Guidelines on the role of the specialist nurse in supporting patients with lung cancer

Recently, there has been a significant increase in the number of nurse specialist posts working with patients with lung cancer in the UK. This has been in response to a recognized need to improve lung cancer services. However, there is concern that these posts have been developed quickly with little strategic planning or evaluation. This paper is a collaborative project by the members of The London and South East Lung Cancer Forum for Nurses and aims to offer guidelines to managers and practitioners on areas where improvements may be made in the care of patients with lung cancer. Recommendations are based on Government guidelines, evidence from recent research studies and the experience of the members of the Forum.     

Consumer participation in the development of psychosocial clinical practice guidelines: opinions of women with breast cancer

Clinical practice guidelines are playing an increasingly important role in defining quality care and consumers have a considerable interest in participating in the development of guidelines. The objective of this study was to explore consumer's perceptions of guideline items relating to psychosocial care of women with breast cancer, developed by Australia's National Health and Medical Research Council National Breast Cancer Centre. Women diagnosed with breast cancer in the previous 2 years ( n  = 313) received a letter about the study via their radiation oncologist. Consenting women were contacted by the researchers to complete a telephone survey. The survey asked women to rate the importance of draft guidelines items, including discussing prognosis, providing information and choice, doctor-patient communication, preparation for surgery, providing emotional support, providing social support, dealing with practical and cultural issues and continuity of care. One hundred and forty women (45%) completed the survey. The results indicated that at least 50% of respondents rated 28 of the 52 items as 'essential' components, with respondents identifying providing information and choice, and doctor-patient communication as the most important aspects of psychosocial care. The findings suggest the guidelines adequately reflect consumer opinions and identify priority areas for clinicians to address in providing psychosocial support to women with breast cancer.     

Key workers in cancer care: patient and staff attitudes and implications for role development in cancer services

The role of the key worker in cancer services was developed in the UK and is now being adopted more widely. Although this role arose out of national guidance, little is known about how it has been implemented, and there been no systematic attempt to investigate how the role is viewed by either patients or staff. This study used a qualitative approach to explore views of the impact of the key worker role in cancer care. Interviews were conducted with 15 staff and 15 patients. Generally, patients were very positive about the role, while staff felt it was just a renaming of their role, which they thought unnecessary. Several differences in the views of staff and patients emerged from the interviews. For example, staff felt the role should transfer to other members of the care team while patients wanted to keep the same worker. Potential reasons for this divergence in attitudes are discussed, and suggestions for the future development of the role made.     

Obstacles to participation in randomised cancer clinical trials: a systematic review of the literature

Accrual to clinical trials continues to be a problem in many countries including Australia despite its fundamental importance to the progress of evidence-based medicine. This paper reviews the current literature addressing the obstacles to accrual excluding those related to protocol design. An electronic search of the literature identified publications in oncology specifically addressing the obstacles to participation in clinical trials. This search was supplemented by searches of key oncology journals. Obstacles fall into three main categories - clinician, patient and system; however, there are overlaps between categories. Clinician behaviour is the most important of these. Exclusion of patients for reasons other than defined eligibility criteria, concerns about increased time requirements, and suboptimal communication with patients all affect accrual. Risk management strategies for clinical trials need to be individualised to address the obstacles most likely to negatively impact on accrual. Communication between clinician and patient appears to be a greater issue than previously recognised. Time concerns need to be addressed as generational change affects the expectations of the medical workforce.     

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions

Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.     

Development and evaluation of an online educational resource about cancer survivorship for cancer nurses: a mixed‐methods sequential study

Cancer survivorship is recognised globally as a key issue. In spite of the key role played by nurses in survivorship care, there is an identified gap in nurse's knowledge in this area. This study reports on the development and evaluation of an educational resource for nurses working with people affected by cancer. The resource was designed using adult learning principles and includes a variety of learning materials and point of care resources. A mixed‐methods sequential exploratory design was used to undertake an evaluation of the programme. This included the use of online surveys and semi‐structured interviews with pilot participants. A total of 21 participants completed an online survey and 11 participants completed a telephone interview. Overall, the participants found the Cancer Survivorship resource to be engaging, practical and intuitive. A major theme emerging from the survey and interview data was that the resource was applicable to practice and useful in developing survivorship care plans. Respondents requested additional information be included on the role of various health professionals working in survivorship as well as guidelines on when to make referrals. This study provides evidence that the Cancer Survivorship tool may be a promising vehicle for delivering evidence‐based education on survivorship care.     

