Cancer Genetics

special interest group newsletter

Volume 18, Issue 1, June 2014
 
   
Ex-Officioís Message:
In My Rearview Mirror

Jacqueline Hale, RN, APN-C, AOCN®, APNG
Flemington, NJ
Hale.jacqueline@
hunterdonhealthcare.org


Hello, Cancer Genetics SIG members. This is my first message as SIG ex-officio. Representing our SIG has been an honor and a privilege. I have enjoyed the opportunity to interact not only with ONS membership and leadership but also to communicate our perspective regarding issues from other organizations that impact our practice. Within ONS, we have updated the ONS position statement “Oncology Nursing: The Application of Cancer Genetics and Genomics Throughout the Oncology Care Continuum,” updated our SIG goals annually, offered many sessions at ONS Congress, and contributed to several ONS publications. Within our SIG, we have discussed and shared our experiences and concerns on such issues as credentialing, organizational accreditation standards, scope of practice, role preparation, and challenges in our various roles. The past two years have been incredibly busy for our SIG, a trend that promises to continue.

Receiving input from our members through things such as our SIG meetings, email, and Virtual Community was the leadership tool I valued most. Although we could not change all the concerns we faced as oncology nurses integrating genetics into our care, we brought the concerns to the attention of other healthcare leaders. I encourage you to remain vocal and supportive of the SIG and our new coordinator. Express your concerns, and share the positives as well. Be outspoken, and be constructive. Genetic information is changing constantly. Keep up to speed, and stay informed.

The American Nurses Credentialing Commission has assumed the certification process for genetic nurses. The demand for nurses prepared to deliver cancer risk assessment continues to increase. Accreditation organizations continue to focus on appropriate educational preparation to deliver risk assessment services. We need to support each other while moving into the future of oncology genetics.

During Congress, Catherine Belt, RN, MSN, AOCN®, assumed the coordinator role for our SIG. She already has been actively involved in leadership activities. Please continue to communicate freely. Offer your support, skills, and knowledge. Share your experience. We are in an exciting time of utilization of genetic and genomic information in the continuum of cancer care. Input from members is necessary for a leader to represent them adequately.

Thank you for all you have shared with me over the past two years. I have gotten to know many of you while serving as coordinator. The experience was rewarding and the peer support phenomenal. I leave this role more convinced than ever that oncology nurses are a very special group of professionals. I will miss being the coordinator, but I eagerly anticipate seeing the future unfold.

 
The Cancer Genetics SIG Newsletter is produced by members of the
Cancer Genetics SIG and ONS staff and is not a peer-reviewed publication.

Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Cigna Genetic Testing Guidelines Update

Jacqueline Hale, RN, APN-C, AOCN®, APNG
Flemington, NJ
Hale.jacqueline@hunterdonhealthcare.org

This issue of the newsletter features individuals, the SIG, and ONS leadership in action. SIG member Cathleen M. Goetsch, MSN, ARNP, AOCNP, shares her experience in the article “Cigna Healthcare 2013 Genetic Testing Precertification Guidelines: A Cancer Genetics SIG Member’s Response“(written prior to publication and SIG receipt of a Cigna policy change). Cathleen took a two-fold approach. She identified the problem and advocated for her client as well as for professional recognition as an advanced practice nurse with specialty training and experience in hereditary cancer syndromes. The SIG also took a two-fold approach. We collaborated with the ONS Executive Board to advocate for nurses with hereditary cancer genetics training and experience (general and advanced practice) to be recognized as genetics providers for education and ordering genetic tests (as allowed with their scope of practice). SIG members also applied (and several were accepted) to be expert content panel members and have a voice in the upcoming certification through the American Nurses Credentialing Center.

ONS Board of Directors President, Mary Gullatte, PhD, RN, ANP-BC, AOCN®, FAAN, sent a letter to Cigna’s national medical director on January 20, 2014, outlining concerns about Cigna’s 2013 precertification guidelines. The ONS communication to Cigna described the requirements to attain the existing credentials of Genetic Clinical Nurse and Advanced Practice Nurse Genetics from the Genetic Nursing Credentialing Commission (GNCC) and supported ALL nurses with expertise and experience in hereditary cancer and genetics. The GNCC officially transitioned to the American Nurses Credentialing Center (ANCC) on December 2013. The 2014 Cigna genetic testing policy guidelines now include nurses credentialed by GNCC and nurses who will be certified through the ANCC.

