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.

Tiercy, J. (2016). How to select the best available related or unrelated donor of hematopoietic stem cells? Haematologica, 101(6), 680-687.

About this ICCN Scholarship Series Blog

In February 2022 ICCN held their second virtual conference, Building Sustainability & Resilience: Global Perspective on Cancer Nursing. ICCN was a three-day event culminating in Plenary 4 simply titled Building Sustainability & Resilience. It was a series of interviews with nursing leaders including ISNCC President Patsy Yates, International Council of Nurses, CEO Howard Caton and European Oncology Nursing Society, President Johan de Munter plus cancer nurses from Afghanistan and Ethiopia discussing the challenges that are facing oncology nurses tasked with providing cancer and palliative care across diverse cultures. This was a highlight of the conference as it showcased the strength and fortitude of nurses who have continued to provide the best possible care during COVID19 pandemic and in some regions war and political challenges. I am pleased to present M. Asif Huassainyar a nurse leader from Afghanistan who was a speaker in plenary 4 and also a recipient of a scholarship from Canadian Oncology Nurses Society [CANO] who writes this blog.

Suzanne Bishaw
ISNCC Chair ICCN Portfolio

Experiences of attending the International Conference in Cancer Nursing (ICCN2022)

Author: Mohammad Asif Hussainyar, Nursing Instructor, Aga Khan University Academic Projects Afghanistan and Board Member Afghanistan Cancer foundation

In Afghanistan, there is not any speciality in nursing including oncology nursing. The nurses who are working in the oncology wards are General Nursing Diploma graduates with few training opportunities in oncology. In Afghanistan there is only one oncology ward in one of the tertiary hospitals with two regional chemotherapy centres in Herat and Mazar Provinces.

The workload caring for oncology patients including those with palliative care needs, is increasing day by day, likely due to borders being closed as a consequence of COVID-19 pandemic and the sudden collapse of government and continuity of care.

The concept of Palliative Care in Afghanistan is new and few nurses have the knowledge and skills to provide palliative care in for people with cancer and other conditions. However, palliative care was added for the first time to the General Nursing Diploma Programme in 2020.

As a BSc Nurse who has the experience of one of the premier hospitals and a renowned university (Aga Khan) and a board member of the Afghanistan Cancer Foundation, I am a great advocate for palliative care for those in need. Moreover, I acknowledge the knowledge and skills of those nurses working in the oncology ward need support.

I appreciate the kind words and fellowship of organisations such as the International Society of Nurses in Cancer Care (ISNCC) in bringing together the International Conference in Cancer Nursing which I found extremely valuable; it is important for nurses to discuss and debate trends in oncology nursing.

This is a call to action to members of the national and international nursing organizations working in health and in particular, in cancer, to support the Afghanistan Nursing Society and also include cancer and palliative care in their curricula as appropriate.  This will lead to a cadre of specialist oncology nurses.  Find out about your global scholarships, visiting fellowships and shared training  - all for nurses in Afghanistan to scale up their knowledge and skills.

Thank you.

Asif

Authors: Karen Kane McDonnell PhD, RN, Associate Professor, Co-Director, Cancer Survivorship Research Center; Amanda R. Bennett MSN, RN, PhD Student; & Vera Bratnichenko MSN, RN, PhD Student; College of Nursing, University of South Carolina, Columbia, SC, United States

November brings awareness to individuals living with lung cancer and their family members and friends. Regardless of the prognosis, a diagnosis of lung cancer creates substantial physical, emotional, and financial challenges on individuals, families, communities, health systems, and countries.¹ Lung cancer continues to be the most common cancer type and the leading cause of cancer death worldwide. Around the globe, the general cancer burden is high and increasing.¹ The highest incidence rates of lung cancer are observed in parts of North America, in East Asia, and in parts of central and eastern Europe.¹

There is good news which fosters HOPE! The number of new lung cancer diagnoses is declining steadily in some countries. The American Cancer Society describes trends in cancer death rates as the best measure of progress against cancer. In the United States, lung cancer death rates declined by 56% since 1990 in men and 32% since 2002 in women. These improvements in lung cancer survival are due to declines in cigarette smoking and advances in early detection and treatments, mostly for non-small cell lung cancers (NSCLC) the more common classification of lung cancer (NSCLC; 82%).² In recent years, more individuals with lung cancer are being diagnosed when the cancer is at an early stage and living longer as a result. The rate of localized-stage disease diagnoses increased by 4.5% yearly from 2014 to 2018, while there were steep declines in advanced disease diagnoses. The result was an overall increase in 3-year survival rates (from 21% to 31%).^2.3

