2015 CANO/ACIO Anuual Conference Presentations by Juravinski Hospital and Cancer Centre's Advanced Practice Nurses


Advances in the Treatment of Non-Small Cell Lung Cancer (NSCLC): A Nursing Perspective 


Dr. Labib Zibdawi, Medical Oncology, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario
Massey Nematollahi, Clinical Coordinator, Clinical Trials Stronach Regional Cancer Centre Southlake, Ontario
Lorraine Martelli, Nurse Practitioner - Cancer Distress Screening and Response Initiative Hamilton Health Sciences Corporation Hamilton, Ontario 


Learning Objectives: • Better understand the evolution of treatment options for patients with NSCLC • Discuss how nurses can influence early biomarker testing to optimize treatment decisions • Review the pivotal role nurses play in working with patients to help them manage the side effects of treatment • Discuss how to incorporate palliative care and symptom management into care of the patient affected by lung cancer
                         lorraine  oct 22 2011         Lorraine Martelli                                                           

Improving Cancer Symptom Management Through Knowledge Translation: Implications for Nursing Practice


Denise E. Bryant-Lukosius, PhD1, 2, Greta Cummings, PhD3, Nancy Carter, PhD2, Margaret I. Fitch, PhD4, Margaret Forbes, RN, MN1, Esther Green, MSc5, Mark Hartman, MBA6, Lynne Jolicoeur, RN, MN7, Wenonah Mahase, MBA8, Lorraine Martelli, NP, MN1, Carole Mayer, PhD6, Gregory Pond, PhD1, 2, Anne Snider, MEd1, Linda Watson, PhD9, Jennifer Wiernikowski , NP, MN1, 1Juravinski Cancer Centre, Hamilton, Ontario, Canada, 2McMaster University, Hamilton, Ontario, Canada, 3University of Alberta, Edmonton, Alberta, Canada, 4Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada, 5Canadian Partnership Against Cancer, Toronto, Ontario, Canada, 6Northeast Cancer Centre/Health Sciences North, Sudbury, Ontario, Canada, 7Ottawa Hospital, Ottawa, Ontario, Canada, 8Cancer Care Ontario, Toronto, Ontario, Canada, 9Alberta Health Services, Calgary, Alberta, Canada.


INTRODUCTION: Many patients with cancer have poorly managed pain and symptoms, despite evidence to support effective practice. To address this research to practice gap, the Ontario Cancer Symptom Management Collaborative (OCSMC) was established to promote uptake of symptom management guidelines in regional cancer centres (RCCs) using a knowledge translation (KT) approach. PURPOSE: To provide the first evaluation of OCSMC KT strategies for improving the use of pain and symptom management guidelines. METHODS: A descriptive study was conducted using qualitative and quantitative methods including document analysis of KT plans, surveys and key informant interviews. Participants included healthcare decision-makers and providers (i.e. physicians, nurses, allied providers) from 14 RCCs. RESULTS: Over one year, RCCs implemented about 8 KT interventions every 6 months. RCC characteristics (e.g., size, geography) did not impact on type or number of interventions. Nurses were the target of 60% of all interventions. Most (95%) interventions focused on provider receipt (51%) and understanding (87%) of the guidelines. Lack of KT expertise and resources were barriers to effective planning. Nurses and other providers reported limited symptom management guideline use. CONCLUSIONS: Nurses were pivotal targets for improving cancer pain and symptom management. Substantive RCC investments in KT planning and interventions did not result in increased symptom management guideline use. SIGNIFICANCE/IMPLICATIONS: Increased use of best practices for pain and symptom management is essential for improving quality of care and patient quality of life. Engaging patients, nurses and other providers in KT planning is needed to address behavioural, team and organizational barriers to symptom management guideline use. Future KT interventions must enable nurses to apply symptom guidelines in their practice through guideline integration into organizational structures and team processes of care delivery.



Denise Bryant-Lukosius

One-Stop Comprehensive Lymphedema Assessment and Treatment Planning 

Margaret F. Forbes, RN(EC), MN, CON(C), Kathy Coskey, RN, BSN, CON(C), Hamilton Health Sciences, Hamilton, Ontario, Canada. 


