Canadian Oncology Nursing Journal最新文献

Chronic Lymphocytic Leukemia (CLL) is the most frequently diagnosed hematologic malignancy with the majority of patients at diagnosis in the "watch and wait" stage of treatment - language that gives the perception of an axe waiting to fall, belying the fact that up to 30% of patients will never need treatment in their lifetime. While receiving active surveillance, patients report anxiety, distress, and depression, yet there is little research capturing the experience of this patient population, nor describing interventions to improve their experience (Damen, 2022). In an effort to "do something," patients may turn to often expensive and unproven alternative therapies. At each clinic visit, there is an opportunity to provide relevant and understandable information, resources to address anxiety, and response to unmet needs to increase the patient's experience of shared decision making. Reframing the experience to a more proactive perspective such as 'Monitor and Move On' versus "Watch and Wait' may empower patients with CLL along their trajectory.

Emergency department (ED) visits and hospitalizations are common among patients receiving cancer treatments. Recognizing the need for appropriate toxicity management for cancer patients in Ontario, a Toxicity Management Advisory Committee (TMAC) was established by Ontario Health - Cancer Care Ontario (OH-CCO) in December 2016. The TMAC's recommendations included ensuring patients have access to remote toxicity and symptom management advice (i.e., tele-triage) from a knowledgeable provider. Following the initial success of an after-hours pilot, OH-CCO entered into a partnership with Bayshore HealthCare Limited to launch the provincial after-hours toxicity management telephone support line - CareChart Digital Health - for patients on cancer treatment. The goals of the partnership were to decrease ED utilization through enhanced toxicity management, and to enhance coordination and communication to improve person-centred care. Since 2018, a team of specialized oncology nurses have supported patients across 72 hospitals after hours (e.g., evenings, weekends, and holidays) utilizing evidence-based tele-triage tools including the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides. Nurses managed most of the calls with self-management strategies and 24% of the callers were referred to the ED. There was an estimated annualized 5,211 ED visits saved, resulting in provincial cost-savings of $3.8 million. Patient experience surveys revealed more than 90% of patients who completed the survey agreed or strongly agreed that they had a good experience with this service and expressed high satisfaction with the quality of the service on all parameters asked.

Advances in the detection, diagnosis, and treatment of cancer have paralleled significant developments in the understanding of tumour biology, pathophysiology, and genomics. In spite of this, cancer remains the leading cause of death in Canada, with an estimated two in five Canadians expected to be diagnosed with cancer and one in four Canadians expected to die of cancer in their lifetime. Although Canada has a publicly funded, universal healthcare system, profound inequities exist across the country. Such inequities are often due to a multitude of intersecting factors. The focus of this paper is to review the impact of rurality on cancer care. People residing in rural and remote regions are known to have reduced access to and availability of cancer care, from prevention through diagnosis, treatment, follow-up, and palliative care. Potential strategies to mitigate the challenges associated with rurality will be discussed, including an overview of the role that nurses can play in addressing the needs of patients in rural regions. Oncology nurses are well suited to help support patients, their loved ones, and healthcare colleagues in rural settings with a view to helping improve equity in access to care, quality of care, and outcomes of care for all Canadians.

Advocating for all people affected by cancer has been identified as a priority for CANO/ ACIO in its 2021-2025 Strategic Plan (CANO/ACIO, 2022). Acknowledging the need to address social injustices and health inequities in cancer care for underserved and/or vulnerable populations, CANO/ ACIO convened a national Underserved and Priority Population (UPP) Working Group to create guiding principles and actions related to CANO/ACIO's activities. To support achieving its mandate, the working group hosted a workshop at the 2022 CANO/ACIO Annual Conference where members explored cancer as a social justice issue and the role of nursing advocacy as a tool for advancing social justice in oncology. Video case studies were used to facilitate large and small group discussion, which included an exploration of barriers to advocacy and mitigation strategies at the individual, interpersonal, and organizational levels. Findings from the workshop discussions and post-workshop reflection will be used to inform the ongoing work of the UPP Working Group, which includes creating actionable recommendations for CANO/ACIO's advocacy activities. This work is an important step towards ensuring those affected by cancer have the resources and tools needed to access high-quality care at any point of their cancer journey.

Background: Glioblastoma Multiforme is a deadly brain cancer that is very challenging for patients and their families. It is associated with rapid progression, cognitive decline, and a low survival rate.

Objective: To determine whether deceased Glioblastoma Multiforme patients had received follow-up service from the palliative care team before their death, whether invasive measures had been reduced, and whether the last antineoplastic treatment was given within 14-30 days before death.

Method: A retrospective study utilizing chart data from January 2020 to March 2022 from an institutional project. Data were gathered to reflect selected indicators of quality of care for palliative care patients.

Results: Of the 30 hospitalized patients with Glioblastoma Multiforme who had died while in hospital, 50% had received support from the palliative care team. Two patients (6.7%) had undergone antineoplastic treatment in the last 14 days of life and 13 (43.3%) had an order limiting invasive measures defined in the last two weeks of life.

Conclusion: In half of the patients monitored by a palliative care team, antineoplastic treatment and limitation of invasive measures occurred in the last 14 days of life. This may be associated with increased suffering of patients, family members, and professionals. Discussions about end-of-life care-related choices and goals of care need to be respected.