Exploring Hot Topics in Radiation Oncology With John Hillson, RN, BSN, OCN®

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, I'm here at ONS Congress, and I'm joined by John Hillson. Thanks so much for joining today.

John Hillson, RN, BSN, OCN^®: Thank you for having me.

Oncology Data Advisor: Would you like to introduce yourself and share what your work focuses on?

Mr. Hillson: Hi, I am a Nurse at the Duke Cancer Center in Radiation Oncology. I'm working primarily with the head and neck population. I've also just recently finished my Doctor of Nursing Practice (DNP) at the University of North Carolina in Greensboro, and for my DNP quality improvement (QI) project, I was looking at Radiation Oncology Nursing Education. It's something that really isn't covered much in core nursing, and it's not been covered quite in the depth I think it needs to be in the oncology world either. The opportunities for education are really quite reduced at the national, state, and local levels, and I really think that prevents us from making the contributions to radiation oncology that we could.

Oncology Data Advisor: So, you presented a session on Wednesday titled Hot Topics in Radiation Oncology. With the rapidly evolving field that this is, what have some of the latest technology improvements included?

Mr. Hillson: There have been some substantial improvements in technology. It was only in 1998 that some of the latest generation of therapy, intensity-modulated radiotherapy (IMRT), became commercially available, and that's now really taken over most of the treatment world, and that's continued to be optimized as well. For my part, working with head and neck means we can spare saliva glands, and we can avoid healthy tissue and spare it to a greater degree than we've ever been able to before. That's had enormous improvements in side effects, and that means we really need to rewrite the book on side effect management.

We're hearing some great things about protons; there are some exciting things coming out about carbon ion therapy. There are a lot of massively exciting new technologies, but the one quote—and this comes from Dr. Fumiko Chino, and there was a New England Journal of Medicine article on health care reform and equity for undocumented immigrants, and when crisis meets opportunity, is—"Ultimately, the answer to reducing mortality from cancer and other serious illnesses in underserved populations lies not in the next Moonshot cure but in improving access to basic on-the-ground care." And absolutely, that is so true. Protons, we hear fantastic things about them. There's not enough for one, for every single state. That means that there are a lot of patients that aren't having that. The odds of having five-year disease-free survival with lung cancer is about one-in-five. It's only about 21%. The vast majority of patients, over 55%, are actually diagnosed when they're already metastatic. We are really seeing a need there for better screening. It's the same way for head and neck cancer. The vast majority of patients are diagnosed after they've already had it spread to the lymph nodes, local regional disease.

Oncology Data Advisor: Are there any new techniques on the horizon that you're looking forward to seeing to help address these, whether in screening or as in treatment approaches?

Mr. Hillson: I think the biggest cause for excitement is that it's actually become something we're acknowledging. Dr. Chino, who I mentioned, and Shearwood McClelland have been absolute giants when it comes to minority groups and disparities. There are some fantastic papers that I think we all need to be reading. They've all been published, and the vast majority has happened only within the last decade.

Oncology Data Advisor: Wow.

Mr. Hillson: I think that the first step to addressing a problem is to be aware of it and acknowledge it. And I think also, within the fairly recent timeline, we're seeing that there's a lot more chance for interdisciplinary work, a lot more chances for collaboration.

Oncology Data Advisor: Yes. Definitely. Do you have any resources you'd recommend for nurses to stay updated on the latest techniques?

Mr. Hillson: In the Radiation Oncology Collaborative Study Group, or ROECSG, Dan Golden has been involved in a lot of research into how to better teach radiation oncology, and the focus was in how to teach medical students and residents because there really wasn't a lot of focus on that within the profession, but they're very open to any nursing collaboration and collaboration with other groups to go and improve the visibility and the understanding of what they're working on. There have been papers within the last few years talking about how radiation in medicine is not well covered for medical students, and the same thing for nurses as well.

I think so far we've been lucky. In some of the nursing research coming out of the Fukushima radiation area, they were finding their nurses were not prepared. We do know when Three Mile Island had their partial meltdown, there were 14 hospitals and 62 nursing homes within a 20-mile radius. Definitely, if there is any kind of radiation disaster in the US, there's no doubt nurses are going to be on the frontline. And for that, the best sources I'm seeing are the Center for Disease Control (CDC) and the Nuclear Regulatory Commission (NRC). They've done some really great work at trying to go and make radiation education accessible and understandable. Radiopaedia, spelled R-A-D-I-O-P-A-E-D-I-A, goes and covers a lot of the side effects of radiation and the radiology component, which I think we've also gone and ignored a bit of.