How does involvement of a hospice nurse specialist impact on the experience on informal caring in palliative care? Perspectives of middle‐aged partners bereaved through cancer

The aim of this study was to retrospectively explore partners' understandings and experiences in relation to caring for a loved one with a terminal illness, with a particular focus on the role of the hospice nurse specialist (HNS). Participants were purposively sampled and recruited through HNS gatekeepers. Seven middle‐aged, bereaved partners participated in semi‐structured, qualitative interviews. The interviews were audio recorded and transcribed verbatim and data were analysed using thematic content analysis. Five main themes emerged regarding the impact of the HNS on informal caring: ‘the ambivalence of caring’, ‘the HNS as a “confidante” in caring’, ‘the HNS as a “champion” in support’, ‘the work of the HNS – an unseen benefit’ and ‘being prepared for death and bereavement’. Findings from this study offer new insights into how involvement of a HNS impacts on the ability of carers to perform their role as an informal caregiver. Results highlight a crucial need for carers to have a clear understanding of all aspects of the HNS role so that full benefit is derived from their input. Recruitment of experienced and knowledgeable nurses is paramount, but equally important for carers is the supportive aspect of the role for which nurses need to demonstrate excellent communication skills and an intuitive, caring approach.     

Psychological distress of cancer and clinical trial participation: a review of the literature

The House of Commons Select Committee on Science and Technology 2000 state that currently less than 5% of adult patients with solid tumours are entered into clinical trials. They recommend that increasing the number of adult cancer patients entering clinical trials must become a high priority. Health-care providers need to prepare themselves for this proposed increase in trial participants by assessing the current status of care and implementing changes within the current infrastructure to provide optimal holistic care. Cancer can change a patient's life either for better or for worse. At one extreme, having cancer leads to enhanced appreciation of life and closer bonds with others. However, at the other extreme, cancer combined with its treatment is viewed as an event that evokes distress and emotional anguish taxing the individual's ability to cope. In the last 25 years, owing to the advent of clinical trials, progress has been made in cancer treatment. Clinical trials may be hailed as the saviour to many therapeutic dilemmas. Treatments are now available which can offer patients hope of cure. Nevertheless, many participants may fear, for the purpose of research, that they may be assigned to less than optimal therapy or that their care will be carried out in a sterile scientific atmosphere devoid of humane and personal consideration. These and other reasons may cause unacceptable personal distress that overrides the potential therapeutic gain. Cancer diagnosis coupled with the ramifications of clinical trial involvement can have significant psychological implications. They may trigger the onset of a mood disorder or exacerbate a present symptom. This article will identify mood disorders in the cancer population, focus on the participants' needs in the clinical trial arena and investigate the influence trial participation has on psychological status.     

The effects of cancer research participation on patient experience: a mixed‐methods analysis

Patient‐reported benefits of research participation have been described by study participants; however, many studies have small sample sizes or are limited to patient groups with poor prognoses. The purpose of this study was to explore the effects of research participation on patient experience using survey responses from a large, national sample of cancer patients (N = 66 462) and interviews with breast cancer patients attending a London trust. Multivariate logistic regression was used to investigate associations between taking part in research and positive patient experience. Based on our analysis, patients who participated in research were more likely to rate their overall care and treatment as ‘very good/excellent’ (OR_adj:1.64, 95%CI: 1.53–1.76, P < 0.001) and to describe positive patient experiences, such as better access to non‐standard care, better interactions with staff and being treated as an individual. However, findings from our interviews indicated that there was no common understanding of what constitutes cancer research and no clear delineation between research participation and standard care, from the patient perspective. Further work to explore how participation positively influences patient experience would be useful to develop strategies to improve care and treatment for all patients regardless of whether or not they choose, or have the opportunity, to take part in research.     

