Palliative radiotherapy: what do nurses know?

BACKGROUND: palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit. AIM: the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis. METHODS: a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses. FINDINGS: the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education. CONCLUSION: nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted.

Polymeric membrane dressings for radiotherapy-induced skin damage.

Radiotherapy is one of the mainline treatments for cancer. One of the side effects associated with radiotherapy includes skin problems, which range from mild (dull erythema and tightening of the skin) to severe (moist desquamation resulting in open wounds that can be very painful associated with sloughy and, in some severe cases, necrosis). The increased use of advanced radical treatments, such as intensity-modulated radiotherapy treatment (IMRT), can also result in a higher number of patients experiencing skin reactions. It is estimated that approximately 87% of patients will experience a moderate-to-severe skin reaction (Harris et al, 2011) An evaluation was undertaken in 20 patients with head and neck cancer following a prescribed treatment of radiotherapy to compare a polymeric membrane dressing (PolyMem®) against the standard treatment. The standard treatment consisted of topical aqueous cream at the start of radiotherapy with the addition of paraffin gauze when moist desquamation occurred. A bespoke evaluation form was completed for a period of 4 weeks or until healed. Patients were asked to complete both qualitative descriptions and numerical scores of pain for symptoms and procedural pain. Analgesia and sleep patterns were logged and, in addition, free text diaries were provided for up to 4 weeks. Common themes were identified and qualitative data analysed.

Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer.

PURPOSE: To identify patterns of locoregional recurrence in patients treated with surgery and preoperative or postoperative radiotherapy or chemoradiation for rectal cancer. METHODS AND MATERIALS: Between November 1989 and October 2001, 554 patients with rectal cancer were treated with surgery and preoperative (85%) or postoperative (15%) radiotherapy, with 95% receiving concurrent chemotherapy. Among these patients, 46 had locoregional recurrence as the first site of failure. Computed tomography images showing the site of recurrence and radiotherapy simulation films were available for 36 of the 46 patients. Computed tomography images were used to identify the sites of recurrence and correlate the sites to radiotherapy fields in these 36 patients. RESULTS: The estimated 5-year locoregional control rate was 91%. The 36 patients in the study had locoregional recurrences at 43 sites. There were 28 (65%) in-field, 7 (16%) marginal, and 8 (19%) out-of-field recurrences. Among the in-field recurrences, 15 (56%) occurred in the low pelvis, 6 (22%) in the presacral region, 4 (15%) in the mid-pelvis, and 2 (7%) in the high pelvis. Clinical T stage, pathologic T stage, and pathologic N stage were significantly associated with the risk of in-field locoregional recurrence. The median survival after locoregional recurrence was 24.6 months. CONCLUSIONS: Patients treated with surgery and radiotherapy or chemoradiation for rectal cancer had a low risk of locoregional recurrence, with the majority of recurrences occurring within the radiation field. Because 78% of in-field recurrences occur in the low pelvic and presacral regions, consideration should be given to including the low pelvic and presacral regions in the radiotherapy boost field, especially in patients at high risk of recurrence.

A study to evaluate nurse-led on-treatment review for patients undergoing radiotherapy for head and neck cancer.

AIMS AND OBJECTIVES: To evaluate a nurse-led clinic for patients undergoing radiotherapy to the head and neck. BACKGROUND: The side effects of radiotherapy to the head and neck are superimposed on already significant physical and psychological morbidity. Medical review clinics tend to focus on treatment complications and there is evidence that specialist nurses can provide more holistic care for patients. However, doubts have been raised about the appropriateness of nurse-led review in this highly symptomatic and complex group. DESIGN: This evaluation compared medical on-treatment review (Phase 1) with a nurse-led clinic (Phase 2) for patients having radiotherapy to the head and neck, using an historical control group. METHODS: Twenty patients were reviewed by their consultant and 23 by a nurse specialist, using a clinic protocol. A mixed-method approach to data collection was taken. Patients completed weekly quality of life questionnaires and were asked about their experiences of support and care. General practitioners completed a questionnaire about the communication received from the clinic. Checklists assessed the content of clinic consultations. RESULTS: Patients valued the relationship developed with the nurse specialist, had longer, more frequent consultations and were more often referred to the multidisciplinary team. The nurse specialist managed 83% of consultations without referral to the consultant. Few significant differences in quality of life were found between the groups. There were indications that oral and nutritional problems were managed more effectively in the nurse-led clinic, although emotional functioning was higher in the medical group. GPs were positive about the timing and content of information received. CONCLUSIONS: On-treatment review for patients with head and neck cancer can be effectively managed by a nurse specialist. Relevance to Practice. Radiotherapy nurse specialists make an important contribution to the supportive care of patients with head and neck cancer. More investment is required to maximize their contribution.

