The Role and Scope of Prehabilitation in Cancer Care

ObjectivesTo recognize cancer prehabilitation as a pretreatment regimen to increase functional status for patients requiring cancer treatment. This article presents current evidence addressing the efficacy and benefits of prehabilitation regimens in different cancer survivor populations.Data SourcesStudies and case reports in the PubMed database.ConclusionCancer prehabilitation may improve outcomes. Prehabilitation may include targeted or whole-body exercise, nutrition, education, psychologic counseling, and smoking cessation. Opportunities exist to further improve access to and delivery of multimodal prehabilitation, and nurses play a critical role in connecting patients to these services.Implications for Nursing PracticeOncology nurses who are knowledgeable of cancer treatment-related effects are poised to assess survivors for existing impairments, advocate for prehabilitation for existing and potential morbidities, and monitor functional status over time. As patient educators, they are key to informing cancer survivors about the role of prehabilitation.     

Prostate Cancer Prehabilitation and the Importance of Multimodal Interventions for Person-centred Care and Recovery

BackgroundProstate cancer is the second most commonly diagnosed cancer globally. Cancer prehabilitation is defined as a process on the continuum of care that occurs between the time of a cancer diagnosis and the beginning of acute treatment. This article will discuss the importance of prostate cancer prehabilitation interventions in optimising physical and psychological recovery to enhance person-centred care.Data SourcesElectronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, professional websites, and grey literature were searched using Google Scholar.ConclusionPrehabilitation in cancer care aims to enhance perioperative care and recovery. An emerging field of research suggests that the preoperative period may be physically and psychologically salient to introduce modifiable self-management behaviours to optimise overall recovery.Implications for Nursing PracticeProstate cancer specialist nurses provide the hub of person-centred care across the entire cancer care continuum embedded within the multidisciplinary team. Individually tailored interventions such as exercise and pelvic floor muscle training programmes, nutritional advice, anxiety and depression reduction, and sexual well-being interventions should be considered in the prehabilitation phase of the cancer care continuum.     

Is There a Role for Palliative Services and Supportive Care in Managing Advanced Penile Cancer?

ObjectivesWe aim to review the benefits of palliative care, describe why a palliative approach to care is needed for patients with advanced penile squamous cell carcinoma and propose ways in which oncology nurses can improve access to and provision of palliative care.Data SourcesA review of the literature was performed and identified a range of randomized trials and systematic reviews regarding the benefits of palliative care in this patient group. Cohort studies of patients with penile cancer were used to describe the psychosocial and physical disease burden of penile cancer.ConclusionThroughout each phase of penile cancer and its treatment, oncology nurses can engage in care that goes beyond cancer-directed treatments to address the whole person, thereby improving quality of life by delivering person-centered palliative care in line with individual needs.Implications for Nursing PracticeOncology nurses are in key positions to explore many concerns that patients with penile cancer have for themselves or their caregivers. Through speaking directly with patients and caregivers, oncology nurses can uncover sources of distress, assess for unmet needs, and advocate for improved primary palliative care or early referral to specialty palliative care teams.     

Prehabilitation as Novel Paradigm Shift in Cancer Care

ObjectivesPrehabilitation aims to optimize patients’ preoperative risk factors while waiting for surgery. The preoperative period is a salient time to modify health behaviors with the aim to mitigate the stress of surgery and facilitate the recovery process.Data SourcesThis is a narrative review of scientific evidence and published reports on aspects of prehabilitation for patients with cancer.ConclusionWhile the prehabilitation team identifies the health issues ahead of the surgical date, patients become engaged in improving their health. This demands a shift in how the perioperative care is organized, taking into consideration the active role of the patient and the multidisciplinary team approach.Implications for Nursing PracticeWhile the patient with cancer is at the center of the perioperative care, the prehabilitation multidisciplinary team, which includes the perioperative physician, the physiotherapist/kinesiologist/exercise physiologist, the dietician, the psychologist, and the specialist nurse, works together with the surgeon and the oncologist to screen, assess, and plan a personalized intervention. In this context, the specialist nurse can collaborate with the team in identifying those patients at risk who might benefit from the prehabilitation program (eg, frail, older, malnourished, smoker, with many comorbidities) . The specialist nurse will be able to coordinate the time of visits, liaise with the caregivers, identify barriers, and participate in decision-making activities.     

