Research Working Group - Updates from 2015

December 2015:

Can the use of remote technology improve care for cancer patients?
The eSMART project

Professor Elisabeth Patiraki

Patients receiving chemotherapy report symptoms that are in the moderate to severe range and have a considerable impact on their quality of life. Chemotherapy toxicity often leads to distressing and potentially life-threatening side-effects, which occur not only during the acute part of treatment but can persist into survivorship. This suggests that our current symptom assessment and management strategies are not effective.

The eSMART (Electronic Symptom Management System Remote Technology) is a pioneering EU-funded project that could improve patients’ experience and outcomes by transforming care delivery to an anticipatory and personalised model of care for people with cancer receiving chemotherapy across Europe.

The eSMART study will take place over a period of five years. The primary aim of eSMART is to evaluate the short and long term impact of the Advanced Symptom Management System (ASyMS) technology on patient-reported outcomes in people with breast cancer, colorectal cancer or haematological malignancies (i.e. HD or NHL) receiving first-line chemotherapy. In addition, eSMART will evaluate the cost-benefit of remote patient-monitoring and changes in clinical practice as a result of the application of the ASyMS intervention in different European healthcare settings. Utilising data from this study, eSMART will conclude with the development of Predictive Risk Models (PRMs) to predict chemotherapy related toxicity for people with breast, colorectal and haematological cancers receiving chemotherapy.

The Advanced Symptom Management System (ASyMS) has been developed by a number of the collaborators in conjunction with cancer clinicians and people with cancer. ASyMS is a mobile phone-based remote-monitoring system that enables the “real-time” monitoring of patients’ symptoms through use of a patient-reported outcome measure (PROM). Combined with technology-driven interventions that are able to capture symptom data in real-time, electronic PROMs (ePROMs) allow rapid clinical decision-making and interventions to improve patient outcomes, and enable the delivery of high quality care irrespective of distance in a variety of settings and economic or cultural contexts.

Wherever you are, whatever you are doing... use the mobile phone...to send your symptom to the nurse...and get more information about your symptoms.

Complementary to such technological innovations is the advent of Predictive Risk Models (PRMs) that enables care to be effectively triaged and clinicians to employ a preventative and anticipatory model of care through identification of patients at greatest risk of adverse events of cancer treatment. Collectively seen, the technologically driven real-time symptom monitoring and predictive risk modelling will allow for a timely, high quality, person-centred supportive care, whose durable effects can support and empower those living with and beyond cancer. Such advances will lead to increased levels of patient safety by assessing risks and mitigating these with optimal symptom management interventions.

eSMART has been granted €6 million from the European Union to fund a large trial of the system and will be run by the University of Surrey, involving 9 European and one American partner as well as cancer care clinicians from all partner countries.

eSMART Partners

A two-group, multicentre, repeated-measures randomised controlled trial will be conducted across 14 sites in Europe (Austria, Greece, Republic of Ireland, Norway, United Kingdom). More than 1000 patients will be recruited, adult (>18 years) patients diagnosed with breast, colorectal cancer or haematological cancers, commencing first-line chemotherapy and planned to receive at least 3 cycles of chemotherapy will be invited to participate.

eSMART Clinical Sites

Map showing eSmart centres across Europe.

The first 18 months of the project have been dedicated to preparing for the system to be deployed in other countries on a technological level, and translating it into the languages needed. Most of the clinical sites have started the feasibility study in the autumn of this year and first patients have already been recruited.

For more information regarding the eSMART project, please, visit the website: www.esmartproject.eu, follow on Twitter @esmart_eu or keep yourself updated on project’s progress through the monthly eSMART Newsletter.

November 2015:

Ulrika Östlund, Research Working Group member, write about the EONS Research Proposal Workshops.

Many nurses identify issues in their clinical practice that are in need of more research. The first EONS Research Proposal Workshop, held in 2011, was designed to help oncology nurses build the confidence and skills to create a proposal for a research project.

The event, held in London, was considered such a success that we decided to do another one the following year. The 2012 workshop took place in Stockholm, Sweden, with ten participants from six different countries, while the 2014 workshop happened in Limassol, Cyprus, with nine participants from six countries.

The most recent one took place in Amsterdam this spring and we had ten nurses from six countries participating.

We have asked participants for feedback to help us evaluate the effectiveness of these workshops. The message is clear: participants believe that these workshops are very useful and believe that EONS should continue running them.

Many participants report that the workshop they attended has helped with their professional development, helping them to get a new job or placement. Others report a renewed interest in research and increased confidence in areas such as presenting and publishing research findings.

Over half of the participants, 57%, have developed the research idea they brought to the workshop into a proposal and 40% have developed another research proposal.

The full evaluation document is available to read online:
+  View the evaluation document

The EONS Research Working Group is pleased to see that the Research Proposal Workshops have fulfilled their aim of supporting participating nurses to develop their research ideas into proposals. This means we have taken a decision to continue organising the workshops.

However, to open up opportunities for nurses with different levels of research experience, the 2016 workshop will be focused on doctoral students.

If this “Research Workshop for Doctoral Students” is successful, we propose holding it on alternate years with the Research Proposal Workshop.

