There was something different about Esther Hinds' patient on this particular assignment. It was not just because she had leukemia and was only 18 years old. Nor was it because she was experiencing the side effects of chemotherapy and radiation therapy. In fact, the young woman was struggling with the psychological aspects of losing her hair, experiencing an identity crisis because she did not look like the person she used to be.

What impressed this RN with 13 years of clinical experience was that this sick young woman was such a trooper. Still, that is not why the oncology nurse will always remember her. Esther holds onto the woman's memory because she and coworkers helped plan her wedding.

"The patient's boyfriend was at her bedside the entire time she was in the hospital, and they decided to get married," explains Esther. "Their wedding gave us a chance to really bond with the patient and her family."

Although the young woman lost her battle with leukemia, she typified the spirit of many cancer patients. "They show great stamina and courage in the face of such difficult treatment and pain," Esther clarifies. And it is this virtually unbeatable strength that keeps so many healthcare travelers seeking assignments in oncology.

AN INVASIVE INTRUDER
Few other words strike such emotional a chord as "cancer." Indeed, it carries such a powerful meaning that some cultures do not even have a word for it in their languages - to utter it would be taboo. However, the disease is bound to touch everyone's life to some degree. Why? Throughout the past 11 years, approximately 16 million new cases - ranging from brain cancer to Non-Hodgkin's lymphoma to prostate cancer - have been diagnosed, according to the American Cancer Society's (ACS) report, Cancer Facts & Figures 2002. ACS also estimates another 1,284,900 new cases will be identified in 2002. When the odds of coming in contact with the disease are calculated for the general population, it is clear that nearly every person will be affected by cancer at some point in his or her lifetime…at the very least, indirectly.

As healthcare professionals well know, what makes cancer more intimidating than so many other disorders is its aggressive nature. Just how pervasive is it really? The Centers for Disease Control and Prevention (CDC) ranks cancer as the second leading cause of death in the United States for 2000, and ACS reports that 555,500 people are expected to die from it this year. That corresponds to 1,500 people per day - or one out of every four fatalities.

POSITIVE PROGRESS
Fortunately, not every cancer case automatically results in a negative outcome. "Cancer is not the death sentence it used to be," remarks Esther, a traveler with Fastaff. "There has been a tremendous amount of research done and scientists are coming up with new modalities all the time."

Indeed, survival rates for numerous types of cancer have risen significantly during the past 30-plus years. For example, the National Cancer Institute (NCI) reports that, in 1997, nearly nine million Americans with a personal history of cancer were alive. Some of those people were considered to be cured, in remission, or undergoing treatment at the time the data was gathered. These figures are far more encouraging than those recorded just 15 years earlier. Most experts point to enhanced technology, advanced pharmacology, and better public health education - including early diagnoses - for the improved outcomes.

Yet, caring for cancer patients is a costly endeavor. The ACS estimates more than $56 billion was spent in 2001 on direct healthcare. Much of the expenses are the result of inpatient hospital stays. According to the CDC, there were more than one million hospital discharges for cancer patients in 2000, averaging 6.7 days per stay. That is notably longer than the national average of 4.9 days per hospital visit.

SHIFTING DEMOGRAPHICS
Despite the progress made in cancer care, overall patient demographics are expected to dramatically change during the next 10 to 15 years as Baby Boomers enter their golden age. It is estimated that nearly 80 million people belong to this generation, and as they get older, a barrage of demands will likely be put on the healthcare system. After all, when people age, they tend to suffer from more illnesses or ailments and, therefore, require additional attention from healthcare providers. And cancer is no exception.

According to ACS, people between the ages of 60 and 79 run the highest risk of developing an invasive form of the illness. In fact, men face a 32.3 percent - or one in three chance - of being diagnosed with the disease. Women fare only slightly better at 20 percent. When the research is broken down into specific diagnoses, men and women in this age group are the most likely to contract lung and bronchus cancer…even more than breast or prostate cancer. When all these factors are taken into consideration, it is no wonder that healthcare analysts declare oncology a high-growth specialty, especially for nurses.

