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Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.

Objective To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. Design Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. Setting Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. Participants 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin’s disease, or non-Hodgkin’s lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. Intervention Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. Main outcome measures The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy—General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory—Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). Results For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference −0.15, 95% confidence interval −0.19 to −0.12; P Conclusions Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A “medium” Cohen’s effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients’ symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. Trial registration Clinicaltrials.gov NCT02356081 .

Objective To design and develop a digital monitoring application to support and improve the care of patients in the first 30 post-operative days following colorectal cancer surgery. Data Sources Patient interviews, health professional focus groups, patient co-creation activities, and health professional prioritization discussions. Conclusion The structured and iterative co-design activities adopted in this study with key stakeholders, including patients and health professionals, lead to the development of a prototype application (app) to support patients at home during the first 30 days following surgery for colorectal cancer. A similar approach could be implemented to develop comparable apps for patients with other cancer diagnoses requiring different surgical procedures. Further research should focus on the continued development and testing of this app in relation to patient care and outcomes as well as the app's affect on nursing and other health services. Implications for Nursing Practice Clinical implementation of remote monitoring following discharge home after surgery for colorectal cancer gives patients the opportunity to report issues of concern to relevant health professionals. This could facilitate the early identification of concerning signs and symptoms, ensuring appropriate and timely interventions to minimize readmission rates. Patients’ experiences during the recovery period could also be improved through the provision of reliable and relevant online information. More specifically, health professionals could easily identify those patients requiring additional support to manage their recovery, for example, those with more severe symptoms or problems, facilitating the direction of appropriate health services to those most in need of their expertise.

Purpose/Objectives: To explore changes over time in self-efficacy and the predictive ability of changes in state anxiety and health-related quality of life during chemotherapy. Design: Secondary analysis of a longitudinal dataset derived from a larger, multicenter study. Setting: Outpatient oncology clinics across eight general hospitals in England, Scotland, and Northern Ireland. Sample: 137 patients scheduled to receive adjuvant chemotherapy for breast or colorectal cancer. Methods: At the beginning of each of six chemotherapy cycles, participants completed the Strategies Used by People to Promote Health questionnaire, the State-Trait Anxiety Inventory, and the Functional Assessment of Cancer Therapy–Breast or –Colorectal questionnaire. Multilevel model analysis was used to analyze longitudinal data, adjusted for demographic and clinical variables. Main Research Variables: Self-efficacy, anxiety, and health-related quality of life. Findings: No significant time effects were found for patients’ overall perceived self-efficacy or self-efficacy parameters. A trend toward greater self-efficacy was evident as chemotherapy progressed. Self-efficacy was significantly associated with decreased state anxiety throughout chemotherapy. Increases in overall self-efficacy and perceived ability to maintain a positive attitude were significantly associated with over-time increases in physical, emotional, and functional well-being, as well as with fewer cancer-related concerns. Conclusions: Findings highlight the importance of clinical assessments throughout treatment that focus on patients’ perceived self-efficacy as a positive regulator of mood and well-being. Implications for Nursing: The current study suggests self-efficacy enhancement should be a key component of psycho-behavioral programs designed to support patients with cancer throughout chemotherapy.

Background: There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective: This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. Methods: There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. Results: The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. Conclusions: Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries. ©Eileen Furlong, Andrew Darley, Patricia Fox, Alison Buick, Grigorios Kotronoulas, Morven Miller, Adrian Flowerday, Christine Miaskowski, Elisabeth Patiraki, Stylianos Katsaragakis, Emma Ream, Jo Armes, Alexander Gaiger, Geir Berg, Paul McCrone, Peter Donnan, Lisa McCann, Roma Maguire. Originally published in JMIR Cancer (http://cancer.jmir.org), 14.03.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)

BACKGROUND There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. OBJECTIVE This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. METHODS There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. RESULTS The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. CONCLUSIONS Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.

