AUGUST 2018 COMMUNICATING & NETWORKING FOR HAEMATOLOGY & ONCOLOGY NURSES ACROSS NEW ZEALAND

Editors’ note cancernetRESEARCH REPORT Welcome to the winter edition of Cancernet. July has been an eventful month for all of us as members of NZNO with the industrial action PICCs, skin and already undertaken and this follows us into August. I hope you have all experienced strong, positive support during this time. Industrial action is chemotherapy - never easy for any nurse to face. I hope for a resolution that recognises our worth, so we can continue to provide excellent care in a sustainable environment - one that cares for us while we care for others. friends or foes? This edition highlights recent endeavours of some of our cancer nurse colleagues nationally. We have a research report article from Sue Morel on Cancer treatment often requires the presence of a stable The CRCHS have a prospective CVAD audit and were PICC-related skin reactions and chemotherapy which she undertook as intravenous access device that can be used for the interested to see if I could formulate a question that part of her post-graduate study. Sue has completed her Master of Health delivery of chemotherapy or targeted therapies as well explored the possible relationships between PICC site Science after submitting this piece of work – congratulations Sue. as providing a means to administer supportive cancer skin reactions and chemotherapy regimens. We welcome Kate Whytock as the newest CNC Committee member and therapy such as antibiotics, blood products and TPN. The question reached - What effect do cytotoxic she has provided her profile, so you can get to know her a little better. Central venous access devices (CVADs) are required drugs have on PICC site skin reactions in the adult Jo Tuaine provides us feedback on her attendance at the CNSA conference for infusional chemotherapy and are identified as a oncology patients receiving chemotherapy within this year and Natasha Chisholm fills us in on a radiobiology course she the CRCHS? attended. Congratulations to Natasha who has also just become an cost-effective way of delivering chemotherapy to RN prescriber. individuals in hospital or to those able to receive Why ask the question? treatment from ambulatory cancer services. We are aiming to provide you with updates from the three cancer clinical Anecdotal belief from oncology practitioners indicated Peripherally Inserted Central Catheters (PICCs) have advisory working groups who support the work of the Ministry of Health by patients receiving certain cytotoxic therapies appear providing a clinical cancer perspective. This edition features a report from become a reliable type of long-term venous access for more likely to develop a PICC skin reaction. the Haematology Working Group kindly written by Anita Wootton one of oncology patients. Reducing the risk or incidence of the current representatives. These reports help provide a national known PICC complications reduces patient and family The aims were to identify: cancer lens to work going on in cancer care at other levels that many of us anxiety and means treatment can be delivered without would not otherwise know about. • Is there evidence within the CRCHS CVAD audit that delay. Any complication related to the PICC such as continued on the next page... There is a brief snippet on what the CNC committee are up to leading into thrombosis, infection or migration could lead to increased the ISNCC conference in September. We are also considering running a institutional costs and interruption to or even premature study day/s in Wellington in 2019, in conjunction with the BGM - details TBC. In this issue: cessation of treatment which may adversely affect a The ISNCC 2018 conference is not far away... September 23-26! We hope as patient’s outcome. many of you as possible have found the opportunity to attend. Report from Haematology As a Master of Nursing (MN) student looking to the Chair 2 Work Group We would love to hear from you on cancer nurse’s achievements, which complete a research report as my final requirement I meeting report 7 often happen quietly, or on the proposed study day/s or issues you may CNC Committee approached the senior nursing team of the Canterbury want us to look at in Cancernet in the future, please email us: news 3 ISNCC Conference [email protected] Regional Cancer & Haematology Service (CRCHS) and details 9 Your Cancernet Editors asked if they could identify a clinical question I could ESTRO Radiobiology Sarah Ellery and Kirstin Unahi examine. Course review 5 cancernet 2 RESEARCH REPORT AUGUST 2018 PICCs, skin and chemotherapy - friends or foes? continued from previous page...

