May 2006, Volume 33, Number 3

Oncology Nursing Society Position

Quality Cancer Care



The Oncology Nursing Society (ONS) believes that quality cancer care is the right of all individuals. The Society is concerned that fiscal considerations, which have driven the restructuring of the healthcare system, threaten access to quality cancer care. Other significant variables adversely affecting adequate access include a growing population of older adults at increased risk for malignant disease (National Cancer Institute, 2004); a critical shortage of nurses, nursing faculty, and opportunities for qualified nursing school candidates (U.S. Department of Health and Human Services, 2002); an increasing number of uninsured or underinsured individuals (National Center for Health Statistics, 2005); limitations on the selection of and reimbursement for treatment options, including access to supportive care services, clinical trials, and end-of-life care; and increased patient expenses for care along the treatment continuum. Quality care demands these competencies: safety and efficacy, timeliness, a patient-centered approach, coordination by a multidisciplinary team, and the integration of evidence-based practice to continuously improve care (Institute of Medicine, 2003).


As a result of its commitment to remove barriers to the provision of quality cancer care, ONS has joined with other professional societies, patient-advocacy groups, and organizations that hold similar values to ensure that the needs of individuals with cancer, rather than decisions based solely on fiscal considerations, drive the provision of care. To ensure quality care, ONS affirms the substantive role of oncology nursing in decision making and the integration of oncology nursing as an equal administrative and practice partner in the planning and implementation of cancer care services across the illness continuum.


It Is the Position of ONS That Quality Cancer Care Includes


Services Across the Illness Continuum


  • Timely access to and coverage for
    • Prevention, early detection, and risk reduction
    • Risk assessment counseling and cancer predisposition genetic testing, when appropriate
    • Definitive diagnosis and staging
    • A full range of treatment options, including evidence-based complementary therapies and scientifically sound clinical trials
    • Second opinions on testing as well as treatment recommendations when requested by patients
    • Off-label use of all U.S. Food and Drug Administration–approved therapies, biologics, and prescription drugs if they have been recognized for treatment of patients’ specific cancers in established medical or drug reference compendia
    • Comprehensive symptom management and palliation, including physical and psychosocial care, across the care continuum
    • Provision of counseling for patients and families regarding the preparation of living wills and/or advance healthcare directives as well as financial counseling regarding healthcare costs and insurance coverage
    • Provision of information about national and local community resources and referrals, as appropriate
    • Long-term follow-up and rehabilitation for cancer survivors, including health promotion, prompt detection and treatment of recurrence, and evaluation, identification, and treatment of long-term physical and psychosocial effects
    • End-of-life and hospice care, including bereavement counseling.


Professional Oncology Nursing Services


  • A workforce adequate to address the needs of individuals with cancer or those at risk for the disease and their families
  • Professional nurses who are competent in the essentials of oncology nursing care who
    • Have been educated and certified in the specialty of oncology and the administration of oncologic therapies
    • Regularly update their oncology knowledge base and skill sets
    • Develop a practice based on current research and evidence-based outcomes
    • Collaborate with other disciplines to determine priority patient care issues in a respectful and collegial environment
    • Are enhanced and supported by the work of nurse scientists and researchers
    • Identify and incorporate indicators and outcomes of nursing-sensitive patient care
    • Practice in a culture of accountability and safety
  • Culturally competent practitioners who value diversity and are able to respectfully inform patients and families about illness, prognosis, interventions, and outcomes in the context of differing value systems.


Patient Rights


  • Education about cancer risks and lifestyle changes that influence the incidence of cancer in diverse populations
  • A full spectrum of treatment options provided in the most appropriate setting, including the routine care costs for scientifically sound and culturally relevant clinical trials
  • Immediate referrals to oncology specialists, including the authorization of specialists to serve as primary care providers during cancer therapy
  • Information about diagnoses and therapies in a language and at a level that is understood by patients, assistance interpreting information relevant to medical status and treatment, and ample opportunity to ask questions
  • Shared decision making, with active participation by patients, family members, and significant others and/or designees
  • The timely and appropriate management of the physical, psychosocial, cultural, and spiritual needs of individuals with cancer and their families
  • Information and/or counseling for patients and families regarding
    • Confidentiality and privacy regulations
    • The preparation of living wills and/or advance healthcare directives
    • Financial counseling regarding healthcare costs and insurance coverage
    • National and local resources, with referrals to organizations and programs as indicated
  • Care that integrates response to treatment and quality-of-life considerations as legitimate goals or end points of care
  • Assurance of confidentiality and privacy
  • Culturally competent services that facilitate optimal individual and family functioning.




Institute of Medicine. (2003). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.


National Cancer Institute. (2004). Plans and priorities for cancer research: Spotlight on research: The interface of aging and cancer. Retrieved February 2, 2006, from


National Center for Health Statistics. (2005). Health, United States, 2005: With chartbook on trends in the health of Americans. Retrieved February 16, 2006, from


U.S. Department of Health and Human Services. (2002). Projected supply, demand, and shortages of registered nurses: 2000–2020. Retrieved February 2, 2006, from


Approved by the ONS Board of Directors 4/97;revised 7/00, 6/02, 10/05.



To obtain copies of this or any ONS position, contact the Customer Service Center at the ONS National Office at 125 Enterprise Drive, Pittsburgh, PA 15275-1214 (866-257-4ONS; Positions also may be downloaded from the ONS Web site (