The 2016 workshop focusing on doctoral students are planned to be held in Scotland in May. More information will soon be available on the EONS website, so if you are interested in participating, keep your eyes open for this opportunity.

October 2015: feedback on the Research Travel Grant

Wendy Oldenmenger summarises some of the feedback from recipients of the EONS Research Travel Grant 2013-2014. This feedback allows EONS to evaluate the effectiveness of grants and measure what impact they have.
+  Read the feedback

September 2015: Smoking prevention - are we doing enough?

Iveta Nohavova, member of the EONS Research Working Group and the Czech Oncology Nursing Society, asks if cancer nurses could do more to reduce tobacco use.

September is here, the month when we welcome Autumn and harvest from our gardens. Many of us are, in some degree, dealing with “back to school” realities. Regardless of what the season or month of the year is, we should be talking about smoking prevention.

Whether you’re talking to your children, family, friends, colleagues or patients, it is not a subject to be avoided. If possible, you should keep returning to the subject as often as it takes.

Let’s focus our attention now on the problems of smoking and tobacco use with regards to us, the oncology nurses, and our duty to help our patients quit. As you probably are well aware, the epidemic of tobacco use is still a major issue that requires more action. Why? Well, smoking contributes to one third of cancer cases but is also responsible for six million deaths worldwide each year [1]. Just reading these well-known facts makes me ask a question: have we been doing enough? Are we doing everything we can to prevent young people from starting smoking and to help those who suffer from nicotine addiction? My blunt answer is: probably not.

Of course, there exist great differences across the world with regards to the standards of nursing care relating to tobacco: the quality and prevalence of screening, interventions, advice and referrals vary greatly from country to country. Countries with advanced policies and practices in place should be examples and mentors to those which have started later.

In the Czech Republic, things have been slowly changing to what should be a good nursing practice: for the past decade, nurses have been getting educated and trained on the topic of tobacco dependence and intervention practices. Hospitals (largely due to the Global Network of Tobacco-Free Healthcare Services initiative) are one by one adding the questions about tobacco use to nursing assessment forms and making it standard nursing care. The Centre for Treatment of Tobacco Dependence (SLZT), led by Assoc. Prof. Eva Kralikova, MD, PhD and her team of nurses, have been pioneers in tobacco prevention for over 20 years. The nurses there have developed guidelines [2] endorsed by the Czech Nurses Association and a whole-day education workshop and have educated nearly 600 nurses on tobacco use, intervention and treatment issues.

And more has also been possible thanks to a Bristol-Myers Squibb Foundation grant to ISNCC (International Society for Nurses in Cancer Care, www.isncc.org) which partners with SLZT in an international project called “Eastern Europe Nurses’ Centre of Excellence for Tobacco Control”. This involves workshops for the nurses who can participate in person, and webcasts broadcast online to reach a wider audience.

This project is focused on helping other countries across Eastern Europe (Hungary, Slovakia, Slovenia, Romania) to create similar Centres of Excellence for nursing education like the one in Prague.

But we have to remember ourselves too. As nurses (the largest health care group), it is our moral obligation to be smoke-free role models to our patients, families and wider society. We should not underestimate this unspoken influence we carry with us. Unfortunately, little attention is paid to Czech nurses who smoke - estimates are around 40% (!) compared to a 21% smoking rate among women in the general public. [3] Interestingly, only 7% of nurses smoke in the USA [4]. Beside the negative effect of smoking on nurses’ health, we know from research studies that nurses’ smoking status negatively influences the effect of interventions on patients [5]. Slowly, but surely, things are changing.

I invite each and every one of you to stop and think for a moment now and try to answer for yourself the following questions:

  1. Who smokes around me to whom I could offer my help with quitting?
  2. When did I last talk to my children and/or relatives about the harmfulness of smoking?
  3. Do I ask every patient what his smoking status is?
  4. Do I know necessary answers about what to do to stop smoking? (5A intervention for start)
  5. Do I know where to look for information and where to refer for a treatment?

And lastly, for those of you who smoke at present - can we, your health care colleagues, help you to quit?

Just imagine if every nurse would help one patient quit each year… Together, we can make a big difference!

References:

  1. WHO report (2015). Last accessed Aug 27, 2015, [http://www.who.int/mediacentre/factsheets/fs339/en/]
  2. Malá, K, Felbrová, V, Kulovaná, S, Nohavová, I. (2015). Tobacco dependence: Information and intervention guidelines for nuses. SLZT, Prague, 22p
  3. Csémy L, Sovinová H, Sadílek P. (2014). Tobacco use in the Czech Republic in 2013. Czech Statistical Office [http://www.szu.cz/uploads/documents/
    czzp/CPVZ_aktualne/Tabak_Sovinova/UzivaniTabaku2013.pdf
    ]
  4. Sarna L, Bialous SA, Nandy K, Antonio AL, Yang Q. (2014). Changes in smoking prevalences among health care professionals from 2003 to 2010-2011. JAMA, Jan 8;311(2):197-9
  5. Sarna, L. et al. (2014). Impact of a Smoking Cessation Educational Program on Nurses’ Interventions. Journal of Nursing Scholarship, 46:5, 314-321

August 2015: Social support, anxiety and depression in patients with sarcoma

Jorge Freitas reports on a study from Portugal.