can demonstrate this belief? Results: Report from the chair • Does the wider literature support such thinking? The study found that of 416 PICCs inserted for • If so are there recommendations to reduce risk chemotherapy administration, 74 recorded Welcome to this edition and improve outcomes? complications (18%) of which 29 (6.9%) were of Cancernet. identified as skin reactions. The literature review looked at identifying Welcome to this edition of the Cancernet. Gender distribution was 76% female and complications of PICCs to see if the skin reaction I am currently enjoying a few warm sunny rates were like those the CRCHs encountered. 24% male. days in Vietnam. There was clear identification of the main Skin reactions were seen in five identified complications of PWO, thrombus, migration and cancer types: colorectal (48.3%, 4); ovarian (3.4%, 1); ICCN conference planning continues. I am so pleased infection but little if any data about skin reactions. oesophageal (6.8%, 2); breast (37.9%, 11); that many of you are planning to attend. Some of you For example, the literature contained some qualitative and pancreas (3.4%, 1). have received grants from the College education fund research in which patients described how they felt The types of chemotherapy given to the audit and we anticipate some wonderful conference reports. about their PICCs (Alpenberg et al, 2015). patients were identified as 8 different regimes: Further requests for grants will be reviewed at our next There were descriptions from patients of irritation, Doxorubicin (6.8%, 2); paclitaxel (27.6%, 8); meeting August 31. and five regimens all containing a combination of itchiness and increased frequency of dressing Moira and I are on both on the organising committee drugs, one of which was 5FU in all cases (58.4%, 18). changes. I wanted to know why skin reaction and the sponsorship committee. The programme appeared not to be an identified complication. The remainder of entries had unidentified drugs sessions are full of exciting presentations and you My belief is that rates of PICC-site skin reactions are (6.8%, 2). will need careful planning as I learnt last year when I lost in the recording of CVAD-related infections but No significant associations were found between attended in Anaheim. unfortunately no research was located which identified skin reaction and chemotherapeutic agent. the source of the CVAD infection as having come The main recommendations from this We and the Cancer Nurses Society of Australia are from a pre-existing skin complication. report were that a more rigorous audit be responsible for the first plenary session. We are The next part of the literature review explored focusing on global equity and access to cancer care performed describing PICC complications, the relationship between chemotherapy and the skin. and treatments and have invited an expert panel to I described the function of the skin and the intrinsic containing consistently recorded details give perspectives from their global area. and extrinsic factors which influence the loss of including but not limited to diagnosis, Thank you to Auckland Hospital for allowing conference skin integrity. The review identified the cytotoxic treatment regimens, allergy status, attendees to visit the Cancer Centre. Their was drugs with known skin toxicities and the likely interventions and results. immediate response for the limited registrations and it influencing variables involved in PICC skin reactions This report did not uncover a recognised is hoped a second tour will be confirmed. Unfortunately such as dressing or cleansing allergies and procedural variations. assessment and intervention tool. we cannot accommodate all those wanting to attend. The development of one would contribute Committee work remains a priority and I thank your Method: to research and practice advancement committee members for their contributions and The research investigated Christchurch Oncology that will improve patient outcomes. expertise to progress ongoing projects. Service audit data on PICC complications (March 2015 Enjoy this edition of the Cancernet and kind regards - May 2017). Each identified skin reaction was examined Sue Morel, Gynae-oncology CNS, Christchurch Hospital to determine gender, chemotherapy type and cancer to you all. Reference: Alpenberg, S., Joelsson, G., & Rosengren, K. (2015). diagnosis. Quantitative data analysis provided Feeling confident in using PICC lines: Patient’s experiences of living Judy Warren descriptive statistics in percentages/counts and tests with a PICC line during chemotherapy treatment. of proportions using the Pearson’s chi square test. Home Management and Practice, 27 (3), 119-125. Chairperson, NZNO CNC cancernet 3 AUGUST 2018

