On behalf of the Nominations and Awards Committee, it is my great pleasure to announce the outcomes of the election for two Executive and three Director Portfolio positions on the ISNCC Board of Directors.

President Elect: Lena Sharp, Head of Department, Regional Cancer Center Stockholm-Gotland, Sweden

Lena Sharp, RN, PhD, is the Head of Department at The Regional Cancer Centre, Stockholm-Gotland, in Sweden. She is the former President of EONS, former chair of EONS advocacy working group and the project leader for the PrEvCan initiative. Lena has been a cancer nurse since 1985. She has long experience in clinical cancer nursing, leadership, teaching and research.

Prior to taking up her post at the Regional Cancer Centre, Lena Sharp was the chief nursing officer and patient safety coordinator at the Department of Oncology at Karolinska University Hospital. Her main focus areas in cancer nursing research are patient safety, communication, leadership, prevention, inequalities and cancer care organisation. She has experience in leading cancer prevention work, regionally, nationally and internationally, with particular focus on cancer related inequalities. Lena and her team received the 1st Health care equality award in Stockholm in 2018. In 2021 Lena was awarded The Robert Tiffany Award in cancer nursing and EONS Life-time Achievement Award.

Secretary / Treasurer: Catherine Johnson, Medical Oncology Clinical Nurse Consultant, Calvary Mater Newcastle, NSW Australia

Catherine Johnson is a clinical nurse and her career in cancer care spans 34 years; specialising in oncology and clinical trials. Catherine is the Clinical Nurse Consultant in Medical Oncology at Calvary Mater Newcastle; where she provides expert clinical advice and consultancy to patients, carers and other health care professionals within cancer services. Catherine is a past board member of the Cancer Nurses Society of Australia (CNSA), the International Society of Nurses in Cancer Care (ISNCC) and the Editorial Board for the Australian Journal of Cancer Nursing. Catherine has a special interest in cancer care in low and middle income countries and has served as the project lead for the ISNCC Cervical and Breast Cancer Prevention and Screening Train the Trainer Project in Latin America and the Breast Aware: A train the trainer programme for nurses in Africa.

She has a strong interest in equity of access to efficient cancer services for patients with cancer. Other key interests include the health and wellbeing of Aboriginal and Torres Strait Islander peoples, supportive care and quality of life issues in cancer care and ensuring nurses and staff are adequately equipped to deliver quality care to meet the needs of their patients. She is also involved with a number of oncology projects on symptom management and supportive care as both principal investigator and co-investigator.

Communications Portfolio: Yuhan Lu, President of Oncology Nursing Committee of Chinese Nursing Association; Director of Nursing Department of Peking University Cancer Hospital

Ms. Yuhan LU, Associate Professor of Nursing, Director of Nursing Dept.,Peking University Cancer Hospital. She has been dedicated to cancer nursing for nearly 30 years and has rich experience in the field of cancer nursing and nursing management. She is also a Board Member of the Asian Oncology Nursing Society, President of Oncology Nursing Committee of the Chinese Nursing Association and the Beijing Nursing Association, Vice Chairperson of Oncology Nursing Committee of the China Anti-Cancer Association. She also serves as an editorial board member and reviewer for many nursing journals. Over the past years, she has made outstanding contributions to promoting the communication and development of oncology nursing on national level in China.

Conference Management Portfolio: Suzanne Bishaw, Lecturer at Curtin University - Unit Coordinator for Undergraduate nursing units located in Perth and Mauritius. Lecturer Post-graduate nursing education in Perth and Singapore.

Suzanne Bishaw is a dedicated educator and leader in nursing education, currently serving as a Lecturer at Curtin University, where she coordinates undergraduate nursing units in Perth and Mauritius and lectures on post-graduate nursing education in Perth and Singapore.

In her role as Chair of the Conference Management Portfolio, Suzanne has successfully led the organization and delivery of both face-to-face and online international conferences in 2021, 2022, and 2023. Her ability to navigate the unique challenges of each year, coupled with her commitment to continuous learning and improvement, underscores her capability to lead a diverse team of volunteers globally. Suzanne's dedication and expertise make her an invaluable asset to the ISNCC Board of Directors.