Prehabilitation. An Interdisciplinary Patient-Centric Conceptual Framework

ObjectivesTo review the recent literature around patient-centric prehabilitation in oncology patients and propose a conceptual framework to inform development of interdisciplinary prehabilitation services leading to focused, individualized prehabilitation interventions.Data SourcesA review of recent peer-reviewed literature, national guidance, and government strategy on prehabilitation in oncology patients.ConclusionPatient- centric prehabilitation is key to improving patient's experiences of cancer throughout the cancer journey while improving population health and reducing financial costs. Successful personalized prehabilitation interventions are comprised of an interplay between individual interdisciplinary roles, as illustrated in the conceptual framework. The role of the nurse underpins this whole process in patient screening, assessment, implementation of the intervention, and patient reassessment, ensuring care is dynamic and tailored to patient need.Implications for Nursing PracticeThe review has discussed the key role that nurses play in the process but warrants more research in the area. The conceptual framework provides a basis to develop interdisciplinary prehabilitation services underpinned by the nurse's role. The review advocates the use of educational interventions to equip all health professionals with prehabilitation knowledge to enable interdisciplinary prehabilitation services to be developed.     

Supporting People and Their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program

ObjectivesTo discuss the unmet needs of patients living with advanced cancer and their caregivers and to review strategies, including collaborating with community and non-profit organizations, to help improve the experience of living with, and beyond, advanced cancer.Data SourcesPublished articles, first person experience (SB), community organization input, and survey data (Canadian Cancer Society).ConclusionPeople living with advanced cancer face significant challenges, including persistent physical symptoms and psychosocial concerns, difficulties with coordination of care, and possible lack of available resources and supports if the person is no longer being followed by cancer health care professionals. More research is required to better understand the needs of patients and their caregivers living with advanced cancer. Existing resources and supports may be inadequate for this population, and delineation of the unique needs of this population may lead to tailored care plans and, ultimately, an improved experience for patients and caregivers alike.Implications for Nursing PracticeOncology nurses are ideally suited to care for this population to help elucidate their unique unmet needs and collaborate with patients and other clinicians to develop interventions to address such unmet needs. Oncology nurses can liaise with community organizations to identify sources of support and resources for patients and their loved ones and advocate for improved care for patients affected by advanced cancer.     

The Effects of Multimodal Prehabilitation Interventions in Men Affected by Prostate Cancer on Physical,Clinical and Patient Reported Outcome Measures: A Systematic Review

ObjectivesTo synthesize existing evidence on the effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical, and patient-reported outcome measures.Data SourcesA systematic review was conducted according to the PRISMA 2020 Statement Guidelines. Electronic databases (ie, Medline, Embase, CINAHL and Cochrane CENTRAL, and clinicaltrials.gov) were searched using key search terms. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. The findings were integrated in a narrative synthesis.ConclusionOf the 5863 publications screened, 118 articles were assessed in full text and 17 studies met the prescreening eligibility criteria. There were a range of study designs that included randomized controlled clinical trials (n = 11), quasi experimental (n = 4), cohort (n = 1), and case series (n = 1), covering a total of 1739 participants. The prehabilitation interventions included physical activity, peer support, pelvic floor muscle training, diet, nurse-led prehabilitation, psychological, and prehabilitation administration of phosphodiesterase-5 inhibitors.Implications for Nursing PracticeSignificant heterogeneity existed in the prehabilitation intervention programs for men affected by prostate cancer in terms of the composition, duration, method of administration, and the outcomes measured to quantify their impact. This systematic review has identified that multimodal prehabilitation interventions are an emerging area for practice and research among men affected by prostate cancer. Importantly, there has been a lack of focus on the inclusion of partners as critical companions during this distressing phase of the cancer care continuum. For the moment, all members of the multidisciplinary team caring for people affected by prostate cancer are encouraged to use the findings in this review to inform holistic models of care.     