NEW CNC COMMITTEE CNC committee meeting report

MEMBER PROFILE The CNC committee meets 3-4 times annually, Memorandum of Understanding’s (MOU’s) generally in Wellington. The last meeting was with HSANZ and CNSA Kate Whytock May and this provides a brief overview from • Discussion with Marilyn Head (NZNO) on the that meeting. submission process (there are generally quite There are a mix of standing items discussed a number of consultation documents sent for us along with new items which may have arisen since to consider if a submission from the CNC is Kate is a southern-trained NZ nurse with almost 25 years experience, the previous meeting. Some of those covered at with the last 15 years spent growing both her paediatric and adult relevant each quarter) this meeting: oncology expertise at Capital & Coast DHB in Wellington. • Updates on the survivorship working group • The ISNCC conference here in September. work, KSF review Kate has been a CNS Cancer Nurse Coordinator since the The CNC are considered the host for this and initiation of the Faster Cancer Treatment (FCT) Initiative in 2013. • CNC website to be updated to a more user three CNC committee members have been working A key stakeholder in the development of CCDHB’s FCT target data, with the ISNCC conference committee to assist friendly format with sustainable resource to she also designed process mapping used to audit the different in organising this global cancer nurse meeting make changes in a timely manner tumour streams and identify system issues against the National • Visit – Vanessa James from MoH cancer services Tumour Standards. • Discussion on the MECA negotiations with our professional nursing advisor (PNA) to discuss work on developing a standard of care Kate provides care coordination, navigation, health literacy and Anne Brinkman, Grant Brookes and Kerry Nuku for cancer patients. This is in early stages and support to patients and whanau with sarcoma and upper GI/HBP will align with the cancer strategy the new cancers. With a strong equity focus she works collaboratively across • Education grants to be given – 12 in total this Minister of Health has asked for. surgical and oncologic specialties, including inter-DHBs. meeting (great to see people applying for the grants) • Current membership: 612 Currently she is contributing to design and development of an IT prospective tracking tool to track patients along their cancer • Work on developing and sustaining There will be a one day meeting August 31st. pathway to improve timeliness to diagnostics and treatment. During the 6 years as Clinical at Wellington Blood & Cancer Centre, Kate trained, certified and supported nurses Closed system drug transfer devices in chemotherapy administration. Occupational exposure to hazardous drugs can decrease She contributed to the EVIQ Anti-neoplastic drug administration fertility and result in miscarriages, stillbirths, and cancers in (ADAC) pilot, becoming an EVIQ facilitator to provide a standardised healthcare staff. Several recommended practices aim to reduce this exposure, including protective clothing, gloves, evidenced-based chemotherapy certification. and biological safety cabinets (’safe handling’). There is She is currently affiliated with the National Upper GI Special significant uncertainty as to whether using closed-system Interest group and holds a PGDip in Clinical Nursing and will drug-transfer devices (CSTD) in addition to safe handling continue with her Master studies. Kate’s other loves are snow- decreases the contamination and risk of staff exposure to boarding, yachting and raising her daughter. infusional hazardous drugs compared to safe handling alone. Kate is excited to be welcomed aboard the committee with a The Cochrane Work Group has published a new review, examining the evidence on the handling of keen interest in developing national collaboration to advance cancer hazardous medicines. Kurinchi Selvan Gurusamy, from UCL Medical School in London England, tells us nursing in New Zealand, improve the patients/whanau experience what they found. and cancer outcomes. Click here to listen to the podcast cancernet 4 AUGUST 2018

CNSA Annual Congress Brisbane, June 2018

CONFERENCE REPORT

often radiation nursing is seen as second research is in symptoms clusters and class to medical oncology. Included in symptom burden. The use of genome the radiation sessions were presentations technology analysis is ground breaking. on chemo/radiation, what it is and the She is researching this technology to In June I had the opportunity to development and establishment of the increasing use and importance of timing identify those individual most at risk of attend the CNSA Annual Congress in McGrath Foundation. He spoke about of treatments. There was also focus symptoms from treatment and those Brisbane. This is the Cancer Nurses the personal challenges that spurred on head and neck cancer and the patients who do not develop side effects Society of Australia annual meeting. him and his late wife to try and improve management of these complex patients and as a consequence of this work has This year is it was held in Brisbane and the support and care for families with and discussion on best practice. lead the research in symptom cluster and was the 21st Annual Congress. breast cancer. At times these were stimulating sessions symptom burden. I wish to acknowledge the The McGrath Foundation supports with diverse views been expressed? Her presentations were informative New Zealand Cancer Nurses College families going through breast cancer Of particular interest is the and inspiring. I understand her who gave me a grant to help fund my and the foundation has led to the development of a radiation knowledge presentations will be online in the attendance at the meeting. I wish also establishment of the McGrath Breast and skills framework that the Australian near future. to thank my management of Therese Care Nurses. Glenn participates on a Cancer Nurses are working on. I found There was also a presentation on Duncan and Lynda Dagg who also voluntary basis. It was an inspiring and this of particular interest and believe that immunotherapy and understanding this supported me to attend this meeting. emotional start to the congress. the New Zealand Cancer Nurses College modality and side effect management of The themes of the congress were There was a diverse range of needs to follow these developments these drugs. Other topical presentations Science, Symptoms and Service Delivery. presentations at the meeting, including closely and work in conjunction with our were on financial toxicity, which I found The program was diverse and the sessions on radiation therapy, models Australian colleagues as this framework interesting and relevant to our own line-up of speakers included international of care, service delivery improvements, is being developed. context in New Zealand. and local Australian nursing experts. immunotherapy and the latest I do not have the ability to comment The congress was stimulating and There was also a strong collaboration developments in this new emerging on all of the major sessions or presenters interesting and it is good to know that with industry partners to highlight field of treatment, survivorship and in a small report but Professor Christine New Zealand care is competing at the improvement in outcomes for patients palliative care. The organising committee Miaskowski from the University of highest level. had attempted to provide a wide range California was inspiring and her two with cancer. Again I wish to thank the College and of topics to cater for the many different keynote presentations were a revelation. Glenn McGrath who is president of my managers for assisting me to attend aspects of cancer nursing. She is an international expert in pain the McGrath Foundation presented the this congress. opening address. Glenn gave at times an There was quite a focus on radiation and symptom management research. emotional and personal account of the nursing which I was very please to see as She is a nurse scientist whose field of Jo Tuaine cancernet 5 AUGUST 2018 ESTRO Basic (or not!!) Clinical Radiobiology Course

