ISNCC and Union for International Cancer Control Collaborative: Cervical Cancer Program in Latin America (English, Español, Português)

August 25th, 2016 in ICNN Articles, International News

Authors:

Catherine Johnson, Newcastle, Australia

Luz Esperanza Ayala de Calvo, Bogota, Colombia

Marise Dutra Souto, Rio de Janeiro, Brazil

Myrna McLaughlin de Anderson, Panama City, Panama

Victoria Brunelli, Buenos Aires, Argentina

Project Team

Project Team (L to R) : Maria del Rosario Caballero Tinoco, Lisseth de Campos (UICC representative) Maria Elena Reyes Nieto, Myrna McLaughlin de Anderson, Catherine Johnson, Marise Dutra Souto, Luz Esperanza Ayala de Calvo, Carla Ford (Association Coordinator, ISNCC) and Irma Medrano (Workshop Participant, Bolivia)

group pic

Workshop Partcipants in Bogota, Colombia.

Latin America has one of the highest rates of incidence and mortality from cervical cancer. Effective early detection strategies have been in place for many years and are now complemented by the availability of a vaccine to protect against some forms of cervical cancer. Vaccination prophylactic against Human Papilloma Virus (HPV) which can help prevent cervical cancer, is approved for use in most Latin American countries; however, few have implemented national immunization programs.

The International Society of Nurses in Cancer Care (ISNCC) and its partners, Union for International Cancer Control (UICC) and Centers for Disease Control and Prevention (CDC) conducted a review of cervical cancer in Latin America. The review identified 4 key issues for action, focused on i) education, ii) screening participation, iii) data monitoring and iv) cultural/ indigenous needs.

Subsequently an educational curriculum on Cervical Cancer, using WHO Guidelines was developed by 4 regional Nurse champions:

Victoria Brunelli from Buenos Aires, Argentina
Marise Dutra Souto from Rio de Janeiro, Brazil
Myrna McLaughlin de Anderson from Panama City, Panama
Luz Esperanza Ayala de Calvo from Bogota, Colombia

The curriculum is divided into 7 modules. The workshop topics included Introduction, Prevention and Control Programs, Community Mobilization, Education and Counselling, HPV Vaccination, Screening and Treatment of Cervical Pre-cancer, Diagnosis and Treatment of Invasive Cervical Cancer, and Palliative Care.

The curriculum has been successfully delivered via three ‘train the trainer’ workshops hosted in Lima, Peru, San Salvador, El Salvador (September 2015) and Bogota, Colombia (July 2016). The objectives of the workshops were to build capacity in cervical cancer prevention and screening amongst nurses from various countries in Latin America.
The San Salvador workshop was led by Myrna McLaughlin de Anderson and Luz Esperanza Ayala de Calvo. This workshop attracted 45 participants from Belize, El Salvador, Guatemala, Honduras, Nicaragua, and Panama.
The Lima workshop was led by Victoria Brunelli and Marise Dutra Souto. A total of 45 participants from Argentina, Brazil, Colombia, Paraguay, and Peru attended.
The final workshop, in Bogota, was led by Myrna McLaughlin de Anderson and Luz Esperanza Ayala de Calvo. A total of 32 participants from Bolivia, Colombia, Costa Rica and Mexico attended.
The workshop in Bogota, Colombia concluded current round of funding for the ISNCC and Union for International Cancer Control Collaborative project.
The project team has now commenced work on a new project funded by the American Cancer Society. The project is part of All of Me (Todo mi ser in Spanish); a program designed to encourage health care providers to integrate breast and cervical cancer education intervention in their practice. ISNCC will expand the scope of the curriculum to include breast health and breast cancer screening and to further develop the skills required for nurses to encourage their female patients to think of their bodies as a whole and what they can do over their lives to live well and stay healthy within three target countries (Brazil, Colombia and Mexico).
The project team welcomes Maria del Rosario Caballero Tinoco and Maria Elena Reyes Nieto from Mexico City, Mexico. The project team looks forward to reporting further on these projects at the International Conference on Cancer Nursing, Hong Kong, later this year.