The Portuguese Oncology Nursing Association (AEOP) study carried out a study in partnership with the Porto College of Nursing Porto (ESEP). It was a descriptive cross-sectional study, conducted in two specialist hospitals in Portugal. The research studied a sample of 24 people with sarcomas (bone and soft tissue).

The Problem

The sarcoma is a rare type of solid cancer, which corresponds to 1% of cancers in adults and 15% of cancers in children (Sarcoma Foundation of America [SFA]). Sarcoma has its origin in the connective tissue or bone tissue, usually being divided into two broad categories: sarcomas of soft tissues (including conjunctive, muscles, nerves, blood vessels and other conjunctive tissue) and bone sarcoma (National Comprehensive Cancer Network [NCCN]).

The most common treatment is surgery, which can be complemented with radiotherapy or chemotherapy (van Herk-Sukel et al., 2012).

The psychosocial adjustment to cancer has been the subject of multiple studies. However, it is clear that these have focused primarily on the most common cancers, and studies with rare oncological diseases are comparatively scarce (Walls, Simões, & Canavarro , 2012).

The management of the disease, as well as the psychosocial implications for rare cancers, is not sufficiently known, as with bone sarcomas and soft tissue. This type of cancer disease usually raises a number of complications, especially when it comes to a tumour located within the spine or limbs, which could bring varying degrees of restrictions on mobility and increase the risk of amputation of the affected limb, associated with physical changes. These situations affect the self-image of the patient and his emotional balance (Walls, Canavarro, & Simões, 2011). It is also important to consider all the side effects of therapies administered that in the long term, may adversely affect the functionality and quality of life of patients with sarcomas (Tang, Pan, Castle & Choong, 2012).

Most studies on the emotional adjustment of people with oncological diseases reveal that most patients have transitional and adaptive reactions to disease, not showing levels of clinically significant psychiatric disorder, as was a common assumption until studies in the 1990s proved this to be methodologically inaccurate (Paredes et al., 2011).).

Purpose / Objectives of the study

This study is part of a larger project that is intended to characterize the self- processes of patients with sarcoma (bone and / or soft tissue). This study aims to describe the perception of social support and emotional adjustment of patients with sarcoma, and their socio-demographic and clinical determinants.

Specific objectives:

  1. Describe the perception of social support of patients with sarcoma;
  2. To evaluate the presence of symptoms of anxiety and depression in patients with sarcoma;
  3. Describe the relationship between anxiety, depression and the perception of social support;
  4. Describe the relationship between socio-demographic and clinical variables of patients with sarcoma, and the perception of social support, anxiety and depression.

We have a sample of 24 patients with sarcomas (bone and soft tissue), with an average of 38 years of age and 10 years of education at school. Most are married and in work. In clinical terms, a significant portion of the sample had already begun treatment for the disease, especially surgical removal of sarcomas, metastases or skin plastic, in combination with other complementary treatments.

In this study, we use the following instruments: a questionnaire on socio-demographic and clinical and Portuguese versions of the Social Support Scale (EaS) and Anxiety Scale and Hospital Depression (EaDH).

The results indicated that the sample had a positive perception about their social support and presented values indicative of “mild” anxiety. They did not show symptoms of depression, although some of the sample participants meet with levels of moderate to severe anxiety - indicative of the need for urgent interventions of psychosocial nature. A statistically significant relationship was also demonstrated between the variables under review and some socio-demographic variables (such as age, education, the number of people who lived with sample participants and the number of children), but not with clinical variables.

Conclusions

We found that the most vulnerable and emotionally distressed patients had certain factors in common:

  • Older age
  • Low level of education
  • Married or in a civil partnership
  • Without professional activity

These results reinforce the importance of social support. Patients perceive the support given by nurses as important and helping to promote their autonomy.

We believe that this study is presented as a first look at an issue that needs further examination, towards the identification of vulnerable groups who need further monitoring by health workers from the early stages of the disease and its treatment.

Nurses should plan and implement a monitoring process of these vulnerable groups and implement therapies tailored to their real needs.

July 2015: Are research nurses prepared for personalized medicine in cancer?

Nuria Domenech Climent asks if nurse researchers are prepared for the latest innovations in targeted medicine.

Personalized medicine provides knowledge about the patient’s individual characteristics in relation to health and intervention outcomes, such as treatment response and adverse side-effects, to develop a tailored treatment plan. The ultimate goal of personalized medicine is to identify individuals at risk for a disease and to tailor prevention strategies including diet, exercise, pharmacological management and frequent screening, as well as treatment based on each patient’s genetic information.

Personalized medicine for some people has substantially improved survival rates. It has become a major issue for oncologists in general, and for all health professionals involved. In addition, the integration of research and innovation focused on personalized attention is also one of the objectives of the Horizon 2020 EU Framework Programme for Research and Innovation. Personalized medicine has become one of the pillars of training strategies for oncologists; but what about nursing? Are we prepared for personalized medicine in cancer?