of NZNO Cancer Nurses College and Oncology Trust. especially late S phase, I attended the European Society of Radiotherapy and of cell cycle. Oncology (ESTRO) Basic Clinical Radiobiology course in Redistribution/ Melbourne over 10th-13th May 2018. Reassortment of I have worked within the Oncology/ Nearly 100 attendees from a variety of professions proliferating cells can Haematology environment for more than including radiation oncology registrars, physicists and increase cell kill if cells 12 years, having recently taken up a newly radiation therapists attended. are caught in a sensitive phase of cell cycle created 0.6FTE position of Clinical The course consisted of four full days of comprehensive after each fraction of radiotherapy. Nurse Specialist Radiation Oncology. learning led by an international faculty providing education on the underlying principles, latest developments Cellular damage and death may induce an increased With a new position comes new learning; and practical application of clinical radiobiology. rate of cellular proliferation/repopulation, this is whilst developing and advancing clinical especially significant in tumours capable of rapid All four main presenters consistently reemphasised proliferation i.e. GI tract, skin, oral mucosa. It was nursing knowledge, assessment and the basics of radiobiology focussing around the reported that accelerated repopulation occurs management of side effects and toxicities “R”s of radiobiology. Initially this started with approximately 2-4 weeks after commencement of patients experience whilst undergoing four “R”s - Repair, Redistribution, Repopulation and radiotherapy, thereby providing a clear and proven radiotherapy, I identified gaps in my Re-oxygenation, a fifth was later added - Radio- rationale for conventional fractionation and current sensitivity, and a further three are now considered learning. How does radiotherapy work? standard treatment times. What is occurring at a cellular level? essential components of radiobiology - iRradiated volume, Restoration and re-iRradiation. The presence of oxygen in malignant cells enhances What cellular processes are causing patient lethal radiation damage, whereas DNA damage may The first four “R”s are principles which explain the symptoms and toxicities – just to name a few. be repaired in hypoxic cells. Re-oxygenation occurs as foundation behind fractionated radiotherapy and the I believe having an understanding of the above the tumour shrinks in response to radiotherapy and dose-rate effect. Delivery of ionizing radiation can enhances one’s ability to understand and predict previously hypoxic cells become better oxygenated. result in three types of cellular DNA damage – (1) lethal certain symptoms and the timeliness of these occurring, It is of general consensus that hypoxia contributes to damage which is irreversible and irreparable and leads thereby resulting in increased accuracy of nursing radiation resistance. to cell death; (2) potentially lethal damage which could assessment and timely intervention. possibly result in DNA repair in certain environmental There appears to be a paucity of educational conditions; and (3) sub-lethal damage in which DNA opportunities in the arena of radiation oncology repair can occur if sufficient time between dose and specifically directed at the nursing profession. environment conditions are allowed. Both the Society (ONS) and Cellular repair occurs via a complex series of the European Oncology Nursing Society (EONS) pathways that relies on the ability of cells to view radiation oncology as an innovative and rapidly recognise damage/injury and activate the repair evolving discipline which poses specific challenges for pathways and cell cycle arrest. nurses from an education perspective. Cells are most radiosensitive during the G2 Therefore, with the goal of increasing my and mitosis (M) phase of the cell cycle and most radiobiology knowledge this course was recommended radio-resistant during the synthesis (S) phase, to me by a clinical supervisor and with the support

continued on the next page... cancernet 6 AUGUST 2018 ESTRO Basic (or not!!) Clinical Radiobiology Course continued from previous page...

