Kimberly Rohan MS, APN, AOCN : The Role of the Oncology Nurse in Biomarker Testing Education

Kimberly Rohan discusses the role of the oncology nurse in biomarker testing education for those patients newly diagnosed with lung cancer.

Kimberly Rohan, MS, APN, AOCN is an Advanced Practice Nurse and an Oncology Clinical Nurse at the Edward Cancer Center in Naperville, Illinois.  She is a member of the Oncology Nursing Society, American Academy of Nurse Practitioners, and the Illinois Society for Advanced Practice Nurses.  Her areas of interest are lung cancers, blood disorders, survivorship, and symptom management.

The Group Room at the 2012 Multidisciplinary Symposium in Thoracic Oncology in Chicago,  was made possible, in part, by:

     Daiichi Sankyo

Lilly

 VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel for the Group Room in Chicago where we are at the 2012 Multidisciplinary Symposium in Thoracic Oncology, which is brought to you by ASTRO, IASLC, ASCO, and the University of Chicago. Joining me now is Kimberly Rohan, an Advanced Practice Nurse in Oncology Clinical Nurse at the Edward Cancer Center in Naperville, IL. Hi, Kimberly.

Kimberly Rohan, MS, APN, AOCN, Adv. Practice Nurse & Oncology Clinical Nurse, Edward Cancer Center, Naperville, IL

Hi.

Selma Schimmel:

What role does the oncology nurse have in helping to navigate patients through this new way in which we’re dealing with cancer diagnostically and also, in choosing therapies for patients?

Kimberly Rohan, MS, APN, AOCN:

I think the challenge is being able to explain to patients what we’re doing and why we’re doing it, and why we’re sending their tumor specimen off for testing and they can’t start treatment, or they may choose to delay treatment for a couple weeks while we’re waiting for those results because it could make a difference between taking intravenous chemotherapy and oral chemotherapy, which for the majority of the patients taking a pill every day sounds much more palatable than getting stuck with IVs and having IV chemotherapy. So I think the challenge is really being able to explain to patients what genomics is, why it’s important to their care, and how we’re going to use that information.

And sometimes that information isn’t even as important initially but going down the line in the future, looking at second line therapies or third line therapies.

Selma Schimmel:

Take us through the dialogue when you try to explain to a patient what is biomarker testing and why it’s important in lung cancer care.

Kimberly Rohan, MS, APN, AOCN:

Typically when I sit down with the patient and family the physician’s kind of laid down the ground work; I kind of work joint practice with Dr. Maria Quejada, we run a multidisciplinary thoracic oncology clinic, so I’m the navigator for all the patients.  So when I sit down with the patients and families initially explaining to them that we’re sending off a piece of their tissue, it’s being sent to a lab where we at least now, and I know just coming from one of the topics – in talking about genomics – you know, should we be doing sequential testing or should we be doing the whole panel of testing? Right now we do sequential testing….

 

Selma Schimmel:

Explain what that means, please.

Kimberly Rohan, MS, APN, AOCN:

So sequential testing is where you send a specimen off and you look at what is the most likely mutation that the patient would have, and right now the majority of them are EGFR.  So we explain to the patient we’re sending their tissue off to see if they have any EGFR – epithelial growth hormone refractory mutation that, then if they do have this mutation they would be a candidate for Erlotinib or Tarceva therapy, which is a pill.

Selma Schimmel:

So if you were going to sort of encapsulate what you just said into what does the patient diagnosed with lung cancer really need to know regarding biomarker testing, how would you respond to that question?

Kimberly Rohan, MS, APN, AOCN:

I think for patients it’s personalizing care; it’s personalizing lung cancer treatment. It’s not all lung cancer patients are going to get treatment A because you have lung cancer. Now we have the ability to say ‘you know what- maybe Treatment A isn’t the best treatment for you, maybe it’s this pill that’s the best treatment for you’. So I think it’s personalizing our approach to care.  As much as we have been able to do for a long time in breast cancer, we are now starting to be able to do that in lung cancer.

Selma Schimmel:

What about re-testing- what point along the way does that issue present?

Kimberly Rohan, MS, APN, AOCN:

We do re-testing; a perfect example, we had actually a patient recently who was on the original ARISTA trial and has been maintained on Tarceva for nine years, and developed a new nodule in the lung. Now that one we re-tested because A) is it the same tumor? B) he did have EGFR, does he still? has the tumor morphology changed? So oftentimes when you’re concerned that a patient has become resistant or this is a new tumor, or a completely different histology, or whatever, we will re-test at that time.

Selma Schimmel:

What about obstacles- what do you feel are the greatest challenges and obstacles in the testing process?

Kimberly Rohan, MS, APN, AOCN:

I think getting it done quickly; I think getting the testing back in a timely manner. I still think that having enough tissue to do all the testing sometimes that we want to do – lung biopsies tend to be, unlike breast, it’s not a big hunk of tissue that you have to work with – so strategizing, what test is going to give us the most answer, the most bang for our buck. So I think that part is challenging. I think cost is always a factor.

Selma Schimmel:

What can the advocate community do to support your clinical efforts?

Kimberly Rohan, MS, APN, AOCN:

Smoking cessation, programs working in that, advocating for that. I think that in treatment and when we’re talking about personalized medicine, it’s educating patients on why we do these tests, what it means for them – not only for their care, but the care of their loved ones – but also, like I said we’ve got to educate the payers, we’ve got to educate our legislators so that there is coverage for these things, especially even our Medicare patients, insuring… the majority of lung cancer patients are older, they fall under Medicare, and it’s really in making sure the government and CMS understands the importance of this so that they’re willing to reimburse.

Typically, payers go by way of CMS, so if we can educate them on the importance and why we need to do this, and what it means for patients clinically and for their quality of life, I think that will go a long way.

Selma Schimmel:

Thank you very, very much. Kimberly Rohan, Advanced Practice Nurse and Oncology Clinical Nurse at the Edward Cancer Center in Naperville, IL. Thank you. Pleasure.

END OF VIDEO

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