The Potential of Prehabilitation in Radical Cystectomy Pathways: Where Are We Now?

ObjectiveThe growing recognition of prehabilitation has caused an emerging paradigm shift in surgical cancer care and an integrated component of the cancer care continuum. This narrative review aims to update and inform the urological community of the potential of prehabilitation before radical cystectomy.Data SourcesA nonsystematic narrative review was performed through a database search in PubMed, and CINAHL using the following search terms: enhanced recovery after surgery (ERAS); Frailty; Prehabilitation and/or Rehabilitation; Physical Activity and/or exercises; Nutrition; Nutritional Care; Smoking cessation; Alcohol cessation; Prevention; Supportive Care; and combined with Radical Cystectomy.ConclusionA multimodal and multi-professional approach during the preoperative period may offer an opportunity to preserve or enhance physiological integrity and optimize surgical recovery. Studies indicate a positive effect of prehabilitation on postoperative functional capacity and earlier return to daily activities and health related quality of life. Meaningful outcomes that reflect recovery from a patient's perspective and clinical outcome measures, as well as validating metrics, are necessary to establish whether prehabilitation diminish the risk of developing long-term disability in high-risk patients.Implications for Nursing PracticeUro-oncology nurses are at the forefront in every ERAS program and vital in screening patients ahead of surgery for common risk factors, current impairments, and limitations that can compromise baseline functional capacity. The growing movement to standardize clinical implementation of prehabilitation, indicate there is a clear need for further investigation, optimization of a multimodal approach and an open discussion between health care providers from different areas of expertise who might best support and promote these initiatives.     

A review on adherence management in patients on oral cancer therapies

PurposeThere is currently an ongoing paradigm shift in cancer treatment from intravenous (IV) chemotherapeutics to oral therapies. Additionally, the increased use of long-term maintenance therapy with oral targeted agents or chemotherapy is contributing to a shift toward a chronic-disease model. This shift is creating challenges and responsibilities for health care professionals in patient adherence management. This article will inform health care professionals of current trends and describe ways that they can overcome common barriers to adherence. A comprehensive review of recommendations and evidence derived from oncological studies describing adherence to oral targeted therapies and maintenance chemotherapy will provide guidance for the use of emerging oral maintenance therapies.MethodsArticles in the scientific literature were reviewed if published between January 1985 and November 2010. Searches were conducted using the PubMed database—search terms included “oral therapy,” “chemotherapy,” “cancer,” and “adherence” or “compliance.”ResultsThe change from IV therapy administered and monitored in hospitals or clinics to self-administered outpatient oral treatments decreases the likelihood of adherence. Methods, such as patient education and monitoring and involvement of family or caretakers, can improve adherence in patients undergoing treatment.ConclusionsAt treatment onset, oncology nurses can engage patients directly in a collaborative dialogue, and when issues affecting adherence arise, oncology nurses may limit nonadherence by providing individually tailored educational material. A practical approach to patient education, along with building strong health care provider–patient relationships, can help patients overcome nonadherence to new oral anticancer therapies and treatment paradigms.     

The Association of Quality of Life and Survival in Cancer Patients

Abstract

The incorporation of 'targeted therapies' into standard cancer care has changed how clinicians treat cancer. Small molecule inhibitors, antibodies, and conjugated agents target cancer cells more specifically than traditional chemotherapy. These therapies can be used alone or in combination with chemotherapy in first-line, refractory, or relapsed settings. Although designed to spare normal tissue, these agents do have systemic toxicity. Notably, their toxicity profiles are distinct from those encountered with chemotherapy. These agents have demonstrated efficacy in terms of improved tumour response, survival, symptom control, and/or quality of life. Cancer treatment will continue to change as additional targeted agents are evaluated in clinical trials and are brought into standard medical care. The palliative care clinician is likely to encounter these agents with increasing frequency, making decisions to continue or discontinue therapy, adding targeted agents to improve symptoms, performance status, or quality of life, or advising patients to return to their oncologists for further advice as new agents become available. Presented here, Part 1 of this review focuses on small molecules. All but one of these agents are oral, and they are all relatively well tolerated. In the future, Part 2 will introduce antibodies and conjugated agents.     