This introduction led in nicely to the first the introduction of bioreductive drugs radiotherapy has a negative influence From here, I plan to of two presentations discussing cellular such as nitroimidazoles which chemically on outcome compared to radiotherapy incorporate basic radio- hypoxia; the first was by Dr Brad Wouters radiosensitises hypoxic cells by alone; as a result it is recommended who spoke on hypoxia and the micro- mimicking the effect of oxygen. that erythropoietin should not be biology into the radiation environment. The DAHANCA 5 study demonstrated administered in addition to radiotherapy oncology nursing He reported on a number of trials concurrent Nimorazole and radiotherapy outside of the experimental setting in orientation package, with conducted that demonstrated hypoxia significantly improved loco-regional patients with head and neck cancers. the aim of providing nurses was a strong negative prognostic factor control in patients with pharynx and Dr Brad Wouters closed the working within this ever for overall survival in patients with supraglottic carcinoma. As a result of presentations with a presentation on cervical, uterine and head and neck this trial, Nimorazole is now part of the ‘How do we continue to improve evolving nursing speciality cancers. It is thought that tumour cells standard treatment schedule for head outcomes’. He controversially suggested a more comprehensive respond and adapt to hypoxia which and neck tumours in Denmark; this that ‘significant improvements will come understanding of radiation drug is not currently licenced outside in turn, alters their biological properties from biology – not technology/physics’. and its expected and by stimulating angiogenesis and of Denmark. He demonstrated the impact and metastasis thereby increasing the Currently studies are continuing with advances physics has had on potential side effects, radiation resistance and malignancy trials reviewing the effectiveness of the radiotherapy over the last 20 years and thereby enhancing the of those cells. use of Carbogen (a gas of 98% oxygen believes the future lies in combining patient centric nursing Professor Karin Haustermans and 2% carbon dioxide) in head and molecular targeted therapies and service available to oncology neck cancers which are showing immunotherapies to enhance followed on by discussing current patients undergoing clinical approaches to modify tumour positive outcomes. radiotherapy. hypoxia. Many clinical trials have been Multiple studies have demonstrated I am exceptionally grateful for the radiotherapy as a treatment conducted in an attempt to overcome low haemoglobin levels are associated support I received from my employer, modality for their cancer the radiation resistance demonstrated with reduced local-regional tumour Oncology Trust Fund and NZNO Cancer diagnosis. in hypoxic cells, including the control and poor prognosis. College that facilitated my attendance in It would be optimal if we, as a national administration of supplementary Melbourne. The DAHANCA 5 trial additionally speciality nursing group, could develop high oxygen content breathing gas, I found attending this workshop observed the effect of low haemoglobin online modular education resources that chemical radiosensitisers, blood and transfusion in patients with head extremely valuable as an introduction to could be used in conjunction with transfusions, erythropoietin’s, and neck tumours, demonstrated that the basics of a very technical and current local and international clinical all of which have shown mixed results. haemoglobin levels were raised with comprehensive subject not traditionally resources. A number of early studies including transfusion during radiotherapy. taught to the nursing profession. References available if interested, feel the MRC HBO trial demonstrated However, surprisingly, transfusion was I believe as I continue to consolidate free to contact me. superior local control of disease in unable to improve the effect of the knowledge gained from this patients with stage III cervical cancer radiotherapy, local regional control and workshop this will have positive Natasha Chisholm RN MHSc – Nursing/Clinical when radiotherapy was delivered overall survival in this patient group. implications to my nursing practice and Clinical Nurse Specialist - Oncology concurrently with hyperbaric oxygen. A 2009 Cochrane review care delivery to patients undergoing Christchurch Hospital These studies fell along the wayside with demonstrated that erythropoietin plus radiotherapy. [email protected] cancernet 7 MEETING REPORT: AUGUST 2018 Haematology Working Group (HWG) reached. This includes data from the 4. Guidelines for National radiation oncology private sector, which Haematology FSA Referral 1. Pharmac update 2. Ministry of Health - will enable a more complete view to be and FCT Data Reporting available and will identify variance An update on current funding applications National Cancer Programme The HWG discussed the draft document across service providers. was provided by two representatives Scott McFarlane provided an overview developed by Richard Doocey (HWG Jane Lyon presented an update on from Pharmac. The specific details of of the National Cancer Programme chair) and Anita Wootton (HWG Nursing Faster Cancer Treatment (FCT). Jane this discussion remain confidential. work plan. Scott described how the new representative). The document has been explained that a review is happening However one of the clear messages from