Prof. Harue Arao
Osaka University Graduate School of Medicine
Asian Oncology Nursing Society(AONS)の第2回目となるカンファレンスが、2015年11月19 日～ 21 日に韓国において盛大に開催されました。
Ferrans博士のQuality of Life of Cancer Patients: Value in Clinical careの講演は、看護の視点から、Patient centered QOL を捉えたものであり、博士らが開発された尺度の紹介がありました。尺度は、英語以外の言語に翻訳するプロジェクトが数ヶ国で進んでいました。今後さらに注目を浴びることでしょう。
by Anisur Rahman Forazy, Begum Rabeya Khatun Chowdhury Nursing College, Sylhet, Bangladesh.
Breast cancer remains the most common cancer among women in Bangladesh. It has become a hidden burden which accounts for 69% of cancer death in women1. In Bangladesh, the incidence rate of breast cancer was about 22.5 per 100000 in females2; Breast cancer has been reported as the highest prevalence rate (19.3 per 100,000) among Bangladeshi women between 15 and 44 years of age when compared to other types of cancer. Cervical cancer ranked second for this group of women, with a prevalence rate of 12.4 per 100,000 in 2008-2010. An increase in incidence rate has been reported due to lack of disease awareness, lack of confidence about medical treatment, improper screening tests and maltreatment of early metastasis3.
Furthermore, patients are kept away from cancer treatment due to poor socio-economic infrastructure, social stigma of the disease and fear of the cancer treatment. The results of the maternal mortality survey conducted by the National Institute of Cancer Research and Hospital in Bangladesh (2010) showed that 21% of total number of death among women between 15 and 49 years of age was due to breast cancer.
Apparently, breast cancer is becoming a major public health concern of the Bangladesh government, which is evidenced by the establishment of the National Institute of Cancer & Research Hospital, Bangladesh. A study conducted in the northern part of Bangladesh named Khulna Division in 2007 – 2008 showed that 87% of new cases of breast cancer were diagnosed as stage III+, where cancer has spread to other parts of the body. The treatment options were limited and very expensive, especially in a low-resource country such as Bangladesh. The main possible reason is lack of public awareness for early detection of cancer, which reflects the actual situation in rural areas of Bangladesh.
Qualified specialty nurses are important as they play a vital role of providing holistic care to patients with cancer. Therefore, there is a strong need of developing a crash programme to prepare competent nurses, who should have knowledge of prevention and early detection of cancer, how to develop and implement an effective care plan, and counselling techniques. As we know, breast cancer in particular, can be treated effectively if detected early. Therefore, there is an urgent need of preparing Bangladesh nurses to take care of cancer patients as well as take part in cancer prevention and early detection of cancer.
- International Agency for Research on Cancer (2008). GLOBOCAN 2008: Cancer Incidence and Mortality Worldwide. http://www.iarc.fr/en/media-centre/iarcnews/2010/globocan2008.php
- Uddin A.F., Khan Z.J., Islam J., & Mahmud, A. (2013). Cancer care scenario in Bangladesh. South Asian Journal of Cancer, 2(2), 102-4.
- Editor (2013, October 9). Feature, Femina. The Daily Star.
by Airong Lu, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China. ISNCC Corporate and Philanthropic Development Committee Member.
The Dreyfus Health Foundation introduced the “Problem Solving for Better Health®” (PSBH®) program in 1989 in China. The principle underlying the PSBH methodology is that individuals should be empowered to take responsibility for solving health problems that they can address. Thus, the approach is a bottom-up rather than a top-down approach. The model was introduced in the Cancer Hospital of Chinese Academy of Medical Sciences in June 2012.
The PSBH methodology includes a five-step problem-solving process that leads the participant to identify a health problem that he or she can directly address. The five steps to the PSBH process are as follows:
- Step 1: Define the problem (size, cause, and contributing factors)
- Step 2: Prioritize the problem (focus on the most important aspect that should be addressed)
- Step 3: Define a solution. Ask the important questions, such as: what needs to be done, with whom, where things should be implemented, and how long it will take to achieve the desired objective
- Step 4: Develop an action plan (including why, what, how, where and a means of evaluation)
- Step 5: Take action
A PSBH workshop was offered to 36 cancer nurses; all the participants were divided into small groups to identify a problem that they could directly address. Participants were introduced to various projects that have been implemented in other PSBH program settings. Group work was emphasized in the workshop, where participants worked together and applied the five-step problem-solving process to identify and tackle the problems. The main roles of the workshop facilitators were to identify the strengths of each group of participants and to support them during the problem solving process. At the end of the workshop, the proposed projects were submitted to the PSBH China program team to review. After revisions were completed, participants were encouraged to implement their projects using resources already available in their hospital, including personnel and equipment.
