Inside this issue: Radiation Therapy (a joint issue with ESTRO) and EONS at ECCO 2017

Oncopolicy in action

EONS members help shape important new colorectal cancer and sarcoma guidelines, playing a key part in developing treatment in two important areas.

Dr Claire Taylor (left) and Dr Verna Lavender (right)

Dr Claire Taylor (left) and Dr Verna Lavender (right)

1/What are these guidelines and how will they help cancer nurses in their work, and patients in their treatment?

Verna Lavender (VL): The guidelines are an initiative of the European CanCer Organisation (ECCO). They provide an overview of elements required to deliver high-quality care to people with a specific tumour type. The aim is to inform patients, health professionals working in oncology, organisations and policy makers, what the ECCO expert groups consider are the Essential Requirements for Quality Cancer Care (ERQCC).

Claire Taylor (CT): These guidelines will be a great reference point for nurses across Europe. They offer essential guidance in the hope that all teams delivering both sarcoma and colorectal cancer care across Europe will feel this is achievable. In some countries, where cancer nursing is less well developed, the guidance might provide them with the evidence and/or the stimulus they need to improve their support and further their own professional development. I hope that as a result, patients will receive better care.

The guidelines highlight each professional's unique contribution to cancer care while also underlining the importance of multidisciplinary team working. They offer a vision of patient-centred care from diagnosis through treatment and into survivorship.

You can access the guidelines here:

ECCO Essential Requirements for Quality Cancer Care: Colorectal Cancer:

ECCO Essential Requirements for Quality Cancer Care: Soft Tissue Sarcoma in Adults and Bone Sarcoma:

2/Who is behind developing the guidelines and how did you both get involved?

VL: ECCO invited its Member Societies to nominate a representative to contribute to the production of the guidelines. In the first instance, guidelines were developed for two types of tumour: colorectal cancer, which was regarded as representative of a common type of tumour, and sarcoma (soft tissue sarcoma in adults and bone sarcoma), which represented a rare tumour type. Danny Kelly, President of EONS (which is a Member Society of ECCO), invited Claire and I to represent EONS in contributing to the ECCO ERQCC colorectal cancer and sarcoma guidelines, respectively.

3/How was EONS involved? Was EONS’ help valuable?

Danny Kelly and Lena Sharp [EONS’ President-Elect] provided guidance and support to us both in submitting the EONS contribution to the guidelines, and the EONS Board endorsed it, particularly in reference to the role of the case manager and the nursing section. EONS also advertised an online survey that Claire and I used to gather key data.

4/What did the guidelines development process entail and what was your input?

VL: ECCO arranged two one-day meetings in Brussels, early in 2016, where experts were brought together from ECCO’s Member Societies for in-depth discussion of issues related to European-wide oncology practice, and guidelines to inform that practice. Production of the guidelines had a very tight deadline. Claire and I were required to submit the initial draft by the end of July and comment on the full draft guidelines prior to a second meeting in August. We then needed to submit subsequent drafts of our contribution and provide comments on the final draft by October. We were also each required to provide relevant references and evidence sources to support the contributions, and comment on the document as a whole in relation to the practice of the professional group we represented.

CT: Our input was primarily to the nursing section but I also made suggestions for the introduction and also to the section on rehabilitation and survivorship. Interestingly, it was much easier adding content to the latter section since this is a large aspect of my role and I suspect was of less interest to other professionals in the expert panel.

5/What have you learned from this experience? Will it change your practice? How will it help you develop your career?

VL: Involvement in the project revealed the scope and variation of oncology nursing practice in Europe and the need for high-quality evidence to demonstrate the added value oncology nurses make to people with cancer. The project also highlighted how the concept of multidisciplinary working was central to cancer care and could be translated into practice across Europe.

Importantly, ECCO invited EONS to contribute to the ERQCC guidelines, which include a dedicated nursing section, highlighting the value that is placed on the role of the oncology nurse in providing cancer care across Europe.

