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‘My challenge is for chemotherapy nurses to take a step back and rethink their role’

Catherine Oakley presents the National Chemotherapy Board Good Practice Guideline for promoting early identification of systemic anti-cancer therapies side effects

Catherine Oakley presents the National Chemotherapy Board Good Practice Guideline for promoting early identification of systemic anti-cancer therapies side effects

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Chemotherapy nurses are being challenged to empower patients. Picture: Alamy

I represent UKONS on the National Chemotherapy Board, which has a remit to provide guidance, oversight and support for the continued development of high-quality, systemic anti-cancer therapies for cancer patients. The Board is attended by members involved in the delivery of systemic anticancer therapies and includes the Association of Cancer Physicians, the Royal College of Radiologists, Joint Speciality Committee of the Royal College of Physicians, the Royal College of Pathologists, UKONS, British Oncology Pharmacy Association, Public Health England SACT, NHS England Clinical Reference Group and lay representatives.

The guideline will be invaluable to cancer nurses. It is the first document to articulate the enormity of the problem where patients with debilitating and life-threatening treatment side effects delay presenting to dedicated cancer helplines. My own research has shown that busy chemotherapy services can become focused on drug delivery at the expense of more relational and holistic care. Further, systemic anti-cancer therapy information delivery, where we list potential side effects for patients to report rather than elicit their concerns and questions, can encourage passivity.

Restyle approaches

Patients who are not empowered, who feel processed through the system and who do not see clinicians as available to help with symptom management appear more likely to delay presenting with serious side effects. My challenge is for chemotherapy nurses to take a step back and rethink their role. What should we be doing to support patients and their carers during chemotherapy?

The guideline can help us to review and restyle chemotherapy services. Two approaches are suggested to help patients manage and report side effects. The first is empowerment or activation and the second approach is focused on proactive monitoring. Specific patient and carer tools and staff training are suggested to encourage early symptom reporting and gaps in the research are highlighted.

The guideline encourages us to take a fresh look at chemotherapy information delivery that can be overwhelming for patients and encourage passivity. Self-management or activation-based approaches should encourage us to rethink the way we deliver systemic anti-cancer therapy information to patients. Currently we tend to list multiple side effects that patients should report to cancer helplines.

We may better engage with patients through developing ongoing patient-centred relationships that include education at times better suited to patients than to our service. Motivational techniques that encourage discussion and focus on patient and carer concerns are likely to improve information exchange.

Traffic-light symptoms

Traffic light-based symptom reporting tools may assist patient and carer engagement with chemotherapy treatment, symptom self-management and early reporting of side effects. Carers can be crucial in helping patients to report their symptoms promptly, but we need to engage with them and provide the information they need so that they recognise when to act and to help patients.

Self-management or activation-based approaches may prompt earlier symptom reporting. How often do patients tell us they had not wanted to ‘bother’ the clinical team when they became unwell during chemotherapy? Evidence suggests that proactive support, such as home visits or telephone calls, particularly during the early stages of chemotherapy, may be effective in detecting and treating symptoms before they become more debilitating or serious.

I urge cancer nurses to use the guideline to inform more patient-focused chemotherapy nursing models. Further, cancer nurses can lead research through generating a robust evidence base to demonstrate any benefit of new models to early and potentially life-saving symptom management. We also need to develop benefits of self-management tools, holistic nursing, proactive interventions at home or by telephone and optimal timings of proactive support.

For more information visit ukons.org

Click here to download the guidelines


Catherine Oakley is the President of the UK Oncology Nursing Society (UKONS)

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