Targeted therapies: a central issue in research

Target Treatments have developed drugs that act selectively against certain molecular targets of cancer cells (so-called targeted therapies) which are used to counteract some cancers in some patients but there are still many more targets to be discovered and developed in order to improve drugs. Targeted drugs work differently from reference chemotherapeutic drugs. They attack cancer cells and, specifically, the targets representing vital points for cell survival, cell replication and metastasis. Usually they cause less damage to healthy cells. In fact, these drugs often produce different side effects compared to traditional chemotherapy drugs. Currently, targeted therapies are a central issue in cancer research and further advances in cancer treatment will most probably focus on this area.

Targeted therapies can be divided into two main categories: antibodies and small molecules. Antibody drugs are artificial versions of immune system proteins designed to hit the outside of the cells focusing on certain targets, which are usually called receptors. Focusing on specific receptors prevents the transmission of some survival signals to cancer cells. Small molecules target cancer cells from their internal life processes. Furthermore, in this case, small molecules prevent the transmission of signals that regulate vital tumor survival.

And, in this context, where is nursing located?

The aim of providing “appropriate treatment for the right patient at the right time” will only be achieved with specific training and continuous advances in research, based on a relationship of trust between the patient and the multidisciplinary care team, in which nursing should be part.

To pursuit excellence in nursing care, it is essential that nurses have knowledge of genomics, to learn about new drugs, their side effects and to become familiar with the treatment objective since nursing care plans may vary depending on the differences between them (can be used to cure cancer, reduce growth tumor or relieve symptoms caused by cancer). Furthermore, toxic effects caused by these drugs highlight the need for pre-clinical testing of new paradigms in early drug development, to assess the chronic side effects resulting from interactions of biological agents used in combination. Oncology nurses will have an increasingly important research role in providing knowledge to cancer patients about what to expect from the new biological therapies addressed, benefits, side effects, etc.

Nursing has also an important role in other ethical issues. Personalized medicine opens the door to strong debate on the right of every patient to have access to highly effective targeted therapies and the economic costs derived. On the other hand, the allocation of resources in healthcare makes it necessary to prioritize spending to the most effective interventions, but nurses must be present to ensure that this is achieved with the highest quality of life for patients.

These changes in the way of treating cancer will influence oncology practice, especially regarding the information needed by patients. In this complex system, the role of research nursing is essential. It acts as a key link in the chain of cancer care.

Research Nurses play a fundamental role in this change of treatment model and nurses will have to meet the needs of our patients.

June 2015: Complementary and Integrative Medicine: the “last resort” becomes everyday practice

Andreas Charalambous, EONS Executive Board member (Education), explains that complementary and integrative medicine can be part of cancer treatment when supported by evidence.

In medical literature there has been an increase in the number of studies published on the use of Complementary and Integrative Medicine (CIM) in care for patients diagnosed with cancer.

Although their popularity has been greater in Asia, in the last two decades people in Western countries have also begun to embrace these interventions as an additional option to treat symptoms relating to their cancer or arising from their cancer treatment. These interventions are not new, as some of these date back to ancient times (e.g. Ayurveda, Chinese Medicine). However, the development of new novel therapies to treat cancer has not been without a heavy price. Increasingly, patients report new, persistent and debilitating side-effects, most of which remain unresponsive to conventional treatment (i.e. palmar plantar erythrodysesthesia).

Some of these side-effects, although not life-threatening, can have consequences such as dose limitation or interruptions in the treatment, which have a negative impact in the curative effect of the treatment. These side-effects also have a negative impact on the patients’ overall quality of life (QoL) through limiting their ability to perform basic activities of daily living (ADLs) and through the burden they place on the patients (and their families) of having to deal with such side-effects for long periods of time and in some cases for the rest of their lives.

For the reasons explained above, CIM has increased its popularity not only among patients but also among healthcare professionals. In the recent Oncology Nursing Society’s congress in Orlando, USA, the recent research developments were presented alongside the ways CIM is integrated into everyday clinical practice. Increasingly high quality data for the effectiveness of CIM are produced through systematic reviews, meta-analyses and clinical trials. Such evidence for thymus honey’s effectiveness in the management of radiation-induced xerostomia and oral mucositis in head and neck cancer patients were presented. Xerostomia is a common, persistent and severe side-effect that can negatively impact the patient’s QoL and one that needs adequate attention by the researchers as it can lead to malnutrition, social isolation, and mucositis just to report a few (Charalambous 2014).

Similarly, oral mucositis is a frequent side-effect in radiotherapy and chemotherapy and accompanied by pain and discomfort in the oral cavity. Oral mucositis has been associated with secondary infections, malnutrition and cachexia as well as increased morbidity and mortality (Gabriel et al 2003). The topical use of thymus honey mouthwashes based on a specific protocol (before and after the radiotherapy sessions) proved effective in minimizing the presence of xerostomia and oral mucositis in cancer patients undergoing radiotherapy (Charalambous et al 2013).