Radiation oncology is descended from radiology. It uses a lot of the same technologies, and for better safety and better outcomes, I think nurses need to be more aware of that as well as radiation in general. The American Board of Radiology has some fantastic resources, very plain language, very accessible, and the American College of Radiology has some great information as well. The National Cancer Institute (NCI) is definitely the best resource I've ever come across for understanding the disease processes and trying to get the overall idea. And ASTRO and RT Answers have some very good materials that they're starting to develop looking at patient education, which is also very helpful for the new nurse as well.

Oncology Data Advisor: Great, thank you. Those are all really great resources, and we'll link to all of those in interviews so that they're easily accessible for everyone.

Mr. Hillson: Oh, good.

Oncology Data Advisor: So, along this line of education, are there any new approaches to patient education recently?

Mr. Hillson: Some of my work started with focusing on the education for the experienced nurse. Unfortunately, the first Radiation Oncology Nursing Needs Assessment was done in 2021, and it showed it was a flip of the coin if any nurse had actually received any onboarding education. The vast majority were learning on the job, trial and error, and maybe learning from their physicians or learning from other nurses who presumably also had the same deficiencies in their education, and nobody had any education on radiation in school. So, to improve our ability to go and contribute to the field, our ability to go and best educate our patients, I think we need to understand the modality. I think we need to understand radiation a little bit better. And for a number of the diseases that are being treated with radiation, nursing school typically covers the top diagnoses. Your breast, prostate, colon, and lung cancer, those that are definitely treated by radiation. Head and neck cancer is something that was never covered in nursing school when I went through, or very minimally if it ever was touched on.

So, while there are some opportunities for how we go and teach our patients, and I like what ASTRO has done with RT Answers and videos that are accessible out there, but one of the challenges with radiation is it has become a precision modality, and that means that I can have a couple patients with head and neck cancer that have completely different stories, completely different side effects. That really does mean that the frontline nurse, all of the frontline workers who are doing the education for that specific patient, they can't go and just simply have a cookie cutter approach to educating everyone. And I do think we've got a lot of opportunities to go and improve on that. Again, for head and neck, NCI does a fantastic job of breaking down the anatomy, and once you know the anatomy then the side effects are easier to predict.

Oncology Data Advisor: Great. That's great to know.

Mr. Hillson: But radiation's a lot more like a scalpel than a drug in that regard.

Oncology Data Advisor: That makes sense. Okay. My final question is, for nurses who weren't in attendance at the talk who are listening to this later, are there any take-home messages about radiation you'd like to share with them?

Mr. Hillson: First, I've been very happy with some of the people that have gone and reached out, tried to go and put some stuff on the ONS communities. I think that's a fantastic resource. There are some very good, very experienced people in this profession, and for some of the next steps really taking radiation oncology nursing into the future, we do need the input of everyone and we need everybody stepping up and giving their best and talking. We need to go and be collaborating more. Definitely never stop learning. There are techniques that have come out for just about every area of radiation oncology that we weren't hearing of just a handful of years ago, that all of a sudden are becoming the standard of care.

And again, like I said, learning more about the modality, learning more about radiation in general, better sets us up to contribute to the future of this specialty and the subspecialty. The other part is remember the nursing role. Never forget the humanity in the high tech, because that really is our wheelhouse. There is starting to be an increasing acknowledgement with poverty, race, access, geography, that patients are isolated and they don't know this. And to go and get them through therapy the best that we can, we really need to understand how multifactorial, how widespread some of the effects can be.

Oncology Data Advisor: Absolutely. Well, thank you so much. This was a great conversation. It was great meeting with you.

Mr. Hillson: Thank you for the time.

About Mr. Hillson

John Hillson, RN, BSN, OCN® is an Oncology Certified Nurse, working specifically in the Head and Neck Radiation Oncology Division at Duke University Medical Center. Ever since he was first exposed to head and neck radiation oncology, it has become a passion of his to further research and develop better ways to treat and manage patients with cancer who are receiving radiation. Mr. Hillson recently graduated in May 2023 and earned his Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) track within the DNP program.

For More Information

United States Nuclear Regulatory Commission (2022). Available at: https://www.nrc.gov/about-nrc.html

American College of Radiology (2023). Available at: https://www.acr.org/

American Board of Radiology (2023). Available at: https://www.theabr.org/

American Society for Therapeutic Radiation and Oncology (2023). Available at: https://www.astro.org/

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.