CAREER GROWTH
In 1974, fewer than 75 RNs attended a nursing session at the ACS/NCI Conference on Advances in Cancer Management. That is not to say there were no other nurses specializing in oncology, but prior to that date, the profession lacked an organized voice. Now, nearly 30 years later, the Oncology Nursing Society (ONS) boasts a membership of more than 30,000 registered nurses and other healthcare professionals practicing in this specialty.

As with the rest of the nursing profession, there are not enough qualified clinicians to fill the anticipated demand. Even now, facilities are experiencing a staffing dilemma. A good indicator is the expanding presence of traveling oncology providers. While the greatest demand for mobile practitioners continues to lie in emergency, critical care, and medical/surgical units, oncology's needs are gaining momentum.

"From the hospital's perspective, travelers are a positive, cost-effective solution to the staffing crisis," notes Phyllis Brackin, director of recruiting for Teamstaff Rx, based in Clearwater, Florida. "Administrators can increase their staff when the patient census is up, while not investing in full benefits." She adds that the greatest needs for oncology nurses are in the Southern states during the winter - when the overall population grows with the influx of "snowbirds" - as well as in small, rural hospitals throughout the country. "The rural hospitals hire travelers because their needs are more critical. In larger, more metropolitan areas, facilities often recruit from each other, but rural institutions do not always have nearby organizations as alternatives for local recruitment."

Interestingly, travel opportunities for oncology specialists are not limited to acute care hospitals. Many patients also have the option of seeking care at private cancer centers, which may specialize in specific forms of the disease. Between the two facility types and the predicted onslaught of new cancer cases, opportunities for traveling oncology nurses will continue to rise.

"I think supplemental staff will become more of a necessity as the population ages," says Nancy Widener, vice president of Travel Nurse Network in Ft. Lauderdale, Florida. "As the Baby Boomers get older, there will be an increased need for oncology nurses. In fact, demand could even mirror that for ICU professionals."

Recruiters also note a growing interest in traveling from nurses specializing in oncology. Ms. Widener adds, "This career alternative is becoming more attractive to permanent staff because of the compensation and other benefits it offers."

EXPANDING FIELD
Nurses are not the only healthcare providers involved in caring for cancer patients, nor are they the only mobile practitioners. Whenever a physician prescribes chemotherapy or radiation therapy, radiation therapists and medical physicists are brought into the picture. While smaller in number - there were 167,000 jobs held by radiologic technologists and technicians in 2000, according to the U.S. Bureau of Labor Statistics, and 4,500 members in the American Association of Physicists in Medicine - this team has become crucial to the treatment of many types of cancer. Additionally, more and more physicians are relying on imaging technology or radiation therapy to help determine a definitive diagnosis.

Like nursing, though, there is a shrinking pool of qualified personnel to fill these positions. In fact, radiation therapy is following the same road in terms of having a population that is primarily older and nearing retirement - without sufficient numbers of new entrants into the discipline.

Several years ago, hospitals made a concerted effort to educate young people about the need and opportunities available in radiation therapy. It worked, and that particular staffing crisis was very short-lived. "Now," says Ms. Brackin, "those therapists are approaching retirement age, which will leave a void." Adds Laura Garrabrant, a recruiter for Teamstaff Rx, "We foresee as much as 25 percent of the workforce retiring in the next few years."

At the same time, the concept of traveling has become more popular with radiation therapy professionals. "Compared to four years ago," states Ms. Garrabrant, "we have had more than triple the number of radiation therapy travelers sign up with us - and that's only been within the past 24 months."

STAYING FOCUSED
While Esther admires the positive attitude of so many of her patients, the intense nature of oncology - including the heightened possibility of losing patients - makes the specialty particularly susceptible to professional burnout. Fortunately, through traveling, clinicians have the opportunity to begin anew with each assignment.

"Any time you work in a new environment, you feel revived," comments Esther, who has been traveling for three years. "Moving from one area of the country to another is a novel experience, and it feels like a fresh start with each contract."

Of course, travelers aren't immune to burnout. The lifestyle, however, does empower them to cope with it in an assertive manner. In addition to changing work settings every few months, mobile clinicians have the option of taking time off between assignments. Sometimes, that is all that is needed to rejuvenate body and soul. Others may choose to alternate between specialties. Radiation therapists, for example, are often cross-trained in other radiologic specialties, such as x-ray, CT scans, and MRIs, so they can change assignment rotations.

