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Editorial
EJCC Editorial K. ROBB, PHD, BSC, Consultant Physiotherapist & Member of Macmillan Consequences of Cancer Treatment Collaborative, London, UK ROBB K. (2014) European Journal of Cancer Care 23, 583–584 EJCC Editorial
Keywords: survivorship, quality of life, palliative care, physical activity, communication.
In this edition of the journal we cover topics including survivorship, palliative care and quality of life. We also have a selection of papers that look at individual members of the MDT and examine aspects of their clinical practice in more detail. Wagner et al. (2014; pp. 585–593) explore the quality of surgeon-patient communication following oncological surgery and the satisfaction of patients with the communication process. Although the messages from this study are mostly positive with respect to the quality of communication, there is some evidence that the information given by surgeons is not always complete. This is particularly evident for patients receiving palliative treatment and raises important and sensitive issues around the holding back of information in order to maintain hope. The authors remind us of the commentary by Mack and Smith (2012) which suggests it is time to ‘begin to shift the discourse in medicine towards honest conversation as fundamental duty’. Groß et al. (2014; pp. 594–606) help us understand how working conditions and job stress affect the ability of oncologists to interact with their patients. Most oncologists were insightful to the factors impacting on their stress levels and it is not surprising to learn that most oncologists suffer from heavy workload, time pressures and stress! There are some interesting findings around the experiences of older oncologists and some implications for practice with respect to how oncologists can manage their job stress and maximise their doctor-
Correspondence address: Karen Robb, European Journal of Cancer Care Editorial Office, Wiley, 9600 Garsington Road, Oxford, OX4 2DQ, UK (e-mail: [email protected]). DOI: 10.1111/ecc.12229 European Journal of Cancer Care, 2014, 23, 583–584
© 2014 John Wiley & Sons Ltd
patient interaction – the latter clearly being a vital ingredient in improving patient care (Hack et al. 2005). Kirsch et al. (2014; pp. 607–615) emphasise the important role of nurses in supporting patients to self-manage and explore the role of the nurse in helping those who are undergoing stem cell transplants to adhere to medication regimes. Although the interventions perceived as most effective by nurses were educational (e.g provision of reading materials), this appears to conflict with recent evidence showing the benefits of behavioural interventions (Conn et al. 2009; Vervloet et al. 2012). Alcantara et al. (2014; pp. 616–623) explore the experiences of Australian radiologists attending breast cancer MDT meetings and examine how they perceive their participation and the impact on their work. This study highlights the important role of radiologists in MDT meetings as well as discussing several benefits for the radiologists themselves. We have a number of papers on survivorship some of which address the topic of ‘physical activity’. There is now general concensus that exercise interventions have widespread benefits for people living with and beyond cancer (Schmitz et al. 2010; Campbell et al. 2011). Banzer et al. (2014; pp. 624–629) adds further weight to the evidence-base in their examination of exercise capacity, quality of life and fatigue in cancer patients during a 4 month exercise intervention. Despite the weight of evidence in support of exercise, few countries have fully integrated physical activity interventions into their cancer care pathways. O’Hanlon & Kennedy (2014; pp. 630–639) surveyed oncology nurses and physiotherapists and uncover the limited nature of exercise services currently available to patients in Ireland. They highlight interesting differences in the knowledge base and clinical practice of the two professional groups and identify a range of barriers with respect to advancing
ROBB
