European Cancer Congress 2013
Live report: Day 3
EONS-ESO Joint Session - Cancer Surgery and Nursing
Both nursing roles and surgery techniques are evolving, which is why we need to keep updating our perception of the nurse’s role in surgery. EONS and the European School of Oncology (ESO) jointly organised a session on cancer surgery and nursing.
Dr M Cardoso of Portugal discussed oncoplastic surgery, specifically in relation to breast cancer treatment. She explained that the range of options for reconstructive surgery has broadened, which is great news but does mean more difficult choices for patients, with no outcomes guaranteed. She said that the key is to give patients the information they need to make a choice, such as telling them about the possibility of scarring. She also emphasised that you can’t expect a patient to make those choices at the same time as receiving the initial diagnosis - they need time to think things over.
Danuta Lichosik of Italy discussed the nurse’s role in robotic surgery. This involves a surgeon manipulating a computer console while robot arms carry out the operation. The nurse’s role is complex, requiring both technical and leadership skills as well as concern for patient outcomes. Key quote: “Nurses are the owners of the operating theatre. Doctors are only the guests.”
Finally we heard from Riccardo Audisio of the UK about surgical oncology in the elderly. He reminded that elderly patients vary wildly, not just in terms of the cancer but also in terms of cognitive function, general health, mental outlook and many other factors. Assessment is essential for the right treatment.
Dr Audisio’s most surprising point: frailty is not necessarily associated with old age. So instead of assuming that all geriatric patients will be frail, we should look at frailty as something to be treated. He also introduced the concept of “pre-habilitation”: why not work on other health problems in the patient, such as malnourishment, before surgery? More than half of elderly hospital patients, in both the US and the EU, are malnourished, and this is associated with poorer outcomes.
Scientific Symposium: The Elderly Cancer Patient
The theme of diversity in elderly patients was continued in today’s scientific symposium. Lucien Noens spoke about diverse reasons for non-adherence to treatment, including side-effects, cost of treatment, life disruptions such as travel and many other reasons. Non-adherence is actually the rule rather than the exception, and non-adherent patients cost healthcare systems much more than treatment-adherent patients. Oral treatment has many advantages, but these are lost without adherence.
The bad news? “There is no perfect method for monitoring treatment adherence, no gold standard”. There is also no perfect method for increasing adherence, but lots of things can play a part: telephone follow-ups, electronic reminders, more openness when prescribing. But in the end, “It all comes down to one thing: we need more time.”
One comment from the floor raised the point that it is the content rather than the channel that matters. What you actually say on the telephone is more important than using the telephone.
Dr van den Berkmortel of the Netherlands spoke at the same session about polypharmacy in the elderly. More patients need interventions where their multiple drugs are assessed and stopped if necessary. These interventions tend to result in the patient being on fewer drugs and self-reporting as more healthy. We also heard from B Esbensen of Denmark on geriatric assessment.
Debate on personalised medicine
The final EONS event of the day was a debate with the motion This House Believes that the Term ‘Personalised Medicine’ is too narrow and should be renamed ‘Personalised Treatment and Care’.
Birgitte Grube, EONS Board Member, spoke in favour of the motion, seconded by patient advocate Jana Pelouchova. Speaking against were Angelo Paradiso of Italy and Didier Jacqmin of France. The debate was chaired by EONS Board Secretary Mary Wells. Birgitte made the point that when patients hear the term ‘personalised medicine’, they think of the personal touch rather than of biomarkers.
Although participants were in strong disagreement about the use of the term in question, there was a lot of agreement across both sides of the debating floor on many issues, such as the importance of multidisciplinarity. The final result was in favour of the motion.