Oncology Nurses, APPs Play a ‘Unique Role’ in Sarcoma Treatment

Several advancements have been made in the diagnosis and treatment of sarcoma over the past few years, including the use of image-guided needle biopsies, specialized radiation techniques, targeted therapies, and surgical methods, an expert said.

Oncology Nursing News spoke with Kate M. Barrie, PA-C, orthopedic physician assistant at Penn Medicine’s Abramson Cancer Center in Philadelphia, to learn more about the advances in the sarcoma space, how they have benefitted patients with the disease, and the benefits of a multidisciplinary approach to care.

What are the recent advancements that happened in the treatment of patients with sarcoma?

At Penn, we utilize image-guided needle biopsies to expedite the diagnostic process. In many cases, we are able to perform same-day biopsies, with results available within 3 to 5 days. This accelerated turnaround allows us to initiate staging and treatment much faster compared to traditional open biopsies, which require an operating room procedure.

Our radiation oncology team is highly specialized, providing personalized treatment plans. One key advancement in radiation therapy is the ability to spare the skin from exposure to radiation prior to surgery, which significantly reduces post-operative complications and wound healing issues.

A particularly exciting development in radiation is the use of proton therapy. This is a more targeted approach that delivers radiation with precision. This minimizes long-term side effects compared to conventional radiation techniques.

While my focus is primarily surgical, we collaborate closely with our medical oncology team. Immunotherapy has become a groundbreaking treatment option and continues to be a major area of development. Additionally, targeted therapies are emerging as promising treatments across many cancer types, including certain sarcoma subtypes. These therapies are typically suited for specific subgroups of patients based on genetic or molecular markers. We have clinical trials at Penn and across the U.S. Our multidisciplinary team plays a crucial role in assessing which patients are candidates for these advanced therapies, ensuring personalized and effective treatment.

These advancements collectively represent a more personalized and efficient approach to sarcoma treatment, aimed at improving outcomes while minimizing side effects.

Can you also discuss advancements made with surgery in this space?

In certain cases, we collaborate with specialized companies to utilize 3D printing and modeling technology. By sending them patient imaging, we can design custom implants or create personalized cutting guides. These guides enable us to make more precise cuts when removing tumors, particularly those located in bone.

The degree of customization in these surgeries is highly individualized and depends on the tumor’s characteristics. Advances such as robotic navigation and computer-aided navigation systems allow us to make more precise cuts, helping us preserve as much of the patient’s anatomy as possible.

In limb salvage cases, we often collaborate with our Penn Plastic and Reconstructive Surgery colleagues, especially in complex situations. The goal of limb salvage is not only to save the limb but to ensure it remains as functional as possible. Techniques such as vascularized fibular grafts or allografts are used to fill gaps where bone may be missing. The plastic surgeons help reconstruct the area with tissue flaps, either from local tissue rearrangement or from other parts of the body known as free flaps.

While we always aim for limb preservation, amputations are sometimes necessary. Even in these cases, we've made significant progress. By working closely with plastic surgeons, we incorporate techniques such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), which have been shown to reduce phantom limb pain—an issue many patients face post-amputation. Additionally, these techniques improve the functionality of advanced prosthetics, such as myoelectric prosthetics, which allow for more natural movement through electrical signals. These advancements ensure that even patients requiring amputation can regain greater functionality and quality of life after surgery.

How can oncology nurses and APPs keep up with the ever-changing landscape of treatment?

What makes sarcoma treatment unique is its inherently multidisciplinary approach, which fosters constant communication between team members. At Penn, we have a weekly tumor board where we regularly collaborate with various specialties. We discuss treatment as a team and stay informed about the latest advancements and technologies. Keeping up with the ever-evolving landscape of treatment is about engaging and being part of a high-caliber team that prioritizes staying up-to-date on the most current treatment options, cutting-edge technologies, and surgical techniques. Continuous dialogue and collaboration are key to ensuring we provide the best care possible.

