Emerging Approaches: Pancreatic Cancer Systemic Therapy - Episode 11

Educating Patients With Pancreatic Cancer on Adverse Events

February 20, 2019

Transcript: Shantal Ginsberg, RN: My name is Shantal Ginsberg. I’m a registered nurse and I work at the NYU Langone Perlmutter Cancer Center, specifically within the Department of GI [gastrointestinal] Oncology and the Pancreatic Cancer Center. I work directly with Dr. Oberstein treating patients with metastatic pancreatic cancer. In doing that, I often meet the patients. I’m their first person they meet from our team when they come for their initial consult. So, in taking their history, I find out how they were diagnosed and get the first insight as to what we think they can tolerate and what treatments to present to them or consider when treating patients’ first-line metastatic pancreatic cancer.

Paul E. Oberstein, MD: So, Shantal, you see many, many patients with pancreatic cancer in our practice. What’s the first thing that you think about when you go in, often as the first healthcare provider who’s seeing them in the GI medical oncology group?

Shantal Ginsberg, RN: I think that most patients who are given this diagnosis are aware of it prior to seeing us, but occasionally that is not the case. And it’s something where they don’t know how to process the information. So first and foremost, I want to make sure that someone asks how they’re feeling, and I think that is something that is not always done. There are so many adverse events or symptoms that go into the initial diagnosis, so I take those into account before we even talk about treatment and then try to understand what the patient’s day-to-day routine is like, what their quality of life is, what they want their quality of life to be, and what I feel they can tolerate in terms of treatment. As I said, patients come in with symptoms and we’re hopeful that chemotherapy can help those symptoms. Get them to understand that although they might have side effects associated with the chemotherapy, they can certainly see improvement and better quality of life even once they’ve started treatment.

Paul E. Oberstein, MD: Often we’ll go in as physicians and present options to the patients and then walk out of the room and leave you as a nurse, or your colleagues, to have more detailed discussions with patients and their family about how to choose a regimen. How does that process go for you in terms of helping the patients make a shared medical decision about their treatment?

Shantal Ginsberg, RN: I think it’s important that they have all of the information we can present so that they can take it home and look it over. I always stress to them that there will be things that we can try to, in terms of adverse events, explain or warn them about, but actually experiencing them is going to be different. I print information, I go over the most common side effects, and then I make sure that they have our contact information, my contact information. Because what we find is that patients go home and look over adverse events, and then they call the office to ask a few more questions or talk about when they feel they want to start therapy. And the nurse is usually the person they end up speaking to, if we are able to answer all their questions appropriately, to then decide what therapy to start and when to start it. So being able to give them some insight into what they might experience and how even though it might be challenging at times, but we’re there to support them always and get them through this.

Paul E. Oberstein, MD: It certainly is my experience that our patients benefit tremendously from having a good relationship with their nurse, both for initial diagnosis and understanding shared medical decision, but also for managing side effects. They’ll often speak more to the nurse practitioners about what they’re experiencing and get day-to-day tips on how to manage those adverse events. What do you think of the role of nurses and nurse practitioners in managing adverse events for patients?

Shantal Ginsberg, RN: Well, I think that a lot of patients, as I said, have never been through this before. They’re not quite sure what they’re going to feel. So they have somebody to confirm that what they’re feeling is normal or appropriate and explain how to manage it in terms of supportive medications or what they can do for themselves at home. And they have somebody who has helped many patients or who has experienced that; this is what they need in finding that comfort and feeling like they can certainly have someone to talk to or get the right information from.

We also work very closely with the nurses who give the chemotherapy in the infusion center, and they are a resource for patients as well in making sure that they have all the information and talking about what they often see. For them it’s a matter of making sure that nothing is too concerning; and if it is and there are these adverse events that we see that are less common but still somewhat appropriate, it’s a matter of how we can support them, what we can do for them to ensure that they can continue getting their treatment. That’s what a lot of patients are most worried about, that something is going to prevent them from being able to get their next infusion. And if there is something we can do to support them to ensure that it does happen, that’s certainly going to be a priority.

Transcript Edited for Clarity