"You have to anticipate burnout and learn to recognize your own signs and symptoms," Esther advises. "When you begin to experience those, you should do something else for a while, either change specialties, work in a different type or size of facility, or take time off." While she has accepted an occasional med/surg placement, Esther admits, "But, I always come back to oncology."

THE IMPORTANCE OF EXPERIENCE
It is always essential that practitioners have enough clinical experience before setting off on a travel career, but when it comes to oncology, it becomes even more crucial. For nurses, Ms. Widener says being certified in chemotherapy is required as well as having at least two years experience in the specialty. She explains, "A lot of the responsibilities associated with this specialty can only be performed by oncology nurses."

"Keep up to date on your treatment formulas and certifications," adds Esther. "Also, consider taking your own references on the road. A hospital may use a different set of resources than those to which you are accustomed. I've found that having familiar references at my fingertips allows me to easily look something up, saving valuable time."

Ms. Brackin and Ms. Garrabrant say that radiation therapists, dosimetrists, and physicists should bring with them a broad resume, both in terms of procedures and equipment. "Facility administrators have an expectation of skills when it comes to traveling professionals," Ms. Brackin explains. "These providers need to cope with the work demand and pace, despite the fact that equipment and procedures may differ from what they have experienced thus far in their careers. There are so many new state-of-the-art procedures today, travelers' skills must match the levels practiced at their contract facilities." Adds Ms. Garrabrant, "They should be familiar with the latest equipment as well as understand how to work with older machines. The more versatility travelers have in these areas, the more desirable candidates they become."

MAKING THE MOST OF THE EXPERIENCE
Once on the road, mobile practitioners are exposed to countless learning opportunities that further their professional development. Because they are on assignment for a limited period of time, supplemental staff members are able to stay clear of hospital politics and the inner workings of how the organization is run. Rather, they can concentrate on delivering high-quality patient care and observing and absorbing new procedures and approaches.

"Traveling broadens your horizons by putting you in different situations," says Ms. Garrabrant. Additionally, learning to adapt to new coworkers aids travelers in fine-tuning their interpersonal and communication skills, which are essential to both contract and permanent employees.

Those professional experiences, on top of the opportunities to meet and care for some extraordinary people, are what first - and still - attracted Esther to a mobile career. "You are there for the patients," she notes, "and because of that, you are able to enjoy the nursing experience. Traveling as an oncology nurse keeps me fresh."

References
American Association of Physicists in Medicine. (n.d.). AAPM Online fact sheet. Retrieved September 12, 2002, from www.aapm.org/org/aapm_fact_sheet.html

American Cancer Society. (2002). Cancer facts & figures 2002. Retrieved September 12, 2002, from www.cancer.org/eprise/main/docroot/stt/stt_0

Centers for Disease Control and Prevention, Media Relations. (2002, September 12). HHS issues report showing dramatic improvements in Americans' health over past 50 years; Infant mortality at record low, life expectancy at record high [press release]. Retrieved September 12, 2002, from www.cdc.gov/od/oc/media/pressrel/r020912.htm

Centers for Disease Control and Prevention, National Center for Health Statistics. (2002, September 11). Cancer, fast stats. Retrieved September 12, 2002, from www.cdc.gov/nchs/fastats/cancer.htm

Oncology Nursing Society. (n.d.). What is ONS? Retrieved September 12, 2002, from www.ons.org/xp6/ONS/Information.xml/About_ONS.xml/
Mission_Statement_and_Vision.xml/What_Is_ONS.xml

U.S. Bureau of Labor Statistics. (n.d.). Radiologic technologists and technicians. Occupational outlook handbook. Retrieved September 12, 2002, from http://stats.bls.gov/oco/ocos105.htm

Wessling, S. (n.d.). Closing the cancer gap. Minority Nurse online. Retrieved September 12, 2002, from www.minoritynurse.com/features/nurse_emp/01-27-02d.html

For more information, contact the American Cancer Society at 800-ACS-2345 (www.cancer.org) and the National Cancer Institute at 800-4-CANCER (www.nci.nih.gov).