International Cancer Nursing News
QUARTERLY NEWSLETTER VOLUME 25 NUMBER 4 2013
ISNCC registered as a charity in US
On behalf of the ISNCC Board of Directors, I am pleased to announce that ISNCC has obtained tax-exempt status in the United States read more »
Call for abstracts for 18th ICCN
Please submit an abstract for the 18th International Conference on Cancer Nursing to be held in Panama in September 2014 read more »
Addressing cancer disparities in Central and Eastern Europe
ISNCC partnered with the Bristol-Myers Squibb (BMS) Foundation to conduct the 2013 Grantee Summit read more »
Volunteering to deliver cancer nursing education in Central America Loyda Braithwaite tells of her experiences of bringing oncology nurse education to Honduras with Health Volunteers Overseas read more »
EONS lifetime achievement award 2013 Shelley Dolan received the European Oncology Nursing Society Lifetime Achievement Award from outgoing EONS President read more »
Applying the case management model for patients with oral cancer in Taiwan In Taiwan lung cancer is the third most common cancer and has the highest mortality rate read more »
Developing a guide to assist in the use of the MASCC oral agent teaching tool
Oral agents for cancer treatment are commonly prescribed throughout the world. Since oral agents usually are self-administered read more »
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ISNCC registered as a charity in US On behalf of the ISNCC Board of Directors, I am pleased to announce that ISNCC has obtained tax-exempt status in the United States of America, under section 501c3 of the Internal Revenue Code. ISNCC is now a recognised public charity in the US. A few years ago, the ISNCC Board of Directors became aware of the complications associated with its charity registration in the United Kingdom. In particular, this registration required audit and financial filing in the UK, although ISNCC has not had an administrative office in the UK for many years. The board then extensively researched international charity registration options and confirmed that registration in the United States was most appropriate for ISNCC — in particular as a result of decreased audit fees, decreased exchange fees, and to access additional philanthropic funding. During the due diligence process, the ISNCC Board of Directors con-
firmed that a USA charity registration would allow ISNCC access to additional funds. The achievement of the ISNCC mission relies on extensive funding from external entities, including corporate and philanthropic funds. ISNCC has a consistent and successful record of international activities that impact communities by advancing the knowledge and skills of international cancer nurses. We have accomplished this through financial partnerships with corporations and other cancer funding organisations. On July 24, 2013, the ISNCC full members met at a duly noticed and held meeting with a quorum present, and resolved that it is in the best interests of the society to transfer its assets and undertaking to the new USA charity and to acknowledge that the members will become the full members of the new charity. Further, the full members resolved to dissolve the ISNCC UK Charity as of July 31, 2013.
As a result of this meeting, ISNCC no longer is a UK registered charity, and has transferred all assets and activities to a new registered charity in the USA. This is a very exciting change for ISNCC that has been a long time coming. It should be noted that this charity change will have no effect on your membership or other activities with the society, but rather it will only benefit the financial status of the organisation. We look forward to this new chapter for ISNCC! Greta Cummings, ISNCC president
Advertise in the ISNCC newsletter International Cancer Nursing News is distributed to over 11,000 cancer nurses worldwide. Advertising in ICNN will allow you to market directly to your target demographic. For further information on this exciting opportunity, please contact the ISNCC Head Office at firstname.lastname@example.org or by phone on +1 604 630 5516.
Call for abstracts for 18th ICCN in Panama 2014 Please submit an abstract for the 18th International Conference on Cancer Nursing to be held in Panama in September 2014. There are four categories: administration/leadership development, clinical/evidence-based practice, education, research. The scientific planning committee would like abstracts, where possible,
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to reflect the concepts of compassion, humanisation, and diversity to address disparities in cancer care worldwide. Abstracts may be submitted in either English or Spanish. If you would like more information on the abstract topics or the format required before you submit an abstract then please go to our call for abstracts webpage. The deadline for abstract submission is January 16, 2014. Abstracts can be submitted here.
ESTAMOS ya está aceptando abstractos!
