Nurse practitioner Ethel Law pursues nursing research as well caring for patients on Memorial Sloan Kettering’s Gastric and Mixed Tumor Service. Here, she discusses her role in the clinic, well as a research study she undertook to improve the quality of life of women who have received pelvic radiation for the treatment of gynecologic or colorectal cancers.
I joined Memorial Sloan Kettering Cancer Center in 1991 directly from nursing school, and began my career caring for neuro-oncology and neurosurgery inpatients. The care of these patients attracted me because it provided me with the experience to build a strong foundation of nursing skills. But more importantly, I felt I could offer a great deal to patients with neurologic problems.
Many such patients have motor or sensory deficits, and helping them overcome these challenges allowed me to begin fulfilling the aspiration that drew me to nursing — to help patients have the best quality of life during and after treatment.
In 1999, I moved to ambulatory care (treatment delivered to outpatients), working first on the Endocrinology Service and later with the Department of Radiation Oncology, where I again worked with neuro-oncology patients who received radiation as part of their treatment. For the next ten years I cared for gastrointestinal cancer patients receiving radiation therapy. Today, I work in the Gastric and Mixed Tumor Service, a surgical oncology service.
Early in my career I knew I wanted to pursue nursing research. I became an active member of Memorial Sloan Kettering’s Ambulatory Nursing Research Council and was also the ambulatory care representative on the institution’s first Evidence-Based Practice Nursing Council.
In 2004, I collaborated on an evidence-based practice project that resulted in the development of a patient-education book for families of Memorial Sloan Kettering patients called A Guide for Caregivers. In 2009, I collaborated on another evidence-based practice project within the Department of Radiation Oncology in which we produced guidelines to manage skin reactions in patients receiving radiation.
It was through my work with women who received pelvic radiation for rectal and anal cancer that I decided to undertake a research study focused on improving patient quality of life. I pursued the research under the auspices of the Nursing Fellowship Program.
Radiation to the pelvic area for the treatment of colorectal or gynecologic cancers can create a number of side effects in female patients, most notably vaginal stenosis, a narrowing and shortening of the vagina. As a result, women may experience pain with intercourse and have difficulty tolerating a pelvic exam, limiting the effectiveness of this critical examination.
To minimize the effects of stenosis, women are often advised to use a vaginal dilator. Historically, adherence to this therapy is low and there has been little follow-up to determine its effectiveness.
My study was focused on evaluating adherence to and the effectiveness of using vaginal dilators to minimize stenosis. We accrued 115 women who had been treated for gynecologic and colorectal cancers at either Memorial Sloan Kettering’s main campus or the regional network sites. This broad sample gave our study a statistically relevant representation of the population. And another wonderful aspect of the study was that it was conducted with a multidisciplinary team approach that included both radiation oncologists and nurses. It was professionally gratifying to bring together this mix of specialists to support the protocol. It made the study even more meaningful, relevant, and thorough.
The study opened in 2009 and we are now performing data analyses. I’m hopeful that the study’s work will shed light on the long-term benefits of vaginal dilator use and will lead to the improvement of patients’ quality of life.
I am committed to continuing to conduct research as I carry on my clinical work. I love caring for and interacting with patients, which has remained my goal since my first day of nursing. And it’s only from this hands-on experience that I can learn about and understand the clinical needs of patients, which will serve as an inspiration for my next research project.
Ethel Law wishes to thank many people for their support and contributions to her study, including Clinical Nurse Specialist Joanne Frankel Kelvin, radiation oncologist Karen Goodman, Senior Research Specialist Bridget Thom, Senior Research Biostatistician Elyn Riedel, Research Study Assistant Ashlyn Tom, Department of Nursing leadership, the Nursing Fellowship Program, and the Geri and ME Fund for nursing at Memorial Sloan Kettering.