In the era of precision oncology, nurses and advanced practice providers (APPs) play expanded roles beyond administering chemotherapy and managing adverse effects. Genetics and genomics now shape cancer detection, prevention, screening and treatment, and genomic testing is routinely used to identify inherited risks and match patients with targeted therapies.
Samantha Shenoy, MSN, NP, an oncology nurse practitioner in multiple myeloma research at UCSF Health, said advances in precision medicine have changed how nurses and APPs support patients and personalize care. “It’s important for nurse practitioners and other APPs to be educated about the types of things that we test for, to understand what genetic abnormalities mean and what their significance is, and to understand how different drugs might target a specific genetic abnormality,” she said.
Nurses are often first to educate, counsel and support patients through complex decisions. Shenoy noted they need to explain the purpose of genetic testing and interpret results so patients can make informed choices. Patients’ understanding of genetic testing varies, and clear explanation of how results may influence treatment helps patients grasp why certain drugs are likely to be effective for their cancer.
Precision therapies, including targeted agents and immunotherapies, are often less toxic than traditional chemotherapy but carry unique and potentially serious adverse effects. These AEs can be delayed, long-lasting or immune-related, making early recognition, patient education and close monitoring essential—especially as many targeted therapies are oral and taken at home. Nurses play a key role in recognizing early warning signs, ensuring timely prophylaxis and advising patients on when to seek urgent care.
One clinical example is rituximab, which depletes B cells and increases infection risk. Patients should be screened for hepatitis B before treatment, started on antiviral prophylaxis if indicated, and monitored for viral reactivation and other infections during and after therapy. Nurses should verify vaccination status, review laboratory values and report signs of fever, cough or rash immediately.
Ashley Martinez, DNP, APRN, director of advanced practice at MD Anderson Cancer Center, said newer precision therapies target specific cancer cell pathways, reducing many severe AEs and improving quality of life during treatment. She stressed that nurses frequently field patient questions about what precision care involves and whether it is appropriate for them. “When nurses are equipped with their own knowledge, they can then transfer that knowledge to patients, serving as patient educators and patient advocates,” Martinez said.
Tumor biomarkers—measurable molecules such as proteins or genes—indicate the presence of cancer or how a tumor is responding to treatment. Nurses can help ensure appropriate biomarker testing is ordered and identify gaps in care by reviewing pathology, genetic and genomic reports. For breast cancer, this typically includes estrogen receptor, progesterone receptor and HER2 status, with additional tests such as PD-1/PD-L1, ESR1 mutation or PIK3CA depending on the tumor profile.
Martinez emphasized the importance of explaining the difference between genetic and genomic testing. Genetic testing identifies inherited mutations that affect a patient and potentially family members, while genomic testing analyzes tumor DNA to identify mutations driving cancer growth and guiding targeted therapy.
Julie C. Martin, DNP, director of research for the Prisma Health Cancer Institute, noted that precision medicine has expanded treatment options and improved outcomes when therapies target actionable tumor variants. Most major cancer centers follow guidelines recommending molecular profiling early in diagnosis or treatment planning for many tumor types, particularly breast, lung, colorectal and hematologic cancers.
Precision oncology has also broadened the use of pharmacogenomics—from assessing drug metabolism to predicting responses to chemotherapy, immunotherapy and targeted agents. Pharmacogenomic markers can inform dose optimization to minimize adverse effects while preserving efficacy. For example, TPMT and NUDT15 gene testing can guide dosing of mercaptopurine or azathioprine in myeloid leukemias.
To stay current, Shenoy urged nurses to expand their knowledge of genetics, genomics and emerging targeted therapies and to engage in ongoing discussions with colleagues. Martin called for more standardized and consistent use of genetic and genomic testing across institutions. She pointed to data showing low rates of early germline testing and said improving testing uptake is crucial, as positive results can guide additional screening and allow family members to receive preventive care.
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