Ahmed Lateef AlkhaqaniM.Sc.,Ministry of Health,Al-Najaf Direction,Al-Sadder Medical Hospital,Al-Najaf 00964,Iraq.

Dear editors

The worldwide burden of cancer is rising,leading to significant premature deaths and productive life-long loss.Cancer-related mortality is disproportionately higher in low-income and middle-income countries(LMICs;estimated at 72%–75%)than in high-income countries(HICs;estimated at 46%).The nursing workforce is essential to cancer control.One goal of Nursing Now is to release the potential of nurses to deliver universal health coverage,ensuring that“all individuals have access to the spectrum of health care services they need without enduring financial hardship”.The general coverage of health care applies to the cancer treatment continuum;in fact,the expansion of the role of oncology nurses can enhance access to cancer treatment services[1].With modern medicine’s continuous improvement and development,the concept of holistic nursing has gradually emerged.Adhering to the return of humanities is the only way to achieve overall care.As a way of humanistic care,oncology nursing has steadily attracted the attention of the nursing community.Cancer care refers to narrative medicine’s humanistic care,respect,listening,and empathy.It is,therefore,timely to reflect on oncology nursing,which has long been recognized as a specialty in high-income countries where roles and responsibilities have grown to meet the unique and changing needs of patients with cancer.However,oncological nursing is not a global term;global inequalities in oncological nursing are widespread.Nurses caring for people at risk or with cancer provide the majority of oncology services in LMICs.However,these nurses are often the least educated in the oncological team,and the oncology nursing role expansion has not kept pace with its growing need.Nevertheless,throughout the world,cancer continuum care principles are very similar,focusing on providing optimal care in the health environment[2].

This article highlights the contribution and impact of oncology nurses along the cancer care continuum.The provision of integrated care and an optimal communication centered on people is an essential component of oncological nursing care,which is often overlooked.More oncology nurses who use,do,and lead research will further demonstrate the critical impact of nurses on the team’s care.The influence of oncology nurses on saving lives by preventing and early cancer detection is remarkable.Supportive care is a central component of cancer nursing,enabling people to manage themselves as much as possible.Globally,oncology nurses make a great positive difference in cancer care worldwide.Their crucial contribution throughout the continuum of care warrants the inclusion and promotion of nursing in every country’s cancer strategy.

Contribution of oncology nursing

Oncology nurses are registered nurses who work in general,specialized,or advanced care of patients.Although oncology nurses are the most visible in direct patient care,their role may include the work of multiple non-direct patient care levels.They may support the patient as a navigator during the whole continuum of care or participate at various stages.In this fast-paced field,high-income oncology nurses play various roles and responsibilities in responding to patients’non-metastatic needs.Nurses caring for cancer patients are higher in low-income,and middle-income countries have fewer opportunities.These opportunities have progressed despite significant challenges such as limited resources and training for the workforce[1].

Oncology nurses have the privilege of helping cancer patients navigate the emotional and physical challenges that are interrelated with cancer.Oncology nurses can help relieve patients’pain and nausea and assist with implementing the treatment plan that is best for the patient.Cancer care is tied to the value of offering personalized,holistic,and contemporary care to cancer patients and their families.In order to deliver this kind of care,cancer nurses have learned to adapt,develop,extend and expand their roles and attempted to meet the demands placed upon them by changing local,regional,national,and international healthcare needs;advances in our understanding of cancer and developments in cancer treatment.In addition to these biomedical advances,cancer care has continuously evolved in various ways and different settings.

Nursing interventions have also adapted to the technological advances in cancer treatment.One of the most important is related to cancer genes.Scientists have developed the boundaries of knowledge regarding genes involved in maintaining certain cancers.Our medical colleagues are studying the therapeutic potential of this knowledge,and cancer nurses are focusing on the psycho-social and decision-making issues that ensue for those individuals and families who may be or perceive themselves to be at risk[3].While it is vital to celebrate the development,diversity,and dynamism of cancer nursing,there is also a danger of losing sight of the essential core skills and values that establish the foundation of cancer nursing.Keeping one eye over our shoulder seems crucial as we constantly move forward.Cancer care,including people’s resources,has limited resources,and every role established by cancer nurses is at risk of abandoning another aspect of cancer care[4].

This contribution is currently extended in several directions.Over the last two decades,cancer nursing has acknowledged the unique needs of children and adolescents and has moved to meet them.However,in the latter case,special needs for men and the elderly were studied through research and dealt with in practice.Cancer nurses’commitment to exploring and facing the challenges of cancer experiences has led to numerous roles being developed.These include engaging in genetic counselling;offering support and information during screening and diagnosis,giving treatment and monitoring and managing consequential side-effects,facilitating coping and adjustment;and promoting rehabilitation and recovery.In addition,cancer nurses continue to support patients throughout the disease’s progression until death and beyond.Such care can be centered in various environments,including hospitals,community health centers,early diagnosis centers,day-care facilities,and hospital rooms.

