PLENARY PRESENTATION

FEATURES/Chroniques

Editor note: This manuscript was based on a plenary presentation provided at the Annual Canadian Association of Nurses in Oncology
Conference 2017 held in Gatineau, Quebec.

The evolution of oncology nursing:

Leading the path to change
by Greta G. Cummings, Sarah D. Lee, and Kaitlyn C. Tate

ABSTRACT
The roles and responsibilities of oncology
nurses have rapidly transformed over the
past century from general nurses providing
bedside comfort care with few technologi-
cal advances to advanced practice oncology
nurses responsible for everything from per-
forming invasive procedures to diagnostic
interpretation and screening for cancer pre-
vention. As cancer care continues to evolve,
nurses will play a key role in the field of
oncology, whether as specialized oncology
nurses providing clinical care or as nurse
researchers spearheading groundbreaking
oncology research.
patient numbers. The situation is not
unique to Canada; the role of oncology
nurses is expanding and adapting to
care needs and scarce resources inter-
nationally (So et  al.,  2016). Supporting
oncology nurses is vital to ensure peo-
ple with cancer are appropriately cared
for and guided through their individ-
ual journeys in a time of utmost need
and vulnerability (Komatsu & Yagasaki,
2014). As cancer rates continue to rise,
we explore the role and responsibilities
of the oncology nurse in cancer care by
reflecting on where it all started, exam-
ining our current practices and think-
ing forward to the future and how to
cancer by the 1920s. However, the way
in which radiation was administered
often left nurses in contact with dan-
gerous substances, such as radium and
radon (Haylock, 2008). Some nurses
refused to take care of cancer patients,
as they believed doing so posed a signif-
icant risk to their own health and ideas
that cancer was contagious were well
entrenched until the 1930s (Haylock,
2008). Another factor influencing the
role of oncology nurses was the broader
context of the shifting roles of women
during World War I. As many men went
off to war, nurses began to take on roles
originally reserved for physicians, such

O ncology nursing has evolved sig-

nificantly over the last century,
as cancer becomes one of the leading
causes of death globally. Current statis-
tics show that almost 45% of Canadian
women and 49% of men will develop
cancer during their lifetime, and one
out of every four Canadians will die
from cancer (Canadian Cancer Society,
2018). This increase in cancer bur-
den has left many oncology nurses
stressed and burned out, as nursing
resources are spread too thin to meet
the care needs of cancer patients (Ko
& Kiser-Larson, 2016). Bakker et al.
(2006) found that Canadian nurses
felt their workload had increased by as
much as 30–50% through increased
ABOUT THE AUTHORS
Greta G. Cummings, RN, PhD,
FAAN, FCAHS
Sarah D. Lee, MSc
Kaitlyn C. Tate, RN, BN, doctoral
student
best practise nursing within oncology.
As cancer remains prevalent, the role of
as venipuncture (Haylock, 2011).
Oncology nursing has developed and
oncology nurses at the forefront of can- changed over recent decades. In the
cer care is more involved and compli- 1940s, nursing of people with cancer
cated than its humble beginnings. began to change with the introduction
HISTORY OF ONCOLOGY
NURSING
Over the last hundred years, cancer
care has come a long way from general
nurses caring for patients with cancer,
using primarily bedside and comfort
measures, to the development of oncol-
ogy nursing as a specialty (Haylock,
2008) with a defined knowledge base,
supported by research and expert prac-
tice. Without specialized education
or training in oncology, early cancer
nurses were often forced to be creative
in caring for patients with various com-
plications of cancer treatment, such as
radiation burns and pain (Ferris, 1930).
In the early 20th century cancer nurs-
ing was perceived as arduous, depress-
ing and even dangerous work, as the
prospects of cancer patients surviv-
ing were slim and nurses were often Figure 1: A physician is changing the
exposed to harmful chemicals (Barckley,
dressing on a patient’s neck, while
1985). Radiation was accepted as the a nurse holds the patient’s head.
therapeutic option for many forms of (Unknown, 1950)