Complementary and Integrative Medicine is not a panacea, nor are all the interventions available supported by scientific evidence. In Canada they have developed the CAMEO program (Complementary Medicine Education and Outcomes) which facilitates an evidence-informed CIM decision making. This tool is utilized by oncology nurses in their everyday practice and it is used as the means to support safe and informed CIM decision-making, to educate patients, families and health professionals on CIM and to facilitate new research on CIM.

Despite their great potential in the management of various symptoms and side-effects, we should use caution when deciding whether or not to use CIM in clinical practice and take into consideration all the necessary variables. Efforts to provide high-quality research data on the effectiveness of CIM measures continue, alongside efforts to increase our understanding of how these interventions work. Until then, bear in mind that “The absence of evidence is not the evidence of absence.” (Carl Sagan).

Charalambous, A, Charalambous, M, Raftopoulos, V, Lambrinou E. (2013). The effectiveness of thymus honey on radiation induced mucositis and xerostomia for head and neck cancer patients: preliminary findings of a RCT. Support Care Cancer, 21 (Suppl 1):S1-S301

Charalambous A. (2014). Hermeneutic phenomenological interpretations of patients with head and neck neoplasm experiences living with radiation-induced xerostomia: the price to pay?. Eur J Oncol Nurs, 18(5):512-20.

Gabriel DA, Shea T, Olajida O, Serody JS, Comeau T (2003) The effect of oral mucositis on morbidity and mortality in bone marrow transplant. Semin Oncol, 30(6 Suppl 18):76-83.

May 2015: Clinical research in oncology nursing: the current situation in Germany

Dr Patrick Jahn, new member of the Education Working Group, gives an update on the current state of German nursing research.

Nursing studies in oncology, particularly publicly funded, are still rare in Germany. This is not a problem specific to oncology care; it’s the same situation in almost all areas of nursing activities. The reason for the lack of nursing research lies in the fact that the German nursing science is still in the process of establishing nursing research [1, 2].

Without a doubt, in Germany nursing research, particularly in oncology, is years behind other countries - for example the US, UK or Scandinavia. The most important requirement for nursing research is the establishment of academic nursing education, thus research attitude and methods must be integrated into the professional role. Academic qualifications for nurses have been developed in Germany relatively late. In the last two decades, about 90 study programs for nurses have been established mainly at universities of applied sciences and with management and educational foci. Only a few university study programs focused on clinical research have been developed, e.g. University Halle or University Witten-Herdecke. According to the classification of Meleis, in Germany the development of nursing science is therefore in the “stage of Education and Administration” [3]. Schaeffer concludes that all energy was initially invested in the development of nursing science training and study opportunities and not in research [4].

Objectives of oncology nursing research

A comprehensive overview of oncology nursing research in Germany is difficult because many German-language publications are not listed in scientific databases (e.g. PubMed). The overview in Table 1 is therefore limited to funded studies and associated projects within the Nursing Research Networks by the Federal Ministry of Education (BMBF).

Current clinical nursing research in Germany is focused on promoting self-management of patients [5-13]. A particular focus is improving patients’ ability to participate actively to reduce the cancer-therapy-related symptom burden. Fatigue [7-9], pain [5,6] or nausea [12] are the symptoms foremost addressed. The interventions are compared to other interventions or standard care. In all studies nurses play an advisory role.

Table 1: Oncology nursing studies within the BMBF funded nursing research networks

Period Title Research Group / Research Institution Design Aim
2012-2015 SCAN - Transitional care of patients with colorectal cancer Landenberger, Bauer, Boese, Kuß, Vordermark, Mau, Dralle, Seufferlein, Schmoll, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, University Hospital Halle (Saale) and other centers. Randomized controlled trial Increasing the participation rate in adjuvant cancer therapy
2012-2015 FAMKOL - Trans disciplinary promotion to increase colorectal cancer screening participation in first grade relatives of colorectal cancer patients Landenberger, Bauer, Jahn, Haug, Kuss, Seufferlein, Riemann, Reinshagen, Hollerbach, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, LebensBlicke Foundation, Hospital Celle, Hospital Braunschweig, National Cancer Centre Heidelberg / German Cancer Research Centre (DKFZ) Cluster- randomized controlled trial Increasing the number of colorectal cancer screening
2007-2011 Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention [5; 6] Landenberger, Jahn, Kitzmantel, Thoke-Colberg, Krasemann, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, University Hospital Halle (Saale) & University Hospital Munich Klinikum rechts der Isar Cluster- randomized controlled trial Reducing patient-related barriers to cancer pain treatment
2007-2011 Somato-psychosocial caring program to improve symptoms in cancer patients with stem cell transplantation (HSCT) [7] Landenberger, Jahn, Schmidt, Boese, Lau, Jordan, Körholz-Mauz, Schmoll, Institute for Health and Nursing Science, Department for Sport science, Martin-Luther-University Halle-Wittenberg, University Hospital Halle Universitätskliniken Halle Non- randomized controlled trial Reducing symptom burden in cancer patients undergoing HSCT
2007-2010 FIBS-Study: Development and evaluation of a patient education program for cancer-related fatigue [8,9] Reif, de Vries, Stuhldreher, Petermann, Görres, Institute for Public Health und Nursing Research (IPP) & Centre for Clinical Studies, Psychology and Rehabilitation, University Bremen Randomized controlled trial Reducing cancer-related fatigue
2007-2010 Promoting self-management and adherence of patients with complex medication regimes (Phase II, prospective clinical trial) [10] Schaeffer, Mueller-Mundt, University Bielefeld, AG 6 Health Services Research / Nursing Science) Non- randomized controlled trial Improving patients adherence to complex medication regimes
2005-2008 Improvement of der self-care competence of patients undergoing stem cell transplantation trough a nurse led counseling program [11] Gittler-Hebestreit, Sayer University Hospital Jena; Landenberger, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg Randomized controlled trial Efficacy of a follow up care program for HSCT patients
2004-2007 Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention [12] Landenberger, Jahn, Renz, Thoke-Colberg, Horn, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, University Hospital Halle (Saale) & University Hospital Munich Klinikum rechts der Isar Cluster- randomized controlled trial Reduction of chemotherapy-induce nausea and vomiting
2004-2006 Efficacy of lavender oil pads in patients with sleep disturbances [13] Etzel, Thielhorn, Wylegalla, Behrens, Clinic for Tumorbiology, Freiburg Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg Randomized controlled trial Reduction of sleep disturbances
2004-2006 IDAK - Inter-professional documentation of informed consent in lung cancer patients [14] Behrens, Luderer, Institute for Health and Nursing Science, Martin-Luther-University Halle-Wittenberg Non- randomized controlled trial Improving contact time with cancer patients