Introduction While some evidence exists that real-time remote symptom monitoring devices can decrease morbidity and prevent unplanned admissions in oncology patients, overall, these studies have significant methodological weaknesses. The electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology (eSMART) study is designed to specifically address these weaknesses with an appropriately powered, repeated-measures, parallel-group stratified randomised controlled trial of oncology patients. Methods and analysis A total of 1108 patients scheduled to commence first-line chemotherapy (CTX) for breast, colorectal or haematological cancer will be recruited from multiple sites across five European countries. Patients will be randomised (1:1) to the ASyMS intervention (intervention group) or to standard care currently available at each site (control group). Patients in the control and intervention groups will complete a demographic and clinical questionnaire, as well as a set of valid and reliable electronic patient-reported outcome measures at enrolment, after each of their CTX cycles (up to a maximum of six cycles) and at 3, 6, 9 and 12 months after completion of their sixth cycle of CTX. Outcomes that will be assessed include symptom burden (primary outcome), quality of life, supportive care needs, anxiety, self-care self-efficacy, work limitations and cost effectiveness and, from a health professional perspective, changes in clinical practice (secondary outcomes). Ethics and dissemination Ethical approval will be obtained prior to the implementation of all major study amendments. Applications will be submitted to all of the ethics committees that granted initial approval. eSMART received approval from the relevant ethics committees at all of the clinical sites across the five participating countries. In collaboration with the European Cancer Patient Coalition (ECPC), the trial results will be disseminated through publications in scientific journals, presentations at international conferences, and postings on the eSMART website and other relevant clinician and consumer websites; establishment of an eSMART website (www.esmartproject.eu) with publicly accessible general information; creation of an eSMART Twitter Handle, and production of a toolkit for implementing/utilising the ASyMS technology in a variety of clinical practices and other transferable health care contexts. Trial registration number NCT02356081. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2016-015016 © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Purpose:\ud \ud To examine the trajectories and predictors of state and trait anxiety in patients undergoing chemotherapy for breast or colorectal cancer.\ud Methods:\ud \ud Secondary analysis of data collected as part of a large multi-site longitudinal study. Patients with breast or colorectal cancer completed validated scales assessing their state and trait anxiety levels (State-Trait Anxiety Inventory) and symptom burden (Rotterdam Symptom Checklist) at the beginning of each chemotherapy cycle. Longitudinal mixed model analyses were performed to test changes of trait and state anxiety over time and the predictive value of symptom burden and patients’ demographic (age, gender) and clinical characteristics (cancer type, stage, comorbidities, ECOG performance status).\ud Results:\ud \ud Data from 137 patients with breast (60%) or colorectal cancer (40%) were analysed. Linear time effects were found for both state (χ2 = 46.3 [df = 3]; p < 0.001) and trait anxiety (χ2 = 17.708 [df = 3]; p = 0.001), with anxiety levels being higher at baseline and gradually decreasing over the course of chemotherapy. Symptom burden (β = 0.21; SD = 0.06; p = 0.001) predicted state anxiety throughout treatment, but this effect disappeared when accounting for trait anxiety scores before the start of chemotherapy (β = 0.85; SD = 0.05; p < 0.001). Patients’ baseline trait anxiety was the only significant predictor of anxiety throughout treatment.\ud Conclusions:\ud \ud Changes in the generally stable characteristic of trait anxiety indicate the profoundly life-altering nature of chemotherapy. The time point before the start of chemotherapy was identified as the most anxiety-provoking, calling for interventions to be delivered as early as possible in the treatment trajectory. Patients with high trait anxiety and symptom burden may benefit from additional support.

Many people diagnosed with cancer will receive chemotherapy as a core component of their care. Recent changes in the delivery of cancer services mean that patients frequently receive care on an out-patient basis and are therefore often required to manage related side effects at home without direct support from oncology health professionals. The use of information and communications technology may be seen as a means of supporting patients receiving chemotherapy in the home care setting. This mixed methods study, reports on the perceptions of nurses (n=35) who participated in a randomised controlled trial of a mobile phone based, Advanced Symptom Management System (ASyMS), in the management of chemotherapy-related toxicity in patients with breast, lung and colorectal cancer. Nurses' perceptions of ASyMS were evaluated at the start and the end of the study. Overall, they could see the benefits of ASyMS in the remote monitoring of chemotherapy toxicity and its role in facilitating early intervention and subsequent management, demonstrating the potential utility of the system within clinical practice.