Lymphedema after lymph node surgery or radiation for cancer treatment is common. To address this a NP at the Juravinski Cancer Centre developed a clinic to assess, diagnose and develop a treatment plan for cancer related lymphedema. Systems impacted include patient wellbeing, patient safety and provider satisfaction. We conclude that a dedicated oncology certified oral cancer therapy nurse navigator providing passionate, purposeful education improves patient knowledge and satisfaction. To enhance the services provided, a nurse and advanced certified fitter were added to the team. After a comprehensive consult, a treatment plan is devised. Patients who require manual lymphatic drainage therapy are resourced closer to their homes. The clinic sees between 3-5 new patients and 12-15 follow-up patients per week. Patients commonly have limb but may have truncal or breast lymphedema. The NP, RN and advanced certifed fitter collaborate to develop a treatment plan. Patients are provided with lymphedema related education pamphlets and a individualized treatment plan that incorporates skin care principles, exercise, health body weight, some form of compression with or without manual lymphatic drainage therapy. Patients are followed on a 4-monthly basis until they are self-managing their lymphedema and accessing lymphedema resources independently. Within this model collaboration with lymphedema therapists and other lymphedema related health care providers in the surrounding communities within our catchment area have been established and fostered. Expansion of this model is aimed at the prevention aspect of lymphedema. A lymphedema teaching class will be offered to patients who are at the start of their cancer journey so they can begin to engage in risk reduction strategies.



      Margaret Forbes

Nurse-Led Model for Oncology Patient Follow-Up


Kathy Coskey, RN, BScN, CON(C), CCRP1, Margaret F. Forbes, RN(EC), MN, CON(C), BScN1,2, 1Hamilton Health Sciences, Hamilton, Ontario, Canada, 2McMaster University, Hamilton, Ontario, Canada.


The incidence of cancer increases with age. This contributes to the numbers of patients being seen at cancer centres. Although diagnosis and treatment is the primary focus, there is a need post-treatment to ensure patients receive ongoing surveillance and assistance in reintegrating into families, workplaces and social environments. The Juravinski Cancer Centre (JCC) is an outpatient facility where physician and nurse teams care for disease site specific groups of patients. Once treatment is completed patients require ongoing follow up for a timeframe, often directed by practice guidelines. Until 2003 follow up care at the JCC was provided by oncologists or general practitioners in oncology. In 2003 a nurse practitioner clinic was established for breast cancer well follow-up to see patients after treatment until transition back to family physician. Visits include assessment, focused physical exam, and mammograms. In 2012 with increasing clinic volumes, a registered nurse joined the team allowing enhancement of services including more time to spend assessing for long term and late side effects, emotional, spiritual and sexual needs, as well as health promotion and disease prevention. Self-management, goal setting and empowerment are strongly encouraged. When patients are self-managing, symptoms are controlled, and there is no need for ongoing follow-up, patients are offered transition to family physician. The patient and family physician are provided with a survivorship care plan that outlines patient specific cancer history, suggested surveillance per practice guidelines, symptoms that may suggest recurrence, and cancer related resources. Between 2012 and 2014 two successful projects that utilized this model were carried out. There were high levels of patient and provider satisfaction to date. Based on this successful model, there are plans to expand this model into other disease sites at the JCC.


Designing Innovative Cancer Services: Responding to the Unmet Supportive Care Needs of Patients with Newly Diagnosed Advanced Colon Cancer 


Suganya Vadivelu, RN, MScN, CON(C), PGDHM1, Denise E. Bryant-Lukosius, PhD2, 1Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada, 2McMaster University, Hamilton, Ontario, Canada


BACKGROUND: Colorectal cancer (CRC) is the second most common cancer among Canadians and about 56% of them are diagnosed with advanced stage disease. Little is known about the supportive care needs (SCNs), healthcare services use and costs associated with a new diagnosis of advanced colon cancer. PURPOSE: To inform healthcare planning and the design of new services, we examined the fit between patient reported SCNs and their use of healthcare services during the diagnostic phase for advanced colon cancer. Healthcare service costs were also determined. METHOD: A descriptive cross-sectional survey was conducted in two cancer centres. Patient completed a self-report questionnaire that included the SCNs Survey-Short Form, Functional Assessment of Cancer Therapy-Colorectal and the Health Service Utilization Questionnaire. RESULTS: Ninety-four patients completed the questionnaire (response rate =77.5%). ‘Fears about the cancer spreading’ was the most prevalent unmet SCN (84%). Unmet SCNs experienced by 65% or more of patients related to lack of control about treatment outcomes, the uncertain future, and concerns about family members well-being. The most severe CRC-specific concerns were related to body appearance and bowel control. About 55% of participants had visited the emergency department and less than 12% used existing supportive care services. CONCLUSION: Prevalent and priority unmet needs were related to psychosocial support and information. Recommendations for designing colon cancer-specific services are provided along with strategies to improve patient use of existing resources. Factors associated with healthcare use and costs will be reported.