La Sociedad Internacional de Enfermería Oncológica (ISNCC) le invita a enviar su abstracto para ser presentado en la 18 va Conferencia Internacional de Enfermería Oncológica Fortalecimiento del liderazgo, unidad y compasión en el tratamiento del cáncer. Haga clic aquí para instrucciones en Español
Board of directors President, International Society of Nurses in Cancer Care Greta Cummings Canada President elect Brenda Nevidjon US Secretary/Treasurer Janice Stewart Canada Chair of the Editorial Committee Winnie So Hong Kong, China
Trustees Yael Ben Gal, Israel Esther Green, Canada Catherine Johnson, Australia Linda Krebs, US Tish Lancaster, Australia ISNCC Secretariat email: email@example.com tel: +1 604 630 5516, fax: +1 604 874 4378 375 West 5th Avenue, Suite 201 Vancouver, BC V5Y 1J6 Canada
Editor Kathryn Godfrey 11 Chesholm Road, London N16 0DP, United Kingdom email: firstname.lastname@example.org All correspondence should be addressed to the editor. http://www. isncc.org Published on behalf of the International Society of Nurses in Cancer Care by: Malachite Management Inc. 375 West 5th Avenue, Suite 201 Vancouver, BC V5Y 1J6 Canada ISSN 09565175
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Addressing cancer disparities in Central and Eastern Europe The 2013 Grantee Summit brought together cancer health professionals to address how to tackle cancer disparities and to build increased capacity ISNCC partnered with the Bristol-Myers Squibb (BMS) Foundation to conduct the 2013 Grantee Summit — Addressing Cancer Disparities in Central and Eastern Europe. This was held in Amsterdam on September 25–26, 2013, as a preconference event to the 17th ECCO European Cancer Congress. The 2013 Grantee Summit was an outstanding success for both BMS Foundation and ISNCC. The 2013 Grantee Summit was planned in partnership with the European Oncology Nursing Society (EONS). The aim of this conference was to support an audience of experienced cancer healthcare professionals from across Eastern Europe — including the 2011 and 2012 BMS Foundation Bridging Cancer Care grantees — to learn from leaders in addressing cancer disparities, and collaborate with others to build increased capacity for healthcare professionals and their communities.
The overarching goal of the conference was to encourage delegates to build capacity by learning from both leaders and each other via collaboration. The overall objectives of the 2013 Grantee Summit — Addressing Cancer Disparities in Central and Eastern Europe were to: share experiences and learnings
on addressing cancer disparities and thereby build capacity — via keynote presentations from international leaders, presentations from all 2011 and 2012 Bridging Cancer Care grantees and networking activities to allow for individual discussion of issues; build the leadership skills of cancer healthcare professionals and thereby mobilise communities — via roundtable discussions on integrative topics and educational workshops on evidence-based practices. In addition to 2013 Grantee Summit activities, attendees were also registered for the 17th ECCO European Cancer Congress, to allow the opportunity for extensive further learning. Invited delegates of the 2013 Grantee Summit included representatives from all 2011 and 2012 Bridging Cancer Care grantees, leaders from cancer organisations currently working in Central and Eastern Europe, identified international leaders in addressing cancer disparities, and identified international leaders in topics associated with evidence-based practice. As a result of attending the 2013 Grantee Summit, all delegates were able to learn internationally success-
ful techniques for addressing cancer disparities, meet collaborators working to address cancer disparities and obtain leadership skills necessary for conducting programmes and mobilising communities. In addition to excellent project presentations from the 2011 and 2012 Bridging Cancer Care grantees, the programme included many lectures from international leaders – including: Keynote: evolution of nursing in Europe — Birgitte Grube, President, EONS. Resources session: UICC International Cancer Technology Transfer Fellowships (ICRETT) programme — Cora Honing, Director of Information and Support, Dutch Cancer Society. Resources session: maximising EONS membership — Birgitte Grube, President, EONS. Keynote: nurse empowerment — Shelley Dolan, Chief nurse, Royal Marsden NHS Foundation Trust. London, UK. Expert panel: policy and advocacy – Wendy Yared, Director, Association of European Cancer Leagues, Julie Torode, Deputy CEO, Union for International Cancer Control, and Casimiro Dias, Technical Officer, World Health Organisation. Skills Building Workshop: Communication and Advocacy — Paul George and Chad Hyett, Porter Novelli Communications. Nurse leadership session — Greta Cummings, President, ISNCC. The outcomes of the 2013 Grantee Summit will help lead to a stronger community-based health care worker capacity, integrative medical care and community based supportive services, and mobilisation of communities to fight disease. These aims direct related to both the ISNCC and BMS Foundation missions. These outcomes will serve as the basis for continuing to build capacity and address cancer disparities in Central and Eastern Europe.