Optimizing Cancer Rehabilitation through Activity-focused Approaches

ObjectivesThis article discusses the effects of cancer on broader domains of health; the evidence and application of activity-focused rehabilitation approaches in rehabilitation populations; and the role of nurses in the promotion of activity-focused rehabilitation.Data SourcesNarrative review of rehabilitation literature.ConclusionCancer impacts activity engagement, community participation, and quality of life. Optimal cancer rehabilitation may lie in adoption and implementation of activity-focused rehabilitation approaches. Recent research suggests that this approach may improve impairments and activity engagement outcomes.Implications for Nursing PracticeNurses are critical for screening for activity limitations and participation restrictions and early referral to rehabilitation treatment. Nurses can also educate survivors on the importance of meta-cognitive and self-management strategies to promote engagement in meaningful activities to reduce long-term disability.     

Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care

ObjectivesTo provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families.Data SourcesResearch and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used.ConclusionMany challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health.Implications for Nursing PracticePediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.     

Spiritual Care for Individuals with Cancer: The Importance of Life Review as a Tool for Promoting Spiritual Well-Being

ObjectiveTo discuss spirituality in the context of cancer, focusing on the use of life review as a tool to help promote spiritual well-being among individuals with cancer.Data SourcesLiterature regarding spirituality and life review of the author in cancer care provided the foundation for this article.ConclusionReliance on spirituality as an untapped supportive resource may surprise patients and their families when dealing with a diagnosis of cancer. Coming to terms with advancing disease can be a time of internal and spiritual growth. It is important that all members of the health care team make efforts to understand that spirituality is part of the journey that the person with advanced cancer is going through and that life review is one way to promote spiritual well-being among patients with advanced cancer.Implications for Nursing PracticeNurses are ideally placed to provide spiritual care. Using life review, nurses can assist individuals coming to terms with their diagnosis and can positively impact spiritual and psychosocial well-being.     

Supportive Care Needs of Patients on Surveillance and Treatment for Non-Muscle-Invasive Bladder Cancer

ObjectiveThis literature review provides an overview of non-muscle-invasive bladder cancer diagnosis (NMIBC), treatment, and surveillance. Existing evidence is reviewed to identify the NMIBC patient pathway, highlight its effect on quality of life, and identify supportive care needs of this patient group. A framework to guide nurses in the care of this underserved population is proposed.Data SourcesElectronic databases including CINAHL, Medline, PsychInfo, Cochrane, and Google Scholar were searched.ConclusionNMIBC is a chronic disease with high recurrence and progression rates with most patients requiring invasive treatment and burdensome surveillance schedules with frequent hospital visits. Treatment-related side effects may interrupt therapy and possibly result in its discontinuation. Patients’ quality of life can be negatively affected at various stages of the cancer trajectory. Specialist nurses provide holistic care throughout all stages of the patient journey to optimize supportive care, information provision, and delivery of appropriate treatment and surveillance protocols. NMIBC research is historically underfunded with a paucity of evidence identifying the supportive care needs of this population. Further research is urgently required to fill the gaps identified.Implications for Nursing PracticeThis timely paper raises the profile of unmet supportive care needs in an underserved research cancer population. Suggestions are proposed to improve the quality of nursing care through standardized practices and the development and integration of patient pathways. Evidence of the effect of NMIBC on family members or carers is absent from the literature. Future research implications and directions are proposed.     