Policy & Advocacy Portfolio: Julia Downing, CEO, International Children's Palliative Care Network (ICPCN); Professor of Palllative Care, Makarere University, Uganda

Julia Downing is a distinguished leader in cancer and palliative care, with over 30 years of dedicated service to the International Society of Nurses in Cancer Care (ISNCC). She began her journey by presenting her first paper on the role of nurses in radiotherapy at an ISNCC conference and has since been an active participant. Julia's notable achievements include winning the ISNCC Robert Tiffany Lectureship Award in 2014 for her impactful work in Uganda and sub-Saharan Africa.

In her roles within ISNCC, including Chair of the Policy and Advocacy Committee, Julia has significantly influenced the development of key position statements and strategic policy initiatives. Her extensive international policy experience includes contributions to the World Health Assembly resolutions on palliative and cancer care and co-authoring the Lancet Commission report on palliative care and pain relief. Julia’s strong global network and collaborative approach make her an essential link in promoting ISNCC’s goals and fostering international partnerships.

The successful candidates will take up their board positions for a four-year term starting this month. They join other continuing members of the Board, including:

• Winnie So, President, China
• Lisa Kennedy-Sheldon, Membership Portfolio Director, United States
• Dorothy Chan, Knowledge Development & Dissemination Portfolio Director, China
• Josephine Visser, Corporate & Philanthropic Portfolio Director, United States

ISNCC wishes to thank and recognize outgoing members Patsy Yates, Linda Watson and Yongyi Chen for their leadership and outstanding contributions to the society over the past four years or more.

On behalf of the Board of Directors, congratulations to all new and continuing board members and we look forward to bringing news and exciting updates in future.

Author: Agnes Nonyem Anarado (PhD Nurs; RN, RM, RNE, FWAPCNM, MEMBER, AORTIC), Prof of Nursing (Rtd) Department of Nursing Sciences, University of Nigeria Nsukka, Enugu Campus

The International Society of Nurses in Cancer Care (ISNCC) was established in 1984 with a vision to lead the global nursing community in cancer control and a mission to maximize the influence of nursing to reduce the global burden of cancer. To actualize her vision and achieve her mission to foster the development of cancer nursing internationally, ISNCC established a donor sponsored travel grant scholarship programme. This Travel Grant scholarship enabled me attend the 2023 ICCN conference in Glasgow UK.

What/Who made the conference attendance possible? ”it’s Divine favour with humans as instruments”. First, the ISNCC Executive Board decision that the 2023 ICCN) conference shall be physical after three years virtual conferences. The only action I initiated was a joint abstract written and submitted with my supervisee for oral presentation at the conference. The abstract was accepted which qualifies us to apply for a travel grant. However, my co-author declined to be the abstract presenter and/or apply for the travel grant as she was not disposed to attend. I accepted both, and was awarded the travel grant scholarship. My perceived pencils in God’s hand that effected required actions were: ISNCC executive, abstract co-author, abstract shortlisting and Travel Grant selection committees’, the Travel Grant donor and the International conference Secretariat (ICS) that executed the Grant plan. The scholarship enabled my physical presence/presentation at this conference the accepted co-authored abstract entitled "Nurses Experiences of Compassion Fatigue in a Comprehensive Cancer Centre". I met face-to-face the ISNCC project team members I have been working with virtually, on "Breast Aware: A train the trainer programme for nurses in Africa", led by Catherine Johnson. I was also privileged to present at the conference the successful phase one report of the project with her. I was also privileged to witness the presentation at the conference another collaborative project on development of Africa Oncology Nursing Competencies, involving ISNCC and other national/international nursing associations’ members under AORTIC –Nursing Special Interest Group (SIG) of which I am a member. These Africa focused projects attest ISNCC mission to maximize the influence of nursing to reduce the global cancer burden in Africa.

I also appreciate the wealth of knowledge/experience gained from attending the Travel Grant Awardees’ invited meetings, highly educative Scientific/plenary/break-out sessions and the opening/closing ceremonies social events. The large number of young attendees especially from Asian countries and their presentations highly impressed me.

I thank the ISNCC Executive, Board of Directors, Conference Organizers, Sponsors, especially my Travel Grant sponsor, Attendees and all who assisted in driving forward the oncology nursing leadership worldwide in line with ISNCC vision. I enjoin fellow awardees to shout a loud ‘THANK YOU” The conference activities and travel couldn’t have been that exciting/stress-free without us all.

