Dee Emon, RN, MSM, NE-BC. Dee Emon, RN, MSM, NE-BCAdvancements in genomics are rapidly changing the cancer treatment landscape. The increasingly widespread availability of genetic testing is exciting—on many levels—but it also presents new challenges to health care providers. We will no longer treat patients simply based on the type of cancer they are diagnosed with, or rely solely on historically published treatment guidelines for direction. Now that we have the technology to assess individual tumors at the molecular level and match treatments accordingly, patients will need (and come to expect) more tailored treatments. As we move forward into the new and unfamiliar territories of genomics, it is critical that we are aware of the challenges and be armed with as much information as possible to ensure continued quality and safe care for cancer patients.FigureRisks and Challenges Genomic testing is opening our eyes to the fact that where a cancer starts—breast, lung, skin, etc.—does not necessarily tell us how the cancer may act or respond to treatment. We need to consider a wider range of treatment options (including those we may not have used in the past), and we need to stay highly informed about the new treatments coming to market. While this new frontier ultimately means better care for patients, it presents challenges as we work to adapt. Three major areas of risk for oncology nurses to focus on include: 1. Unintended errors: When evidence-based guidelines are not available there is the potential for uncertainty, which could lead to unintended errors; 2 .Lack of research: Traditionally, in the event that evidence did not exist or was severely limited, a systematic research study would be warranted. Individual treatment based on genomic profiling, however, may not be conducive to conducting research that could provide the necessary evidence on which to base nursing practice(s); and 3. Varying treatment protocols: Without evidence to support and mitigate the treatment risks, each patient undergoing a genomic-based treatment may need to be treated at the acuity level as though on an early-phase trial. To manage these risks, it is important that oncology nurses recognize the need to evolve preexisting, traditional plans. Best Practices for Safe Patient Management Improved internal communication among each patient's coordinated care team will be key to ensuring safe, quality care. It will become increasingly important that nurses have a thorough understanding of the rationale used to determine individual treatment plans based on the genomic profile, which will help decrease uncertainty and reduce unintended errors. In my practice, I encourage and facilitate the following protocols: Well-documented treatment plans: All plans must include the thought process and rationale for treatment of each individual patient; Thorough hand-off communication: The hand-off or transferring of patient information and responsibility of care must be performed as meticulously as possible to ensure patient safety and satisfaction; Detailed patient records: It is crucial that all treatment responses and physical findings are carefully noted in each patient record to start developing a data repository from which future evidence and guidelines may be developed; and Relentlessly seeking clarification from the treating physician: During times of uncertainty, nurses must be encouraged and empowered to ask questions in order to advocate for the highest possible quality of care for their patient. Uncertainty is not an option when considering the safe management of cancer patients and their families. Staying Informed It is also critical to stay informed about the latest developments in genomic testing. The American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards are widely recognized as the foundation in ensuring patient safety and should still be viewed as the gold standard as we move into the era of genomic testing and treatment. Oncology nurses have a duty to understand these safety principles and integrate them into their professional practice, and should look to these and other organizations as resources for additional information: American Society of Clinical Oncology (asco.org); Oncology Nursing Society (ons.org); National Comprehensive Cancer Network (nccn.org); and Center for Medical Technology Policy (cmtpnet.org). Nursing leaders need to take a proactive approach in ensuring the safe care of each patient in this new environment. Appropriate staffing levels need to be established and re-evaluated frequently. Additional education and training will need to be provided and competency requirements will need to be set for nurses to feel confident at the point of care—all of which will be a challenge considering the tightening of resources in the health care landscape. Advancements in genomics make this an incredibly exciting time to be an oncology nurse. We are making medical history that will benefit our current and future cancer patients. As medicine evolves, we must continue asking questions, trading answers, and holding each other accountable for the quality care and safe management of every patient we treat.