The Cigna response to the ONS Board President indicates that nurses with specialty genetics training may contact Cigna and may be eligible to be listed as genetics providers. Interested nurses should contact Stuart Goldenberg, National Director of Affordability Programs at Cigna. Several organizations (ONS, American Society of Clinical Oncology, National Accreditation Program for Breast Centers, and City of Hope) have written Cigna with concerns about the 2013 genetic testing guidelines. Cigna publications indicate that policies are reviewed every six months. I encourage you to stay up-to-date on this issue. Access the most recent Cigna policy.

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Cigna Healthcare 2013 Genetic Testing Precertification Guidelines: A Cancer Genetics SIG Memberís Response

Cathleen M. Goetsch, MSN, ARNP, AOCNP
Seattle, WA
cathleen.goetsch@vmmc.org

Note from the coordinator and editor: This article was written prior to receipt of Cigna response. ONS has a position statement about the role of general genetics oncology nurses and advanced practice genetics oncology nurses. The ONS Board of Directors President, Mary Gullatte, PhD, RN, ANP-BC, AOCN®, FAAN, sent a letter to Cigna’s national medical director on January 20, 2014, outlining concerns about Cigna’s 2013 precertification guidelines. Cigna has responded, and the policy was amended in February.

Cigna Healthcare insurance has changed its precertification process for approving genetic tests for its members, effective in fall 2013 (Cigna, 2013).

The patient must meet guidelines for medical necessity, and an attestation must be signed that the person recommending the testing (justifying the medical necessity) is one of the following.

  • Board-certified medical geneticist or board-eligible medical geneticist
  • American Board of Medical Genetics or American Board of Genetic Counseling Certified Genetic Counselor (not employed by a genetic testing lab)

This recommendation may have been instituted to make sure customers received genetic counseling before tests were ordered. However, it effectively limits patient access to many knowledgeable and experienced genetics providers (e.g., nurses, nurse practitioners, medical specialists). This limited access especially is true for patients with cancer.

Cigna’s new guidelines not only limit patient access to providers but, in effect, also mandate or limit the scope of nursing practice. Genetic education/counseling/testing is an activity that is recognized by states and by the American Nurses Association and International Society of Nurses in Genetics (2006) as appropriate for nurses with training, education, and experience concordant with the service provided.

Several years ago, Uniform Healthcare had a similar requirement. In my experience, this strategy caused a delay in patients receiving services in a timely manner (e.g., patients with breast cancer waiting to make surgical decisions based on genetic test results). In one instance, the patient received duplicate services and had duplicate charges (genetics nurse and genetic counselor).

Using an appeal letter, I have been successful in obtaining Cigna approval for an individual patient’s genetic tests, although I experienced a week’s delay in getting approval using this appeal process. See an example appeal letter.

The following are organizational position statements that support the role of genetics nurses and advanced practice genetics nurses.

References
American Nurses Association and International Society of Nurses in Genetics. (2006). Genetics/genomics nursing: Scope and standards of practice. Silver Spring, MD: American Nurses Association.

Cigna. (2013). Cigna medical coverage policy. Retrieved from https://Cignaforhcp.Cigna.com/public/content/pdf/coveragePolicies/medical/
mm_0001_coveragepositioncriteria_genetic_testing_for_breast_and_ovarian_cancer.pdf

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Meet Your New SIG Coordinator

Catherine Belt, RN, MSN, AOCN®
Hatfield, PA
cathy.belt@uphs.upenn.edu

I am proud and humbled to admit that I have been a professional nurse for 40 years as of May 2013 and an oncology nurse for 30 years. After completing my Bachelor of Science in Nursing at Temple University in Philadelphia, PA, I began my nursing career in Ft. Lauderdale, FL. I completed my Master of Science in Nursing (MSN) degree while in my 40s, raising a family, and working as a nurse manager at a mid-sized suburban community hospital. I first became an oncology certified nurse in the 1980s after transitioning my general medical-surgical unit into an oncology-dedicated unit and outpatient infusion suite. This was the most singularly rewarding experience of my nursing career—to lead the journey for the nursing staff members to become specialized in their knowledge and skills to provide for the special needs of patients with cancer. I completed my MSN in 1997 from Gwynedd-Mercy College in Gwynedd Valley, PA, as an oncology clinical nurse specialist with a double concentration in administration and education and sat for the Advanced Oncology Certified Nurse (AOCN®) examination the first year I was eligible. I have maintained my AOCN® since 1997. I began specializing in hereditary cancer genetics nursing in 1999 while working at Pennsylvania Hospital in Philadelphia, PA.