A supportive nursing care clinic: conceptions of patients with head and neck cancer.

Patients with head and neck cancer have complex long-lasting physical and psychosocial needs due to illness and treatment, and studies have shown deficiencies concerning support in these respects. The purpose of this study was to describe how head and neck cancer patients with eating problems conceived the significance of a supportive nursing care clinic before, during and after completion of radiotherapy. Thematic interviews were carried out in an open dialogue with 12 patients treated with radiotherapy for head and neck cancer. The phenomenologischer method was used in the analyses. The findings showed that the nurse clinic could meet head and neck cancer patients' needs of safety and security, which was especially important before and after completion of treatment when no other regular contacts in the health care system existed. The significance of the nurse clinic varied depending on where in the trajectory the patients were, what needs and problems they experienced, and how severe these were experienced by the individual patient. The supportive nursing care clinic could meet these patients' needs of knowledge, care and support both concerning practical measures related to the disease and its treatment, and emotional needs. This way of organising the care can contribute to these patients' health and wellbeing.

The state of the art in radiation therapy.

OBJECTIVES: To describe the modalities used to administer radiation therapy and discuss the acute effects and long-term survivorship issues experienced by patients who receive radiation therapy. DATA SOURCES: Radiation oncology, surgical, and oncology nursing journals, textbooks, electronic resources. CONCLUSION: New technology and state-of-the-art equipment has resulted in improved treatment modalities, thereby expanding traditional treatment paradigms and exploring new frontiers. IMPLICATIONS FOR NURSING PRACTICE: It is critical that oncology nurses remain cognizant of advanced technology and its influence on treatment outcomes and patient toxicity. Such knowledge will better serve patients and hopefully influence evidence-based treatment interventions.

Role of the radiation oncology nurse.

OBJECTIVES: To discuss the role of the radiation oncology nurse as changes in technology and treatment impact care delivery. DATA SOURCES: Published articles and texts, professional organizations, and the authors' experience. CONCLUSION: Patients receiving cancer treatment today face a myriad of treatment options that can be delivered over days, weeks, and months. As treatments become more complex and standard chemotherapy regimens are combined with new agents and targeted agents, radiation oncology nurses need to have the knowledge and skills to accurately assess and intervene. The radiation oncology nurse is the cornerstone of patient advocacy, care, and education. IMPLICATIONS FOR NURSING PRACTICE: Changes in treatment and technology continue to drive cancer care. Radiation oncology nurses need to collaborate with colleagues and incorporate evidence into practice.

Advanced practice nursing in radiation oncology.

OBJECTIVES: To discuss the roles of advance practice nurses in radiation oncology. DATA SOURCES: Published articles and textbooks, personal communications, and authors' experience. CONCLUSION: Radiation oncology advance practice nurses (NP and CNS) are becoming essential members of the multidisciplinary team, with distinct roles and responsibilities. Providing direct patient care, involvement in specialized procedures, and conducting initial and/or follow-up visits allows advance practitioners to become more involved with patients undergoing radiation therapy. IMPLICATIONS FOR NURSING PRACTICE: As more combined modalities are being offered to patients undergoing oncology treatments and the complexity of patients are becoming more difficult, advance practice nurses can add value to the workload, quality patient care, and make a difference in patient's lives.

Use of preferred music to reduce emotional distress and symptom activity during radiation therapy.

Music therapy has decreased anxiety levels in many medical settings. This randomized clinical trial examined the effectiveness of a music listening intervention, delivered by a board-certified music therapist, in patients undergoing curative radiation therapy (RT). Emotional distress (anxiety, depression, and treatment-related distress) and symptoms (fatigue and pain) were measured at baseline, mid-treatment, and end of treatment in 63 patients undergoing RT. Although patients who listened to self-selected music reported lower anxiety and treatment-related distress, there was a decline in these outcomes for patients in both groups over the course of RT. Depression, fatigue, and pain were not appreciably affected by music therapy. Within the music group, there was a significant correlation between number of times music was used/week and the change in treatment-related distress, suggesting that higher doses of music produced greater declines in distress. While these findings provided some support for the use of music in reducing distress during RT, further research demonstrating clear differences between intervention and control conditions is needed. Physical symptoms were not affected by the use of music over the course of RT.