 

Colaboración Internacional de la ISNCC y la Unión para el Control del Cáncer: Programa de cáncer cérvico uterino en América Latina.

América Latina tiene una de las tasas más altas de incidencia y mortalidad por cáncer de cuello uterino. Durante muchos años han estado en vigor estrategias eficaces de detección temprana y ahora se complementan con la disponibilidad de una vacuna para proteger contra algunas formas de cáncer de cuello uterino. La vacunación profiláctica contra el Virus del Papiloma Humano (VPH) que puede ayudar a prevenir el cáncer de cuello de útero, está aprobada para su uso en la mayoría de los países de América Latina, sin embargo, pocos han implementado programas nacionales de inmunización.

La Sociedad Internacional de Enfermeras en el cuidado del cáncer (ISNCC) y sus socios, la Unión Internacional para el Control del Cáncer (UICC) y los Centros para el Control y la Prevención de Enfermedades (CDC) realizaron una revisión sobre el cáncer cervical en América Latina. La revisión identificó 4 temas clave para la acción, se centró en i) educación, ii) participación en el tamizaje o cribado, iii) control de datos y iv) las necesidades culturales especiales y de grupos como los indígenas.

Posteriormente, utilizando las directrices de la OMS,  fue desarrollado  un programa de educación sobre el cáncer de cuello uterino, por 4 líderes regionales de enfermería:
Victoria Brunelli, de Buenos Aires, Argentina,
Marise Dutra Souto, de Río de Janeiro, Brasil,
Myrna McLaughlin de Anderson, de Ciudad de Panamá, Panamá,
Luz Esperanza Ayala de Calvo, de Bogotá, Colombia.

El plan de educación se divide en 7 módulos. Los temas de los módulos incluyen: Introducción, programas de prevención y control, movilización de la comunidad, educación y orientación o consejería, vacunación contra el VPH, detección y tratamiento del lesiones pre malignas de cáncer cervical, diagnóstico y tratamiento del cáncer invasor de cuello uterino, y cuidados paliativos.

El plan educativo se ha desarrollado con éxito a través de tres jornadas de un día, tipo taller de “formación de formadores” en tres ciudades: Lima, Perú y San Salvador, El Salvador (en septiembre de 2015) y Bogotá, Colombia (en julio de 2016). El objetivo de estos talleres fue incrementar la capacidad de las enfermeras de diversos países de América Latina, en la prevención y detección del cáncer de cuello uterino.

El taller de San Salvador fue desarrollado por Myrna McLaughlin de Anderson y Luz Esperanza Ayala de Calvo. Este taller atrajo a 45 participantes de Belice, El Salvador, Guatemala, Honduras, Nicaragua y Panamá.
El taller de Lima fue dirigido por Victoria Brunelli y Marise Dutra Souto. Asistieron 23 participantes de Argentina, Brasil, Colombia, Paraguay y Perú.


El último taller, en Bogotá, fue realizado por Myrna McLaughlin de Anderson y Luz Esperanza Ayala de Calvo, con un total de 32 participantes de Bolivia, Colombia, Costa Rica y México. Este taller en Bogotá concluyó la actual ronda de financiación para el proyecto colaborativo de la ISNCC y la Unión International para el Control del Cáncer

El equipo de trabajo ya ha comenzado a trabajar en un nuevo proyecto financiado por la Sociedad Americana del Cáncer. El proyecto forma parte de All of Me (“Todo mi ser” en español), un programa diseñado para motivar a los proveedores de atención en salud a integrar en su práctica la educación y la intervención sobre el cáncer de mama y el de cuello uterino.  La ISNCC ampliará el alcance del plan de educación para incluir el cuidado de la salud de la mama y el cáncer de mama y para desarrollar las habilidades requeridas por las enfermeras para alentar a sus pacientes de sexo femenino a pensar en su cuerpo como un todo y lo que pueden hacer sobre sus vidas para vivir bien y mantenerse saludable, dentro de los tres países de destino (Brasil, Colombia y México).
El equipo del proyecto da la bienvenida a María del Rosario Caballero Tinoco y María Elena Reyes Nieto de Ciudad de México, México. El equipo de trabajo espera ofrecer más información sobre estos proyectos en la Conferencia Internacional de Enfermería Oncológica, en Hong Kong, próximamente, este año.