314 Volume 28, Issue 4, Fall 2018 • Canadian Oncology Nursing Journal
Revue canadienne de soins infirmiers en oncologie

Figure 2: Patient receiving Cobalt 60 cancer therapy. (Unknown, 1951)
of oncology nursing as a specialty in
the United States and the creation of
specialized education and training
for oncology nurses (Lusk, 2005). In
1947, the first university course in can-
cer nursing was offered at Columbia
University and represented the begin-
ning of a shift in oncology nursing edu-
cation (Yarbro, 1996). By the 1950s, the
full impact of cancer was starting to be
realized, which led to the recognition
that nurses required additional prepa-
ration to provide comprehensive care to
those who had cancer (Peterson, 1954).
Cancer care continued to change rapidly
over the next few decades. According
to Lynaugh (2008) “the period between
1950 and 1980 was a time of erratic, but
fundamental change in every arena of
nursing” (Lynaugh, 2008, p. 13). The
1960s saw an increase in the number
of clinical trials in oncology and with
this came the desire of care continuity
from trial participants (Haylock, 2011).
During this time of rapid change, the
role of the oncology nurses evolved
from a primarily task-oriented care role
to integral member of the cancer care
team, often serving as liaison between
clinical investigators and other disci-
plines that were becoming common
to cancer care teams (Haylock, 2011).
During this time of change, nursing
leaders in oncology saw the need and
an opportunity to found societies and
Canadian Oncology Nursing Journal • Volume 28, Issue 4, Fall 2018
Revue canadienne de soins infirmiers en oncologie
associations of cancer nurses across var-
ious countries to support nurses and
share oncology nursing knowledge.
The International Society of Nurses in
Cancer Care (ISNCC) was founded in
1984 (International Society of Nurses in
Cancer Care [ISNCC], 2018) and in con-
junction, the first cancer nursing jour-
nal, Cancer Nursing: An International
Journal for Cancer Care was established
in 1978 (Cancer Nursing, 2018). Shortly
after ISNCC, the Canadian Association
of Nurses in Oncology (CANO/ACIO)
was founded in 1985, by a unanimous
vote of more than 300 Canadian oncol-
ogy nurses, with the goal to create a
professional body to support other
Canadian nurses working with cancer
patients and advocate for appropriate
care for patients and roles for oncology
nurses (CANO/ACIO, 2018).
SUPPORTING THE
PROFESSIONAL
DEVELOPMENT OF
ONCOLOGY NURSING
The role of CANO/ACIO has evolved
since its inception along with the chang-
ing field of oncology nursing, most nota-
bly with the development of the CANO/
ACIO Standards of Care for oncology
nursing in the early 2000s (CANO/ACIO,
2017). These nine standards of care were
intended to reflect the core compo-
nents of oncology nursing and include:
individualized/holistic care, family-cen-
FEATURES/Chroniques
tred care, self-determination, navigat-
ing the system, coordinated continuous
care, supportive therapeutic relation-
ship, evidence-based care, professional
care, and leadership (CANO/ACIO,
2017). Standards were developed to
guide oncology nurses in their work, but
the mechanisms by which these apply
to the day-to-day practice of oncology
nursing in Canada are less understood.
One study found a lack of awareness of
CANO standards of care among oncol-
ogy nurses, as well as a disconnect
between predefined roles and enactment
of these roles (Lemonde & Payman,
2015). Oncology nurses were most chal-
lenged in taking on leadership roles and
engaging in professional development,
warranting the further development of
leaders in the field of oncology nursing
(Lemonde & Payman, 2015).
While many studies have shown that
relational nursing leadership is signifi-
cantly related to improved outcomes
for the nursing workforce, the work
environment (Cummings et al., 2018)
and for patients (Wong, Cummings, &
Ducharme, 2013), it is helpful to under-
stand what leadership is and how it
applies to the role of the oncology nurse.
Leadership is being able to see the pres-
ent for what it really is, seeing the future
for what it could be, and then taking
action to close the gap between today’s
reality and the preferred future of tomor-
row (Cummings, 2012). For the nursing
leaders in the early 1980s who envisioned
that oncology nursing societies were
needed to support nurses in their roles to
provide the best care, education and sup-
port for those living with cancer and their
families, seeing what this future looked
like and then moving on to actually build
and sustain that future is an awesome
feat. Likewise, we have many immediate
opportunities to envision and act to build
a preferred future with our patients every
shift, every day, every year. In many dif-
ferent ways, all oncology nurses can be
leaders, as they envision, advocate and
innovate ways that caring with and for
their patients can be improved, expecta-
tions can be discussed and outcomes can
be changed. It may mean that there is
something you will do differently tomor-
row that will lead to different outcomes
315
 for your patients. You will listen differ-
FEATURES/Chroniques
ently, advocate more clearly, prepare
your care with new knowledge, take on
a new perspective, and see the work and
its problems differently. Nursing lead-
ership is characterized by critical think-
ing, action and advocacy across all roles,
practice settings and domains of nursing
practice (Truant & Chan, 2017).
LOOKING TO THE FUTURE
While it is important to examine
the history of oncology nursing, we
must also consider where the future of
oncology nursing is headed. One way
in which oncology nursing is changing
is in the increased specialization and
advancement of nurse training, includ-
ing an increase of specialized oncol-
ogy nurses and Professional Cancer
Navigators. Professional Navigators
are nurses who provide continuity for
patients and their families through-
out the entire cancer treatment process
by helping them navigate the system
and liaising with other healthcare pro-
fessionals and community agencies
on their behalf (Cook et al., 2013). The
future is pointing towards an increase
in advanced practice nurses (APNs), as
they function to meet both the medical
and nursing needs of patients through
a model of collaboration, shared respon-
sibility, and accountability (Rieger
& Yarbro, 2003). Most provinces in
Canada now have APNs in oncology
that provide advanced nursing care to
patients and families.
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The role of oncology nurses will con-
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