Awareness of breast and cervical cancer risk factors and screening behaviours among nurses in rural region of Turkey

Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. There is limited data on breast and cervical cancer knowledge, screening practices and attitudes of nurses in Turkey. A self-administered questionnaire was used to investigate the knowledge and attitude of nurses on risk factors of the breast and cervical cancer as well as screening programmes such as breast self-examination (BSE), clinical breast examination, mammography (MMG) and papanicolaou (pap) smear test. In total, 125 out of 160 nurses participated in the study (overall response rate was 80.6%). The risk factors and symptoms of breast cancer was generally well known, except for early menarche (23.2%) and late menopause (28.8%). For cervical cancer, the correct risk factors mostly indicated by the nurses were early age at first sexual intercourse (56%), smoking (76%), multiple sexual partners (71.2%). As for screening methods, it was believed that BSE was a beneficial method to identify the early breast changes (84.8%) and MMG was able to detect the cancer without a palpable mass (57.6%). Little was known about the fact that women should begin cervical cancer screening approximately 3 years after the onset of sexual intercourse (23.2%) and if repeated pap smear test were normal, it could be done every 2–3 years. Most of the nurses considered that MMG decreases the mortality in breast cancer (65.6%) and also believed that pap smear test decreases the mortality in cervical cancer (75.2%). Despite high level of knowledge of breast cancer risk factors, symptoms and screening methods, inadequate knowledge of cervical cancer screening method were found among nurses.     

Vaginal self-sampling is a cost-effective way to increase participation in a cervical cancer screening programme: a randomised trial

Background:

Cervical cancer screening coverage remains insufficient in most countries. Our objective was to assess whether in-home vaginal self-sampling with a dry swab for high-risk human papillomavirus (HR-HPV) testing is effective and cost-effective in increasing participation in cervical cancer screening.

Methods:

In March 2012, 6000 unscreened women aged 30–65 years, living in a French region covered by a screening programme, who had not responded to an initial invitation to have a Pap smear were equally randomised to three groups: ‘no intervention'' ‘recall'', women received a letter to have a Pap smear; and ‘self-sampling'', women received a self-sampling kit to return to a centralised virology laboratory for PCR-based HPV testing.

Results:

Participation was higher in the ‘self-sampling'' than in the ‘no intervention'' group (22.5% vs 9.9%, P<0.0001; OR 2.64) and ‘recall'' group (11.7%, P<0.0001; OR 2.20). In the ‘self-sampling'' group, 320 used the self-sampling kit; for 44 of these women with positive HR-HPV test results, 40 had the recommended triage Pap smear. The ICER per extra screened woman was 77.8€ and 63.2€ for the ‘recall'' and ‘self-sampling'' groups, respectively, relative to the ‘no intervention'' group.

Conclusions:

Offering an in-home, return-mail kit for vaginal self-sampling with a dry swab is more effective and cost-effective than a recall letter in increasing participation in cervical cancer screening.     

Culture and cancer: the relevance of cultural orientation within cancer edcation programmes

Health professionals are frequently called upon to care for those whose cultural backgrounds are unfamiliar and different from their own. The impact of the family's cultural values and beliefs in their response to a diagnosis of cancer are not emphasized in health professionals' education and consequently, may be underestimated, leading to less effectsivce care. Analysis of the experiences of 12 immigrant families in a western health care setting reveals that culturally embedded meanings are attached to illness, and this frequently affects patient and family responses to care.
For instance, in certain cultures, the occurrence of cancer may be attributed to insufficient use of herbal medicine, an insult to an ancestor ordue to a perceived punishment. Thus, standard medical approaches may not always appeatr releveant to certain groups in multicltural patient populations.
The purpose of this paper is to describe patient and family coping experiences and stress-related factors in Italian, Portuguese and Chinese immigrant families as they have been described during routine family assessment interviews.
It is argued that there is need for an expanded knowledge of health professionals who manage those with cancer so that culturally embedded meanings can be adequately understood. It is maintained that models of patient and family care should allow for possible discrepancies in patient-care giver understandings, and encourage a collaborative approach towards treatment and care. The paper concludes that cultural content must be an integral part of cancer education programmes in order for health professionals to be effective in their practice and care.     