Future issues for oncology nursing research

In many countries, nurse researchers have coordinated their future strategies in national research agendas, e.g. The National Institute for Nursing Research (NINR) Strategic Plan for the US [15], SRAM - Swiss Research Agenda Nursing [16], or since the fall of 2012 the German Nursing Research Agenda [17]. There are specific chapters e.g. within the SRAM [18] or separate agendas for oncology nursing [19,20]. Within the German nursing research agenda there are Topic 03 “Living with a chronic disease” and 06 “care in acute settings”. Both are potentially relevant for oncology nursing. However, it is now necessary to conclude specific oncology nursing issues from those topics.

Conclusion

In the past decade oncology nursing research has been developed in Germany. It is now crucial to maintain and further improve established structures. The scientific collaboration with other European partners with a longer research tradition could help to reach this goal and EONS is a great resource to facilitate this. Furthermore the closer collaboration in research and educational issues could strengthen a consistent perspective of oncology nursing across Europe with benefits for our nursing colleagues and our cancer patients.

Dr. Patrick Jahn
University Hospital Halle (Saale) | Head of Nursing Research Unit
Ernst-Grube-Str. 30 | 06120 Halle (Saale)
Tel.: +49-(0)345-557-2220 | Fax: +49-(0)345-557-2258
Email: patrick.jahn@uk-halle.de

Literature (German-language reference index)

[1] Wissenschaftsrat (2012) Wissenschaftsrat. Empfehlungen zu hochschulischen Qualifikationen für das Gesundheitswesen, Drs. 2411-12; Berlin 2012. URL: http://www.wissenschaftsrat.de/download/archiv/2411-12.pdf (accessed 11.12.2014)

[2] Schaeffer D (2010) Pflegeforschungsverbünde als Beitrag zur (Exzellenz-)Entwicklung der Pflegewissenschaft in Deutschland. URL : http://www.uni-bielefeld.de/gesundhw/ag6/pfv/downloads/Schaeffer_Pflegeforschungsverbuende.pdf. (accessed 11.03.2015)

[3] Meleis, A.I. (1997). Theoretical nursing: Development and progress (3rd Ed.). Philadelphia: Lippincott Co.

[4] Schaeffer D, Moers M, Rosenbrock R (2004) Public Health und Pflege. Zwei neue gesundheitswissenschaftliche Disziplinen. 2. Auflage. Sigma: Berlin.

[5] Jahn P, Kitzmantel M, Renz P, Kukk E, Kuss O, Thoke-Colberg A, Horn I, Landenberger M. (2010) Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial. Trials 11(1): 29.

[6] Jahn P, Kuss O, Schmidt H, Bauer A, Kitzmantel M, Jordan K, Krasemann S, Landenberger M. (2014) Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial. Pain. 155(4):746-54

[7] Renz P, Jahn P, Landenberger M (2009) Somato-psychosoziales interdisziplinäres Pflegekonzept f¨r onkologische Patienten mit hämatopoetischer Stammzelltransplantation (HSCT) zur Steigerung der Versorgungsqualität: eine prospektive nicht-randomisierte klinische Studie. Hallesche Beiträge zu den Gesundheits- und Pflegewissenschaften 8 (33).

[8] Stuhldreher N, Reif K, de Vries U, et al. (2008) Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial. BMC Nurs 7:12.

[9] Reif K, de Vries U, Petermann F, Görres S. (2013). A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. Eur J Oncol Nurs. 17(2):204-13.

[10] Schaeffer D, Müller-Mundt G. (2012) [Management of complex medication regimes in chronic illness - challenges and support needs from the health professional's view]. Pflege. 25(1):33-48 [German].