What role do oncology nurses and APPs play in administering these treatments?

Oncology nurses (RNs) and Advanced Practice Providers (APPs) play a pivotal role in patient care due to our ability to be deeply involved in the treatment process and journey. I collaborate closely with many RNs, APPs, and physicians across the treatment team, which includes surgical teams, radiation oncology, and medical oncology as a large majority of the work revolves around coordination of care.

While I personally do not administer systemic therapies or medical oncology treatments, I work closely with colleagues who do. I regularly communicate with patients as they are receiving this treatment as well. The medical oncology APPs and RNs regularly assess patients, monitor lab results, and ensure that patients are prepared for their treatments, such as infusions. Additionally, I maintain strong relationships with various specialties to coordinate pre-operative planning, arrange for pre-op imaging, and ensure timely surveillance imaging post treatment. This close collaboration ensures that patients receive comprehensive and well-coordinated care throughout their treatment and subsequent surveillance.

As a surgical APP, I am involved in almost every aspect of surgical care including pre-operative planning, assisting in the operating room, post-operative management, and surveillance.

Can you go into more detail about adverse effect management in this space?

Adverse effect management largely depends on the individual patient and the type of treatment they are undergoing. Preoperatively, I focus on setting clear expectations and counseling patients on what to anticipate post surgery. Postoperatively, managing wounds and wound complications is often a priority, especially for patients who have undergone radiation. It is also imperative to promptly manage wound complications if patients need to resume systemic therapy as wound complications can delay the resumption of treatment.

The approach to managing symptoms varies based on the treatment. For instance, chemotherapy can lead to critical issues such as a drop in white blood cell counts or the need for blood transfusions or even delays in surgery. Monitoring lab results and understanding the normal ranges is essential to determine whether a patient is fit to proceed with treatment or if intervention is needed.

I work closely with an RN who conducts the initial post-operative follow-up calls. If a case becomes more complex, I step in to manage post-operative care. I also see patients for their initial post-operative visits. While I am not a surgeon, I play a significant role in the post-operative assessment and treatment. I evaluate post-operative patients, and if there is uncertainty about intervention, I consult with the attending surgeon to ensure the appropriate course of action is taken.

Typically, APPs and RNs are the first point of contact for patients with concerns or complications. Many patients experience anxiety, unsure if what they are going through is normal. Often, it’s about reassuring them, listening to their concerns and facilitating resources such as counseling. While many of the side effects or complications are expected, our role is to manage them effectively and provide patients with the guidance they need.

What advice would you give to RNs and APPS caring for these patients?

Advanced Practice Providers (APPs) and Registered Nurses (RNs) have an incredibly unique role in the care of sarcoma patients. While this aspect of care may not always be formally taught, our positions gives us the opportunity to form close, empathetic relationships with patients, ensuring that they feel truly cared for. Often, we're able to spend more time with patients, which helps us to provide that extra layer of comfort and helps us build these relationships.

With experience in oncology, we learn to anticipate what might cause stress for patients, as well as recognize the level of support they have in their lives. This enables us to better manage interactions and often take on the role of a counselor, offering emotional support beyond just medical care. In many cases, we find ourselves becoming a source of emotional support, akin to a psychologist or therapist. Patients don’t necessarily want to be treated like a medical case—they want to feel seen and heard as individuals. They seek assurance that their fears and anxieties are acknowledged and managed.

The key advantage of our role is that we are able to view the patient’s journey from multiple angles. We understand the intricacies of their treatment plans but also recognize that patients often require additional resources beyond medical care, such as therapy, support groups, or nutritional guidance. Our role allows us to think holistically about their well-being. We are afforded more time to focus on these other dimensions of care.

Ultimately, we serve as a bridge, ensuring that patients receive comprehensive care that extends beyond their physical treatment, addressing their emotional, psychological, and social needs.

This transcript has been edited for clarity and conciseness.