Support for head and neck cancer patients

Ask any surgeon — or surgical patient — and they'll tell you that every surgery is unique and requires specialized care. But there are some complex surgical procedures that require a certain skill set to help get patients back on their feet again, especially surgeries performed around the head and neck.

That's why Sharp Memorial Hospital recently added nurse practitioner Cliff Felarca, FNP, to its specialized oncology team — the first nurse practitioner in oncology at a Sharp hospital.

In his unique role, Felarca meets with patients before they have surgery to remove tumors from the head, throat, thyroid or larynx. He sees patients again after surgery and is involved in their care every step of the way until they return home.

"I'm here to provide assistance and answer any questions about the surgery or about their care," he says. "After their surgery, I can order or change medications to better relieve pain or side effects, and order physical, occupational or speech therapy to make their hospital stay as comfortable as possible, with a goal of helping them recover faster."

Felarca also provides another set of eyes for the doctors, attuned to the needs of this special population of patients, such as assessment of cranial nerves, speech and suture sites. He says this is especially important for critically ill patients who need specialized monitoring throughout the day. For example, if Felarca notices critical red flags such as swelling, he can immediately order steroids to reduce swelling for appropriate patients.

By working side-by-side with doctors, he says he's able to anticipate how each would care for a certain kind of patient and provide this feedback to the others, allowing them to work better as a team. Felarca also provides daily reports about hospitalized patients to the head and neck nurse navigator and oncology dietitian at the hospital's Outpatient Pavilion, making for an easier transition when patients leave the hospital and begin receiving outpatient care.

"Cliff has been a great addition to our program," says Christy Wenger, oncology service line director. "He is detail-oriented and, in a short time frame, has developed a trusting rapport with the surgeons and the patients."

According to Felarca, one of his most important roles is getting the patient well enough to go home. "I'll round with the doctor in the morning. As the doctor talks about the surgery and some aspects of the release to home with the patient, I will listen in and be part of their conversation. I put in the orders and document exactly what the doctor said. Once the doctor leaves, I'm there to reinforce exactly what the patient needs to do before released and provide education about how they can care for themselves, once home," he says.

Another important aspect in preparing patients for going home is working with case managers and providing orders for any special medical equipment such as nebulizers or suctioning devices.

Felarca says the feedback he's received from patients and caregivers has been positive.

"Patients tell me they enjoy the time I spend with them," he says. "They know the doctors are sometimes busy, so after the doctor visits with them, they appreciate the overview of their care I provide, and my time."

As a native San Diegan who recently moved back from Los Angeles, Felarca says he's thrilled to finally be home.

"To me, it all comes full circle," he says. "Being here and being able to help patients at Sharp is exactly what I wanted to do. Spending time with patients and really helping them — I feel I've made a difference in someone's life. It's extremely rewarding."