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Attendees of the 2013 Grantee Summit held in Amsterdam
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Volunteering to deliver cancer nursing education in Central America Loyda Braithwaite tells of her experiences of bringing oncology nurse education to Honduras with Health Volunteers Overseas My interest in cancer care began early in my professional career. During undergraduate nursing studies in Panama I performed clinical practices at the Panamanian National Oncology Institute. Since then, I knew oncology was my calling. While practicing as a registered nurse in the United States, I have had many opportunities to acquire the latest knowledge and evidence-based practices in cancer care nursing. However, I was aware that there are several limitations that impede nurses in developing countries to access these resources. Even though I had a strong desire to share these opportunities with my colleagues in developing countries, I had not been able to reach this goal. When I read about Health Volunteers Overseas (HVO) and their International Cancer Corps programme in conjunction with the American Society of Clinical Oncology (ASCO), I was thrilled with the idea of volunteering in oncology nursing education. In June 2013 I had the opportunity to be part of the team made up of a physician, two nurses and an administrator from ASCO that travelled to Honduras. After reviewing nursing educational needs identified by previous volunteers in Honduras, the team developed new educational material. The teaching sessions were focused
on chemotherapy safety, blood products administration, symptom management, assessment skills, interdisciplinary communication, and palliative care. The first day we toured around Hospital San Felipe, Tegucigalpa, Honduras which was very helpful to assess the educational needs of the nurses. During this time I met with the oncology chief nurse, the charge nurses for the inpatient and outpatient areas, the director of the blood bank, two oncology pharmacists, and some of the medical oncologists. This initial activity was very helpful to reassess the current nursing educational needs, in addition to identify availability of resources, and to recognise other topics of interest such as nursing skills training and incorporation of teamwork. The oncology nursing education programme was presented in two daily sessions from Tuesday to Friday, to allow nurses from all shifts to be able to attend. The first lecture was about improving communication among caregivers. The importance of providing high quality communication between members of the health care team and its positive effect on patient outcome was discussed. This presentation was followed by Chemotherapy Safety Administration, part one. This session
Oncology nurses at Hospital San Felipe during a presentation of “Chemotherapy Safety Administration”
included: the importance of using personal protective equipment, the risks for health care personnel, routes of contamination; chemotherapy storage and labelling, safe techniques for chemotherapy administration, verification of patient before and during the administration of chemotherapy. I also discussed procedures and presented the Oncology Nursing Society’s protocol for accidental chemotherapy spill. The third day in Honduras was dedicated to educating nurses about the importance of physical assessment and its clinical value in the decisionmaking process. The lecture was dedicated to this topic since it was identified as a major educational need of nurses at all levels. Due to cultural, societal and traditional roles, physical assessment as well as wound care and pain management is done by medical students and medical residents. The importance of physical assessment was explained. An example of normal assessment and a review of techniques used during the assessment (observation, palpation, and auscultation) were performed. Thursday’s lecture was on blood administration. It explored basic concepts of blood administration and discussed similarities as well as differences between Hospital San Felipe and general standards in the United States. The role of nursing through the process, the management of transfusion-related complications, and the importance of standardisation of blood management protocols in health care institutions were covered. On Friday, I presented two lectures. These were Chemotherapy Safety Administration, part two and a lecture covering the basics of palliative care. Because the administration of chemotherapy is done purely on empirical
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Feature information and without any type of training, nurses were lacking evidencebased knowledge regarding: different routes of administration, types of infusions, types of medication, the role of nursing in the prevention and management of chemotherapy-related complications. I also discussed basic elements in the administration of chemotherapy, the role of nurses in the prevention and management of complications such as irritation, extravasation, and anaphylaxis as well as evidence-based nursing interventions for each scenario. The presentation on palliative care was well received by the audience. The main focus was to present the general concept of this specialised area of care that seeks to alleviate the suffering and provide quality at the end of life. I discussed the importance of palliative care in the dying process, the recommendations for its initiation, elements included in palliative care such as: symptom management, communication, comfort, respect, privacy, sensitivity and compassion, the role of nursing. Finally, the group discussed professional experiences with dying patients and the social, clinical, and cultural limitations to providing quality of care at the end of life.