Structural visualization of expert nursing: Expert nursing care for a patient undergoing outpatient radiotherapy.

In the past, almost all patients underwent radiotherapy during the hospital stay. So nurses took care of patients after radiotherapy in the hospital where patients could receive nursing care 24 hours a day. However, recently more and more patients have undergone radiotherapy at clinics as outpatients. This benefits them in enabling them to receive the therapy with improving QOL and maintaining their style of living--on the other hand this requires much self-care ability on their part and patient compliance of outpatient visits depends on their own positive decision-making. Nurses are considered to make decisions or take implementation of various kinds of intervention in the limited time of pre and post proceedings of the therapy when they accommodate patients directly. The process of their intervention has not so far been clarified so that the quality of the care depends on the degree of each individual's capacity or devotion. In addition, with the trend in decreasing hospitalized days, it is predicted that more and more patients will undergo outpatient radiotherapy. So it is significant to clarify the process for quality assurance of nursing.

Ionising radiation: promoting safety for patients, visitors and staff.

Diagnostic radiology and sealed and unsealed sources of radiotherapy are valuable in the treatment of cancer. However, unwanted consequences can result from excessive exposure to ionising radiation. Therefore, its administration requires great care not only to protect the patient but also the nurses involved in patient care. Nurses should be aware of the safety issues in the diagnostic and therapeutic use of ionising radiation so that they can work safely and confidently.

Information Sharing and the Nursing Practice for the Certified Nurse in Radiation Therapy Nursing.

This study is conducted in order to clarify, however practice and get or sharing information in the Radiation Therapy Nursing of Certified Nurses. We have the group interviews from the four members the Certified Nurses in Radiation Therapy Nursing. It was found that Certified Nurses in Radiation Therapy Nursing felt that don't have the information about the patients who receives radiation therapy. In addition, they thought not able to even determine about whether time required, and not provide the professional nursing care practice. They say that we need the time, place and information. They were determined to be there to be necessary in for exhibiting their abilities. In particular, the most important problems that there aren't systematic information of the patients who receives radiation therapy. It's mean that, not have described the information for Radiation Therapy Nursing, and not obviously structure of nursing process or important assessment's, yet.

[Experiences and results from standardised observations of conventional and kinaesthetic nursing in a nuclear and radio-therapeutic ward]. / Erfahrungen und Resultate von standardisierten Beobachtungen konventioneller und kinästhetischer Pflege auf einer radioonkologischen Abteilung.

In the Clinic for Nuclear Medicine and Radiotherapy, City Hospital Triemli (Zurich, Switzerland), a controlled observational study was carried out. The investigation aimed at comparing conventional and kinaesthetic nursing interventions with respect to the agility and body orientation of the patients, and with respect to their interaction with the nurses. The observations were limited to the interventions washing, positioning, and mobilizing and lasted 20 to 60 minutes. During this time, an experienced nurse, who did not belong to the nursing team, completed a checklist. The checklist items comprise operationalized criteria of the kinaesthetic concept by Hatch and Maietta, as well as two questions directed to the patients. Body motion and orientation were judged by a 12-items scale, identical for observations prior to and immediately after the nursing intervention. The interaction between patients and nurses was judged by means of a 10-items scale. Group 1 (13 patients) was observed during conservative nursing; group 2 (another 13 patients) was observed almost half a year later during kinaesthetic nursing. All observations were recorded with the same instrument. There was a general positive effect of the nursing interventions. Kinaesthetic nursing, however, only showed a trend towards better effects on the patients' agility, body orientation or interaction abilities in comparison to conventional nursing. The results are discussed with respect to a recently published study on objective measurement of kinaesthetic nursing effects. There is a certain discrepancy between the well-known positive valuation of kinaesthetic nursing by the nurses themselves and the measurable effects of the method. This discrepancy cannot simply be explained by sample size, type of measurement, or the nurses'experience with the method.

Improved pain management with daily nursing intervention during radiation therapy for head and neck carcinoma.