Finally,cancer nurses need to ensure that support structures are available for the consolidation and development of the specialty in education,ethical debate,research,audit,dialogue across the world,sharing resources and information,mentorship,and clinical supervision.Cancer nurses do not work alone from the experiences of patients and families who care for them;what the nurses feel is stressful in a sense,rewarding and satisfying.The resource lies within each cancer nurse to be instrumental in reviewing,participating in,or leading nursing development and establishing and maintaining a working environment in which cancer nurses and cancer nursing flourish.

Professional training

Nursing studies have shown that people with cancer have expectations of the nurses caring for them.Competency is the most important expectation.People care that the nurse can start the IV and give chemotherapy,change a dressing,insert a urinary catheter,provide education about medications and treatments,communicate effectively with their physician colleagues,and know how to respond to an emergency.Nurses can also develop their knowledge in several subspecialties such as radiation oncology,surgical oncology,medical oncology,palliative(comfort)care,cancer prevention and early detection,and genetic counselling.In addition,there is specialized experience within the spectrum of cancer care settings:inpatient nursing,hospice,home care,research,ambulatory,office nursing,and managed care.Some nurses,particularly in large regional cancer centers,may develop an even more specific area of interest,such as breast,colon,prostate cancer,or pain control.Some skills,for example,patient education,systems coordination,or navigation,can cross many care areas.Cancer nurses are skilled at coordinating care with and providing referrals to physicians,social workers,psychologists,physical and occupational therapists,nutritionists,and other health care professionals and services.

Nurse-doctor team

The nurses collaborate with radiation oncologists,radiation physicists,radiology technicians,social workers,psychologists,psychiatrists,physical and occupational therapists,and clinical dietitians to carry out the treatment plan prescribed by the radiation oncologist for each patient.Treatment and care do not take place in a vacuum.Cancer nurses are not isolated but work individually between nurses and patients they care for and cooperate with medical practitioners.No professional group can claim credit for a successful outcome;however,some might try;no matter how major and significant any contribution is,it relies on the cooperation,expertise,and commitment of other caring team members.Effective cancer treatment requires a team effort.Oncologists(surgical,medical,and radiation)are responsible for diagnosing and planning effective treatment.A professional collaboration between oncology physicians and nurses continues to grow.Oncology nurses make decisions on patient care within their practice areas,depending on their educational level,experience,and professional qualifications.

In the hospital,the staff nurses are with patients twenty-four hours a day,seven days a week.The doctor will often ask the nursing team for updates on the condition.Nurses may make“walking rounds”with the doctor to find out how they are doing and make plans for the upcoming day.The oncology nurse at the hospital monitors vital signs,gives medication,assesses lab work and physical findings,evaluates needs,and calls the physician when necessary.Clinical nurse specialists are clinical leaders who work to improve nursing care.Nurse managers are the nurse leaders who work to make the unit function.The nurse will work with the patient during treatment on an outpatient basis,in the office,or in an ambulatory care setting.The doctor maps out the treatment plan;the doctor and oncology nurse carry it out.Nurses may help the doctor plan and decide the most effective way to deliver chemotherapy drugs.Nurse practitioners have an independent role,which varies with the scope of practice in different states.

Communication skills

Good communication skills are necessary for oncology nurses because of the nurses’unique and central position in patient care.They are one core means of achieving person-centered care across the cancer care continuum.Oncology nurses are often directly linked to patients,families,and other multidisciplinary team members.Multidisciplinary communication is an important component of the team’s environment to achieve a truly integrated human-centered care model.Communication is often underestimated,but in fact,effective individual communication can have a direct impact on the outcome of patients.Cancer survivors reported being more satisfied with how their providers communicate with them and received more efficient care,reduced visits,and improved health outcomes.However,good communication is often defined exclusively in terms of the dominant cultural norms.These settings are,in turn,assumed to be universally appropriate without recognizing cultural diversity,which is crucial to effective communication[5].

Supportive care for patients and family

The role of the oncology nurse varies depending on where and what kind of care is needed at any particular moment.But improving the quality of life for people with cancer is a primary goal of cancer nursing practice.To reach that goal,the oncology nurse is devoted to reducing physical discomfort and providing emotional support to patients and their families.Cancer and the side effects of treatment may have symptoms that are distressing or affect day-to-day life.Healthcare teams must work together to identify and relieve these symptoms.There is now a great deal of nursing knowledge that lets the oncology nurse evaluate,advise on,and effectively take the edge off symptoms like nausea and vomiting,pain,constipation,diarrhea,mouth sores,shortness of breath,loss of appetite,and emotional distress.It is important that whatever needs patients to have for emotional support be matched with the resources available in the community.These needs often change throughout an illness and may depend on individual cultural and religious differences and the availability of family,friends,and community support.