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Left to right: Honduran nurse demonstrating physical assessment skills taught by HVO nurses: Roberta Beiso (sitting) and Loyda Braithwaite (far right)
After a week of daily teaching sessions, I believe our contribution to the education of oncology nurses in Honduras was effective and well received. As a team, I believe we provided valuable information targeting their educational needs. However, as stated in their final evaluation, oncology nurses are in a great need of more education about chemotherapy and blood transfusions, palliative care, and physical assessment. After practicing nursing in two different countries, cultures, and languages, I was able to identify with some of the limitations of the Honduran nurses. The restricted educational mate-
Loyda Braithwaite (left) and a group of Honduran oncology nurses at Hospital San Felipe, Tegucigalpa, Honduras
rial in Spanish, the lack of institutional resources, the absence of continuing education, and an unclear definition of the scope of nursing were aspects that I had experienced in my own professional career before moving to the Unites States. However, I think this was a positive experience for the trainees because we were able to connect not only through the Spanish language, but through the struggles and frustrations we all experienced due to the lack of knowledge and resources. I felt that my major contribution was to empower nurses, strengthening their professional confidence, and provide them with basic knowledge that will open new opportunities and solidify their careers as nursing professionals. However, this was just a small step in the development of well-prepared oncology nurses who are able to use their knowledge and professional skills to improve the care of patients and families affected with cancer. I also enjoyed being able to offer these educational sessions in the nurses’ primary language — Spanish. Volunteering in Honduras has been a great experience in my professional career. Through oncology nursing education, HVO and ASCO are making a great impact in the development of health professional across the world, and I am proud to be part of it. Loyda Braithwaite, Nurse Clinician Chemotherapy Services, University of Wisconsin Hospital and Clinics, Carbone Cancer Center, Madison, US
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Research and news
EONS lifetime achievement award 2013 Shelley Dolan (centre) received the European Oncology Nursing Society Lifetime Achievement Award from outgoing EONS President Birgitte Grube (left) and EONS Board Member Mary Wells (right) at the 2013 European Cancer Congress in Amsterdam. Shelley, a previous ISNCC board member, has been working in the field of oncology nursing for over two decades, inspiring and leading other nurses to strive for better care. Currently chief nurse at the Royal Marsden NHS Foundation Trust, UK, her career highlights include developing the largest critical care unit in the UK and the first clinical leadership course for cancer nurses in South Africa.
Outcomes of applying the case management model for patients with oral cancer in Taiwan Background
In Taiwan, cancer is one of the leading causes of death, and oral cancer is the number five cause of cancer death. Based on the latest report of the Taiwan National Cancer Registry, over 6,500 new cases of oral cancer are diagnosed per year, with approximately 2,249 deaths per year, and the incidence may be increasing. Overall, oral cancer constitutes about 7% of all malignancies. Oral cancer is the fourth most common malignancy in males, and is associated with lower socioeconomic status and heavy betel nut use and smoking. These interacting factors raise concerns that head and neck cancer (HNC) patients may have particular need of interventions but be less likely than other cancer patients to participate and be compliant with treatment (Fillion et al, 2009; Kagan, 2009; Newton, 2010). Effective management of patients for oral cancer requires an interdisciplinary team in which the case manager is considered as the key member. The case manager may:
• monitor patients’ health status, • manage symptoms and side effects, • educate patients and family members, • coordinate care and referrals
to other clinicians and services (Goodwin et al, 2003). In order to improve the quality of cancer diagnosis and care, the cancer centre at National Cheng Kung University Hospital (NCKUH) has adopted a case
Figure 1: Indicators that were used for evaluation
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Research Data collection
management model for cancer patients since 2004. But the outcome of this case management model in our centre had not yet been explored. Moreover, there was no native study about the effect indicators of case management in the past.