This study evaluated the response to a defined mouth care and analgesic treatment protocol for oropharyngeal mucositis in patients undergoing radiation therapy for head and neck carcinoma. Nineteen patients completed a 15 question pain survey before each radiation treatment. Patients were given instructions on the use of mouthwashes and a three-step analgesic protocol: acetaminophen, acetaminophen with codeine suspension, and oral morphine (20 mg/mL) for mild, moderate, and severe pain, respectively. Patients were seen daily by a radiation therapy nurse who reviewed the survey and prompt changes in the prescribed analgesic regimen were then made by a physician. Marked differences in control of pain related to radiation mucositis were observed when compared to patients from our prior study who used the same daily survey but had only sporadic nursing intervention and no analgesic protocol. Patients having daily nursing intervention reported fewer days of moderate/severe pain, had less pain throughout the day, and noted less disturbance in sleep, eating, and energy level. Weight loss of greater than 5 kg was noted in only three patients. Analgesics were used on 77% of treatment days and relieved all or most of the pain in 94% of these days. Daily review of a symptom survey by a radiation therapy nurse, combined with a well-defined strategy for mouth care, and analgesics results in improved pain management of radiation induced oropharyngeal mucositis because of prompt attention to patient needs. Future trials should incorporate defined strategies for oral care and analgesic use to control for possible bias in assessing efficacy.

Model quality assurance program for radiation oncology nursing.

The first step in developing a quality assurance program for radiation oncology nursing is to define the services the nurse should provide to the patient receiving radiation therapy. The focus of radiation oncology nurses should be quality of life issues provided through their roles as teachers, direct care givers, and counselors. With this focus in mind, a three-phase plan was developed at Fox Chase Cancer Center to operationalize a quality assurance program for radiation oncology nursing based on Guidelines for cancer nursing practice by the Oncology Nursing Society (ONS) and the American Nurses' Association (ANA).

Assessing nursing problems of importance for the development of nursing care in a radiation therapy department.

The challenges to nurses working in the rapidly changing milieu of radiotherapy in cancer care are great. New treatment regimens continually require reexamination of old assumptions about patients' needs and communication between colleagues. In order to continue the development of the nursing care in the radiation therapy department, the purpose of this study was to assess the nursing problems experienced in the care of the cancer patients and the nursing problems experienced in work with other professionals from the nurse's perspective. Eighteen of the 38 nurses in the radiation therapy department were invited to participate in the study. The mean age of the nurses was 39 years (range 25-57 years). The study was carried out by using a three-phase, structured, communication-process method according to the Delphi technique. The nurses reported "poor follow-up of patients who have completed radiation therapy," closely followed by "finding time to document the nursing care" and "finding time to treat the scheduled patients" as the most problematic areas of importance for the development of nursing care. The nursing problems considered to be the most difficult in the work with other professionals were "lack of communication," "lack of knowledge of our work and competence," and "lack of comprehension of each other's professions." With the present trend in the health care system toward smaller financial resources, it is necessary to find new ways of organizing nursing care in order to find time to take care of the patient's problems during and after the radiation therapy. This study constituted the base for organizing a nursing care clinic in the department with sufficient time to assess and monitor side effects, patient education, sexual counselling, and coping assistance.

Thai Buddhist patients with cancer undergoing radiation therapy: feelings, coping, and satisfaction with nurse-provided education and support.

Ninety male and 89 female Thai Buddhist patients with cancer undergoing radiation therapy at a Bangkok hospital outpatient radiation therapy clinic were subjected to a questionnaire study. The purpose of the study was to (i) describe feelings, coping, and satisfaction with nurse-provided education and support and (ii) identify possible gender differences. The results showed that the most common feelings of both genders at first knowledge about radiation therapy were "acceptance/calmness," and the women more often than the men felt "anxiety" and "fright/fear." The most common ways of coping with radiation therapy for both genders were "rest," "talk with family/friends," "visit doctor," and "meditate," and in this regard there were no significant gender differences. The men expressed their highest satisfaction with "nurse has knowledge about disease/treatment" and "nurse listens to patient's problem," whereas the women expressed their highest satisfaction with "patient dares to ask questions" and "nurse likes to explain information." The satisfaction with different aspects of nurse-provided education and support was commonly higher among the men. When oncology nurses are to provide education to radiation therapy patients, it is essential that they are aware of their patients' characteristics, such as the ones identified here, that are related to cultural values and religious beliefs as well as to gender.