The “War on Cancer” began in the 1970s. While advances in surgical techniques and radiation required specialized nurses who understood the intricacies of these specialties, it was in the new inpatient medical oncology units that nurses faced the greatest challenges. The complexities of chemotherapy combined with its tremendous side effects called for a special type of nurse, one who could combine intelligence, technical skill, and compassion while comforting patients fearing death.
In 1973, the American Cancer Society held the first National Cancer Nursing Conference in Chicago, and a small group proposed an organization specifically for cancer nurses. Starting with 488 nurses in 1976, the Oncology Nursing Society has grown to 35,000 nurses.[1] As chemotherapy treatments moved from the hospital ward to the outpatient unit and dramatically improved the lives of patients, oncology nurses led the change. When new supportive treatments like ondansetron (Zofran) for nausea and G-CSF (Neupogen) for low white blood counts became available, it was the responsibility of oncology nurses to manage them. Today, whether patients receive complex treatments in the hospital or while living their lives at home, they are supervised and comforted by these remarkable nurses.
Betsy Candon, RN
Betsy Candon was one of these nurses. As a new nurse in the 1970s, she was present at the start of the modern era of cancer treatments. Recently retired, Betsy took time to talk about her career and the field of oncology nursing.
How did you choose oncology nursing?
As a new nurse in the 1970s at Albany Medical Center, I started working with cancer patients. At that time, you either worked on a medical or surgical floor. There weren’t any specialized floors. As for oncology, the field was just beginning.
I choose to work on a medical floor. We were just starting to give chemotherapy. I remember the first time a patient got cisplatin. He died a little while later. That was what oncology was like; it seemed like very few people survived.
At the start, the interns and residents gave the chemotherapy. Pretty soon, everyone realized that the people giving the chemo needed to be specially trained. They wanted nurses to do that, and I got certified.
So, I sort of fell into oncology because it was a new field and very interesting.
What was oncology nursing like in those early years?
At the start, everything was done in the hospital. In the early 1980s, I went to Memorial Sloan Kettering Cancer Center in New York City to get more experience. It was the start of oncology nursing, and they were ahead of us in Albany. It was something to see how they did things. Nausea and vomiting were big problems that we had to manage. That was before Zofran, and we would have to sedate some patients so that they could get through the treatments. Chemo vomiting was so hard that some poor patients would need to get sedatives the minute they walked onto the ward. I remember after I quickly sedated one patient, the intern was mad because he couldn’t do an admitting history. We told the intern to read the old chart. We weren’t going to let one of our patients be miserable waiting for him!
The technical issues were also interesting. We were using ports, and the nurses took care of those. We also had some special pumps to give timed chemo. I remember one patient came from Egypt to get treatment. He brought his own doctor with him, and I taught him how to use the port and the pump.
We were trying all these new experimental drugs, too. Most of them didn’t even have names, just numbers.
How did the oncology nursing change in the 1980s and 1990s?
In the mid-1980s we started to give patients chemo is outpatients, so I became the assistant head nurse in the new outpatient oncology unit. You could really get to know patients there, and the outpatient nurses were encouraged to be more independent. A big deal was that we helped patients with pain. The doctors were grateful we could spend that time with the patients. They gave us a lot of freedom and always had our backs.
The field really changed in the 1990s. When Zofran for nausea and vomiting came out, it meant we could give many more treatments in the outpatient unit. Neupogen shots meant we could prevent low white blood counts and infections. It was very exciting.
That was also the time of HIV/AIDS. Since the antivirals were not good, many of those poor patients had terrible cancers like lymphomas and Kaposi’s on the skin. But despite that, they were also fun. Some of them were wild and crazy.
That was also the time we were doing bone marrow transplants for breast cancer. That did not go over that well. I remember my first patient who did a transplant was a nurse. She lived for years but was sick all the time, poor thing. She kept working as nurse, though.
