Providing Optimal Care for Cancer Patients in Rural Alaska With Joscelyn VanDuren, MSN, FNP-C
At the recent 47th Annual Oncology Nursing Society (ONS) Congress in Anaheim, California, Joscelyn VanDuren, Family Nurse Practitioner at Advanced Oncology Associates in Alaska, gave a presentation about the challenges faced by patients receiving cancer treatment in rural Alaska and her experiences in treating them. Afterwards, she spoke with Oncology Data Advisor to share additional strategies for nurses and nurse practitioners for providing optimal care for their patients residing in rural areas.
Oncology Data Advisor: What are some of the biggest challenges in cancer care that patients face in Alaska?
Joscelyn VanDuren, MSN, FNP-C: Access to actual care. Given that it's such a large state—70% of the entire US land mass, with more coastline than the entire US combined—we have a very diverse population, and trying to get them from point A to point B can be really difficult. Weather permitting, we can get them where they need to be. However, 75% of Alaska is not on a road system, so they may need alternative transportation: four-wheeler, snow machine, boat, whatever may be available. Then if they can't get out and there's a significant health issue, we try to get a medevac in. Access to care is the biggest challenge.
Oncology Data Advisor: What post-radiation issues concern you the most when treating your patients?
Ms. VanDuren: It really varies depending on the type of cancer. If I'm treating a patient with head and neck cancer, I'm going to be concerned about their long-term dry mouth, their mucositis, and their ability to maintain adequate caloric intake to recover. If my patients with breast cancer have any skin toxicities, I want to manage those. For my rectal cancer patients, it's making sure that they're not having significant diarrhea or constipation.
If patients leave right after treatment, I make sure that I can get ahold of them, and they can get ahold of me. I also make sure that they're going to come in for their follow-ups, because their cancer care doesn't stop when they're done with treatment. They need to get screenings, checkups, labs, imaging, or scopes. It's important that patients realize that just because we stop their treatment, it doesn't mean that they're done; they then go into recovery follow-up mode.
Oncology Data Advisor: What strategies can you recommend in helping patients from rural areas receive cancer care, based on your experiences in Alaska?
Ms. VanDuren: Outline everything in the beginning. Once you have patients there with you, outline everything and write it down. If they have a care partner that comes with them, give them that information too, because two sets of ears are better than one. By having it in writing, they're going to be more apt to be able to refer back to it because they're not as overwhelmed. If I tell patients that they'll have all of these side effects in the beginning, they'll get to it and they'll be so overwhelmed.
At this point, they've probably seen a medical oncologist, a radiation oncologist, a surgeon, any of the other specialties. They've had all these types of imaging and testing done. It's very overwhelming. This is the patient's first journey through this, but it's not ours. Our goal is to walk with them, keep them on this path, and then remind them that every time they need help, we're here to get them where they need to be. That's what we do every day.
Oncology Data Advisor: What types of educational resources can nurses provide to their patients from rural areas who are receiving radiation therapy?
Ms. VanDuren: Honestly, keep it simple and ask them how they prefer to learn: if they prefer videos, if they prefer written, or if they need it in a different language. That's going to be a big thing because a lot of Alaska's native languages are a dying out, and it's hard to get information in those languages. Just make sure that you're giving patients whatever education it is they need in the best way that they understand it.
About Ms. VanDuren
Joscelyn VanDuren, MSN, FNP-C, is a family nurse practitioner at Advanced Oncology Associates in Anchorage, Alaska, where she specializes in radiation oncology. She has particular expertise in managing toxicities and promoting coordination of care for patients receiving cancer treatment in rural Alaska.
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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.