 

Projeto de Colaboração entre a ISNCC e a União Internacional para Controle do Câncer: Programa de Câncer do Colo do Útero na América Latina

A América Latina tem uma das mais altas taxas de incidência e mortalidade por câncer do colo do útero. Há muitos anos já está em vigor estratégias eficazes de detecção precoce  e agora estão complementado pela disponibilidade de uma vacina para proteger contra algumas formas de câncer cervical. A vacinação profilática contra o papilomavírus humano (HPV), que pode ajudar a prevenir este câncer, foi aprovada para uso na maioria dos países latino-americanos; no entanto, poucos têm implementado programas nacionais de imunização.

A ISNCC e seus parceiros, a União Internacional para Controle do Câncer (UICC) e os Centros de Controle de Doenças e Prevenção (CDC) conduziram uma revisão sobre câncer cervical na América Latina. A revisão identificou quatro questões-chave para a ação, com foco em i) educação, ii) participação na triagem, iii) monitorização de dados e iv) necessidades culturais / indígenas.

Posteriormente um currículo educacional sobre o câncer do colo do útero, usando as diretrizes da OMS, foi desenvolvido por quatro enfermeiras líderes regionais:
Victoria Brunelli de Buenos Aires, Argentina
Marise Dutra Souto do Rio de Janeiro, Brasil
Myrna McLaughlin de Anderson da Cidade do Panamá, Panamá
Luz Esperanza Ayala de Calvo de Bogotá, Colômbia

O currículo está dividido em sete módulos. O workshop incluíu os temas: Introdução, Programas de Prevenção e Controle, Mobilização Comunitária, Educação e Aconselhamento, Vacinação contra o HPV, Rastreamento e Tratamento de Lesões Precursoras, Diagnóstico e Tratamento da Doença Invasiva, e Cuidados Paliativos.

O currículo foi apresentado com sucesso através de três worshops ‘formar o formador’ realizados em Lima, Peru, San Salvador, El Salvador (ambos em setembro de 2015) e Bogotá, Colômbia (julho de 2016). O objetivo foi capacitar enfermeiros de vários países da América Latina em rastreamento e prevenção do câncer do colo do útero.

O workshop de San Salvador foi liderado por Myrna McLaughlin de Anderson e Luz Esperanza Ayala de Calvo, e reuniu 45 participantes de Belize, El Salvador, Guatemala, Honduras, Nicarágua e Panamá.

O workshop de Lima foi liderado por Victoria Brunelli e Marise Dutra Souto. Representantes de Argentina, Brasil, Colômbia, Paraguai e Peru totalizaram 45  participantes.

O workshop final, em Bogotá, foi liderado por Myrna McLaughlin de Anderson e Luz Esperanza Ayala de Calvo. Bolívia, Colômbia, Costa Rica e México foram representados por 32 participantes.

Este workshop concluíu o atual ciclo de financiamento do Projeto de Colaboração entre ISNCC e UICC.

A equipe agora começou a trabalhar em um novo projeto financiado pela American Cancer Society. O projeto faz parte do All of Me (Tudo sobre Mim) um programa elaborado para motivar os prestadores de cuidados de saúde para integrar educação e intervenção sobre câncer de mama e do colo do útero na prática. ISNCC irá expandir o escopo do currículo atual e incluirá a saúde da mama e o rastreamento deste câncer.  A partir daí desenvolverá competências necessárias aos enfermeiros para incentivar suas pacientes a pensar em seus corpos como um todo e o que elas podem fazer em suas vidas para viver bem e permanecer saudável. Essa ação abrangerá três países-alvo: Brasil, Colômbia e México.