Background A significant proportion of patients undergoing chemotherapy for many cancer types may experience oral problems, such as mucositis and any deterioration in the health of the oral cavity can have a significant effect on a person's well-being. Trends towards shorter hospital stays and the increase in out-patient chemotherapy mean that patients are required to adopt increasingly participatory roles in their self-care and are subsequently coping with mouth problems while they are at home without the direct support of oncology health professionals. Objectives This study aimed to evaluate the acceptability and feasibility of an oral care diary by patients receiving chemotherapy. Design An oral care diary was developed to incorporate oral assessment using the Oral Assessment Guide (Eilier, J., Berger, A., Peterson, M., 1988. Development, testing and application of the oral assessment guide. Oncology Nurse Forum 15, 325–330) and guidance about oral self-care. This exploratory study utilised purpose designed pre- and post-study questionnaires and semi-structured interviews to evaluate patients' perceptions and experiences of the oral care diary. Setting The study took place in 2-day chemotherapy units in Scotland: 1 in a cancer centre and 1 in a district general hospital. Participants A consecutive sample of patients ( n = 45 ) receiving out-patient chemotherapy for a range of cancer diagnoses participated in the study over 2 cycles of chemotherapy. Methods Following recruitment, patients were instructed in the use of the oral care diary to assess their mouth daily while at home on a daily basis. Patients were asked to complete 2 structured purpose designed questionnaires—the first prior to starting diary completion and the second following their participation in the study. Nine patients participated in semi-structured interviews to explore their actual experiences of using the oral care diary in more depth. Results The participants found the oral care diary acceptable and feasible. Awareness of oral symptoms and related mouth self-care post-chemotherapy improved. Conclusions The oral care diary is an acceptable and feasible method of enhancing oral self-care during a course of chemotherapy. Further study is required to evaluate its impact on clinical outcomes

Recent changes in cancer service provision mean that many patients spend a limited time in hospital and therefore experience and must cope with and manage treatment-related side effects at home. Information technology can provide innovative solutions in promoting patient care through information provision, enhancing communication, monitoring treatment-related side effects and promoting self-care.The aim of this feasibility study was to evaluate the acceptability of using handheld computers as a symptom assessment and management tool for patients receiving chemotherapy for cancer. A convenience sample of patients (n = 18) and health professionals (n = 9) at one Scottish cancer centre was recruited. Patients used the handheld computer to record and send daily symptom reports to the cancer centre and receive instant, tailored symptom management advice during two treatment cycles. Both patients' and health professionals' perceptions of the handheld computer system were evaluated at baseline and at the end of the project.Patients believed the handheld computer had improved their symptom management and felt comfortable in using it. The health professionals also found the handheld computer to be helpful in assessing and managing patients' symptoms.This project suggests that a handheld-computer-based symptom management tool is feasible and acceptable to both patients and health professionals in complementing the care of patients receiving chemotherapy.

Objectives: Changes in cancer services to out-patient care have resulted in patients spending limited time in hospital. The use of IT within healthcare has seen the development of innovative ways to support patients in the community. This study aimed to test the procedures and technical systems involved in using an advanced symptom management system (ASyMS) in the home monitoring and symptom management of patients receiving chemotherapy. Patients and methods: Ten patients were recruited from two centres in Scotland. Patients in the intervention group used the mobile phone to record and send their symptom reports to their hospital and receive self-care advice, while the control group received standard care. A risk model was developed which alerted health professionals of symptoms that were severe or life threatening. Patient and professional perceptions were evaluated throughout. Main results: Patients believed that the ASyMS system improved the management of their symptoms and felt reassured they were being monitored at home. Health professionals also found the system beneficial in the management of symptoms and the promotion of timely interventions. The full randomised controlled trial is now underway. Conclusion: The ASyMS system has the potential to improve the management of symptoms in patients with cancer receiving chemotherapy. © 2006 Elsevier Ltd. All rights reserved.

