The Summary of the 2nd Book Donation Activity at ICCN 2018

October 15th, 2018 in ICNN Articles, ISNCC Projects

Affecting by the disparity of global economic development, the imbalanced distribution of cancer nursing education resources is a fact. There are insufficient cancer textbooks in low and middle-income countries.

Based on the achievements of the 1st book donation activity, the 2nd book donation activity aims to provide texts to nurses in low and middle-income countries who do not have adequate access to new/relatively new cancer nursing materials.


  • Recorded the information of book donators and recipients on the book donation information form.
  • This 2nd book donation activity was greatly supported by all the ISNCC members and participants of ICCN 2018 with 56 textbooks in English and 15 textbooks in Chinese donated to nurses from underdeveloped areas, e.g. Kenya,Tonga, Uganda,South Africa , Zambia, Brazil, Nepal,Ghana,India, Indonesia, western region of China.
  • The contents of books covered: Clinical Guidelines for Cancer Care, Evidence-based Cancer Care, Cancer Palliative Care Handbook, Vascular Access Devices Guidelines for Cancer, Cancer Targeted Medicine Care, Quality Control of Cancer Care, etc.
  • Traced the influence of book donation and invited some of the recipients to write blogs regarding their feelings and thoughts towards this activity.


  • Promote the sharing of educational resources.
  • Advance the development of cancer care in underdeveloped areas.
  • Enhance the internal and external communication of ISNCC.
  • Dedicate love to cancer nurses in need globally.

Global Efforts Fighting Cancer

October 4th, 2018 in ICNN Articles, International News

Author: Yongyi Chen
Affiliations: Hunan Cancer Hospital

As the vice president of Hunan Cancer Hospital (HCH), I feel truly honored to attend the Global Academic Programs (GAP) Conference at Stockholm, Sweden from 15-17 May, 2018. HCH is the 31st Sister institution of MD Anderson Cancer Center (MDACC) worldwide, the 5th in mainland China. MDACC and HCH have conducted in-depth cooperation in training medical personnel, transferring international treatment, disseminating medical techniques, sharing medical solutions, etc.

The GAP Conference this year is held by Karolinska Institutet and Karolinska University Hospital in Stockholm. The institute is famous for the Nobel Committee for annual assessment and award of Nobel Prize in physiology or medicine. The theme of GAP Conference 2018 is “Global efforts fighting cancer”. With the joint goal, the annual GAP Conference offers a platform for faculties from MDACC and its Sister institutions to work collaboratively. Experts and scholars form 38 Sister institutions all over the world attended the conference to discuss the progress on cancer treatment and care. The fundamental research, epidemiology, treatment status and progress of oncology were included and deeply analyzed. The experts put forward a series of methods and measures to improve the diagnosis and treatment of cancer. The participants really get great inspirations.

There were over 600 abstract submissions, 16 simultaneous sessions, 155 oral presentations at the conference. Among them, 7 oral presentations and over 20 poster presentations from HCH ware accepted. I delivered an oral presentation “Life satisfaction of cancer patients: what contributes to a better satisfaction with life” at the Nursing Program. Our academic reports were acclaimed by other colleagues from all over the world, which laid a solid cooperative foundation for scientific research.

ISNCC President Patsy’s keynote speech at the China Cancer Nurses Conference

October 4th, 2018 in ICNN Articles, International News

China Cancer Society Cancer Conference was held from August 17-20, 2018 in Shenyang, Liaoning.

Patsy Yates

President of the International Association of Oncology Care, Professor Patsy Yates of the Department of Nursing, Queensland University of Technology, Australia, brought a greeting from the International Association of Cancer Care Nurses to Chinese nurses. At the same time, she put forward the important point of the current status of pulse oncology care: nurses should carry out role transformation and provide personalized cancer treatments. Today’s cancer treatment is becoming more and more precise, and the development of technology provides a new approach to care, and nurses play a key role in ensuring the best outcomes and experiences of patients. Nurses should understand the impact of the experiences on patients, customize interventions for patients, and support patients’ self-management.

Kim Alexander

Then, Professor Kim Alexander of the Department of Nursing at the Queensland University of Technology in Australia gave a detailed explanation of this point, detailing the new approach to cancer care research – personalized symptom care. He exemplified “new measures on understanding experiences” and “new measures on test interventions”. New measures to opening a new way of thinking about cancer care. Bring together wisdom thinking, stimulate innovation vitality, enhance the connotation of disciplines, and improve the level of discipline construction.