[11] Gittler-Hebestreit N (2006): Pflegeberatung im Entlassungsmanagement - Grundlagen, Inhalte, Entwicklungen. Schlütersche: Hannover.

[12] Jahn P, Renz P, Stukenkemper J, Book K, Kuß O, Jordan, K., Horn I., Thoke-Colberg A., Schmoll, H-J, Landenberger M. (2009). Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial. Support Care Cancer 17: 1543-1552.

[13] Wylegalla C, Etzel BS, Thielhorn U, König P (2011): Lavendelölauflagen bei Schlafstörungen , Pflegewissenschaft First! (E). URL: http://www.printernet.info/detail.asp?id=813. Zugriff 16.03.2011.

[14] Luderer C, Behrens J.(2008) Don't leave me alone! Inter-professional documentation relating to the effects of time spent in the communication of information to lung cancer patients regarding their status. Eur J Oncol Nurs. 12(4):393-7.

[15] NINR - National Institute for Nursing Research (2006) The NINR Strategic Plan 2006 -2010. URL: http://www.ninr.nih.gov /NR/rdonlyres/9021E5EB-B2BA-47EA-B5DB-1E4DB11B1289/4894/NINR_StrategicPlanWebsite1.pdf. [assessed 16.03.2015].

[16] Imhof L, Abderhalden C, Cignacco E, Eicher M, Mahrer-Imhof R, Schubert M, Shaha M. (2008) [Swiss Research Agenda for Nursing (SRAN): the development of an agenda for clinical nursing research in Switzerland]. Pflege. Dec;21(6):375-84.

[17] Behrens J, Görres S, Schaeffer D et al (2012): Agenda Pflegeforschung für Deutschland, Halle (Saale) http://www.agenda-pflegeforschung.de/ [accessed 16.12.2014].

[18] Shaha M, Schmid-Büchi S, Abt J, Mathis-Jäggi F, Holdener E, Riederer E, Stoll HR, Fliedner M, Imhof L. (2008) [The contribution of oncology nursing to the Swiss Research Agenda for Nursing - SRAN]. Pflege. 21(6):385-403.

[19] Berger AM, Cochrane B, Mitchell SA (2009) The 2009-2013 research agenda for oncology nursing. Oncol Nurs Forum 36:E274-82.

[20] Grundy M, Ghazi F (2009) Research priorities in haemato-oncology nursing: results of a literature review and a Delphi study. Eur J Oncol Nurs 13: 235-249.

April 2015: Research Working Group updates

For the April 2015 Research News Update, Professor Daniel Kelly shares the recent activities of the Research Working Group and plans for the future.

The EONS Research Working Group has met twice over the past year. The latest meeting took place on 26 March 2015 at the Royal Marsden Hospital in London, where we reviewed our activities and priorities for the coming year. As in all the EONS Working Groups, a lot goes on behind the scenes and people volunteer their time to make things happen for the benefit of the wider membership. At our most recent meeting we reviewed forthcoming awards including the Research Travel Grant and the EONS Research Grant (which this year will rise to EUR 40,000).

The aim of these awards is to encourage cancer nurses across Europe to engage in evidence generation that will improve evidence-informed care and enhance cancer nursing knowledge. We are also reviewing the Research Proposal workshop after three very successful years and will be announcing an exciting development to the workshop format for 2016 soon. We are also very excited to announce a new award, the Royal Marsden/EONS Change Champions Award. Further details will be made available in the near future and we will be offering the opportunity for a member to spend time at the world famous Royal Marsden to instigate a planned change in their practice.

Plans are also well advanced for ECC2015 in Vienna in September this year. There is still time to submit your abstracts and we are looking forward to receiving as many as possible this year!. An exciting programme of invited speakers is planned and we hope to see as many of you as possible attending under the nursing delegate category. Abstract submission is open until 28 April 2015. Any questions you may have about abstract submission can be directed to abstracts@ecco-org.eu

The website europeancancercongress.org will provide you with more detailed information.

We will also be announcing a new Co-Chair for the Research Working Group to work with Professor Mary Wells when Daniel Kelly takes up the EONS President role in Vienna.

We would also encourage you to check out the research content of the EONS website as we will be developing new content over the coming months. As ever, we are happy to receive your comments or suggestions - and if you would like to work with us on any research activity, please do feel free to contact EONS. We will also be sharing these new developments in more detail in the EONS magazine, so watch out for that too.

In the meantime best wishes to all from the co-chairs and members of the EONS Research Working Group.

March 2015: cancer-related fatigue

For the March 2015 Research News Update, Theresa Wiseman reports on an important research paper coming out soon on cancer-related fatigue.

This month’s update is to alert readers of a new innovative paper by Foster et al. (2015) which can be accessed from the following link ahead of print:
+  http://onlinelibrary.wiley.com/doi/10.1002/pon.3747/abstract.

With an increasing number of people (over 25 million worldwide) living with and beyond cancer1, evidence shows that many of these cancer survivors are struggling with the consequences of treatment and/or have unmet needs particularly towards the end of treatment2. Cancer related fatigue (CRF) is one of the most prevalent and debilitating consequences of cancer and its treatment, impacting on all aspects of daily life3. It affects at least a third of patients following primary treatment4.