Several studies have identified inadequacies in the care and treatment received by older patients with cancer, as opposed to their younger counterparts. These include over or under diagnosis, ineffective symptom management and lower survival rates in older people with cancer. Despite these inadequacies, there is lack of evidence of older peoples' perspectives regarding their cancer diagnosis and treatment. This on going 2-site hospital based study focuses on older people's perceptions of information and decision-making in relation to treatment for cancer by using a semi-structured interview schedule. Results of the pilot study with 6 patients are presented and discussed in the light of research and clinical implications.

Although much progress has occurred in the last decade regarding the management of chemotherapy-induced nausea and vomiting, these remain among the most intolerable side-effects of treatment and patients continue to report the negative impact such symptoms have on their ability to enjoy life. Inadequate control of nausea and vomiting reduces patients' quality of life and functional status and jeopardizes the delivery of optimal treatment, so making its management a priority for oncology health care workers. This article will reflect on past and present evidence regarding the management of chemotherapy-induced nausea and vomiting while highlighting some of the most recent scientific advances before drawing conclusions about the future management of this troublesome symptom for patients receiving chemotherapy.

The drive toward evidence-based healthcare aims to promote effectiveness and thereby improve quality. The challenge for cancer nursing is to continually evaluate what it does, retaining effective interventions and working to develop new ones and refine those interventions that require improvement, thereby enhancing both practice and patient outcomes. The aim of the project was to assimilate an evidence base to support the development, delivery, and evaluation of cancer nursing services in the United Kingdom. It was believed that determining the extent of the current United Kingdom evidence base through a review of the literature and current and recent research endeavors would allow for comparison with current priorities and facilitate informed strategic planning regarding the process of research commissioning. A rigorous, explicit, and thorough literature review was undertaken of all United Kingdom literature pertaining to cancer nursing and related issues published between 1980 and 2000. Fourteen individual databases were searched using specific keywords, thesaurus terms, and additional search terms. Data were extracted from each individual publication and stored in a purpose-designed database. Current and recent United Kingdom cancer nursing research projects were identified through a mailed survey questionnaire sent to people and organizations involved in cancer-related research. Research projects were categorized according to Royal College of Nursing research priority themes: Care and Caring Practices, Healthcare Environment, Organization and Management of Care, and Healthcare Workforce. Four-hundred forty-six pieces of literature were considered appropriate for inclusion in the review. Two-hundred sixty-four pieces of evidence were included in the Care and Caring Practices theme, which also had the greatest number of current and recent research projects (48%, n = 50). The Healthcare Environment theme included 80 pieces of evidence but only 3% (n = 3) of the current and recent research projects. Thirty-two percent (n = 33) of the current/recent research projects fell into the third theme of Organization and Management of Care, which contained a total of 104 pieces of evidence. The final theme, Healthcare Workforce, included 17% (n = 18) of the current and recent research projects, and the literature review incorporated 49 pieces of evidence in this theme. A number of recommendations have been drawn, which focus on methodological challenges, research considerations, and gaps in the evidence base. The drive toward evidence-based practice is essential for cancer nurses to establish who they are, what they do, and what effect they have on patient outcomes. Currently, although the United Kingdom evidence base for practice is vast, it frequently lacks depth. Although evaluating national evidence for practice is valuable, a more global approach to evidence synthesis is required. Through such endeavors, cancer nurses should realize their potential, support the strategic development of cancer nursing research, and so generate an evidence base that supports their unique contribution to patient outcomes.

The reorganization of cancer services in recent years has presented cancer nursing with a range of organisational and developmental challenges. It is therefore encouraging to note that the specialty has evolved to the extent that an efficient and effective cancer nursing workforce is now acknowledged as a prerequisite for the provision of high-quality cancer care (Department of Health, 1995; 2000a; 2000b). However, despite the advances there has been little evaluation of the critical issues faced by specialist cancer nurses. This project was undertaken as part of a larger scoping exercise designed to assimilate an evidence base to support the development, delivery and evaluation of UK cancer nursing services. This element of the project aimed to provide information to support the development and organisation of cancer nursing services by focusing on specific aspects of care (DoH, 2000a). The results indicate that lead cancer nurses are striving to ensure that patients are provided with the best quality care through nurses' participation in collaborative endeavours, for example with the primary care and the voluntary sectors. There is still much to be achieved, primarily in the areas of workforce planning, the skill development of non-specialist nurses, and research and development. The evidence demonstrates that cancer nursing will continue to accept the challenges of changing practice, working to ensure that patients receive a high-quality service.

