Research in action

EONS is pleased to present short reports from researchers undertaking current research. Click on each section to read more about the researcher and their research.

I am Head Nurse at an Infectious Diseases Unit of a University Hospital in Athens. The research protocol entitled “Symptom clusters of patients’ with colorectal cancer: study of the experience and its determinants” will be contacted in purpose to complete my dissertation in Nursing Department, School of Health Sciences, National and Kapodistrian University of Athens.

The aim is to identify Symptom Clusters (SC) in patients with colorectal cancer undergoing chemotherapy and explore the correlation of the severity of their symptoms with personality traits and the immune response of patients. Many studies have tried to model SC using diverse statistical methods. Two different approaches will be used to identify SC : 1) the use of a quantitative standardised scale , the MD Anderson Symptom ?nventory to collect data of the severity of patients' symptoms and statistical analysis and 2) a semi-structured interview and interpretative phenomenological analysis of patients' lived experience of multiple concurrent symptoms. Revised Life Orientation Test and the 15 item Systems of Beliefs Inventory scale will be used to measure optimism and spirituality. Patients' immune response will be accessed by blood tests : CRP, Neutrophil Lymphocyte Ratio (NLR) and cytokines TNFa, IL-8, IL-10 and IL-25 in serum. The sample will be 50 patients with colorectal cancer at any stage, undergoing 3rd cycle of chemotherapy. The data collection will be cross sectional.

Growing evidence suggests that pain, fatigue, sleep disturbance and depression may be associated with cytokine-induced sickness behavior. If cytokines levels in serum are correlated with symptom severity and NLR, NLR will possibly be a useful biomarker that can be a routine blood test of patients with colorectal cancer without significant cost.

This research protocol will potentially contribute to the development of sensitive and specific biomarkers that correlate with subjective reports of symptoms and QOL. These biomarkers could be used to identify patients at risk for more severe symptoms and poorer QOL. Also, the qualitative approach to model symptom clusters can clarify relations between symptoms that contribute to the development of non-pharmacological interventions (e.g. cognitive behavioral).

For the last decades I worked as a oncology nurse. In 2011, I completed the master Evidence Based Practice. At the moment I am working as nurse practitioner in training, with a focus on melanoma, targeted - and immunotherapy. Besides that, I am a PhD student. My research is about targeted - and immunotherapy treatment in cancer patients.

Cancer treatments become more and more personalised, based on tumor characteristics. This approach will lead to an improved patient selection which makes long-lasting treatment possible. Patients on targeted and immunotherapy treatment are faced with toxicities due to these treatments and due to disease-related complaints, together summarised as symptoms.

Even if experienced symptoms are mild in nature, they may cause a high level of symptom burden, which decreases wellbeing and thereby are a threat to the quality of treatment. Patients are faced with uncertainties caused by symptom burden. Uncertainty influences patients behavior, like treatment adherence and effective use of self-management strategies.

By using patient reported outcome measurement tools in daily practice early recognition of symptom prevalence and intensity is realised. Also, insight into the effect of interventions performed is accomplished. This insight provides a more personalised patient education, support with management of adverse events (AEs) and self-management.

This approach is needed to make personalised, (long-lasting) cancer treatment with targeted - and immunotherapy successful.

The aim of this study (2017-2020) is to investigate how community nurses can reduce the burden on the relatives of patients diagnosed with cancer, heart failure or chronic obstructive pulmonary disease (COPD) in the last months of their lives.

In many countries patients prefer to spend their last phase of life and to die at home. Then relatives play an important role - by just being there for their loved ones but also as the caregiver, managing and monitoring the patient’s symptoms and treatment. On average relatives spend 25 hours per week on informal care during the last months of life. They are at a risk of overburden, which both increases their physical and psychological problems and the risk of acute hospital admission of the patient for which they are caring.

Although some work has been done on possible methods to assess caregiver needs, nurses are still primarily focused upon the needs of the patient and pay minimal attention to the caregiver. However, nurses do have opportunities to include care for the relatives when diagnosing patient problems and planning for outcomes and interventions.

Based on the existing literature and the experiences of nurses and relatives, we will develop a training programme to improve community nurses’ diagnostic skills and study its effectiveness on reducing the caregiver burden in a cluster randomised trial. We hope this study will contribute to a better quality of nursing care and a better quality of life at the end of life, for patients and for their relatives.