What influenced you to become an oncology nurse?
Over the course of my 40-year career, I have seen many changes in nursing and health care. Many significant scientific advancements have happened across many specialty areas, but none more dramatic than in oncology nursing and the cancer genetics field. Genomics has exploded over the past 10 years. My first medical-surgical staff nurse position in the early 1970s was challenging. Options for cancer treatment were limited, no supportive care medications existed, and patients presented with late-stage and devastating diseases. ONS had not yet been established when my career began, so resources were limited for bedside nurses caring for patients with cancer. After returning to my Pennsylvania roots, I worked at a local community hospital. Over the course of 23 years, I rose from the ranks of staff nurse, to nursing supervisor, to clinical educator, and then nurse manager. By 1984, cancer treatment had advanced significantly. As a nurse manager of a general medical-surgical nursing unit, I recognized that my staff members wanted to differentiate their area of clinical expertise from other nursing units and provide specialized care for patients with cancer who were being admitted to general medical-surgical units throughout the hospital. I submitted a proposal to senior administration to transition all patients with cancer to our unit and develop the oncology clinical expertise of our nursing staff. Using the ONS clinical practice guidelines, chemotherapy courses, and other resources for staff development, we developed into oncology care experts. Since that time, I have held several cancer center administrative director positions. When I joined Pennsylvania Hospital in 1999, I implemented a Cancer Risk Evaluation Program (CREP) in collaboration with the Abramson Cancer Center of the University of Pennsylvania. I’ve been passionate about cancer genetics and risk evaluation since that time.

What do you do in your current position?
I am a senior administrator with the Penn Cancer Network at the Penn Medicine Abramson Cancer Center. Along with assisting with oncology service line development, I coordinate the development and implementation of the Penn Medicine CREP at our community partner hospitals. I work with our partner hospitals on developing their interdisciplinary teams—usually a physician and genetic counselor or genetics nurse—validating their competency and building the infrastructure for the CREP. I also assist hospitals in meeting the certification standards for the American College of Surgeons Commission on Cancer and the National Accreditation of Breast Programs. My other areas of specialty are in cancer survivorship, program development, and nursing education.

What prepared you for this role?
My past experiences as an oncology administrative director at three hospital systems gave me a foundation for my current position. In the area of cancer genetics, I have clinical experience in providing risk evaluation services at two different hospitals. I have completed the course requirements for the City of Hope Intensive Cancer Risk Assessment Course and the Fox Chase Advanced Course for Nurses in Genetics and have taken post-graduate genetics courses at the University of Pennsylvania. I belong to ONS, the International Society of Nurses in Genetics, and, in the past, the American Association of Nurse Executives and use the many resources and experts from these organizations. Being a lifelong learner is the best characteristic that any nurse can possess.

What advice do you have for oncology nurse leaders heading a new program?
Recognize the value of networking, learning from others who already have traveled this path, and use your professional organization resources. Be a forever learner in everything you do—ask questions, seek answers, be open to various opinions and options, and thank those who share their perspectives.

What is your best advice to aspiring oncology nurse leaders?
The best advice I received from my mentors was to be engaged, participate, and share your experience and your quest for knowledge. I encourage you to be involved with the ONS Cancer Genetics SIG.

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

New Genomic Educational Resources

 

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

CAG SIG Members Go to the Podium

Jacqueline Hale, RN, APN-C, AOCN®, APNG, and Rachel Rando, MS, CGC, Hunterdon Healthcare, presented “Practicing in Partnership” at the First Annual Scripps Cancer Care Symposium on September 29, 2013, in San Diego, CA. The purpose of the presentation was to illustrate the depth and effectiveness of multidisciplinary collaboration in bringing comprehensive genetic/genomic services to oncology and preparing for advances in personalized medicine.

Jennifer Loud, RN, CRNP, DNP, National Cancer Institute; Patricia Kelly, DNP, APRN, CNS, AOCN®, Texas Health Presbyterian Hospital Dallas; and Alice Kerber, APRN, ACNS-BC, AOCN®, Georgia Center for Oncology Research and Education, presented “Personalized Oncology Care: Clinical Applications and Research” at the ONS Connections: Advancing Care Through Science Conference from November 7–10 in Dallas, TX.