Fatigue is the most common symptom associated with cancer and its treatment and is now widely recognized as a significant problem for patients with cancer (Ream & Richardson 1999). As a result of the restructuring of cancer services, much of the care given to patients is delivered by a multitude of nurses across a spectrum of clinical settings. While some research, albeit minimal, has evaluated nurses' knowledge and attitudes of cancer-related fatigue in various clinical settings, factors associated with institutional management of fatigue and the support and encouragement given to nurses by institutions regarding cancer-related fatigue appears to be unexplored. Nurses were recruited from community, general medical, general surgical and oncology clinical settings. A postal questionnaire to evaluate institutional cancer-related fatigue management was administered. Data were analysed descriptively. Institutional management of fatigue is poor across the clinical specialties involved in this survey. Topics addressed were interdisciplinary working, documentation and standards, accountability, information giving, staff education and quality assurance initiatives. Little difference was detected across the clinical specialties for the majority of these issues. Although individual health professionals have a personal responsibility to ensure the care they provide addresses patients' needs appropriately, institutional support and direction is essential. It seems that health-care institutions have not recognized the importance of this issue. This unacceptable situation must be resolved to ensure all health professionals are supported by their institutions to make every effort to improve the management of this symptom for patients with cancer.

Mouth care is an integral part of nursing practice. However, it has become a ritualistic and banal activity, a topic of conflicting advice and subjective conclusions from sporadic research. Rarely do experts teach it, and it frequently is delegated to the most junior members of the nursing staff. Many cancer treatments result in unavoidable oral toxicity, and the significant prevalence of oral complications in oncology makes mouth care a particular priority for cancer nurses. The confusion and conflict that surrounds best nursing practice in relation to delivering appropriate mouth care should be redressed. This review article details pertinent research to date regarding oral care, with an aim to clarify intervention options, and to identify and promote best nursing practice.

The rate of evolution of cancer nursing in the UK has been remarkable over the past 20 years. Legislative changes and reform have provided the impetus for a range of developments in practice, research and education, and the push to achieve evidence-based practice has also driven the profession. There is a collective aspiration that all patients with cancer should expect to be supported by a cancer nursing service that is skilled, caring and competent. Demonstrating the value of nursing in terms of its effects on patients has never been so important. This project, commissioned by the Department of Health, was designed as a scoping exercise to assess the current state of the evidence base to support the development, delivery and evaluation of cancer nursing services in the United Kingdom. Three distinct elements were implemented concurrently to achieve this. The first was a review of UK literature centred around aspects of developing, delivering and evaluating cancer nursing and cancer nurses. The second was the development of a research directory profiling recently completed, currently under way and planned UK research concerned with cancer nursing and cancer nurses. The final element was a review of the organisation of cancer nursing services in England. This paper will report on the first two elements. The results of the third element will be published separately.

Many psychologists maintain that the attitudes we hold about a particular topic or subject will influence the way in which we will behave towards it: positive attitudes lead to positive behaviours and vice versa. A literature search was conducted using the databases of MEDLINE and CINAHL. This produced research-based evidence showing that despite treatment advances, cancer remains one of the most feared of all diseases, not only among the public but also among oncology health-care professionals. However, the practice of measuring attitudes is fraught with difficulties. This review article will discuss the link between attitudes and behaviour and review pertinent literature regarding public and professional attitudes towards cancer before critically analysing the most common tools for evaluating cancer attitudes and making recommendations for the future of attitude measurement.

