Mary Dunn: We’ve Come a Long Way in Treatment for Urologic Cancers

After a period with no new treatments in bladder, kidney, and prostate cancers, there are now opportunities to collaborate among health care providers on choosing the right treatment for the right patient, sequencing drugs, and managing toxicities, said Mary Dunn, MSN, NP-C, OCN, RN, nurse practitioner and adjunct faculty, Department in Urology, University of North Carolina, School of Nursing.

Dunn participated in a session, “Chemotherapy and Immunotherapy for Urologists and Advanced Practice Providers,” where she was joined by Edouard Trabulsi, MD, MBA, professor and chair, Department of Urology, Albert Einstein Medical Center; and Costas Lallas, MD, professor of urology, Thomas Jefferson University Hospital.

During the session, the speakers discussed treatment options in the first line and beyond for hormone-sensitive advanced and metastatic prostate cancer, castrate-resistant metastatic and nonmetastatic prostate cancer, high-risk non–muscle-invasive bladder cancer, locally advanced and metastatic bladder cancer, and locally advanced and metastatic kidney cancer.

They reviewed most recent treatment guidelines and the studies supporting them, and each presenter included timetables of the treatment landscapes in prostate, bladder, and kidney cancer to show how far it has come.

“At one point in time there was these really big gaps where we had no new treatments to offer patients,” Dunn said.

This made it difficult to talk with colleagues about sequencing drugs, picking the best treatment for the right patient, managing toxicities, and the integration of nurse practitioners and physician assistants with physicians “to ensure that patients are getting the most appropriate care depending on what kind of cancer that have and what stage they are.”

She also spoke to the barriers to treatment, which remain a big challenge in her work as a urologic nurse practitioner.

“One of the most frustrating parts about doing this work is that there are seemingly so many barriers sometimes to being able to provide the comprehensive care that we so desperately want to, and that our patients need,” Dunn said.

Time is one barrier simply because health care providers see a lot of patients and with current staffing challenges, there aren’t enough people working to support the care that needs to be provided to patients. In addition, there are barriers with payers and getting medications approved. She discussed the delay in treatment when they have to go through an appeals process.

Finally, she noted that patients may have their own barriers, such as a lack of transportation to get to appointments, financial barriers, or not enough caregiver support at home.

“Cancer care is really, really, really complicated, and there’s always stuff going on behind the scenes with our patients that we don't know,” she said. “Anything, in my opinion, that we can do as their oncology or urology providers to make this part of their story as smooth as we can and smooth out some of those barriers—controlling what we can control on our side—I think is key to making sure they get the care that they need.”