exercise in cancer care. It is clear that further training is needed for many professional groups to advance clinical practice. Training needs are also highlighted by Green et al. (2014; pp. 640–652) in their exploration of health behaviour models, nutrition and physical activity after a cancer diagnosis. Their findings support the need for training in health behaviour change to assist healthcare professionals in utilising ‘teachable moments’ (Demark-Wahnefried et al. 2005). Andersen et al. (2014; pp. 653–667) remind us of the significant impact chemotherapy-related pain can have on breast cancer patients but re-enforce that exercise interventions have an important role during treatment. The findings from their interviews of younger women taking part in a group exercise programme are particularly relevant for readers with a joint interest in pain management and physical activity. The final article on survivorship explores the benefits of a cancer support and education programme in New Zealand. Kane et al. (2014; pp. 668–674) highlight several important benefits for patients but also remind us of the need to examine the heterogeneity in groups and select participants carefully to ensure maximum benefit for all. Studies investigating quality of life in people living with and beyond cancer remain an area of significant interest to our journal. Bayram et al. (2014; pp. 675–684) evaluate QoL in Turkish breast cancer patients undergoing chemotherapy and their satisfaction with nursing care. The authors provide examples nursing care which is meeting the needs of patients but also where improvements could be made. Bužgová et al. (2014; pp. 685–694) examine quality of life and unmet needs in palliative patients in the Czech Republic and identify key patient-expressed
REFERENCES Campbell A., Stevinson C. & Crank H. (2011) The British Association of Sport and Exercise Sciences Expert Statement on Exercise and Cancer Survivorship. The Sport and Exercise Scientist 28, 16–17. Conn V.S., Hafdahl A.R., Cooper P.S., Ruppar T.M., Mehr D.R. & Russell C.L. (2009) Interventions to improve medication adherence among older adults: meta analysis of adherence outcomes among randomized controlled trials. The Gerontologist 49, 447–462. Demark-Wahnefried W., Aziz N.M., Rowland J.H. & Pinto B.M. (2005) Riding the crest of the teachable moment:
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needs which impact on autonomy and patient health. The authors conclude that assessing QoL with respect to unmet needs, is vital and should be routinely targeted in medical and nursing interventions. However, we must not forget the important role of Allied Health professionals in the care of these patients, particularly as they are have expertise in rehabilitation and are ideally suited to foster independence and empowerment and work towards improving QoL (NCAT & Macmillan 2013). The final theme in this issue is Palliative Care and we present 2 papers which address very different issues. Wu et al. (2014; pp. 695–700) present a retrospective analysis of the factors associated with hypercalcaemia in patients with advanced cancer and make some clear recommendations around the clinical monitoring of patients and which groups may need special attention. The impact of Hospice Nurse Specialists on the experiences of partners bereaved through cancer is explored by Borland et al. (2014; pp. 701–711). It is perhaps not surprising that this study confirms the value of the specialist nurse but what is especially pertinent, particularly in the context of economic constraints, is the economic argument for maintaining and developing specialist nurses in palliative care. We must continue to develop the economic evidence-base in support of specialist posts to ensure patients have access to the highest quality supportive care, wherever they find themselves in their cancer journey. As you can see, we have a diverse range of articles under several different themes for your perusal this month. If any of these papers prompt you to respond, please consider a letter to the editor or contact us with ideas for future editions. Thank you for your ongoing support of EJCC.
promoting long-term health after the diagnosis of cancer. Journal of Clinical Oncology 23, 5814–5830. Hack T.F., Degner L.F., Parker P.A. & SCRN Communication Team (2005) The communication goals and needs of cancer patients: a review. Psycho-Oncology 14, 831–845, discussion 856–7. Mack J.W. & Smith T.J. (2012) Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. Journal of Clinical Oncology 30, 2715–2717. National Cancer Action Team (NCAT) & Macmillan Cancer Support (March 2013) Cancer Rehabilitation: Making Excellent Cancer Care possible.
Schmitz K.H., Courneya K.S., Matthews C., Demark-Wahnefried W., Galvao D.A., Pinto B.M., Irwin M.L., Wolin K.Y., Segal R.J., Lucia A., Schneider C.M., von Grunigen V.E. & Schwartz A.L. (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise 42, 1409–1426. Vervloet M., Linn A.J., van Weert J.C., de Bakker D.H., Bouvy M.L. & van Dijk L. (2012) The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. Journal of the American Medical Informatics Association: JAMIA 19, 696–704.