It is widely accepted that the major cause of lung cancer is tobacco smoking, which is responsible for 80–85% of lung cancer cases worldwide. The World Health Organization describes tobacco use as a global epidemic.⁴ Tobacco smoke contains more than 7000 chemicals and at least 69 carcinogens, including polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, and benzene. About 8 out of 10 (81%) deaths from lung cancer are expected to be caused from smoking cigarettes. Both the amount and how long someone smokes increase the risk of dying from lung cancer. People who smoke are about 25 times more likely to develop lung cancer than those who never smoked. Second-hand smoke causes almost 3% of new diagnoses of lung cancer and is expected to cause about 3% of deaths. After smoking, the next leading cause of lung cancer is exposure to radon gas, which is released from soil and can build up indoors. Relative to the hazards of smoking cigarettes and cigars, the full hazard profile presented by electronic nicotine delivery systems (NEDS) and by cannabis smoking are largely unknown at this time.^2,3,4

Chronic obstructive pulmonary disease (COPD) is the most common smoking-related illness in the world and the most common co-morbidity for persons with lung cancer. Even though, it is well established that COPD is associated with the risk of lung cancer it is often under-emphasized as a comorbidity for those with lung cancer.⁵ Clinically, the co-existence of lung cancer and COPD can have a dramatic impact on the patient’s quality of life (QOL) and survival.⁵

Optimal treatment of concurrent lung cancer and COPD is crucial to the success of lung cancer therapy. Oncology and advanced practice nurses can play an essential role in these patients’ care, which requires early and close attention to prevention, assessment, treatment, and surveillance of both diseases, related symptomatology, and lifestyle behaviors. Patients with lung cancer and COPD benefit from a multidisciplinary disease management approach throughout their illnesses to ensure maximum QOL and functional status. In collaboration with a team that includes pulmonologists and oncology physicians, oncology nurses can help improve these patients’ health outcomes using pharmacologic and nonpharmacologic treatments and symptom management. More clinical research is needed to expand our understanding of the management of patients with this twofold disease burden, to increase the use of existing evidence-based interventions, and to develop, and test new QOL-boosting interventions.⁵

The outlook is more promising than ever for individuals with lung cancer at all stages of disease with and without COPD. Around the world, nurses who care for persons with a history or current diagnosis of lung cancer can make a positive impact. The Position Statement on Cancer Nursing’s Potential to Reduce the Growing Burden of Cancer Across the World describes nurses as “essential” to cancer control.6 The Call to Action is clear. It is our role as nurses to reduce the global burden of cancer across the cancer trajectory. 

References:
1.    Wild, C. P., Weiderpass, E., & Stewart, B. W. (Eds.) (2020). World Cancer Report: Cancer Research for Cancer Prevention. International Agency for Research on Cancer. http://publications.iarc.fr/586.

2.    Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2022). Cancer statistics, 2022. CA: A Cancer Journal for Clinicians, 72(1), 7–33. https://doi.org/10.3322/caac.21708

3.    American Cancer Society. (2022). Cancer Treatment & Survivorship Facts & Figures 2022–2024.

4.    World Health Organization. (2021). WHO Report on the Global Tobacco Epidemic, 2021: Addressing new and emerging products. World Health Organization.

5.    Newsome, B. R., McDonnell, K. K., Hucks, J., & Estrada, R. D. (2018). Chronic obstructive pulmonary disease: clinical implications for patients with lung cancer. Clinical Journal of Oncology Nursing, 22(2), 184.

6.    Yates, P., Charalambous, A., Fennimore, L., Nevidjon, B., So, W. K., Suh, E. E., Woodford, E. Young, A. (2020). Position Statement on Cancer Nursing’s Potential to Reduce the Growing Burden of Cancer Across the World. Cancer Nursing, 43(6) 433-435. doi: 10.1097/NCC.0000000000000900

Disclosure: An American Cancer Society (ACS) Mentored Research Scholar Grant support Dr. Karen Kane McDonnell [#MRSG-17-152-01].