Professor Brenda Marion Nevidjon, CEO of the American Society of Cancer Nursing, conducted an exchange on the study of the tolerant behavior of cancer nurses. The professor took the rapid changes in the cancer care industry as an entry point to deeply analyze the psychological state of cancer nurses, from three aspects: thought, behavior, and performance. Provide guidance to nurses working on cancer: strengthen self-cultivation, improve work resilience, and serve human health.

Professor Anne Fitzgerald and Prof. Margaret Hjorth from ICON Medical Group of Australia shared the Australian cancer care model with participants from the three aspects of cancer patient assessment and program development, oncology nursing professional ability training and safety skills training.

Through learning exchanges, Chinese oncology nurses have been enlightened to learn advanced cancer care knowledge and technology to improve the level of cancer care.




A Program to Mitigate the Potential Risks Associated with the Subcutaneous and Intramuscular Injection of Special Oncology Drugs

October 4th, 2018 in ICNN Articles

LING Wai Man, RN, MSc, FHKAN (Medicine-Oncology), Member of Communications Committee of ISNCC;
CHU Yuek Kei Florence, RN, BN
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital

The use of subcutaneous (SC) and intramuscular (IM) injection of special drugs in oncology setting is escalating in Hong Kong recently due to the advances in medical science. Some of them are used to treat the treatment side effects, such as the growth factors, whereas some are used to treat the cancer disease itself or its complications, like the hormones or anticoagulant. Nowadays, they have accounted for almost one-fourth of the parenteral injections in our Oncology Department. However, the sophisticated drug preparation and injection techniques of some of these drugs pose significant quality and safety issues in the nursing practice. In 2016, a prostate cancer patient ended up with a local abscess at the injection site and required incision and drainage after an improper subcutaneous injection of a long-acting hormonal drug. Post-incident review identified a number of actual and potential risks associated with the related nursing procedure. Therefore, a workgroup was formed in our Department to formulate and implement the improvement actions for mitigating the risks.

The quality improvement program aims to (i) enhance the accuracy and safety of SC and IM injection of the special oncology drugs identified, and (ii) evaluate the nursing staff compliance to the recommended new injection practice.

We revisited our current practice, performed literature review, developed evidence-based guidelines on SC and IM injection of the drugs identified, and designed a quick reference poster as well as a record sheet for clear documentation. Training was provided to our Department’s nurses before the promulgation of the new practice. It covered the drug preparation process, different injection techniques among drugs, choice of injection sites, importance and sequence of site rotation, proper documentation, and patient education on post-injection care. Clinical compliance audit and staff satisfaction survey were then performed in the 4th quarter of 2017 to evaluate the program.


Poster presented at Hospital Authority Convention 2018, Hong Kong.

Results and Outcomes:
There was no incidence of injection-related adverse reaction reported after implementing the new guidelines. The overall staff compliance rate of the clinical audit was 99.5%. The nurses were able to fulfil the requirements in all the major aspects of clinical practice concerned. They gave positive feedback on the new practice designed and the staff support provided. Moreover, the value of this program was recognized by the nursing colleagues at the ten General Out-patient Clinics of Hong Kong East Cluster. We had been invited to conduct a lunch talk to them in 2017. We shared our guidelines and the quick reference poster with them to improve their practice as well. In May 2018, our program was accepted for poster presentation in the Hong Kong Hospital Authority Convention, which had attracted over 5,600 delegates from Hong Kong and overseas.


Oncology nurses play a significant role in safeguarding the patient care and service standard in clinical practice. Our program has successfully benefitted the patients by mitigating the potential risks associated with these SC and IM injections. We have also helped our service partners of the same Cluster to improve their service by sharing of good practice.


A feasibility study to evaluate the relationships between endocrine symptoms, drug adherence and genetic polymorphisms in breast cancer patients receiving tamoxifen therapy

December 14th, 2017 in ICNN Articles

 A feasibility study to evaluate the relationships between endocrine symptoms, drug adherence and genetic polymorphisms in breast cancer patients receiving tamoxifen therapy 

Carmen WH Chan PhD 1, Ka Ming Chow DN 1, Alexandra McCarthy PhD 2, Judy YW Chan PhD 1 , Mary MY Waye PhD 1 , Stephen KW Tsui PhD 3, Winnie Yeo MBBS, MD 4, K C Choi PhD 1, Winnie KW So PhD 1, Winnie Soo MbChB, FHKAM 4, Christine Miaskowski PhD 5

1 The Nethersole School of Nursing, The Chinese University of Hong Kong
2 School of Nursing, The University of Auckland
3 School of Biomedical Sciences, The Chinese University of Hong Kong
4 Department of Clinical Oncology, The Chinese University of Hong Kong
5 Department of Physiological Nursing, University of California

A common practice to prevent cancer recurrence after treatment is to prescribe
adjuvant tamoxifen, an anti-hormonal therapy, for at least five years.