In developing these guidelines, Claire and I collected data from a variety of sources, including an online survey advertised by EONS. The process of data collection, analysis and findings will be published in a separate report in the cancer nursing journal Cancer Nursing Practice in the near future. Verna has also written an editorial on our experience in the British Journal of Nursing.

These guidelines will hopefully support the development of oncology nurse services and ensure essential requirements for oncology nursing practice are in place across Europe to be able to provide high-quality care to people with colorectal cancer and sarcoma, respectively.

Representing EONS provided a fantastic opportunity to engage in the development of European-wide guidelines and this work is something that we are both very proud to have been involved with.

CT: I have found it an interesting process and it was exciting to see the panel's thoughts on the requirements gradually reach agreement and the guidance take shape. As an aside, Verna has alluded to some challenges in this process and this did give us both interesting insights into team dynamics and the positioning of nursing within cancer care, from others' perspectives.

It is rewarding to be recognised as an expert in your field and to be asked to represent EONS. It is also gratifying that the work has been published in a prestigious journal. This sort of output is expected in my role and can help with career development.

6/How did you come to be submitting a paper on this to a professional journal?

VL: At the outset, it was agreed that the guidelines would be published in an international, peer-reviewed professional academic journal. The journal choice was discussed with group members; the Policy team at ECCO managed submissions of manuscripts to the journal and notified the co-authors when the manuscripts were accepted.

CT: We are also working on a piece for Cancer Nursing Practice (RCNi) from RCN Publishing.

7/What was it like working together on this project rather that individually? Can you tell us about any obstacles you encountered along the way?

VL: Due to unforeseen circumstances, Claire was not able to attend the meetings in Brussels, so Verna attended and shared the aims and actions of the meetings with Claire. The contribution about the role of the oncology nurse as part of the multi-disciplinary team was questioned by representatives of some Member Societies, and the contribution made by an EONS representative was challenged. The core issue was in relation to the transferability of the findings across all European countries, where there is a good deal of variation in the practice of the oncology nurse (where such a role exists) and nurses working in cancer care where dedicated oncology nurse roles do not exist. After careful re-wording of the core text, this issue was resolved and the contribution of the EONS representatives was not further challenged. During this process, support from each other was enormously helpful and appreciated. We are both very grateful also to the EONS Board for their unwavering support, particularly when the fundamentals of the role of the oncology nurse were challenged.

CT: I have been most grateful to work with Verna, who has approached the evidence-gathering process very systematically and thoughtfully. She is also a clear and concise writer and so writing a subsequent publication about the guidance has been a joy for me. We have been able to offer one another support over the eight months that the project took – which proved to be more necessary than we had anticipated. We have also shared some of the core content of what makes essential requirements for both sarcoma and colorectal cancer nursing. I hope that our learning will also be considered and hopefully utilised when the next tumour site essential requirements are written. A whole series is planned.

8/What advice would you give to a cancer nurse wanting to follow a similar path?

VL: If a similar opportunity presents itself, and it is something you feel you have the knowledge, skills and expertise to become involved with, we’d encourage other oncology nurses to find the time to get involved to ensure the voice of the oncology nurse in Europe is documented and heard.

Being part of the ECCO ERQCC group was challenging, sometimes very challenging, but it was also a great honour to be able to represent EONS and oncology nurses working with patients with sarcoma.

CT: Yes, I would also encourage nurses to do so if they feel they have the right skills and knowledge. It has on occasions been a time-consuming process and since this sort of work can be difficult to fit into the working week, you have to be prepared to do some of it in your own time. It really helps to have as much support from nursing colleagues within your speciality to run ideas by, so that you are speaking with a collective voice.  

We now require healthcare organisations to implement the requirements in this guidance.

Dr Verna Lavender is a Senior Lecturer in Cancer Care, at Oxford Brookes University, Oxford UK. Dr Claire Taylor is a Macmillan nurse consultant at London North West Healthcare NHS Trust, London UK