The purpose of this study was to evaluate the indicators of case management, analyse the effectiveness of implementing the case management care model on oral cancer patients, and to identify the effective indicators of case management for oral cancer. Figure 1 shows indicators that were used for evaluation
This was a retrospective study design to evaluate the effectiveness of case management model on oral cancer care in a medical centre in Taiwan.
Table 1 shows that the average length of hospitalisation was 22.26 ±11.74 days in 2009 and 19.84 ± 9.91 days in 2010. Although the average length of stay in 2010 was 2.42 days less than that in 2009, the difference was statistically insignificant (p = 0.224). We calculated the length of stay only on patients who underwent radical surgery with reconstruction, because they always needed multidisciplinary cooperation, such as ENT,
Characteristics of the sample
Data was collected from the case management databases, patients’ medical charts, and the patient/staff satisfaction scales of NCKUH. The satisfaction scale included questionnaires on how satisfied were the patients and medical team members with the case manager. Each question had a scaled response of 1–5, with 1 corresponding to “very unsatisfied” and 5 corresponding to “very satisfied”. Cronbach α was used to examine the internal consistency of the questionnaires; the alpha values were 0.87 and 0.95 respectively.
Population: patients who were diagnosed with oral cancer (ICD9:140-146) in NCKUH in Southern Taiwan in 2009–2010. Accessible population: recruited from NCKUH cancer report databases.
Table 1: The length of hospital stay of oral cancer patients Year
Length of stay
Table 2: The average in patient/staff satisfaction level Year
Staff satisfaction level
Patient satisfaction level
Table 3: The other performance indicators of oral cancer case management model Year
Continue treatment rateb
Complete treatment rate
Loss follow up rate
a Loss follow up rate: cases who fail to return in 15 months (excluding deceased cases) divided by the total number (in case manager program) of cases in a year b Continue treatment rate: patients who were diagnosed with oral cancer and started treatment in the hospital divided by the number of total diagnosed patients at NCKUH in Taiwan. c Complete treatment rate: the number of patients who had received and completed the whole treatment plan (including surgery, radiotherapy and chemotherapy) at NCKUH divided by the total number of patients who had received treatment at NCKUH in Taiwan.
dental and plastic surgery. We also needed speech and language therapists and dieticians to take care of the patients. The role of the case manager was to facilitate communications between these disciplines. Table 2 shows the average score in patient/staff satisfaction levels. Staff satisfaction levels were 4.75 and 4.68 in 2009 and 2010, but patient satisfaction levels were 4.2 and 4.25 respectively. Further study is needed to examine the gap between staff and patient outcomes. Table 3 shows the other performance indicators of the oral cancer case management model. The followup loss rate reduced from 2.58% to 2.11%, and the rate of continuing treatment increased from 85.49% to 89.88%. Although the treatment complete rate decreased slightly, it was still over 90%.
The results showed that average length of hospitalisation in 2010 was less than that in 2009 by 2.42 days, the followup loss rate reduced by 0.47%, and the rate of continuing treatment increased 4.39%. However, the case enrol rate, treatment complete rate and satisfaction were all decreased when compared with that in 2009. The results can help us review the case management care model and provide us with a direction to improve quality of care for oral cancer patients and the health care system. The experience and results of this study would serve as preliminary reference for relevant native studies in the future. Chen-Lin Lin1, Mei-Chih Huang2, Jia-Ping Chang1, Yi-Lin Wu1 1= Nursing Department of National Cheng Kung University Hospital, Tainan, Taiwan, ROC 2= Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC References
Fillion L et al (2009). Professional patient navigation in head and neck cancer. Seminars in Oncology Nursing, 25(3), 212-221. Goodwin JS et al (2003). Effect of nurse case management on the treatment of older women with breast cancer. Journal of the American Geriatrics Society, 51 (9):1252-1259. Kagan S J (2009). The influence of nursing in head and neck cancer management. Current Opinion in Oncology, 21, 248-253. Newton JT (2010). Reactions to cancer: Communicating with patients, family and carers. Oral Oncology, 46, 442-444.