The way forward: I will:

1. offer the required nursing leadership support in mentorship, practice, education and research to drive the Breast Aware: TOT in Africa
2. lobby Boards of Nursing for inclusion of Breast Aware as a mandatory Continuing Professional Development (CPD) programme for nurses.

Thank you

Breast Aware: A Train the Trainer Program for Nurses in Africa

The ISNCC Breast Aware Train-the-Trainer program for nurses in Africa was shortlisted for the Vanessa Moss prize at the Global Cancer Control: Bridging boundaries conference at the Royal College of Physicians London UK in November. This was presented by Vera Samba, project nurse representative from Cameroon.

The ISNCC Breast Aware project aims to design and deliver training on early diagnosis of breast cancer including health awareness messages and clinical breast examinations in Cameroon, Ghana, Nigeria, Tanzania and Uganda. These aims are being accomplished in the following ways:

• Holding focus groups in each country to develop content that addresses the specific needs, barriers and available resources for their country.
• Facilitate design changes needed for each country to ensure materials are culturally sensitive.
• Develop high quality educational materials for training other nurses including a trainer’s guide.
• Provide mentorship to nurse leads in each country to deliver training events.
• 

This project seeks to contribute directly to the development of nurse leaders and strengthen their capacity to improve breast cancer control across all facets of the healthcare system. Participants of the program will use their skills, knowledge and acquired resources to train other nurses in their local communities to improve understanding of prevention, early detection, screening, and supportive care for women at risk of breast cancer in resource poor countries.

On November 17, 2023, the CACA Integrated Nursing Summit, hosted by the Chinese Anti-Cancer Association and organized by Tianjin Medical University Cancer Hospital, Tianjin Anti-Cancer Association, and China Institute for Integrated Medicine Development Strategy, was held in Tianjin, China. The theme of this conference was "Innovation Leadership, Integration for Mutual Benefit".

In 2012, Academician Fan Daiming, the Chairman of the Chinese Anti-Cancer Association, first proposed the concept of integrated medicine, marking the beginning of the era of integrated medicine in cancer prevention and treatment. In 2023, the Chinese Anti-Cancer Association established the Integrated Nursing Professional Committee. Academician Fan Daiming, the Chairman of the Chinese Anti-Cancer Association, was appointed as the Chair of the Integrated Nursing Committee, and Director Qiang Wanmin from the Nursing Department of Tianjin Medical University Cancer Hospital was appointed as the Executive Chair. During this nursing summit, Professor Qiang Wanmin, guided by the concept of integrated medicine, innovatively proposed the concept and connotation of integrated nursing. Director Qiang pointed out that integrated nursing is supported by precision nursing and evidence-based nursing as scientific and technological foundations. It is an extension and expansion of holistic nursing. "Integration" is not simply about stacking resources together, but about appropriately matching them. It requires both a holistic perspective and artistic skill. By leveraging digital and intelligent technologies, integrating multidisciplinary knowledge, techniques, and resources, it aims to provide optimized and personalized integrated care for cancer patients, achieve maximum benefits for patients, and attain the best rehabilitation outcomes.

Professor Patsy, past president of the International Society of Nurses in Cancer Care and executive dean of Queensland University of Technology Centre for Healthcare Transformation, shared a special report on "Advances in Symptom Management". She emphasized that the core strategies of symptom management lie in integrating patient-reported outcomes, applying genomics to cancer symptom management, designing personalized symptom management plans, and implementing chronic disease management service models.

Professor Winnie K.W. So, a professor at the Nethersole School of Nursing, The Chinese University of Hong Kong, a fellow of the American Academy of Nursing, and currently the President of the International Society of Nurses in Cancer Care (ISNCC), delivered a keynote presentation titled "Call to action: build and strengthen global oncology nursing leadership". The presentation emphasized the need for effective leadership in oncology nursing to address the current global burden of cancer, shortage of nursing personnel, and challenges posed by the digital health era. Professor Winnie launched ten initiatives for oncology nursing leadership, aiming to collaborate and achieve mutual success in the future.

