Submitted by Fedricker D. Barber, PhD, ANP-BC, AOCNP, University of Texas MD Anderson Cancer Center, Houston, TX
Did you know that November is Pancreatic Cancer Awareness Month and that November 21, 2019 is World Pancreatic Cancer Day? Pancreatic cancer is one of the deadliest cancers worldwide and is one of the leading causes of cancer mortality in developing countries (World Health Organization, n.d.). In 2018, approximately 458,000 people were diagnosed with pancreatic cancer, and an estimated 456,280 people are expected to die from this disease by 2020 (World Health Organization, n.d.). Currently, there is no cure for pancreatic cancer and there are no screening tests to detect this disease, therefore, education and awareness are key to preventing pancreatic cancer.
The incidence rate for pancreatic cancer varies, for example, the highest incidence rate was in North America (50,745) and Europe (128,045) in 2018 (World Health Organization, n.d.). Whereas, the lowest incidence rate was in Africa (15.458) in 2018 (World Health Organization, n.d.). Generally, pancreatic cancer is more prevalent in men than in women and is a disease of older adults, with a median age of onset of 71 years (Ilic & Ilic, 2016; McGuigan et al., 2018; McWilliams et al., 2016).
Researchers are making progress in understanding the causes of pancreatic cancer, however, the precise cause is unknown. Epidemiological data suggests that family history of pancreatic cancer, smoking, obesity, diabetes mellitus, and chronic pancreatitis are associated with pancreatic cancer (Ilic & Ilic, 2016; McWilliams et al., 2016). Additionally, alcohol use > 26 grams daily has been identified as a risk for pancreatic cancer (Ilic & Ilic, 2016; McWilliams et al., 2016).
Unfortunately, clinical manifestations of pancreatic cancer usually do not occur until the cancer has invaded other organs (McGuigan et al., 2018). Common symptoms include: unexplained weight loss, epigastric pain that radiates to the back, jaundice, anorexia, abdominal bloating, clay-colored stools, nausea, and fatigue (McGuigan et al., 2018).
The major factor impacting survival and outcomes in patients with pancreatic cancer is the tumor stage. For instance, the 5-year survival rate for patients with pancreatic cancer is 6% worldwide, however, with localized disease, the 5-year survival rate is 37% versus 3% for stage IV disease (McGuigan et al., 2018).
Treatment for pancreatic cancer varies depending on the stage of the disease. Surgical resection such as pancreatico-duodenectomy or total pancreatectomy potentially can cure pancreatic cancer (McGuigan et al., 2018). Other treatment options such as chemotherapy and chemo-radiotherapy have been showed to increase overall survival (71%-76%), however, patients tend to have recurrent disease within two years (McGuigan et al., 2018).
Given that there is no reliable screening test available to detect pancreatic cancer, education and awareness is key to prevention and early diagnosis.
Ilic, M., & Ilic, I. (2016). Epidemiology of pancreatic cancer. World J Gastroenterol, 22(44), 9694-9705. doi:10.3748/wjg.v22.i44.9694
McGuigan, A., Kelly, P., Turkington, R. C., Jones, C., Coleman, H. G., & McCain, R. S. (2018). Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol, 24(43), 4846-4861. doi:10.3748/wjg.v24.i43.4846
McWilliams, R. R., Maisonneuve, P., Bamlet, W. R., Petersen, G. M., Li, D., Risch, H. A., . . . Lowenfels, A. B. (2016). Risk Factors for Early-Onset and Very-Early-Onset Pancreatic Adenocarcinoma: A Pancreatic Cancer Case-Control Consortium (PanC4) Analysis. Pancreas, 45(2), 311-316. doi:10.1097/mpa.0000000000000392
World Health Organization. Cancer tomorrow. (n.d). Retrieved from http://gco.iarc.fr/
The International Society of Nurses in Cancer Care (ISNCC), founded in 1984, is an international federation of National Cancer Nursing Societies. Globally ISNCC represents nurses from 80 countries. ISNCC’s mission is to lead the global community to reduce the burden of cancer and that nurses worldwide are vital and central leaders in cancer care and control. As an international society the ISNCC will develop and engage nurse leaders and influence global health policy. With our global mission the ISNCC is pleased to announce its new Global Citizen Program.
The Global Citizen
ISNCC has recently launched the Global Citizen program at the International Conference on Cancer Nursing (ICCN) 2018 in Auckland, New Zealand. The program recognizes nurses or other professionals, whether or not they are members of their national society, who wish to support the ethos, objectives, strategy and philanthropic goals of the ISNCC. The program provides various contribution options and benefits to the global community.