The Use of Comfort Kits to Optimize Adult Cancer Pain Management

BackgroundPain is one of the most feared of all symptoms for the cancer patient. Some studies estimate that up to 90% of all cancer patients experience pain. Advances in pharmaceuticals and expert provider knowledge have improved pain management overall for the patient with cancer; however, complementary therapies can synergize medications to provide optimal pain relief while decreasing the side effect profile. Despite this, nurses may have limited access to such resources. Many therapies can be administered directly by the bedside/chairside nurse with minimal training and the nurse can then teach the patient and family how to use the selected complementary therapy after leaving the hospital or clinic.ObjectivesThe oncology nurse will be able to identify several easy-to-implement complementary therapies that can supplement pharmacologic pain management for cancer patients.MethodsAs a quality project, comfort kits, containing such items as handheld massagers, guided imagery audiotapes, and aromatherapy essential oils, were distributed for use with patients through unit-based pain resource nurses.AnalysisMore than 500 comfort kit items were tracked by the pain clinical nurse specialist during the comfort kit trial, both by medical record review and by follow-up phone calls to patients. During the comfort kit trial, average pain intensity decreased by 2.25 points on a 0-10 scale in the 24-hour period after use of the item from the comfort kit. Patients also had an overall decrease in the use of pharmacologic pain interventions and an increase in ambulation in the 24-hour period after implementation.ConclusionsComfort kits allow nurses easy access to inexpensive tools to supplement pharmaceutical pain management. Optimizing nonpharmacologic pain management can increase patient and nurse satisfaction, improve overall pain management, and decrease untoward side effects.     

Management of Gynecologic Cancers In Relation to Genetic Predisposition

ObjectiveTo review hereditary gynecologic cancer syndromes and outline current clinical management considerations.Data SourcesRetrieved articles and guidelines dated 2013–2018 from PubMed, National Comprehensive Cancer Network, American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and National Institutes of Health databases.ConclusionAdvances in genetic testing technology have allowed for the identification of a growing number of patients with genetic mutations associated with hereditary cancer. Individuals with a hereditary predisposition to cancer may qualify for targeted drug therapies, risk-reducing surgeries, and/or high-risk cancer surveillance depending on the specific gene mutation(s) they harbor. Furthermore, there are clinical implications for relatives.Implications for Nursing PracticeThis article is an educational guide for oncology nurses who often play a key role in identifying patients at risk for hereditary cancer, prompting referrals for genetic evaluation, and providing follow-up care for these patients.     

Big Data,Machine Learning,and Artificial Intelligence to Advance Cancer Care: Opportunities and Challenges

ObjectivesThe rapid advances in artificial intelligence (AI), big data, and machine learning (ML) technologies hold promise for personalized, equitable cancer care and improved health outcomes within the context of cancer and beyond. Furthermore, integrating these technologies into cancer research has been effective in addressing many of the challenges for cancer control and cure. This can be achieved through the insights generated from massive amounts of data, in ways that can help inform decisions, interventions, and precision cancer care. AI, big data, and ML technologies offer, either in isolation or in combination, unconventional pathways that facilitate the better understanding and management of cancer and its impact on the person. The value of AI, big data, and ML technologies has been acknowledged and integrated within the Cancer Moonshot program in the U.S. and the EU Beating Cancer Plan in Europe.Data SourcesRelevant studies on the topic have formed the basis for this article.ConclusionIn a shifting health care environment where cancer care is becoming more complex and demanding, big data and AI technologies can act as a vehicle to facilitating the care continuum. An increasing body of literature demonstrates their impactful contributions in areas such as treatment and diagnosis. These technologies, however, create additional requirements from health care professionals in terms of capacity and preparedness to integrate them effectively and efficiently in clinical practice. Therefore, there is an increasing need for investment and training in oncology to combat and overcome some of the challenges posed by cancer control.Implications for Nursing PracticeAI, big data, and ML are increasingly integrated in various aspects of health care. As a result, health care professionals, including nurses, will need to adjust in an ever-changing practice environment where these technologies have potential applications in clinical settings to improve risk stratification, early detection, and surveillance management of cancer patients.