Karen Kane McDonnell, PhD, RN, Associate Professor*; Amanda Bennett, MSN, RN, Vera Bratnichenko, MSN, RN, Fattona Umari, BA, BSN, RN, PhD Students; and Ella Weinkle, MSN, RN, Research Associate 

Cancer Survivorship Research Center, College of Nursing, University of South Carolina, Columbia, SC 29208, United States

*Corresponding author: Karenkm@mailbox.sc.edu

A lack of management of anxiety and depression are associated with diminished quality of life and increased mortality. Both symptoms are underrecognized and undertreated.1

Integrative oncology is a growing field of cancer care. It is a patient-centered, evidence-based field of supportive cancer care that utilizes integrative therapies such as mind-body practices, acupuncture, massage, music therapy, nutrition, and exercise in collaboration with conventional cancer treatments. Patient interest and utilization has been growing in popularity over several decades. Clinical research has shown the benefits of some of these approaches to improving symptom management and quality of life. The availability of these integrative oncology programs at cancer centers and in communities is also growing, though it is still highly variable from location to location along with program structure and implementation.1

• A joint effort between the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO) reviewed the evidence and made recommendations about therapies targeting adults with cancer experiencing symptoms of anxiety and/or depression.1,2 The recommendations were developed based on a comprehensive review and analyses of the research literature.2 The literature search from 1990 to 2023 identified 110 relevant studies (30 systematic reviews and 80 randomized control trials).2 Most importantly, these new recommendations can guide clinicians as to which interventions will be most effective in helping their patients. 

  The following four questions guided the review:

• 1.     What integrative therapies are recommended for managing symptoms of anxiety experienced after diagnosis or during active treatment in adults with cancer?
• 2.     What integrative therapies are recommended for managing symptoms of anxiety experienced post-treatment in adults with cancer?
• 3.     What integrative therapies are recommended for managing symptoms of depression experienced after diagnosis or during active treatment in adults with cancer?
• 4.     What integrative therapies are recommended for managing symptoms of depression experienced post-treatment in adults with cancer?2

• The guideline development process was detailed. An international, multidisciplinary, 18-person expert panel, which included a patient representative, and two doctorly-prepared nurses were responsible for providing critical review and finalizing the guideline. BRIDGE-Wiz software, the GuideLines into Decision Support (GLIDES) methodology, the Cochrane risk-of-bias tool, and the AMSTAR 2 instrument were used to measure the quality of the evidence (rated as High, Intermediate, Low, or Insufficient) and the strength of a recommendation (Strong, Moderate, or Weak).3-5

  Twenty-one recommendations regarding therapies are included in the guideline. The following four recommendations were the only ones rated as Strong:

• 1.     Mindfulness-based interventions (MBIs) should be offered to people with cancer to improve anxiety during active treatment. 
• 2.     MBIs should be offered to people with cancer to improve anxiety post-treatment. 
• 3.     MBIs should be offered to people with cancer to improve depression during active treatment. 
• 4.     MBIs should be offered to people with cancer to improve depression post-treatment. 

Even though the review of MBIs provided the strongest evidence, other types of interventions provided sufficient evidence to inform the recommendations. Those interventions included aroma therapy, acupuncture, expressive writing, hypnosis, music therapy and music-based interventions, reflexology, relaxation techniques, acupuncture, tai chi, qigong, and yoga.2

Other interventions provided inconclusive evidence for informing recommendations, revealing many gaps in the existing evidence base and demonstrating the need for more research. Studies testing acupressure, dance and movement therapy, dietary supplements, healing touch, therapeutic listening, laughter therapy, light therapy, massage, natural products, nutritional interventions, and psilocybin-assisted therapy were included in this category.2

Survivors with cancer use integrative (sometimes referred to as complementary) therapies to help manage side effects and symptoms.

Guideline Implementation

Guidelines are developed for implementation across health-care settings around the world. However, many barriers can slow dissemination. A team approach—in which clinicians partner with expert mindfulness practitioners and translational researchers in their respective settings—may improve the chances of successful implementation. 

Due to the evidence base gaps (i.e., not enough studies conducted that could be considered in the review), the expert panel was not able to make recommendations for many supportive care modalities. The panel specifically recommended that more research be conducted with populations other than women with breast cancer, in contexts other than metastatic disease, and among people from diverse backgrounds. 