Authors:
Ya-Ting GAO RN, MN 1,2 ; Yan LOU PhD, Associate Professor 1 ; Ying LIN RN, MN 1 ; Shuai-Ni LI RN, MN 1,3 ; Mei-Rong HONG RN, BN 1 ; Yu-Lu XU RN, BN 1 ; Wei YU RN, BN 1
1.  School of Nursing, Department of Medicine, Hangzhou Normal University
2.  Sir Run Run Shaw Hospital (SRRSH), School of Medicine, Zhejiang University
3.  The Children's Hospital, School of Medicine, Zhejiang University


Cancer-related fatigue is a long-lasting and distressing symptom for CRC patients, and it would exhibit a detrimental effect on their quality of life. Physical activity could relieve fatigue, and aerobic exercise combined with resistance training can maximize the fatigue-relieving effect. Nevertheless, it has been challenging in promoting combined aerobic exercise and resistance training among CRC patients, especially training for improving lower limb flexibility, muscular strength, and endurance.1 Novel strategies are needed to enable these individuals to monitor their physical activity levels, encouraging them to set goals to achieve adequate physical activity levels for themselves. Mobile-health was suggested to be a desirable platform to administer physical activity program for this purpose.2

We conducted a study that aimed to design and implement a combined aerobic exercise and resistance training program for CRC patients with fatigue via a mobile-health platform. Overall, our twelve-week exercise program involved a combination of aerobic exercise and resistance training, and it was supplemented with flexibility exercises. Progressive increase in the frequency, intensity, duration and volume of the exercise have been introduced as the participants progressed through the program. The core elements of personalized intervention included an individualized goal setting, autonomous habit training, staged professional guidance and targeted interactive encouragement. The feasibility and applicability of the mobile-health-based personalized exercise management program for CRC patients with fatigue were also evaluated.

This study was conducted using a multi-step approach.

Step 1:  Development of the exercise movement library
Four exercise guidance movement libraries were established . Specific movements included: (i) the dynamic stretching movement library; (ii) the aerobic exercise movement library; (iii) the resistance training movement library (iv) the static stretching movement library. The combination of these movements forms three progressive aerobic exercise and resistance training sets.

Step 2:  Digitization of intervention program
We used multi-media technology including audio, video, and motion graphics to present the program and make it adaptable to the mobile-health platform.

Step 3: Evaluation of intervention program
Face-to-face or virtual expert consultation method were used to evaluate the feasibility and applicability of the program. Seven experts with a professional background of human kinesiology or nursing care for CRC patients validated the applicability of the exercise management program, and the suitability of movement library for CRC patients. These experts provided feedback and comments on the ways to improve the program.

Step 4: Design of the mobile-health platform
WeChat Mini Program was selected as the mobile-health platform for the presentation of the exercise management program. An iterative interactive process was used. The research team and the software designers held six rounds of face-to-face interviews, and online communications were also established with them, where the technical aspects of presenting the program via the mobile-health platform were discussed and sorted.  

Step 5: Preliminary test
Twenty CRC inpatients and their families were invited using a purposive sampling method to evaluate the WeChat Mini Program. Face-to-face semi-structured interviews were used to collect the qualitative data on the patients’ experience and feedback in using the WeChat Mini program. The thematic analysis method was used to extract themes from the data.

Overall, the development and implementation of the personalized exercise management program for colorectal cancer patients with fatigue appeared to be feasible. CRC patients and their families who participated in this program perceived that the WeChat Mini Program, “Huì Dòng” (Smart Exercise), was easy to use. Program content was suitable and beneficial for them to do exercises, and almost all of participants expressed willingness to continue using it, although two were concerned about the low potential of long-term adherence to the program. The WeChat Mini Program could be improved from the perspective of optimized format design, such as the use of light color background in the video, the incorporation of oral interpretation into the motion graph, and enhancement of cognition education on exercise. Further cohort studies should be conducted to evaluate its effect on the level of physical activity, the relief on CRF, self-efficacy in exercise and quality of life.



Figure: The Resistance Training Program-Beginning Level.

References

1. Nakagawa H, Sasai H, Tanaka K. Physical Fitness Levels among Colon Cancer Survivors with a Stoma: A Preliminary Study. Medicina (Kaunas). 2020 Nov 10;56(11):601. doi: 10.3390/medicina56110601.

2. Cheong IY, An SY, Cha WC, et al. Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy. Clin Colorectal Cancer. Jun 2018;17(2):e353-e362.

Haiqin Hu, MMed, Department of Thyroid Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences

Oral cancer is a malignant tumor occurring in the oral cavity. Currently, surgical resection is still the major treatment strategy for oral cancer, but undergoing such treatment may lead to a repertoire of postoperative conditions such as bacterial imbalance, a condition that involves an imbalance of health-promoting and pathogenic bacteria in the gastrointestinal tract. This may have an adverse effect on the prognosis and quality of life of patients after surgery. The perioperative care requirements of oral cancer patients are different from those of patients of other diseases, which demands proficiency of the nurses in their professional practice. At present, there is still a lack of corresponding evidence-based practice of oral care in China. To enhance the quality of life of people with oral cancer, a set of care standards for oral cancer management needs to be developed. To facilitate this, we conducted a review on the evidence-based practice of oral care for oral cancer patients, with the aim to develop, based on the JBI evidence-based health care model, a set of scientific and standardized evidence-based oral care practice program that can guide clinical nursing staff for increasing the efficacy of oral cancer care that they can deliver. This may help provide a more scientific and effective decision-making basis for clinical nursing practice in oral care.