1 Despite the acknowledged benefits in terms of reduced recurrence rates associated with its use,
adherence to tamoxifen is less than ideal. Approximately 1 in 5 patients who are
prescribed adjuvant tamoxifen do not achieve the optimal adherence threshold of
≥80% during the first year of treatment.

2-3 The most significant factor contributing to non-adherence is the tamoxifen-related endocrine (hormone deprivation) symptom
profile. Symptoms include sudden, severe, and often permanent vasomotor symptoms,
and related insomnia, somatic symptoms, depression and sexual dysfunction.

4-5 Toxicities, and the way that tamoxifen is metabolized, are largely influenced by
individual genetic makeup. Different forms of some genes found in the population
(i.e. polymorphisms) which are involved in the metabolism of tamoxifen (e.g.
CYP3A4 and CYP2D6) may influence the toxicity, side effects, and symptom
experiences of tamoxifen.

6-7 We want to explore if, and how, endocrine symptoms of tamoxifen correlate with both
drug adherence and polymorphisms in genes that regulate the metabolism of 2
tamoxifen in Chinese women with breast cancer. This is a collaborative study among
colleagues from the Chinese University of Hong Kong, University of California at
San Francisco, and the University of Auckland. Our research team comprises
oncology specialists, credentialed oncology nurses, molecular geneticists, a
biostatistician and technical staff. We plan to conduct a cohort study to follow 200
Chinese women over 12 months and assess their clinical symptoms and genetic
variations. Endocrine symptoms and drug adherence will be scored during interviews
with standardized questionnaires including the Greene Climacteric Scale (GCS), the
Functional Assessment of Cancer Therapy-Endocrine subscale (FACT–ES)
questionnaire (Version 4), the Medication Possession Ratio. Polymorphisms in
significant target genes will be determined using commercial assays of saliva samples.
Participants will also maintain a logbook to record their intake of tamoxifen and any
other compounds, such as Chinese medicines, on a daily basis for 12 months.

In the past 3 months, our group has conducted a pilot study and successfully recruited
30 participants (response rate: 68.2%). Based on the data collected to date, some
allelic variations in some candidate SNPs, including ABCB1 rs1128503, UGT2B15
rs4148269, ABCC2 rs717620, CYP3A5 rs776746, CYP1A2 rs2470890, ABCC1
rs35628, CYP2B6 rs3745274, CYP2C19 rs4244285, showed considerably large
differences, with standardized mean differences of > 1 in endocrine-related symptom
score. This pilot study demonstrated the feasibility of recruitment and data collection.
The participants reported that the study design is simple and not time consuming.
This study will be the first to uncover any unique profile or gene(s) that are associated
with tamoxifen-related endocrine symptoms and other important outcomes. We will
pioneer exploration of the associations between genotypes, endocrine symptoms and
drug adherence in Chinese women with breast cancer.

1. Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2005). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15- year survival: an overview of the randomized trials. Lancet 2005; 365: 1687-717.

2. Hershman, D.L., Shao, T., Kushi, L.H., Buono, D., Tsai, W.Y., Fehrenbacher, L., Kwan, M., Gomez, S.L., Neugut, A.I. (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Research and Treatment 126: 529–537.

3. McCowan, C., Shearer, J., Donnan, P.T. (2008) Cohort study examining tamoxifen adherence and its relationship to mortality in women with breast cancer. British Journal of Cancer 99: 1763–1768.

4. Barron, T.I., Connolly, R., Bennett, K., Feely, J., Kennedy, M.J. (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109: 832–839.

5. Cluze, C., Rey, D., Huiart, L. (2012) Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Annual Oncology 23:882-90.

6. Briest, S., Stearns, V. (2009) Tamoxifen metabolism and its effect on endocrine treatment of breast cancer. Clin Adv Hematol Oncol. 7:185–192.

7. Cronin-Fenton, D.P., Damkier, P., Lash, T.L. (2014) Metabolism and transport of tamoxifen in relation to its effectiveness: new perspectives on an ongoing controversy. Future Oncology 10:107–122.