Read the full joint SIO-ASCO Clinical Practice Guideline for Integrative Oncology Care of Anxiety and Depression in Adults with Cancer at either link below:

SIO website: https://integrativeonc.org/practice-guidelines/guidelines

www.asco.org/survivorship-guidelines

References

• 1.     Semeniuk, G., Bahadini, B., Ahn, E., Zain, J., Cheng, J., Govindarajan, A., Rose, J., & Lee, R. T. (2023). Integrative oncology and the clinical care network: Challenges and opportunities. Journal of Clinical Medicine, 12(12), 3946. https://doi.org/10.3390/jcm12123946
• 2.     Carlson, L. E., Ismaila, N., Addington, E. L., Asher, G. N., Atreya, C., Balneaves, L. G., Bradt, J., Fuller-Shavel, N., Goodman, J., Hoffman, C. J., Huston, A., Mehta, A., Paller, C. J., Richardson, K., Seely, D., Siwik, C. J., Temel, J. S., & Rowland, J. H. (2023). Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO Guideline. Journal of Clinical Oncology, 41(28), 4562–4591. https://doi.org/10.1200/JCO.23.00857
• 3.     Shiffman, R. N., Michel, G., Rosenfeld, R. M., & Davidson, C. (2012). Building better guidelines with BRIDGE-Wiz: Development and evaluation of a software assistant to promote clarity, transparency, and implementability. Journal of the American Medical Informatics Association, 19(1), 94–101. https://doi.org/10.1136/amiajnl-2011-000172
  
  
• 4.     Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L., & Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, d5928. http://doi.org/10.1136/bmj.d5928    
• 5.     Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., & Henry, D. A. (2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 358, j4008. http://dx.doi.org/10.1136/bmj.j4008

Disclosure: Karen Kane McDonnell is supported by the American Cancer Society under award number MRSG-17-152-01. The content is solely the responsibility of the authors and does not represent the official views of the American Cancer Society.

From September 29 to October 2, 2023, the International Conference on Cancer Nursing (ICCN2023) was held in Glasgow for four days. The theme of the conference was "Building Global Excellence in Nursing, Achieving Excellence in Cancer Care," and it was divided into four main themes and five sub-forums. Leading cancer care experts from the UK, USA, Australia, China, Japan, South Korea, Singapore, and other countries in Africa gathered to discuss the latest developments in cancer care.

During the conference, the Palliative Care Committee of the Chinese Nursing Association and the Palliative Care Committee of the Chinese Anti-Cancer Association donated more than 30 books in Chinese and English, including "Palliative Care: A Technical Guide for the Integrated Diagnosis and Treatment of Cancer in China." These donation provided strong support for and promoted the development of global palliative care.

Through this international Cancer Nursing Conference, the influence of the Palliative Care Committee of the Chinese Nursing Association has been further enhanced. We expect that palliative scholars from around the world will actively participate in the practice and research of palliative care, contributing to the further development of palliative care in our country.

by: Roselyne Anyango Okumu

ISNCC Travel grant scholarship recipient (2023) 

President - Oncology Nurses Chapter- Kenya

The International Society of Nurses in Cancer Care (ISNCC) was founded in 1984 with a vision to lead global nursing communities in cancer control. ISNCC works towards improving the health and well-being of people at risk of living with cancer through leadership development, supporting the development of cancer nurses around the world, and promoting nurses' role in improving cancer care delivery. The Executive committee included Prof Winnie So- President, Patsy Yates -- Past president, and Linda Watson - Secretary/Treasurer.

The ISNCC Nominations and Awards Committee granted me a full travel scholarship to participate in the International Conference on Cancer Nursing 2023 (ICCN 2023) in Glasgow, UK, 29 September– 2 October 2023. The scholarship program was established to further the mission and vision of the ISNCC to foster the development of cancer nursing internationally. The planning process was smooth air travel and accommodation organized by the ISNCC secretariat, my stay in Glasgow was very interesting. I enjoyed the sumptuous dinner themed on Scottish culture and the dance.