If you have presented on genomic topics or published genomic articles or a book chapter, please send the information to CAG SIG Newsletter editor Patricia Kelly. We want to highlight member accomplishments.
 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

ANCC Seeking Genetics Nurses

The American Nurses Credentialing Center (ANCC), in collaboration with the International Society of Nurses in Genetics, is in the process of creating two new certifications for nursing specialists working in genetics. As a part of the process, ANCC is recruiting nurses working in this specialty to apply for their Content Expert Registry and to be considered for service in various roles. Any travel expenses to meetings will be covered by ANCC and, if selected, nurses may be awarded with the certification to which they contribute their expertise. For more information on how you can be a part of this exciting process, you can contact the ANCC Certification Program staff.
 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Exclusive Articles Available Before Print

The Oncology Nursing Forum (ONF) and the Clinical Journal of Oncology Nursing (CJON) have unveiled advanced print exclusive articles to give our readers access to important, cutting-edge content ahead of print. Articles from the journals are available on the main ONF and CJON pages. These articles are open access, meaning they are available to members and non-members alike, until they appear in print at a later date. At that time, the content will become password-protected like other articles that appear in print as online exclusives in the journals.

The latest article to receive the advanced print exclusive designation is “Associations Between Multiple Chronic Conditions and Cancer-Related Fatigue: An Integrative Review” by Fay Wright, MS, RN, APRN-BC; Marilyn J. Hammer, PhD, DC, RN; and Gail D'Eramo Melkus, EdD, C-NP, FAAN. The purpose of this ONF article is to summarize the current state of nursing knowledge related to the association of multiple chronic conditions and cancer-related fatigue in patients with solid tumors during chemotherapy. Check out this timely and informative article today.

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Check out the ONS Connect Blog

The official blog of ONS is written by oncology nurses for oncology nurses on a variety of topics of interest, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses.

This month, you’ll find the following new discussions.

As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Five-Minute In-Service

The latest Five-Minute In-Service explains how the U.S. Survey Reports Oral Chemotherapy Practice and Safety Patterns.

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Ask a Team Member

The latest Ask a Team Member column answers the question What Should Nurses Know About Statistics to Better Understand Reported Oncology Research Results?

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

ONS Searches for New CEO

The search has begun for ONS's next CEO. Learn more about this opportunity and how to apply or nominate a qualified candidate.

 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Membership Information

SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
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  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://ons.org/membership including
    • Educational opportunities for your subspecialty
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Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is

  • Visit the "Find a SIG" page.
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once on your SIG’s main page, click “Join Group,” and log in using your ONS Profile. Don’t have an ONS Profile? Create one today, and then return to your SIG to join.

Subscribe to Your SIG’s Virtual Community Discussion Forum
Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so,

  • Select "Log In," located next to "New User," and enter your information.
  • Next, click on the "Discussion" tab on the top right of the title bar.
  • Locate and select "Subscribe to Discussion"
  • Enter e-mail address.
  • Click "Finish."
  • You are now ready to begin participating in your SIG’s discussion forum.

Participate in Your SIG’s Virtual Community Discussion Forum

  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on "Discussion" from the top title bar.
  • Click on any posted topic to view contents and post responses.

Sign Up to Receive Your SIG’s Virtual Community Announcements
As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.

  • From your SIG’s Virtual Community page, locate the "Sign Up Here to Receive Your SIG’s Announcements" section.
  • Select the "Click Here" feature, which will take you to a link to subscribe.
  • Once the "For Announcement Subscription Only" page appears select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on "Next Page."
  • Click "Finish"
  • You are now subscribed to receive announcements.
 
 
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Cancer Genetics

Special Interest Group Newsletter  June 2014
   

Cancer Genetics SIG Officers

Coordinator (2014-2016)
Catherine Belt, RN, MSN, AOCN®
Hatfield, PA
cathy.belt@uphs.upenn.edu

Ex-Officio (2014-2015)
Jacqueline Hale, RN, APN-C, AOCN®, APNG
Flemington, NJ
Hale.jacqueline@hunterdonhealthcare.org

Editor
Patricia Kelly, DNP, APRN, CNS, AOCN®
Dallas, TX
patriciakelly@texashealth.org

 

Web Administrator
Lisa Aiello, RN, MSN, APN-C, AOCNS®
North Cape May, NJ
lba34@drexel.edu

Special Projects
Julie Eggert, RN, PhD, GNP-C, AOCN®
Greer, SC
jaegger@clemson.edu

ONS Copy Editor
Jessica Moore, BA, BS
Pittsburgh, PA
jmoore@ons.org

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Specialist Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership & Component Relations Department Contact Information

Brian K. Theil, CAE, Director of Membership and Component Relations Department
btheil@ons.org
412-859-6244

Diane Scheuring, MBA, CAE, CMP, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership Specialist—SIGs
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org

 
 
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