbott.

During the third semester, students begin clinical training, working alongside physician and NP mentors who are bringing cutting edge therapies to patients. Yet, students do not have to wait until their third semester  to observe clinicians in action. “They can be at the Cancer Center as part of their learning experience whenever they want.”

Abbott, who has joint appointments at the Cancer Center and Columbia Nursing, says the Center’s expanding research portfolio is creating more opportunities for NPs to conduct research or provide clinical care. “The faculty had eight members in August 2014. Now there are more than 40,” she notes. “They’re recruiting from Columbia Nursing and students are always being invited by physicians and scientists to see what’s going on firsthand.”

Abbott also invites experts from different backgrounds, such as Richard Carvajal, MD, director of experimental therapeutics and of the melanoma service, and Naiyer Rizvi, MD, director of thoracic oncology and of immunotherapeutics, to speak to the students about their research and clinical work. “These experts bring basic science right out of the lab,” she says. “They share studies, images and survival curves. They show actual patient scans, so our students see clinical data immediately.”

Such real-time learning makes the oncology sub-specialty program especially dynamic, says Alice Johnson, who is working toward her degree as a pediatric NP. “Learning from people who are on the cutting edge of changes in the field has been phenomenal,” Johnson says. “We’re getting the most up-to-date information through stories of real life patients.”

To practice communicating with patients, Abbott and her students assume the respective roles of patient and clinician and act out hypothetical scenarios. “We might review a case study of a patient who is getting an immunotherapy drug or enrolled in a clinical trial and ask students what they would do in a particular situation, as if they were responsible for the patient,” she explains.

Sometimes Abbott bases examples on her own cases. “She describes how she handles patients who don’t take their medications because they don’t like the side effects,” Johnson says. “She doesn’t sugarcoat it. She tells it exactly how it is.”

As cancer research produces new treatments, and as more people live longer with cancer, the need for providers will increase. Billings says, “Nurse practitioners are ideal, because we address psychosocial issues as well as medical concerns. What I am learning will help me take a more comprehensive approach to caring for my patients.”

*Not his real name.