The experience at ICCN was unmatched as I followed the proceedings, I learned a lot from the research, best practices, and experiences of nurses across the globe. It was also exciting to learn about progress made in nursing education across the globe as well as to identify gaps and explore possibilities of continuous improvement in cancer care. Indeed, these aligned very well with the conference theme of Building Global Nursing Excellence for Tomorrow’s Cancer Realities. Additionally, the networking with colleagues was very exciting accompanied by meeting some people that we have depended on reading their research papers and articles to inform practice in my home country was very inspiring.

I also attended the ISNCC General meeting where I got great insights, especially on what it takes the leadership to manage operations at such a high-level institution. I was also delighted to know that the Oncology Nurses Chapter Kenya (ONC-K) has now become a member of ISNCC. I also learned a lot about what is happening around the globe and the need to have ISNCC global citizens. We were pleased to meet some of the ISNCC board members and the leadership and to learn from them. As I come back home, I am thrilled to know that we have an organization that we can look up to for mentorship in order to prepare ourselves to better handle future challenges in cancer care across the continuum.

I am very grateful for this opportunity to participate in this year's presentation on the status of cancer in Kenya; and the role of oncology nurse. It pleases me as the ONC-K leader that one of our mem- bers was granted the past president award in line with her contributions to cancer care. We look forward to building the relationship further as we learn and empower the nurses.

It was such a pleasure attending this conference and am continually indebted to ISNCC for this. I will endeavor to share the knowledge gained with my colleagues as we seek to improve the quality of cancer care. I will be willing to take up any role assigned to me by ISNCC in furtherance of its agenda. Please allow me to invite you to come and visit Kenya and see what we are doing at various institutions and at ONC-K as we seek opportunities to collaborate.

Thank you

Author: Yongyi Chen, Boyong Shen, Junchen Guo

Affiliations: Hunan Cancer Hospital; Palliative Care Technology Training and Guidance Base of Hunan Province

The inaugural meeting of the Hunan Palliative Care Remote Multidisciplinary Collaborative Alliance was successfully held in Changsha, China on March 10, 2023. More than 300 representatives from 93 medical institutions from within and outside Hunan Province attended this conference.

Professor Yimin Zhu, Deputy Director of the Health Commission of Hunan Province, delivered a keynote speech. He stressed that the development of palliative care in Hunan Province needs the joint efforts of the whole province to achieve common progress and benefit more patients, and hoped that the Hunan Palliative Care Remote Multidisciplinary Collaborative Alliance would spare no effort to promote palliative care with high starting point planning, high standard promotion, high efficiency implementation, and high-quality implementation.

Professor Yazhou Xiao, President of Hunan Cancer Hospital, pointed out that the Hunan Palliative Care Remote Multidisciplinary Collaborative Alliance is in line with the overall development healthy, and is based on the current situation of the ageing population and high incidence of cancer. Hunan Cancer Hospital will shoulder the mission and play a leading role to further comprehensively improve the quality of life of end-stage patients.

Professor Winnie So, President of the International Society of Nurses in Cancer Care, joined the conference online. She said that the establishment of the Hunan Palliative Care Remote Multidisciplinary Collaborative Alliance is a model for the provision of high-quality palliative care. The collaboration of multidisciplinary experts can have a synergistic effect so that more patients in need of palliative care can live the last journey of life in peace, comfort and dignity without regrets.

The conference formally established Hunan Cancer Hospital as the presiding unit of the first Hunan Palliative Care Remote Multidisciplinary Collaboration Alliance; Professor Lihui Zhu, the deputy secretary of Hunan Cancer Hospital, as the chairman of the alliance; and Professor Yongyi Chen as the chief expert. 8 hospitals were included as the vice-chairman institutes, and 84 hospitals were included as the committee institutes.

The establishment of the Hunan Palliative Care Remote Multidisciplinary Collaborative Alliance shows that palliative care work in Hunan has reached a new stage. As a next step, the Alliance will gradually improve the palliative care service system and standardise the industry standards in Hunan.

World Cancer Day is coming up on February 4th and the ISNCC Board of Directors are pleased to mark the date by releasing a video series and forum on the critical role of nursing leadership in closing the cancer care gap.

These videos explore the role of nurse leaders and examine strategies to accelerate nursing leadership developing. Presentations are delivered by outstanding nursing leaders in cancer control who share examples of how nursing leadership is applied at the system and organizational levels to close the cancer care gap.

Visit the video series page by clicking on the button below and we invite you to share your ideas and ask questions in the public discussion forum.

