This article will outline the link between the immune system and cancer, and provide a historical timeline of immunotherapy developmental milestones.
Published data and peer reviewed ...publications/manuscripts, and textbook chapters.
Science has provided a greater understanding of the interactions between cancer and the human immune system. As this knowledge has grown, there has been significant progress in the development of clinically effective cancer immunotherapies.
Nurses’ knowledge of the different types of immunity and the interaction of cancer cells with the immune system provides foundational knowledge for understanding cancer immunotherapy. Familiarity with the history of cancer immunotherapy will allow nurses to better comprehend why immunotherapy is now a pillar of cancer treatment that continues to develop. This knowledge will translate to better understanding and provision of care for patients receiving immunotherapy for the treatment of cancer.
To determine factors contributing to the infrequent provision of spiritual care (SC) by nurses and physicians caring for patients at the end of life (EOL).
This is a survey-based, multisite study ...conducted from March 2006 through January 2009. All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (response rate = 73%) and 339 nurses and physicians (response rate = 63%) participated. The survey assessed practical and operational dimensions of SC, including eight SC examples. Outcomes assessed five factors hypothesized to contribute to SC infrequency.
Most patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference = .043). Majorities of patients indicated that SC is an important component of cancer care from nurses and physicians (86% and 87%, respectively; P = .1). Most nurses and physicians thought that SC should at least occasionally be provided (87% and 80%, respectively; P = .16). Majorities of patients, nurses, and physicians endorsed the appropriateness of eight examples of SC (averages, 78%, 93%, and 87%, respectively; P = .01). In adjusted analyses, the strongest predictor of SC provision by nurses and physicians was reception of SC training (odds ratio OR = 11.20, 95% CI, 1.24 to 101; and OR = 7.22, 95% CI, 1.91 to 27.30, respectively). Most nurses and physicians had not received SC training (88% and 86%, respectively; P = .83).
Patients, nurses, and physicians view SC as an important, appropriate, and beneficial component of EOL care. SC infrequency may be primarily due to lack of training, suggesting that SC training is critical to meeting national EOL care guidelines.
Background
This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of ...psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective.
Objectives
To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well‐being, patient health status and satisfaction.
Search methods
For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies.
Selection criteria
The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before‐and‐after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research.
Data collection and analysis
Two review authors independently assessed trials and extracted data to a pre‐designed data collection form. We pooled data using the random‐effects method. For continuous data, we used standardised mean differences (SMDs).
Main results
We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow‐up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).
Ten trials contributed data to the meta‐analyses. HCPs in the intervention groups were more likely to use open questions in the post‐intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low‐certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate‐certainty evidence), and less likely to give facts only (SMD ‐0.26, 95% CI ‐0.51 to ‐0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low‐certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate‐certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.
There were no differences between the groups with regard to HCP 'burnout' (low‐certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low‐certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias.
Authors' conclusions
Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
This study aimed to discuss how compassion fatigue (CF) develops and its repercussions on the personal and professional lives of oncology nurses.
A discursive article, with systematic searches were ...performed in seven databases to find publications on CF in oncology nurses.
So as to better organize the findings, three categories were developed to present and discuss issues related to CF: (1) Characteristics of CF and its developments: describes the components related to CF and the manifestation of this phenomenon; (2) Repercussions of compassion fatigue: reports on the impact of CF on the personal and professional life of oncology nurses; and (3) Resources for dealing with compassion fatigue: lists interventions, sources of support, professional personal training, qualified nursing care in the face of adversity, and gratitude and recognition.
the factors that trigger or protect CF are multifactorial, with the need for collective and individual interventions as a way of helping oncology nurses to protect themselves, to avoid or manage this phenomenon. CF has a direct clinical impact on the life of the oncology nurse, causing several changes. It also indirectly impacts the patient's life clinically, as it is a phenomenon that has repercussions on the provision of care.
CF affects the personal and professional lives of oncology nurses, so nurses need to seek resources to deal with it. Nursing staff employers and managers can use the evidence from this research to help nurses manage and protect themselves from compassion fatigue.
...initiatives include support and training from twinning programmes,1 short-term in-country training,2,3 and online teaching programmes.4,5 However, until there is a serious commitment from ...governments in LMICs to fund and support the development of health-care infrastructure, including personnel (physicians, surgeons, nurses, pharmacists, and radiotherapists) and to address the material and resources (eg, intravenous pumps, personal protective equipment, and chemotherapy) required, there is little hope that major improvements can be made in the current mortality statistics in these countries--72-75% of patients with cancer in LMICs will die from the disease.6 Nurses are a crucial component of any country's cancer control programme.
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