There are nurses,social workers,psychologists,and psychiatrists in private practice who have a special interest in and experience with people who have cancer.Most oncology nurses and social workers will be able to give the patient information about support resources.Nurses are especially active in referrals for support services,particularly the cancer support groups that are widely available.These groups can be led or facilitated by social workers,psychologists,or psychiatrists.Many are co-facilitated by nurses.Many groups are led by professionals who have been diagnosed with cancer.

Nursing home care

Because outpatient treatment has become more widespread,home care is becoming an essential part of oncology care.There are now a variety of home care agencies that oncology nurses’staff.Many people choose this type of treatment simply because they prefer to get their chemotherapy in the privacy of their homes with family and friends close by themselves.Generally,home nursing care varies with the intensity and duration of treatment.Chemotherapy is not the only treatment patient can get at home.Under the oncologist’s direction,the oncology nurse can provide the patient with wound care,central venous(CV)line care and teaching,intravenous(IV)hydration,IV antibiotics,and total IV nutrition.Evidence suggests that advanced nursing practices may influence the management of difficult cancer care problems.However,nurses must be educated appropriately to provide quality care for cancer patients,following the development of a core curriculum for post-basic education for nurses in cancer care.In recent years,local and national strategies have been emphasized for cancer nursing research[6].

Finally,all kinds of information are powerful tools for supporting change in nurses and individual organizations.Developing so fast that nobody working alone can keep track of the necessary knowledge to give appropriate care.Nurses,doctors,and other disciplines often hold patient care conferences to discuss treatment.Nurses can point out changes in condition that doctors might not be aware of,some of which could possibly change the treatment plan.In research,oncology nurses may work independently or collaborate with physicians.There is a growing body of nursing research in symptom management and quality of life.The research nurse conducts clinical trials involving new therapies,collecting data,and assessing responses and side effects.There is a greater acknowledgement of collaboration as more studies are coauthored in journals.The goal is not only to secure knowledge bases but also to provide knowledge-based cancer nursing services,guiding decisions and actions based on evidence.Nurses engaged in cancer care have reached a new level of maturity,working at both an individual and collective level worldwide.The informationgained through the work presented will enable frameworks to be built to advance cancer nursing practices that illustrate the environment,roles,and skills necessary to move cancer nursing forward.

The global cancer burden is increasing,and it is time to focus on the essential care of oncology nurses.The cancer care continuum is a useful framework for illustrating the evidence-based contribution that oncology nurses make to caring for people at risk or with cancer along the various stages of care in different settings.For oncology nurses,people-centered approaches have become a strong point of reference and a necessity in cancer care,with patient and multidisciplinary communication a key component of relationship-based care for people affected by cancer and also for effective multidisciplinary teamwork.Coordination of patient care is essential for many oncology nurses;nurse navigators not only help patients overcome health-system barriers,but also can affect outcomes,e.g.,and increase screening rates.Nurse researchers and clinical study nurses support evidence-based to improve care outcomes.Oncology nurses,by their actions,often being part of an intervention,have the potential to save lives through preventative measures(such as tobacco control and screening for cervical cancer)and to optimize the quality of life and the care experience of this population during treatment,survivorship,and palliation.Supportive care,including palliative care,is a wide range of areas that permeate all phases of the continuum of care.It is an area where oncology nurses excel,e.g.,in effectively reducing cancer symptoms and treatment-related symptoms or rehab limitations,increasing healthy lifestyle behaviors,and addressing the psycho-social needs of people with cancer and cancer survivors.

Cancer nurses are constantly developing,and depending on the scope and level of interaction,they need different skills and knowledge to function in different environments and situations.Nurses often have a role in the organization,but such a role does not always go beyond borders and affects a wider cancer treatment plan.Aspiring leaders must be identified,supported,and developed.Senior cancer nurses are obligated to identify and then positively nurture talent,encourage and develop leadership qualities and skills and create a climate that enables future generations of leaders to challenge and take risks.

Competing interests

The authors declare no conflicts of interest.

Abbreviations

LMICs,low-income and middle-income countries;HICs,high-income countries;CV,central venous;IV,intravenous.

Citation

Alkhaqani AL.Advancing oncology nursing practice:a vital and changing role.Cancer Adv2022;5:e22015.doi:10.53388/2022522015.

Executive editor:Chun Ling.

Received:21 June 2022;Accepted:27 June 2022;Available online:30 June 2022.

?2022 By Author(s).Published by TMR Publishing Group Limited.This is an open access article under the CC-BY license.

(http://creativecommons.org/licenses/BY/4.0/)