Effectiveness of interventions to increase the participation rate of gastric cancer screening in the Republic of Korea: a pilot study

This study assessed the effectiveness of three intervention strategies to improve the participation rate of gastric cancer screening among people who had never undergone such screening, and those who had been screened for the disease, but not recently. It was conducted in the Ilsandong-gu District of Goyang City, Korea. The population for the current study was restricted to male residents, aged 40-65 years, who received an invitation letter to undergo gastric cancer screening from the National Health Insurance (NHI) Corporation at the beginning of 2010. The subjects were divided into two categories according to their screening history: never-screened, and ever-screened. A total of 2,065 men were eligible: 803 never-screened and 1,262 ever-screened. In each screening category they were randomly assigned to one of three intervention groups: 1) tailored telephone counseling; 2) tailored postcard reminder after tailored telephone counseling;and 3) tailored telephone counseling after tailored postcard reminder. At 3 months post-intervention, never- screened men with any intervention were more likely to undergo gastric cancer screening (OR=2.75, 95% CI: 1.22-6.18) compared to those in the reference group (no intervention). However, there was no statistically significant intervention effect in ever-screened men (OR=1.21, 95% CI: 0.65-2.27). Examination of the intervention effects by intervention group among never-screened men showed that those in the postcard reminder after telephone counseling group to be statistically significantly more likely to undergo gastric cancer screening (OR=4.49, 95% CI: 1.79-11.29) than the reference group (no intervention). Our results highlight that use of tailored postcard reminders after tailored telephone counseling is an effective method to increase participation in gastric cancer screening among men who had never been screened.     

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation

Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.     

Esophageal cancer metastatic to the kidney: report of a case

On December 12, 1988, 51-years-old man was admitted to our clinic with asymptomatic gross hematuria. He had been undergone total esophagectomy for esophageal cancer in the surgery service of our hospital on June 22, 1987, and histopathological diagnosis was squamous cell carcinoma, Stage III, a2, n(-), m0, pl0, ly(+), V(+). X-ray CT revealed a irregular, obscure bordered tumor image in the left kidney and angiography showed a hypovascular tumor. On December 20, nephrectomy was performed. Histologically, it proved to be squamous cell carcinoma metastasized from esophageal cancer. The present case is the 11th of those cases which have been clinically diagnosed as renal metastasis of esophageal cancer in Japan. An extremely small number of clinically reported cases compared with autopsy cases are thought to be ascribable to scarce detectability while living of such metastasis, but not to its rare occurrence. The coming diagnostic improvement may well make such case more and more increasing.     

Interventions to improve patient participation in the treatment process for culturally and linguistically diverse people with cancer: A systematic review

Disparities in cancer outcomes for people from culturally and linguistically diverse (CALD) groups are well known. Improving CALD patients' active participation in treatment processes holds potential to improve outcomes, but little is known of effective strategies to facilitate this. This systematic review investigated interventions to improve three aspects of participation in cancer care among CALD groups, namely involvement in decision‐making, communication with health providers and treatment adherence. A comprehensive search of electronic bibliographic databases was conducted to identify intervention studies that reported outcomes relevant to patient participation for CALD groups. Two reviewers independently critically appraised the studies and abstracted data. Of 10 278 potential articles, seven met the inclusion criteria, including three randomized controlled, three non‐randomized and one mixed‐method experimental studies. Interventions included the use of patient navigators, videos and decision aids. The impact on patient participation was varied. The effect of a decision aid and patient navigator interventions on communication with health providers was positive. While the use of a decisions aid successfully facilitated shared decision‐making and patients' perception of treatment adherence, the use of patient navigators was ineffective. A computer support system was found to improve general patient participation; however little clarification of what this involved was provided. This systematic review identified few rigorous evaluations of interventions to improve treatment participation for CALD people with cancer, highlighting the lack of a robust evidence base to improve this crucial aspect of care. The development and evaluation of interventions for diverse populations remains a priority.