For me, one of the most special things about oncology was that you were always thinking ahead. You had to think about what might happen with the treatment you were giving, what the patient and their family might be facing, and what you would do next if they needed more treatment.
Where did your career go next?
In the 1990s, I moved to a new private oncology practice which was starting about thirty miles away, in Saratoga Springs. It was a small office, and we took care of many people in the community. We had great nurses who were all very well trained and could handle anything. We gave all types of chemo, even into the spinal fluid, did clinical trials, genetic testing, all different procedures, and even managed pumps that fed chemo into the liver. That was my specialty. People would come from all over to have me fill their pumps. You name it, we did it.
We were a team and could cover for each other in any situation. I remember one day I was looking over the waiting room and saw somebody I didn’t know who didn’t look too good. Then I realized he wasn’t breathing. Basically, he had died in our waiting room. But we all worked together and got him back. Turns out, it was his first new patient visit. He thanked us on his second visit!
The patients really appreciated us because they could get their treatments close to where they lived. They all knew each other and had coffee, played cards, or knit together in the chemo room. With them, HIPPA (privacy) went out the window!
After many years, as we all got older, the practice became part of the local community hospital (Saratoga Hospital). I retired a few years later.
So, I worked in all different settings, from the big medical school hospital to the community office.
What were some of the other changes you remember best?
The change from radical mastectomies to lumpectomy and radiation for breast cancer. I remember our first patient who did that. She was the wife of one of the docs and had to go to New York City. It was a real big advance.
I remember using Taxol for the first time, too. We did it first as an inpatient infusion over twenty-four hours, then later in the outpatient unit. It was still a very long infusion, and someone had to come in early for first outpatients and stay late. But we did it. Now it is routine.
And, of course, the targeted treatments like Rituxan and Herceptin. They helped so many patients, although we had to learn how to give them.
What did you like best about being an oncology nurse?
I never met an oncology patient I didn’t like.
Often at the start they were angry. But not with you. Once they got going, they were nearly all upbeat and personable. And they were grateful, even the ones that were not doing well. For most, their families were always there.
The best part was just talking to them.
What were the hardest parts?
Losing some patients. Some hit you in the heart. You often shed a tear or three and cried with the families.
Most of the time you have to keep people at arm’s length, because you can’t be extremely close to everyone. But some you get very attached to and your heart just goes out. And if it goes bad, you have to mourn that person’s death but not get caught up in it. You have to be ready to help the next person.
Mixing the chemo was hard in the days we did that. I was afraid of doing something wrong. We always checked each other.
Phone calls were hard. I remember once a relative told me a patient wasn’t doing well. I called him and asked him why he hadn’t called me. He said because I told him these things were going to happen, so he figured I knew.
Calling people to come in and get bad news was hard. They knew.
Do you have any advice for young nurses thinking about oncology?
Go in with an open mind and open heart and you will learn how to deal with things. You will probably get more involved than you should at the start. I have been with many new nurses who cry and cry when they learn someone is going to die. Remember, there will be rough days and terrible days, but there is always a light at the end of each tunnel. You will survive those days.
Before you go into oncology, be sure you have a couple of years of med-surg experience.
It was a great job. The patients were lovely. The physicians (most of them) were lovely. And you learn things you never thought you would learn or would want to learn.
Betsy and her support crew
You had treatment for breast cancer yourself recently. How has that gone?
Well, I remember years ago I always said there was no way I am ever going to take chemotherapy, because there were not good outcomes. But, of course, times have changed.
I’ll never forget that morning I felt my lump. Oh, shit (actually, it was a different word), I said. But then came the mammogram, biopsy, and all the tests. Then surgery, and here was chemo.
I was prepared to be sick, but I wasn’t. With the first treatment, I had no energy and wanted to sleep. I was in bed for two days. The second treatment was better. The main issue for me is some lower leg edema. I lucked out. In truth, you deal with it. Get up in the morning and put one foot in front of the other. Now I am on Herceptin once every three weeks … that’s nothing.
And my oncology nurses are very good.