Oncology Central

The bone marrow transplant clinical nurse specialist in hemato-oncology: an interview with Susan Paskar


Susan Paskar speaks to Sebastian Dennis-Beron, Commissioning Editor: Susan qualified in 1997 as a registered nurse and has 20 years of experience, in a range of specialties including hematology, medical and surgical oncology, general surgery, bariatric, breast, endocrine, head & neck, liver, urology and bone marrow/stem cell transplant. Working in both the UK and the USA, in regional transplant centers since 2002, she is considered expert in care of the bone marrow transplant patient from point of referral to long term follow-up care and palliation. She has been responsible for development and implementation of a Nurse-led late-effects post-bone marrow transplant service at the Freeman Hospital in Newcastle upon Tyne, as their Anthony Nolan Nurse Specialist.

1. Could you please provide a brief summary of your career to date? Did you always want to become a clinical nurse specialist?

I qualified as a nurse in 1997 from Leeds University (Leeds, UK), and worked on a general surgical ward in St James’ Hospital (Leeds, UK). Interestingly, as a student nurse I was lucky enough to travel to California (USA) for 3 weeks with a small group to have a taste of work experience in the USA healthcare system. This visit led me to explore the possibility of future travel and working in the USA. I worked initially on a Hematology/Oncology unit near Los Angeles (CA, USA), and later in Cedars Sinai Medical Center (Los Angeles, USA) on the Hematology/Oncology/Bone Marrow Transplant (BMT) Unit, where I had clinical experience of giving chemotherapy and looking after complex BMT patients. I gained qualifications as a chemotherapy provider, became an ‘Oncology Certified Nurse’, and completed my BSc in Nursing through the Royal College of Nursing and University of Manchester distance learning program.

Later, as I then had substantial BMT experience I was offered the opportunity to work as an Allogeneic Transplant Coordinator at City of Hope hospital in Duarte (CA, USA), which as well as developing my organizational skills, needed expert patient and family education. This was generally a fantastic environment to work in, with an inspirational team and world class care for the patients’ it serves.

I spent over 11 years in California, before I made the decision to re-locate back to the UK. I applied for a BMT Clinical Nurse Specialist (CNS) post at the Freeman Hospital in Newcastle upon Tyne (Newcastle, UK), which was essentially an Allogeneic Transplant Coordinator role but also included looking after post-transplant patients. In 2014, the charity Anthony Nolan [1] offered our Trust funding to develop a post-transplant late effects service, so an Anthony Nolan BMT Nurse Specialist post was created, which I applied for and was able to start our nurse-led long-term BMT follow-up clinic. My career path leading to being a CNS was just a natural progression from the clinical experience gained over the years in each department I have worked in.2.

2. How have you seen the management of hematologic malignancies develop over your career?

It is almost hard to believe I will have been a qualified nurse for 20 years this year, but that means I have seen changes to how treatment of blood cancers is approached.

Targeted therapies, such as those used to treat chronic myeloid leukemia, allow many patients to achieve a durable remission from their disease, which means a transplant is no longer needed for the majority of patients. Immunotherapy and monitoring for disease at a molecular level are further examples of how blood cancers are being managed. DNA testing has been used to develop supportive drugs, (such as growth factors), and is essential to monitor engraftment after transplantation, to detect early relapse in these patients, or guide practitioners to manipulate the transplant to promote long term remission.

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