To start off, we first established a research team, consisting of nursing professors, medical specialists in head and neck, clinical psychologist, dietician rehabilitation nurse specialist. The team members conducted a review in order to summarize and evaluate the literature that reports oral care programs currently practiced worldwide. PubMed, Cochrane Library ,Web of Science , the National Comprehensive Cancer Network (NCCN) and the Oncology Nursing Society (ONS) were used in the literature search, using a combination of keywords including oral cancer, oral care and perioperative. In our search, we retrieved four articles for inclusion in this review, including three practice guideline papers and one systematic review paper (Adelstein et al., 2017; Cervenka et al., 2019; Dort et al., 2017; Joo et al., 2019). Upon the retrieval of these articles, we conducted a summary of the evidence presented in these articles, and an evaluation on their suitability in clinical practice. The collected evidence was then summarized narratively in our review, presenting the latest evidence-based practice for perioperative oral care of patients with oral cancer. Recommendations on the care practice were classified into six major themes, including perioperative oral care rehabilitation, behavioral habits, psychology, flap care, nutrition, and pain.

According to the included evidence and the preliminary investigation, the possible obstacles in the implementation of oral care practice were also analyzed. We finally established the final draft of perioperative oral care practice plan for oral cancer patients, including an action plan and a flow chart of this plan (Figure 1).

In order to scientifically and effectively establish an evidence-based practice plan for perioperative oral care for patients with oral cancer, we also carried out a survey among current oral cancer patients. After review of the survey data, we found that current oral care practice does not involve the medical staff to evaluate the oral function of patients before surgery, to guide patients to quit smoking, nor to use skin temperature detectors to monitor the oral flap temperature of patients after surgery.

Overall, our review and survey have highlighted the importance of the evaluation of preoperative and postoperative oral function, nutrition, pain and psychological status among patients, the provision of rehabilitation training to patients, as well as the guidance for them to quit smoking and excessive alcohol consumption.


References
Adelstein D, Gillison ML, Pfister DG, Spencer S, Adkins D, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, et al. NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017. J Natl Compr Canc Netw. 2017; 15(6): 761-770.

Cervenka B, Pipkorn P, Fagan J, Zafereo M, Aswani J, Macharia C, Kundiona I, Mashamba V, Zender C, Moore M. Oral cavity cancer management guidelines for low-resource regions. Head Neck. 2019; 41(3): 799-812.

Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, Simon C, Uppington J, Zygun D, Ljungqvist O, et al. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society. JAMA Otolaryngol Head Neck Surg. 2017; 143(3): 292-303.

Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, et al. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol. 2019; 12(2): 107-144.

Figure 1. Flowchart of perioperative oral care plan for patients with oral cancer.                             

Author: Huiting Zhang, MSN., RN; Case Manager, Head Nurse, Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China


Breast cancer patients having undergone curative treatment, including surgery, chemotherapy and radiation therapy, often face problems upon returning to work .after completion of such treatments. For example, the function of the affected limbs may not have fully recovered after surgery, while nausea and vomiting caused by chemotherapy may affect the patients’ adaptability to work. In addition, hair loss as a result of chemotherapy may lead to a tendency of the patients to avoid facing their colleagues. These patients would also face a repertoire of psychological issues as a result of the treatment, which may potentially have negative effect on their attitudes towards returning to work. A better understanding on the factors that would hamper and facilitate the patients to return to work after cancer treatment is needed, in order to address the psychological issues that contribute to the patients’ reluctance to return to work. Therefore, we conducted a qualitative study that explores the psychological changes and influencing factors of breast cancer patients having completed their curative treatment and were returning to work during the rehabilitation period. Study findings may provide a basis for constructing individualized interventions that facilitate patients to return to work.

We used a phenomenological approach to conduct this study. Ten breast cancer patients who were either receiving endocrine therapy or having completed all curative treatments, who have returned to work or were planning to return to work, were recruited. Semi-structured interviews were conducted with the patients to explore their views upon returning to work, and the factors that may encourage or hamper them from doing so.

