Charlotte Bloodworth

Non-Hodgkin's lymphoma

Why ‘watch and wait’ is still a valuable option for low grade lymphomas

In 2016, the National Institute for Health and Care Excellence (NICE) released guidelines recommending people with asymptomatic advanced follicular low grade lymphoma should be offered rituximab monotherapy treatment upfront at diagnosis ( NICE 2016 ). Traditionally asymptomatic patients were not treated upfront but were put on active surveillance, known as ‘watch and wait’, and only offered treatment once they reached disease progression ( Mcnamara 2012 ). This ‘watch and wait’ period could stretch to as long as ten years or longer ( Rosenberg 1985 , Ardeshna et al 2003 , Advani et al 2004 ). Being diagnosed with a cancer and then not offered active treatment can be a relief but it has also been shown to cause anxiety ( Latini 2007 , Wagner et al 2015 , Tompa 2016 ). Haematology clinicians had become well versed at explaining why a ‘watch and wait’ approach for low grade lymphomas was a better option than treating them upfront with chemotherapy. The new NICE guidelines’ shift in focus away from a surveillance approach has had a big impact on current practice. Guidelines, however, are statements that have been developed to assist clinicians in decision-making; they are not rules ( Samanta et al 2003 ). This article explores the evidence that guided the NICE review while also examining why active surveillance may still be a valid approach.

Fast Facts: Myeloma for Patients and their Supporters

Haematology clinical nurse specialist Charlotte Bloodworth reviews Fast Facts: Myeloma for Patients and their Supporters

Myeloma cell

Measuring quality of life in patients with myeloma

Myeloma is a potentially debilitating and life-limiting haematological cancer and maintaining quality of life (QOL) for people with this disease is important. As survival rates improve, measuring QOL will become more important in myeloma care. This article reports on a project and audit that involved measuring the QOL of patients with myeloma in an outpatient clinic in a single centre in Cardiff. The project and audit raised three main issues: measuring QOL is difficult due to its individualised nature; the tools available to measure QOL in myeloma are designed for use in clinical trials and are not easily transferable to a clinical setting; and the act of measuring QOL is just as important for patients and healthcare professionals as the results. The project has resulted in the development of a dedicated, nurse-led QOL clinic, which will be audited in future.

Developments in diagnostics and treatment for myeloma

Over the past decade, many novel treatments for myeloma have been developed and are now in use. The limited treatments delivered previously were chemotherapy based and either intensive, such as the autologous transplant, or gentle oral drugs, such as low-dose melphalan and dexamethasone. In addition to treatment developments, diagnostics have also evolved. This article explores three important aspects of modern myeloma care: diagnostics, treatments and survivorship. It discusses how nurses can improve their input in each area to provide more effective support for people living longer with the disease.

Challenging the myth of the 12-hour shift: a pilot evaluation

Aim The aim of this pilot evaluation was to assess whether changing a nursing shift pattern to incorporate 12-hour shifts would have positive effects for patients and staff in a ward environment. Method All nurses, night sisters and therapists in contact with the ward during the trial were asked to complete a questionnaire. Data on sickness, agency use, ‘untoward incidents’ and spread of unsocial hours were also analysed to see what effects a change in shift pattern had. Results The new shift pattern offered benefits for patients through improved communication, increased continuity of care and more content staff. In addition, staff complied to the Working Time Regulations ( DTI 1998 ) with no change to their unsocial hour pay. There was also a reduced need for agency nurses. Conclusion This study illustrated the potential a new nursing shift pattern involving 12-hour shifts has for patient care, as well as for staff job satisfaction and efficient management of the ward. Twelve-hour shifts are infamous in nursing and many studies cite exhausted and dissatisfied staff as a reason for the negative press ( Fitzpatrick et al 1999 Todd et al 1993 ). In particular, Todd et al ( 1989 ) claimed that the quality of patient care was negatively affected on wards that used a 12-hour shift pattern. The study reported here challenges Todd et al ’s work ( 1989 , 1993 ) by demonstrating the benefits a change in shift pattern to 12-hour shifts can have for patients and staff in a ward environment.