ISNCC Global Citizens have access to exclusive functions, benefits and offers including:
- Attendance at the President’s Social at the International Conference on Cancer Nursing (available for Silver and above Global Citizens)
- Recognition on the ISNCC website and at the International Conference on Cancer Nursing (ICCN)
- Opportunity to support an ISNCC scholarship to enable nurses from low resource countries attend ICCN
- Acknowledgement of your contribution, including provision of an ISNCC Global Citizen Ribbon (available at ICCN)
- Mentoring opportunities
- Electronic subscription to Cancer Nursing, ISNCC’s official journal, a bimonthly publication that addresses the whole spectrum of problems arising in the care and support of cancer patients
- Participation (non-voting) in the Annual General Business Meeting
- Networking opportunities through participation in society activities such as the International Conference on Cancer Nursing, educational and research initiatives, workshops, task forces, committees, and joint initiatives with other international health groups
How do I become an ISNCC Global Citizen and support ISNCC to achieve its Mission?
You can now become an ISNCC Global Citizens! The ISNCC has established a tiered annual contribution structure to allow you to contribute according to your circumstances and preference. The funds raised through the Global Citizen contributions are used to support ISNCC’s work, including contributions to Scholarships and Organizational Memberships for low resource countries.
For further information, please go to: https://www.isncc.org/ or email: firstname.lastname@example.org
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.
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!
 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.
Authors: Jeanne M. Erickson, RN, PhD, AOCN
Affiliations: Assistant Professor, University of Wisconsin-Milwaukee College of Nursing
Oncology nurses continue to make progress to improve care for patients with advanced cancer at the end of life. An important group behind this progress is the American Association of Colleges of Nursing (AACN), who in 1997 developed recommendations for educating undergraduate nursing students about end-of-life care in Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-life Nursing Care.1 AACN also developed the End-of-Life Nursing Education Consortium (ELNEC), a project to train health care providers and improve end-of-life care for patients in their communities. To date, the ELNEC project has reached over 550,000 health care providers in 88 countries.2
Today, nearly 20 years later, the emphasis is moving to educate nursing students and nurses about palliative care and to distinguish palliative care from end-of-life care. Palliative care is defined as the management of symptoms and side effects in patients who have been diagnosed with a serious or life-threatening disease or condition, such as cancer. A palliative care approach emphasizes that symptom relief needs to begin at the time of diagnosis and continue throughout the course of the disease. Palliative care prioritizes the patient’s comfort and quality of life and should not be emphasized only at the end of life when cure or control of disease is no longer possible.
The AACN has again taken a lead in this educational endeavor and has developed recommendations to educate nursing students about palliative care concepts. These recommendations for palliative care competencies, Competencies and Recommendations for Educating Undergraduate Nursing Students: Preparing Nurses to Care for the Seriously Ill and Their Families, are built on the original work of the AACN related to end-of-life care and emerged from a roundtable of palliative care experts held in the fall of 2015.3 This latest AACN document suggests content and possible placement for the content in undergraduate nursing courses. AACN also plans to make a series of modules with condensed ELNEC content available for nurse educators in 2017 to promote integration of palliative care content into schools of nursing.
The International Society of Nurses of Nurses in Cancer Care (ISNCC) also recognizes and supports the central role of oncology nurses in the delivery of palliative care. In October 2015, ISNCC approved a Palliative Care Position Statement that recommends palliative care as an educational priority for health care providers, especially for the global workforce of nurses.4 This Statement also acknowledges the special needs of local and global communities with inadequate resources, where patients may suffer due to a lack of medications and other interventions to relieve distressing symptoms.
It is now up to us as oncology nurses and nurse educators to advance the competencies of current and future nurses to deliver palliative care to all patients throughout their course of cancer treatment, especially those patients who are vulnerable due to a lack of resources. We can promote these recommendations for palliative care education by sharing them with our colleagues at affiliated schools of nursing. As educators, we can work to incorporate this content as we teach in clinical and classroom settings and mentor nurses to become leaders in the field of palliative care. As clinicians and administrators, we can ensure that we follow current, evidence-based palliative care interventions that prioritize the comfort of our patients and their families. As researchers, we can work to improve the science of symptom management to address the complex symptoms of our patients. As a global nursing workforce, we can promote the delivery of palliative care through our practice, education, research, and service.
- American Association of College of Nursing. Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-life Nursing Care. (1997). Accessed March 26, 2016 at http://www.aacn.nche.edu/elnec/publications/peaceful-death
- American Association of College of Nursing. ELNEC Fact Sheet. Accessed March 26, 2016 at http://www.aacn.nche.edu/elnec/about/fact-sheet
- American Association of College of Nursing. CARES: Competencies And Recommendations for Educating Undergraduate Nursing Students. Accessed March 26, 2016 at http://www.aacn.nche.edu/elnec/New-Palliative-Care-Competencies.pdf
- International Society of Nurses in Cancer Care. ISNCC Palliative Care Position Statement. Accessed April 2, 2016 at http://c.ymcdn.com/sites/www.isncc.org/resource/resmgr/Position_Statements/ISNCC_Palliative_Care_Positi.pdf