Multicentre research and the WISECARE experience The benefits of collaborative research are becoming recognized increasingly within the profession of nursing due to the associated increased likelihood of funding, variety of practice settings and increased access to resources that collaboration brings. While such benefits have made collaborative research one of the most desirable strategies for achieving the goals of research, the potential problems of language and communication, culturally sensitive instruments, access to subjects, availability of technology and lack of research resources have complicated collaborative international research initiatives. Review of the literature, although encouraging such initiatives, does little to provide information regarding the processes involved in multinational collaboration or the associated advantages and disadvantages to guide those embarking on such large scale, multinational, cross-cultural studies. The diverse meanings of collaboration within research initiatives further hamper this understanding. Positive definitions focus on aspects such as sharing expertise, making a valuable contribution to the research and ultimately shared ownership of the accomplishments of the research. One such research project led by nurses was the WISECARE project. WISECARE (Workflow Information Systems for European Nursing Care) was funded by the European Commission and aimed to improve cancer nursing practice and ultimately patient outcomes through the integration and utilization of state of the art information technology. Such a project was developed as a result of nursing's apparent invisibility within health care delivery and the problems experienced by nurses in articulating their worth within an increasingly cost-conscious health care system. Oncology care was selected as the domain for the project not only because this speciality of nursing already has an established network of nurses throughout Europe in the European Oncology Nursing Society (EONS) but also because the practice of cancer nursing encompasses all aspects of nursing care. This paper will address the advantages and disadvantages associated with collaboration, using the WISECARE project as an example.

Background Healthcare professionals are known to be particularly susceptible to ageist stereotyping because of increased exposure to elderly and infirm individuals. Demographic changes resulting in increasing numbers of elderly people and increased cancer incidence with age make it imperative to understand oncology healthcare professionals’ attitudes towards older people. Design A descriptive survey design was conducted, within a regional Cancer Centre, to evaluate oncology healthcare professionals’ attitudes towards elderly people. The measurement scale used was Kogan’s Old People Scale. Results Regardless of gender, profession and clinical experience persistently negative attitudes were displayed towards elderly people. No statistically significant difference was detected between gender, profession, clinical experience or specialist education and although small in number, no large differences in scores were notable between group means. Conclusions If oncology healthcare professionals are to provide optimal treatment and care for elderly people, negative attitudes must be addressed. These results indicate the need for a radical cultural shift in attitudes, especially when considered in conjunction with changing demographics and increased cancer incidence with age.

Throughout the 20th century the proportion of people aged 60 and over has increased in all countries of the world. Disturbingly, despite the increasing number of elderly people, ageism persists within society and impinges on many areas of older people's lives. Indeed, although advancing years and cancer are clearly linked, evidence exists to support the presence of ageism throughout cancer care.As nurses are the main providers of care for the elderly, nursing should be utilizing the power gained through specialist education and both national and international health legislation to effect a change that will ensure appropriate care and treatment for this population.

Objectives: To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS©) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer. Design: A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial. Setting: Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals. Participants: One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy. Interventions: A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS©). Main outcome measures: Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand-foot syndrome and diarrhoea). Results: There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio∈=∈2.29, 95%CI∈=∈1.04 to 5.05, P∈=∈0.040) and reports of hand-foot syndrome were on average lower in the control group (odds ratio control/intervention∈=∈0.39, 95%CI∈=∈0.17 to 0.92, P∈=∈0.031). Conclusion: The study demonstrates that ASyMS © can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.

Chemotherapy forms a core component of treatment for the majority patients with cancer. Recent changes in cancer services mean patients frequently receive such treatment as outpatients and are often required to manage side effects at home without direct support from oncology health professionals. Information technology continues to develop to support patients in the community; this study evaluated the impact of a mobile phone-based advanced symptom management system (ASyMS) on chemotherapy related toxicity in patients with lung, breast or colorectal cancer. One hundred and twelve patients were randomized from seven clinical sites across the UK; 56 patients used the mobile phone to record their symptoms, sending their reports directly to the nurses at their clinical site; 56 control group patients received standard care. Health professionals were alerted about any severe or life-threatening symptoms through the development of a chemotherapy symptom risk model. Patients' perceptions of ASyMS were evaluated pre and post participation. Patients reported many benefits of using ASyMS including improved communication with health professionals, improvements in the management of their symptoms, and feeling reassured their symptoms were being monitored while at home. ASyMS has the potential to positively impact on the management of symptoms in patients receiving chemotherapy treatment.