A total of 31 PSBH projects were developed at the PSBH workshop. All of these projects were approved and received small amounts of seed funding from the Dreyfus Health Foundation. The 31 projects included: a research study related to smoking cessation, the development of evidence-based practice guidelines for the administration of chemotherapeutic agents, improvement of hand hygiene compliance, various quality improvement strategies, and psychological support for oncology nurses. In September 2013, the 31 PSBH nursing projects were completed successfully. About ten articles have been published as a result of the PSBH program at the hospital and 98% of the PSBH participants were satisfied with the workshop. The application of PSBH in our cancer hospital has been successful. It really helped to strengthen the nursing workforce and improve quality of care for cancer patients.
by Auxilia Chideme-Munodawafa, Hospice & Palliative Care Association of Zimbabwe, Mutare, Zimbabwe.
Putting a Cancer Strategic Plan Together: A Zimbabwean Experience
Cancer is the third leading cause of death globally, with 12 million new cases and 7.6 million deaths (2007). The figures are projected to increase to 26 million cases and 17 million deaths annually by 2030. According to World Health Organization (WHO, 2007), as long as a country develops and implements a well-managed national cancer control program, cancer incidence is bound to be lowered and the lives of cancer patients and their families improved irrespective of the challenges faced by individual countries, particularly those in the low resource category. WHO uses four approaches in the fight against cancer: prevention, cure, care and management (2007). To achieve this, WHO has facilitated the development of strategies for cancer control across countries worldwide.
In Zimbabwe, cancer is a major cause of morbidity and mortality with over 5000 new diagnoses and over 1000 deaths per year per the Zimbabwe Cancer Registry 2007 annual report (2011). The Ministry of Health and Child Welfare and its partners in cancer control are prioritizing cancer policy and implementation of relevant advances, with the vision that Zimbabwe will have a system for cancer control that will reduce the cancer incidence, morbidity and mortality rates and improve quality of life of people with cancer and their families by 2017.
The Process of Developing the Zimbabwe 2013-2017 Cancer Strategy
Because cancer care is provided at all levels of care in Zimbabwe , the Ministry of Health invited all levels of health care professionals to come together in the development of the 5-year strategic plan, (2013-2017). The team included oncologists, radiologists, radiographers, surgeons, nurses, physical and occupational therapists, palliative care specialists, representatives of Traditional Healers Association, (including Hospice & Palliative Care Association of Zimbabwe (HOSPAZ), a full member of the International Society of Nurses in Cancer Care (ISNCC)), universities offering oncology and palliative care education (the University of Zimbabwe, Africa University and the Zimbabwe Open University), and national and international nongovernmental organizations in cancer control. Because of the consultative nature of developing the strategic plan, it took a full year to develop the plan, from 2013 under the auspices of the Principal Director of Non Communicable Disease. The plan was adopted by the government of Zimbabwe in 2014 and included the planning year to run from 2013-2017.
Programs rolling out of the Strategic Plan
Several programs and documents such as policies and curricula have been rolled out from the 5-year strategic plan. The Ministry of Health Zimbabwe also requested HOSPAZ to develop palliative care policy, and an oncology nursing education curriculum. A one-year diploma in oncology nursing was commenced in 2014 at one of the state nursing schools in Zimbabwe. This is a ground breaking program because such training program never existed before in Zimbabwe. More cancer screening and diagnostic programs are also being put in place.
The best way to fight against cancer with better outcomes in low resource countries is that health professionals should work hand-in-hand together through partnership and collaborations with the Ministry of Health .We look forward to sharing with you more about the impact of this 5-year strategic plan on cancer control in Zimbabwe in the near future.
The National Cancer Prevention and Control Strategy for Zimbabwe 2014-2018 is available online: http://www.cancerzimbabwe.org/articles/Nat%20Cancer%20Prevention%20and%20Control%20Doc_18_3_14.pdf
- Chokunonga, E., Borok, M.Z., Chirenje, Z.M., Nyakabau, A.M., & Rukainga, R. (2011). Zimbabwe National Cancer Registry 2007 Annual Report.
- World Health Organization (2007). The World Health Organization’s Fight Against Cancer: Strategies That Prevent, Cure and Care. Retrieved from http://www.who.int/cancer/publicat/WHOCancerBrochure2007.FINALweb.pdf