GO TO VIDEOS AND DISCUSSION FORUM

Author: Kathryn Ciccolini DNP, AGACNP-BC, OCN, Mount Sinai Hospital

Allogeneic hematopoietic stem cell transplantation (AlloSCT) is potentially a curative treatment for various hematologic malignancies. Patients referred for evaluation for an AlloSCT to the bone marrow transplant (BMT) program at Mount Sinai Hospital (MSH) are immediately evaluated for donor availability. The process of a donor search is multifaceted requiring a specialized and highly unique skillset. At MSH, our group of transplant nurse coordinators and administrative donor coordinators have extensive training and are one of the very few members in the hospital who perform this exceptionally rewarding patient care coordination. Although, identifying a donor is not so straightforward, let’s delve behind-the scenes to learn more.

Basics of HLA and Transplantation

There are many factors that can influence transplantation outcome, one of which is an absolute pre-requisite and a paramount criterion for an alloSCT, donor-recipient histocompatibility (matching of donor and recipient human leukocyte antigen [HLA] protein). In short, HLA proteins are cell-surface inherited proteins found on the major histocompatibility complex (MHC) and play a major role in the immune defense system’s ability to identify self from non-self (NMDP 2021). The most pertinent genes for transplantation belong to MHC Class I (HLA-A, HLA-B, and HLA-C), and MHC Class II (HLA-DR, HLA-DQ, and HLA-DP) (Furst et al, 2019). Detailed HLA typing is used to determine match grade between recipient and donor and donor eligibility. Matched HLA allows for engraftment and reduces the risk of graft-versus-host disease (GVHD) and graft rejection. It is also the most consistent, predictive factor for outcome post HSCT from unrelated donors (Petersdorf, 2016). Donors can be related or unrelated as the source of stem cells resulting in several possible approaches for transplantation. Related donors can either be full match or half match thus siblings, children, parents and even second degree relatives can be considered (NMDP 2022; Sugita, 2019). While an HLA-identical matched sibling donor remains the preferred stem cell source for allogeneic stem cell transplantation, only 30% of patients clinical situation meet this standard leaving the remaining 70% requiring further exploration in other donor sources emphasizing the importance of volunteer donor registries such as National Marrow Donor Program (NMDP) (Ayuk, & Balduzzi, 2019; Petersdorf, 2016; Sugita, 2019). Factors to consider for a successful transplant beyond HLA are donor age, CMV status, cell dose, donor sex, pregnancy history, ABO compatibility, and the presence of donor specific HLA antibodies (DSA) (Ayuk, & Balduzzi, 2019).

Related Donors

At the initial BMT clinic visit, the patient (recipient) is extensively educated on the donor search process for their transplant and is assessed for their initial HLA lab markers by blood test. The recipient completes a family information sheet which is used to arrange initial HLA related donor HLA blood testing. The selection of related donors per recipient can vary with sometimes having over ten options, all of which the interdisciplinary team manages simultaneously. The HLA results of both recipient and donor(s) are compared to assess their match degree. All potentially qualified donors are notified and assessed for willingness to voluntarily donate to share the results with the recipient. The prospective donors are screened for eligibility and suitability by a transplant physician (who is not primary physician of the recipient) and nurse coordinator which includes a comprehensive history and physical evaluation, infectious disease screening and educational session on modes of donation (bone marrow harvest and peripheral blood stem cell), collection process, and medical clearance. Once a donor is identified, and donation stem cell source preference is established by the clinical team and donor, they are brought to the apheresis center for a tour, the nurse coordinator arranges mobilization therapy, addresses central venous catheter requirements, and organizes their collection.