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Developing a guide to assist in the use of the MASCC oral agent teaching tool Oral agents for cancer treatment are commonly prescribed throughout the world. Since oral agents are usually self-administered or administered by lay caregivers, patient education is vital to help ensure that the oral agents are being stored, handled, and taken correctly. When oral agents are taken as prescribed and patients are well informed about signs and symptoms to report, patient outcomes are optimised. Patient education varies globally; consequently, there is a need for a consistent and comprehensive approach to educate patients about oral cancer treatment. In August 2007, a basic tool, the Multinational Association for Supportive Care in Cancer (MASCC) Oral Agent Teaching Tool (MOATT©), was written by six nurse experts. The tool was reviewed by a pharmacist and nurse coordinators for comprehensiveness, accuracy, and cultural sensitivity. The MOATT© contains four sections (Table 1). The tool has been implemented in nine countries; translated and adapted into thirteen languages, all available on www.mascc.org.
The MOATT© provides a structured format to ensure all key areas of patient assessment and teaching are addressed. It allows for individualisation of teaching and uses evidencebased tenets in patient education. The MOATT© has been recognized as a useful tool which has been cited in articles, used in research and quality improvement projects, and as an easy assist in patient education. Evaluations revealed that, while it is popular and appreciated, the MOATT© was underutilised. Feedback suggested that what was needed was better marketing and a user guide to serve as an introduction and to assist in how to use the MOATT©, giving examples. Three of the original experts and the new education group chairperson reviewed the content for the guide. This was further conceptualised by
Table 1: The MOATT© sections and their contents I: Key assessment questions To assess the patient’s knowledge of the treatment plan, current medications, and ability to obtain and take an oral cancer agent II: Patient education General patient teaching instructions applicable to all oral cancer agents (storage, handling, disposal, system to remember, actions to take if here are problems) III: Drug-specific information Used to provide drug-specific information (dose and schedule, side effects and potential interactions) IV: Evaluate Questions that may be asked to ascertain understanding of the information provided An additional page is added as a hand-out of drug-specific information that can be given to the patient in the absence of any other prepared information
a team of MASCC members from the study group who became directly involved in the development, dissemination, application and evaluation. The content of the user guide includes: a patient education tutorial, background about the development of the MOATT©, four case studies from four countries that demonstrate clinical application, two abstracts concerning the tool’s use in research, a copy of the tool, sample adapted education templates (courtesy of Dana Farber from Boston, US), samples of abstracts and posters presented at conferences. The user guide can be downloaded from http://www.mascc.org/assets/ documents/moatt_userguide.pdf at no cost. We ask that MASCC be notified should it be used in research. Sultan Kav, Baskent University Faculty of Health Sciences, Department of Nursing, Ankara, Turkey; Judi Johnson, HealthQuest, Minneapolis, USA; Cynthia N Rittenberg, Rittenberg Oncology Consulting, New Orleans, USA; Manon A Lemonde, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; Linda Barber, PPD, INC, Ocean Isle Beach, USA
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Kav S et al (2010). Development of the MASCC teaching tool for patient receiving oral agents for cancer. Supportive Care in Cancer, 18(5): 583–90. DOI: 10.1007/s00520-009-0692-5 Rittenberg C (2012). Meeting educational needs and enhancing adherence of patients receiving oral cancer agents through use of the MASCC oral agent teaching tool©. European Oncology & Haematology, 8(2): 97¬100
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Published on Dec 10, 2013