Technology is a central aspect of young people's lives, with the internet and mobile phone technology providing the preferred means of communication. This pilot explored perceptions and experiences of young people, parents and healthcare professionals on the role of technology in monitoring and managing chemotherapy-related toxicity.To introduce the WISECARE+ process for recording and communicating symptoms following chemotherapy to a teenage patient population and evaluate its usefulness with patients, parents and nursing staff.A convenience sample of 11 young people (aged 13 to 20 years) with a haematological or solid tumour undergoing primary treatment, were recruited from two UK regional paediatric oncology centres. The young people completed a daily symptom questionnaire for 14 consecutive days following a course of chemotherapy. They evaluated the presence or absence of symptoms of nausea, vomiting, fatigue and oral problems, their severity and how much the symptom bothered them. Perception questionnaires were completed by the 11 young people, four parents and eight nurses at the end of the 14 days.Young people and parents found the symptom questionnaire simple to understand, easy to complete and they liked the paper format. The nurses' confidence with IT varied but all felt that it could be useful in their clinical practice.These young people appeared to gain from their participation in the project, especially in relation to completing the questionnaire as they were able to see a change in symptoms over time that was encouraging, particularly in situations where the young person had been quite ill. This work is continuing with formats such as a handheld computer or mobile phone being considered to collect symptom information. Additional factors such as reading levels and dyslexia are also being considered.

While the use of chemotherapy has significantly improved survival rates, the symptoms associated with chemotherapy remain a major burden for patients. Preventing or appropriately managing side effects significantly improves patients' functional status and quality of life, ultimately leading to greater patient acceptance of chemotherapy. However, symptom assessment and management are fraught with difficulties such as poor patient recall, retrospective assessment conducted by clinicians and lack of appropriate, clinically relevant and patient friendly symptom assessment and management tools. Furthermore the differences between clinician and patient perceptions of stresses and distress during chemotherapy are well recognised. This study aimed to evaluate the impact of a nursing intervention incorporating structured symptom assessment and management, facilitated by information technology, on chemotherapy-related symptoms, nausea, vomiting, fatigue and mucositis. This pan-European study, involved 8 clinical sites from Belgium, Denmark, England, Ireland and Scotland. Adults (n = 249) receiving first line chemotherapy for breast, lung, ovarian or colorectal cancer, osteosarcoma, acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL) or lymphoma were recruited to the study. Patients completed daily symptom assessment questionnaires for 14 days following consecutive cycles of chemotherapy. Symptom outcomes were compared before and after the introduction of the intervention with positive impact on patients' experiences of nausea, vomiting and oral problems. Fatigue was not significantly improved. (C) 2008 Elsevier Ltd. All rights reserved.

Summary Fatigue is a highly prevalent condition among patients with cancer affecting between 70% and 100% and patients describe their fatigue experiences as the most distressing of symptoms. However, the management of fatigue is complicated by our current lack of understanding of its pathophysiology. This study aimed to gain an insight into the longitudinal fatigue experiences of patients receiving chemotherapy. A convenience sample of patients receiving chemotherapy ( n = 249 ) were recruited and recorded their fatigue experiences using a paper questionnaire for 14 consecutive days following each cycle of chemotherapy. Fatigue was reported in 57% of all completed questionnaires. Patients report fatigue as a relatively constant presence following chemotherapy. Moreover, fatigue experiences increase over consecutive cycles of chemotherapy. This study supports the existing evidence illustrating fatigue as a significant problem for patients with cancer and provides new data demonstrating patterns of fatigue over the duration of a course of chemotherapy. Understanding this experience of fatigue should prompt health professionals providing care for this patient population to seek and test a range of management strategies to help patients maintain their quality of life during cancer treatment.