Two themes were generated from the interview data. The first theme pertains to the journey of the breast cancer patients in promoting their mental health when they returned to work. The journey has three phases. First, ‘Avoid and surround themselves’, where the patients showed a low willingness to return to work when they were still at the early stage of treatment. Second, ‘Forget the past, set sail again, when they would try to let go of their pain and illness, accept the reality and resume their work, after a period of recovery at post-treatment. Finally, ‘grasp today and harvest the future’, where the patients who had returned to work, after a period of adjustment, could work as normal, believing that their illness had brought unexpected benefits, while feeling satisfied with their job, and being hopeful and optimistic for their future. The second theme involves the factors affecting breast cancer patients' return to their work after completing their treatment. Economic pressure, work ability and experience, the correct mentality in the face of the illness, the pursuit of social values, and social support were identified to be the stimulating factors for patients to return to work, while work pressure was found to be a hindering factor.

Indeed, the process for patients to return to work is dynamic, where the patients’ feelings would change over the course of rehabilitation from their illness. They will have different attitudes towards returning to work at different times. Returning to work can help to forget the pain of their illness, improve their self-value, and return to a normal life. In the future, medical staff should carry out relevant interventions that address the influencing factors of patients returning to work. For example, rehabilitation volunteer groups may be set up, where the patients can receive social support from the medical staff, enabling the patients to maintain positivity and optimism during their rehabilitation.

Authors:

Liyan Zhang (Registered Nurse) 1; Jieyuan Cai (Master Student) 1; Hong Sun (Doctor of Medication) 2; Lin Shen (Doctor of Medication) 1
1 The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China 2 Department of Intergrative Medicine & Geriatric Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China;
*Corresponding author: Hong Sun

Regorafenib is a novel, oral anticancer agent used in cancer treatment. Despite its known benefit in improving survival among cancer patients, it was reported to induce hand–foot skin reaction (HFSR) in patients . HFSR is characterised by numbness, tingling sensation, swelling, desquamation, ulceration, hyperkeratinized or pain in hands and feet. It significantly affects the quality of life (QOL) of patients, even upon dose reductions or treatment discontinuation. Currently, the methods for managing HFSR include moisturization, avoiding friction or chemical injury, or drug dose adjustment, although these treatments have limited efficacy. Traditional Chinese medicine (TCM) is useful in skin-related symptoms by regulating internal imbalance, promoting skin wound healing, relieving pain, anti-inflammatory. However, there is no clinical studies to confirm the effect of TCM in alleviating HSFR.

In view of this, we conducted a study that aimed to investigate whether a compound traditional Chinese medicine (CTCM) oil would alleviate HFSR induced by regorafenib, in order to enhance the physical function and quality of life of cancer patients on a regorafenib treatment regime.

The study involved 85 patients with metastatic colorectal cancer presenting with HFSR. These patients were divided into the control group (n = 42) and the intervention group (n = 43). The HFSR among the control participants was managed as keeping skin moisture, avoiding friction or chemical injury and using pain killers or other medication following doctors’ order. The intervention participants was treated with a CTCM oil comprising five selected herbs which can alleviate skin swelling, pain, injury anti-inflammatory, eventually promoting skin repair and wound healing . This oil generally works by regulating immune functions and the molecular pathways leading to inflammation. The oil was given to the intervention participants for external application twice daily for two weeks. To evaluate the effect of the application of this CTCM oil, we compared the HFSR remission rate and quality of life (QOL) between the two groups of participants at post-intervention (two weeks after the start of intervention).

Our data support that CTCM oil application is effective in the treatment of HSFR and improving the well-being of the patients. Notably, the post-intervention HFSR remission rate was significantly higher among participants in the intervention group than those in the control group (65.1% vs 16.7%; p < 0.01) indicating that the use of the CTCM oil can alleviate the severity of HFSR among the patients. Consistent with this, participants in the intervention group also experienced lower levels of pain caused by the inflammatory events associated with HFSR (p < 0.01). Besides, the oil significantly improved patients’ physical function such as walking and grabbing stuffs, emotional function as depression and the social function as social activities. (p < 0.05). Overall, our data demonstrated that the CTCM oil can effectively alleviate HFSR and improve the QOL of patients using regorafenib.

The findings suggest the CTCM oil can be considered as an optional management of patients undergoing therapy with regorafenib. Future research may explore the efficacy of CTCM oil in reliving other skin conditions.

Before CTCM oil application             After CTCM oil application

Before CTCM oil application              After CTCM oil application

Figure 1. HRSR before and after intervention
Note: Before treatment, both patients’ feet occur HFSR, presenting as skin hyperkeratinized (as yellow part shown), swelling and severe pain, affect their walking badly. After treatment, the symptoms significantly relieved.

This study was presented at ICCN2022 virtual conference.
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