Foram saudadas as novas integrantes Maria del Rosario Caballero Tinoco e Maria Elena Reyes Nieto, representantes da Cidade do México, México. A equipe aguarda ansiosa para trazer mais informação sobre estes projetos na Conferência Internacional de Enfermagem Oncológica, em Hong Kong, ainda neste ano.

 

The 25th Multinational Association of Supportive Care in Cancer (MASCC) Meeting

August 11th, 2016 in Reflection

Author: Gillian Blanchard

Affiliations: Conjoint Lecturer School of Nursing and Midwifery, University of Newcastle, Australia 

MASCC 2016 brought together over 1070 delegates from 50 counties to Adelaide, South Australia.

The meeting’s motto is “supportive care makes excellent cancer care possible” and was held over 4 days from the 22nd to the 24th of June. It featured a pre-conference cancer nurse practitioner workshop and patient seminar; six pre-conference Study Group workshops (mucositis research, nutritional care in advanced cancer, supportive care and immunotherapy, end of life, cancer related cognitive impairment and sleep, drowsiness and fatigue), plenary sessions on survivorship, gastrointestinal toxicity, and the future of supportive care, a patient seminar, e-posters, and a parallel paper session for each MASCC Study Group.

ISNCC hosted a display at the conference; this provided Australian ISNCC members an opportunity to promote the work of ISNCC and the benefits of membership.

The Cancer Nurse Practitioner pre- conference workshop was organized by the Cancer Nurses Society of Australia Nurse Practitioner Specialist Practice Network (CNSA CNP SPN). This event was designed for Cancer Nurse Practitioners and Advanced Clinicians. The program incorporated plenary presentations and Supportive Care Interactive Learning Sets (SCILS) and was attended by 53 delegates.

The plenary sessions featured local and international speakers Prof Dorothy Keefe: Supportive care challenges, Dr Karen Mustian: Exercise oncology from behavior to biology – Treating cancer-related fatigue, Tracey Doherty: The role of the nurse in supportive care and Prof Lawrence Einhorn: Controversies in management of chemotherapy-induced nausea and vomiting.

The SCILS workshops focused on Breathlessness and persistent cough, Anxiety and Depression, Clots and novel anticoagulants and Oral health, mucositis and osteonecrosis of the jaw. Overall the workshop provided a great opportunity for networking and updating one’s skills and knowledge in the area of advanced practice nursing.

Prof Larry Einhorn presented ‘Nausea is the New Black’.  Prof Einhorn proposed that in 2016, nausea not vomiting is the main element of toxicity for Chemotherapy Induced Nausea and Vomiting (CINV) and that Olanzapine, an anti-psychotic, may be the most promising drug for mitigating nausea.  Indeed in 1974 when Prof Einhorn began using Cisplatin chemotherapy in testicular cancer patients they could experience up to 10 episodes of emesis a day and now the number is closer to zero.

Karen Mustian, an exercise physiologist and researcher spoke about the optimal dose of exercise for cancer related fatigue.  She advised health care professionals (HCP’s) need to become aware of our patients limitations and as such exercise should be individually tailored.  Karen emphasized that the bottom line is to avoid inactivity by starting slow and increase both intensity and duration of physical activity. Exercise interventions, it seems, are better than pharmaceuticals at reducing cancer related fatigue.

There were many other presentations that used improving patient engagement and partnering with others eg. Pharma, NGO’s and other HCP’s to meet the supportive care needs of our patients.  As clinicians we must be better at toxicity management as reported by patients, including managing both the physical and psychosocial burden these toxicities cause.