Cancer Care Research Centre, Department of Nursing and Midwifery, University of Stirling, Stirling FK9 4LA, UK School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK Acute Division Headquarters, Falkirk & District Royal Infirmary, Westburn Avenue, Falkirk FK1 5SU, UK Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK Chemotherapy Out Patients Unit, Ninewells Hospital, Dundee, UK Kintore Unit Ward 6, NHS Forth Valley, UK Falkirk and District Royal Infirmary, Westburn Avenue, Falkirk FK1 5SU, UK

Background: Several studies have identified inadequacies in the care and treatment received by older patients with cancer, as opposed to their younger counterparts. These include over or under diagnosis, ineffective symptom management and lower survival rates in older people with cancer. Despite these inadequacies, there is a lack of evidence of older peoples' perspectives regarding their cancer diagnosis and treatment. Materials and methods: Studies for review were identified from systematic searches of literature published between January 1990 and November 2003, using PubMed, CINAHL and PsycINFO. Studies were selected for inclusion by using a number of criteria (i.e. date and language of publication, age of participants and thematic area). The aims of the review were to summarize and evaluate previous evidence on the views of older patients with cancer, regarding information, decision making and treatment. Results: Eighteen studies of various methodologies met the criteria of the present review. In summary, older people with cancer are generally content with the information they receive, but not entirely satisfied with the quantity and quality of care and contact. They present with various needs, which are not always well met. Finally, they wish to be kept informed of their cancer diagnosis and treatment progress, but often do not wish to be told about progression of their illness and length of survival. Conclusions: Previous research has suffered a number of limitations regarding sampling procedures and methods of data collection. Other limitations included lack of consideration of the heterogeneity of older people with cancer and lack of a well-defined theoretical framework to guide design and data analysis. These may compromise not only rigour and the ability to generalize findings, but also the provision of patient-focused care. The difficulties of doing research in this area are also discussed and suggestions for future research are made.

Background Despite the known benefits of screening, early detection and advances in treatment modalities, negative attitudes to cancer persist among health care professionals, and cancer remains the most feared disease in modern society. Attitudes to cancer may create a barrier to communication between patients and health care professionals, hinder early detection, treatment and rehabilitation, and may influence decision making about referral to specialist services and the selection of appropriate treatments. Design A descriptive survey was conducted, within a Regional Cancer Centre, to evaluate oncology health care professionals’ attitudes towards cancer. Attitudes were measured using the Burns’ Cancer Belief Scales. Results Regardless of gender, profession and clinical experience, all health care professionals displayed persistently negative attitudes towards cancer. No statistically significant difference was detected between gender, profession, clinical experience or specialist education, and although small in number, no major differences were found between group means. Conclusions Oncology health care professionals hold negative attitudes towards cancer and changing these attitudes presents a significant challenge. Educational programmes and supportive strategies may alleviate fears and promote a more positive image of cancer. However, such strategies must be based on an understanding of current attitudes towards this phenomenon.

This article describes an NTResearch survey which outlines how UK cancer nursing services have evolved over the past seven years in response to changes in government policy.

• Although nursing represents around half of Europe’s healthcare budgets, its impact is seldom evaluated. However, given the current era of cost-containment, nursing must prove the value of its clinical effectiveness. • Through European collaboration, the WISECARE project is working towards identifying the unique contribution of cancer nursing. • This paper will explain the rationale and goals of the WISECARE project and demonstrate the collaborative processes involved within such a project. • The latest results of the project will be presented to prove the value of collaboration in ensuring the development of European standards of nursing care.

Longevity is the greatest risk factor for developing cancer. However, despite the increasing focus placed on cancer in the elderly, a prominent discrepancy relating to the age of the patient persists, with elderly people often receiving less than optimal treatment and care. There is no doubt that ageism has a profound impact on health care received by elderly people. Incorporating ethical principles into their clinical practice could facilitate health professionals in the provision of optimal treatment and care for elderly patients with cancer. This article explores some basic ethical assumptions regarding the needs of this patient group in relation to the ethical dilemmas of truth telling, consent and relationships, and power.