© 2014 John Wiley & Sons Ltd
Editorial
EJCC Editorial K. ROBB, PHD, BSC, Consultant Physiotherapist & Member of Macmillan Consequences of Cancer Treatment Collaborative, London, UK ROBB K. (2014) European Journal of Cancer Care 23, 583–584 EJCC Editorial
Keywords: survivorship, quality of life, palliative care, physical activity, communication.
In this edition of the journal we cover topics including survivorship, palliative care and quality of life. We also have a selection of papers that look at individual members of the MDT and examine aspects of their clinical practice in more detail. Wagner et al. (2014; pp. 585–593) explore the quality of surgeon-patient communication following oncological surgery and the satisfaction of patients with the communication process. Although the messages from this study are mostly positive with respect to the quality of communication, there is some evidence that the information given by surgeons is not always complete. This is particularly evident for patients receiving palliative treatment and raises important and sensitive issues around the holding back of information in order to maintain hope. The authors remind us of the commentary by Mack and Smith (2012) which suggests it is time to ‘begin to shift the discourse in medicine towards honest conversation as fundamental duty’. Groß et al. (2014; pp. 594–606) help us understand how working conditions and job stress affect the ability of oncologists to interact with their patients. Most oncologists were insightful to the factors impacting on their stress levels and it is not surprising to learn that most oncologists suffer from heavy workload, time pressures and stress! There are some interesting findings around the experiences of older oncologists and some implications for practice with respect to how oncologists can manage their job stress and maximise their doctor-
Correspondence address: Karen Robb, European Journal of Cancer Care Editorial Office, Wiley, 9600 Garsington Road, Oxford, OX4 2DQ, UK (e-mail: [email protected]). DOI: 10.1111/ecc.12229 European Journal of Cancer Care, 2014, 23, 583–584
© 2014 John Wiley & Sons Ltd
patient interaction – the latter clearly being a vital ingredient in improving patient care (Hack et al. 2005). Kirsch et al. (2014; pp. 607–615) emphasise the important role of nurses in supporting patients to self-manage and explore the role of the nurse in helping those who are undergoing stem cell transplants to adhere to medication regimes. Although the interventions perceived as most effective by nurses were educational (e.g provision of reading materials), this appears to conflict with recent evidence showing the benefits of behavioural interventions (Conn et al. 2009; Vervloet et al. 2012). Alcantara et al. (2014; pp. 616–623) explore the experiences of Australian radiologists attending breast cancer MDT meetings and examine how they perceive their participation and the impact on their work. This study highlights the important role of radiologists in MDT meetings as well as discussing several benefits for the radiologists themselves. We have a number of papers on survivorship some of which address the topic of ‘physical activity’. There is now general concensus that exercise interventions have widespread benefits for people living with and beyond cancer (Schmitz et al. 2010; Campbell et al. 2011). Banzer et al. (2014; pp. 624–629) adds further weight to the evidence-base in their examination of exercise capacity, quality of life and fatigue in cancer patients during a 4 month exercise intervention. Despite the weight of evidence in support of exercise, few countries have fully integrated physical activity interventions into their cancer care pathways. O’Hanlon & Kennedy (2014; pp. 630–639) surveyed oncology nurses and physiotherapists and uncover the limited nature of exercise services currently available to patients in Ireland. They highlight interesting differences in the knowledge base and clinical practice of the two professional groups and identify a range of barriers with respect to advancing
ROBB