Researchers in the UK have developed a web-based intervention (RESTORE) which is designed to enhance self-efficacy to aid self-management of cancer related fatigue following primary cancer treatment. Self-management is becoming an essential part of tailored follow-up with care pathways adapted to an individual’s needs4. However following treatment, patients may be left feeling vulnerable or lacking in confidence, which may act as a barrier to accessing support5. Rebuilding patients’ confidence, by enhancing their self-efficacy, can leave them in a better position to self-manage CRF and access further support if needed.

The web based RESTORE intervention includes five sessions designed to be completed at weekly intervals: sessions 1 and 2 include an introduction to cancer related fatigue and goal setting, whilst sessions 3 to 5 can be tailored to user preference and are designed to cover areas of daily life where CRF may impact such as: home and work life, personal relationships and emotional adjustment. The paper reports on the development of the web-based intervention and can be used to aid development of similar interventions.

  1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington DC, 2007.
  2. Foster. C. et al. Psychosocial implications of living 5 years or more following a cancer diagnsis: a systematic review of the research evidence. Eur J Cancer Care, 2009, 18: 223-247.
  3. Bower. JE et al. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol, 2000, 18: 743.
  4. NCSI. Living with and beyond cancer: taking action to improve outcomes. 2013, Department of Health.
  5. Foster. C., Fenlon. D. Recovery and self-management support following primary cancer treatment. Br J Cancer, 2011, 105: S21-28.

February 2015: three useful research papers for cancer nurses

This month’s Research Working Group update showcases three research papers recently published in EJON (the European Journal of Oncology Nursing). They have been collated by Lena Sharp of the Research WG.

Effects of supervised exercise on motivational outcomes in breast cancer survivors at 5-year follow-up

Does participating in a supervised exercise programme help breast cancer survivors to maintain physical activity levels in the long term?

This study is a follow-up to a previous report on the effects of a 12-week supervised group exercise programme for breast cancer survivors. Participants in the original research were contacted five years later and assessed for current levels of activity. They were also assessed on other factors such as current fitness level and attitude to exercise.

Authors: Linda Trinh, Nanette Mutrie, Anna M. Campbell, Jennifer J. Crawford, Kerry S. Courney

+  Download PDF

Information exchange in oncological inpatient care - Patient satisfaction, participation, and safety

Providing patients and their families with adequate information concerning treatment and care is a challenge in most health care organisations. This study aims to assess patients’ own perceptions of how information is exchanged within inpatient oncology wards. It also explores the links between information exchange and patient satisfaction, treatment adherence and safety.

One of the authors of this paper is Lena Sharp, member of the EONS Research Working Group and co-chair of the Education Working Group.

Authors: Anna Kullberg, Lena Sharp, Hemming Johansson, Mia Bergenmar

+  Download PDF

A clinical study to assess the efficacy of belly dancing as a tool for rehabilitation in female patients with malignancies

This study explores the impact of belly dancing on health-related quality of life, perceived social support and overall life satisfaction among female patients receiving standard care for malignant diseases.

Authors: Szalai M, Lévay, Szirmai A, Papp I, Prémusz V, Bódis J.

+  Read the abstract on PubMed

January 2015: Wishes for a year of greater capacity in cancer nursing research

Elisabeth Patiraki of the EONS Research Working Group shares her hopes for the coming year.

At the New Year celebrations, people share greetings. We welcome the new year with hope and plans to face the forthcoming challenges with creativity and productivity.

At the dawn of 2015, as a member of the EONS Research Working Group, my wish is that all cancer nurse researchers will keep caring through research and enjoy research challenges.

I also wish that the cancer nursing community as a whole will:

  • Acknowledge the value of research in clinical practice
  • Be aware of research findings
  • Discuss research issues with well-informed colleagues
  • Have more time to read research
  • Be able to read and interpret research studies
  • Have the authority to make changes in practice
  • Have adequate time and resources to implement new ideas
  • Be supported by administrators, colleagues and physicians
  • Cooperate with staff willing to change, or try new ideas
  • Achieve higher self-efficacy in research
  • Not only follow new guidelines but develop and implement them
  • Collaborate with other nurses, patients and carers as partners in all stages of the research process
  • Use creative methods of dissemination
  • Participate in multi-centre studies
  • Participate in determining the direction of the research agenda in cancer care

I strongly believe that everyone of us can contribute in filling the research-practice gap in cancer care.

2015 can be a year of progress, improvement, better use of human and material resources, actualization and effective application of science and technology in cancer care.

To fulfill this expectation we all have to be more proactive.

  • Researchers in cancer nursing should act responsively towards the needs of practicing nurses and clinical nurses to use research findings in improving their practice and effectiveness
  • Evidence-based care should be a work setting priority for managers who will be supporting nurses in their research efforts
  • Cancer nursing research should have more planning and strategic direction
  • Nurses should value research evidence in clinical practice - everyone can be responsible for using evidence.

Cancer nursing research can become a vehicle for change toward professional growth and improvement in the quality of patient care.

EONS and its Research Working Group are driving this forwards.


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