Unrelated Donors

However, when a related donor search is not feasible or did not yield a potential donor, the nurse coordinators initiate a preliminary search through the NMDP, a national resource for facilitating unrelated donor and cord blood stem cell transplants. This is the only organization in the USA that matches unrelated volunteer donors, arranges collections and transportations of stem cells, manages collection and analysis of multi-center data on both donor and cord blood unit (CBU) process, stem cell donation side effects, patient transplant outcomes, and histocompatibility, and maintains a research sample repository (NMDP 2021). Preliminary searches are often proactively done in tandem of conducting related donor searches in the circumstance a suitable related donor is not found. This search identifies potential unrelated stem cell donors and CBU representing a “snap shot’ of potential matches at a given time which can help shape a recipient’s treatment plan. When potential donors are selected from this search after thorough collaborative clinical team discussion, the search is formalized by requesting confirmatory HLA testing on identified potential unrelated donors. The coordinators work closely with NMDP case manager on unrelated donor workup, eligibility and clearance domestically, nationally, and internationally requiring consistent follow up and assurance of donor medical clearance. Once the donor is identified and cleared, the team works with the NMDP case manager on the donor collection, delivery of cells to MSH requiring tremendous logistical coordinator with NMDP, recipient, family, our Cell Therapy Lab, and other members of the BMT program.

Challenges with Donation Coordination

Besides the inherently complex process from donor identification to recipient transfusion, there are many donor-related challenges the coordinators address including physical symptoms and often moral distress. Donors may experience feelings of ambivalence, grief, anguish, fear, pressure in being responsible for the recipient’s outcomes, feeling pressured (Gutierrez-Aguirre et al. 2021). The coordinators are heavily relied upon to demystify the process of what it means to be a donor, address psychosocial concerns, dispel misconceptions of donation, educate on expected adverse events associated with donation, and could be faced with donors with religious conviction or occupational barriers (Garcia et al, 2013; NMDP 2022). Further, the coordinators face challenges with donors living in remote areas with limited access to medical care, communicating with donors who are in different time zones and in different languages, governmental import and export restrictions for international donors, and travel limitations for donors with visa issues. A large majority of the donors registered in the database are of Western European ancestry impeding HLA match access for certain ethnic origins (Tiercy, 2016). Our geographic location and the diversity of New York City complicates finding a well-matched related or unrelated donor resulting in exploration of alternative donors allowing for greater degree of mismatch.

Final Thoughts

It takes up to an estimated ten hours per recipient to perform preliminary searches, formalize donor searches to clear and collect a donor, and coordinate cell delivery to MSH and recipient admission given exquisite and meticulous logistical coordination and attention. Between 2020 and 2021, 469 related donors were typed requiring coordination of HLA testing and counseling on donor matches and process. I hope this article sheds light on the value of a strong donor search coordination program and the highly unique skills needed to provide quality care within our bone marrow transplant and cellular therapy program at Mount Sinai Hospital. 

References

Ayuk, F. & Balduzzi, A. (2019). The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies [Internet]. 7th edition. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK554000/

Furst, D., Neuchel, C., Tsamadou, C., Schrezenmeier, H., & Mytilineos, J. (2019). HLA Matching in Unrelated Stem Cell Transplantation up to Date. Transfusion Medicine and Hemotherapy, 46(5), 326-336.

Garcia, M.C, Chapman, J.R., Shaw, P.J., Gottlieb, D.J, Ralph, A., Craig, J.C., & Tong, A. (2013). Motivations, Experiences, and Perspectives of Bone Marrow and Peripheral Blood Stem Cell Donors: Thematic Synthesis of Qualitative Studies. Biology of Blood and Marrow Transplantation, 19(7), 1046-1058.

Gutierrez-Aguirre, C.H., Jaime-Perez, J.C., de la Garza-Salazar, F., Guerrero-Gonzalez, G., Guzman-Lopez, A., Ruiza-Arguelles, G.J., Gomez-Almaguer, D., & Cantu-Rodriguez, O.G. (2021). Moral Distress: Its Manifestations in Healthy Donors during Peripheral Blood Hematopoietic Stem Cell Harvesting. Transplantation and Cellular Therapy, 27(10), 853-858.

National Marrow Donor Program (2021). Manual of Operations Chapter 2: NMDP Search and Matching Process. Retrieved from https://network.bethematchclinical.org/transplant-centers/policies-and-protocols/tc-manual-of-operations/

National Marrow Donor Program (2022). HLA Matching. Retrieved from: https://bethematch.org/

Petersdorf, E.W. (2016). Mismatched Unrelated Donor Transplantation. Semin Hematol, 53(4), 230–236.

Sugita, 2019. Allogeneic hematopoietic stem cell transplantation for hematological malignancies: an algorithm for donor selection. Rinsho Ketsueki, 60(6), 626-634.