exercise in cancer care. It is clear that further training is needed for many professional groups to advance clinical practice. Training needs are also highlighted by Green et al. (2014; pp. 640–652) in their exploration of health behaviour models, nutrition and physical activity after a cancer diagnosis. Their findings support the need for training in health behaviour change to assist healthcare professionals in utilising ‘teachable moments’ (Demark-Wahnefried et al. 2005). Andersen et al. (2014; pp. 653–667) remind us of the significant impact chemotherapy-related pain can have on breast cancer patients but re-enforce that exercise interventions have an important role during treatment. The findings from their interviews of younger women taking part in a group exercise programme are particularly relevant for readers with a joint interest in pain management and physical activity. The final article on survivorship explores the benefits of a cancer support and education programme in New Zealand. Kane et al. (2014; pp. 668–674) highlight several important benefits for patients but also remind us of the need to examine the heterogeneity in groups and select participants carefully to ensure maximum benefit for all. Studies investigating quality of life in people living with and beyond cancer remain an area of significant interest to our journal. Bayram et al. (2014; pp. 675–684) evaluate QoL in Turkish breast cancer patients undergoing chemotherapy and their satisfaction with nursing care. The authors provide examples nursing care which is meeting the needs of patients but also where improvements could be made. Bužgová et al. (2014; pp. 685–694) examine quality of life and unmet needs in palliative patients in the Czech Republic and identify key patient-expressed
REFERENCES Campbell A., Stevinson C. & Crank H. (2011) The British Association of Sport and Exercise Sciences Expert Statement on Exercise and Cancer Survivorship. The Sport and Exercise Scientist 28, 16–17. Conn V.S., Hafdahl A.R., Cooper P.S., Ruppar T.M., Mehr D.R. & Russell C.L. (2009) Interventions to improve medication adherence among older adults: meta analysis of adherence outcomes among randomized controlled trials. The Gerontologist 49, 447–462. Demark-Wahnefried W., Aziz N.M., Rowland J.H. & Pinto B.M. (2005) Riding the crest of the teachable moment:
584
needs which impact on autonomy and patient health. The authors conclude that assessing QoL with respect to unmet needs, is vital and should be routinely targeted in medical and nursing interventions. However, we must not forget the important role of Allied Health professionals in the care of these patients, particularly as they are have expertise in rehabilitation and are ideally suited to foster independence and empowerment and work towards improving QoL (NCAT & Macmillan 2013). The final theme in this issue is Palliative Care and we present 2 papers which address very different issues. Wu et al. (2014; pp. 695–700) present a retrospective analysis of the factors associated with hypercalcaemia in patients with advanced cancer and make some clear recommendations around the clinical monitoring of patients and which groups may need special attention. The impact of Hospice Nurse Specialists on the experiences of partners bereaved through cancer is explored by Borland et al. (2014; pp. 701–711). It is perhaps not surprising that this study confirms the value of the specialist nurse but what is especially pertinent, particularly in the context of economic constraints, is the economic argument for maintaining and developing specialist nurses in palliative care. We must continue to develop the economic evidence-base in support of specialist posts to ensure patients have access to the highest quality supportive care, wherever they find themselves in their cancer journey. As you can see, we have a diverse range of articles under several different themes for your perusal this month. If any of these papers prompt you to respond, please consider a letter to the editor or contact us with ideas for future editions. Thank you for your ongoing support of EJCC.
promoting long-term health after the diagnosis of cancer. Journal of Clinical Oncology 23, 5814–5830. Hack T.F., Degner L.F., Parker P.A. & SCRN Communication Team (2005) The communication goals and needs of cancer patients: a review. Psycho-Oncology 14, 831–845, discussion 856–7. Mack J.W. & Smith T.J. (2012) Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. Journal of Clinical Oncology 30, 2715–2717. National Cancer Action Team (NCAT) & Macmillan Cancer Support (March 2013) Cancer Rehabilitation: Making Excellent Cancer Care possible.
Schmitz K.H., Courneya K.S., Matthews C., Demark-Wahnefried W., Galvao D.A., Pinto B.M., Irwin M.L., Wolin K.Y., Segal R.J., Lucia A., Schneider C.M., von Grunigen V.E. & Schwartz A.L. (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise 42, 1409–1426. Vervloet M., Linn A.J., van Weert J.C., de Bakker D.H., Bouvy M.L. & van Dijk L. (2012) The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. Journal of the American Medical Informatics Association: JAMIA 19, 696–704.
© 2014 John Wiley & Sons Ltd