The MASCC guidelines and assessment tools can be found on their website at www.mascc.org

A Case Sharing- An Exceptional Challenging Cancer Patient

July 14th, 2016 in Reflection

Annda LumAuthor: Annda Lum

Affiliations: Pamela Youde Nethersole Eastern Hospital, Hong Kong

[Special acknowledgement to Dr Kwok Sing Ng, CP Mr Victor Kong, SWA Ms Christy Lee]

Case Background

Ms X was a 50 years old lady having hormonal-responsive, HER-2 positive breast cancer with multiple metastases in Feb 2013. She was initially managed in Hospital A, with chemotherapy and radiotherapy given, later defaulted follow-up. Afterwards, she had started to receive Tamoxifen and Herceptin since Mar 2014 in our Unit, eventually passed away in Dec 2015.

Characteristic Exceptions Demonstrated by Ms X

Throughout her treatment process, she demonstrated several characteristic exceptions.

Exceptional keen for hospitalization- prolonged stay in our Orthopedic unit for 537 days and 215 days in our unit without clinical indication.

Exceptional plan for hospitalization- after discharge from Hospital A, Ms X went to different hospitals and requested admissions.

Exceptionally being refused- because of Ms X’s violent behavior, several hospitals marked ALERT not to admit her.

Exceptional treatment refusal- Ms X refused most management as planned for her.

Exceptionally irritable- she attacked staff and generated ward conflicts multiple times. She was diagnosed having adjustment disorder, delusion disorder and personality difficulties.

Family Background and Psychosocial Formulation

Ms X had no contact with family after quarrel at her adolescence. She was an ex-jewelry saleslady. Lived alone in a public housing unit and a Comprehensive Social Security Assistance (CSSA) recipient. Ms X was discriminated by her neighbors too. After onset of her illness, she refused home. Ms X was defensive and hostile towards hospital staff. Nevertheless, she was nice and helpful towards other patients. For instance, she shared pizza with other patients in ward and assisted daily task of another elder in ward.

Ms X was referred to clinical psychologist for illness coping. Rapport building turned out to be a challenging task, as she appeared interpreting any assessment as an attempt to label her as mentally ill. Due to Ms X’s defensiveness and downhill physical condition, intensive psychotherapy targeting delusional beliefs or personality issues was not a realistic option. Instead, psychological intervention focused on providing emotional support and problem solving on her immediate concerns. Efforts were made to facilitate insight regarding how her cognitions affected emotions and medical treatment.

Last Journey and Team Reflection

When Ms X was very weak, she still did not disclose any after-death business. Our team paid much effort to find if Ms X had self-arranged her funeral matter before. Multiple NGOs were contacted and ultimately our social worker was able to identify one to address Ms X’s final need. During the last moments of Ms X, chaplain was invited to see her, our staff and social worker accompanied her at bedside. Conveyable comforts words like “let go” through her ears were done to enhance her spiritual peace. Ms X’s last wish of funeral concern was addressed and fulfilled at her final moment. She rested in peace without lingering time.

Even though Ms X was an exceptional challenging patient to care, we still tried our best to preserve her dignity and the humanity. Our team awareness was increased after debriefing was done regarding to our own emotions and feeling towards Ms X’s care. Mutual staff support with good team spirit was vital for this kind of challenge.

 

 

Rising to the Challenge of Patient Reported Outcomes

June 9th, 2016 in Hot Topics

Sally Thorne

Author: Sally Thorne, RN, PhD, FAAN, FCAHS 

Affiliations: University of British Columbia School of Nursing

Cancer nurses have a strong commitment to the idea of documenting, interpreting and making use of that which patients report about their own cancer experiences and outcomes. As a consequence, many have taken up qualitative methods in an attempt to shed light on what it is for patients to live with diagnosis, treatment, and survivorship, to engage with cancer care systems, and to wrestle with the social and psychological implications of this disease. Historically, nurses drew directly upon social science methods (such as phenomenology, grounded theory, ethnography) for such work, but increasingly came to realise that such methods were designed more toward building theory than generating the kinds of useful knowledge that nurses need to inform practice.

Over the past three decades, I have been involved with figuring out how the great technique that was invented for social theorizing can be extracted, adapted and reworked to better match the real questions that nurses need to ask. For example, rather than assuming there is a singular dominant experience in any context, nurses will always expect important human variation. In fact, alerting the clinical imagination toward the detection and interpretation of that variation is a fundamental attribute of expert clinical practice. So our research approaches have to be applied rather than just theoretical in order for the knowledge we produce to shape the disciplinary need.

In the early days of qualitative research in nursing, we assumed that neophyte researchers (such as clinicians and graduate students) were best served by following a methodological rulebook. Now we understand that the core foundational ideas of nursing provide a great deal of direction for the “detective work” that constitutes a great qualitative study. We are freeing up nurse researchers to position their disciplinary knowledge needs and professional audiences front and centre in their thinking as they work through study design. Using nursing logic, they can build an accessible and credible line of reasoning from their research question through to its answer. An example from our previous work is a study of patient perceptions of poor communication, considered from the perspective of what we in the care system might actually do to prevent it.[1]

I have been honoured to be part of this ‘movement’ in emancipating qualitative methodology so that it becomes an accessible resource and tool in the hands of thoughtful practicing nurses, and not the exclusive privilege of those with elite academic training. Every day I encounter amazing nurses generating powerful insights with application at the point of care, challenging the status quo assumptions of our care systems on the basis of experiential knowledge they glean from the cancer patients they study, and filling in the gaps in our understanding that population-based (quantitative) evidence leaves behind. In the newly published second edition of my methods text[i], I am demonstrating how nurses build knowledge translation right into their designs, rather than considering it an afterthought. This is not something I ‘invented;’ rather, it is an approach to knowledge generation that I have observed throughout my career as the classic inquiry style of great nurse thinkers. And there are so many from whom to learn!

Cover Photo

[1] Thorne, S., Oliffe, J.L., Stajduhar, K. I., Oglov, V., Kim-Sing, C., Hislop, T.G. (2013). Poor communication in cancer care. Cancer Nursing, 36(6), 445-453

[i] Thorne, S. (2016). Interpretive description: Qualitative research for applied practice. New York & London: Routledge.

 

跨專業團隊合作新模式

May 27th, 2016 in Reflection

Author: Choy Yin Ping, NC (ONC), KWC

Affiliations: Nurse Consultant., Princess Margaret Hospital, Hong Kong

去年,我有幸代表我的團隊到首爾參加第二屆亞洲腫瘤科護理會議(AONS 2015 Conference),發表了有關跨專業團隊合作診治新服務模式的學術報告。很高興這份報告被大會評審為大會最佳報告之一。

所謂跨專業團隊合作診治新服務模式,是病人接受抗癌治療期間,除了醫生的診症外,我們會定期加入腫瘤科護士和其他專業團隊(如臨床藥劑師)的診症服務。這種服務模式最大的優點是各專業團隊可以發揮其專業所長,相互協作,為病人和家屬提供更有效率和更全面的服務。

腫瘤科護士可透過對病人的診症、評估、教育與輔導,發揮全人護理中「身、心、社、靈」的理念,提升了腫瘤科護士在癌症治療中的重要角色。這種嶄新的護理模式深得病人和其家屬的肯定,在每一次的病人滿意程度調查中,我們的護理診症服務都被給予很高的評價,實在令人鼓舞。

隨著癌症治療科學日新月異的發展,各種癌症的治愈機會愈來愈高,病人的壽命亦得以大大延長。病人和其家屬在治癌以至復康的漫長過程中所需的支援便愈來愈多。身為腫瘤科護士的我們肩負的任務將會愈加重大,但我深信這是我們專業發展中必須前進的路向,而這種跨專業團隊服務的模式相信亦是醫療發展的方向之一。

 

Choy Yin Ping