government, means we have a new previously discussed and reviewed by which will consider what the next step is the clinicians was that priority focus should Minister of Health whom has requested the HWG. The group is in agreement for the health targets from 1 July 2019. be given to at-risk population groups, a new cancer strategy is written by with the latest iteration, which Richard National achievement against the cancer where current funded therapies are 30 June 2018. will now submit for publication through health target is currently 93%. Jane absent or sub-optimal. Implications for Scott explained that this is the first the Ministry of Health, with a view to this outlined that work to standardise FCT nursing taken from the overall discussion opportunity we as stakeholders have to being available to the MoH website in reporting mechanisms nationally with Pharmac, include the following: influence the national cancer service due course. remains ongoing. Jane then went on to landscape since 2005. He went on to The group agreed to socialise the • New therapies within the context of acknowledge the work of the Central say that a new cancer service work plan final document within their own haematology continue to be approved. Cancer Network in the area of will follow on from the release of the regional departments. With the view This will impact clinical resources survivorship - which includes the release new cancer strategy. This will encompass that this document will support national within the context of haematology, of a national survivorship statement that a significant focus on equity, which the with hospital treatment centres already focuses on quality, not merely duration. consistency in haematology FSA referral working at (and beyond!) capacity. new government has as a key priority management, which in turn will augment area. His broad ideas for such a work 3. BMT national service plan robust FCT data reporting within the • Cancer nurses who are responsible for plan include an examination on the haematological tumour stream. the administration and monitoring of The HWG discussed the draft document governance of cancer in NZ, better Nurses working in haematology services, patients receiving new therapies will which Richard Doocey (HWG chair) has national connectivity, and a revision of particularly those dealing with FSA need to develop their knowledge and been developing. This is intended as a the current ‘standards of practice’ to a companion document to the original have access to education opportunities referral’s and FCT will hopefully find this philosophical shift that includes models BMT national service plan written in 2011. for these new anti-neoplastic agents. document helpful. of aligned thinking and practice. The companion document provides 5. Access and delivery of • A new oral anti-coagulant is about to Scott explained that the national updated data from the ABMTRR privately funded drugs/therapies be introduced on 1 August 2018. tumour standards for service provision (Australasian Bone Marrow Transplant in public hospitals The HWG requested that Pharmac released in 2013 had varying uptake, and Recipient Registry) and resource make it a priority to prepare a set of were never fully implemented, hence modelling to inform national service The HWG discussed the combined public national clinical guidelines, that they are being re-examined. The tumour planning in response to the growing and private care of cancer patients in NZ. includes an approved antagonist, streams of bowel, lung and urology are a demand in haematopoietic stem cell The topic was actively debated, largely to be available to clinicians when this priority. Gaps exist for neurological transplantation in New Zealand. This has through the use of anonymised clinical new agent becomes available. tumours, and neuro-endocrine tumours. service-wide implications, including examples shared by the haematologists. • It is important that nurses working in Scott provided an update on the workforce planning relevant to the whole Concern was raised regarding haematology maintain an awareness Cancer Health Information Strategy multidisciplinary team, including nursing. treatment centres already at capacity. of clinical trials activity. In particular (CHIS). Activity continues particularly in The group agreed with the current The group agreed that clarity around - clinical trials often require inter-DHB the areas of clinical indicators and the draft, which Richard will now submit for what the MoH’s current official position travel. Therefore patient advocacy, cancer registry. publication through the Ministry of statement is regarding this topic is navigation, care-coordination and An agreement for a Radiation Health, and will be available on the MoH required ASAP. This is important in the communication are paramount. Oncology minimum data set has been website in due course. current landscape of novel therapies,

continued on the next page... cancernet MEETING REPORT: 8 AUGUST 2018 Haematology Working Group (HWG) continued from previous page... and clinical trials. Nurses working in EWS system. The general feedback 10. Haematology Nursing Workforce Anita Wootton (HWG nursing rep) haematology, as well as our medical was positive. Examples were given An Auckland-based Haematologist raised provided some background commentary colleagues can field questions from which described how the parameters this item for discussion by the HWG, based on nursing training and recruitment in patients regarding private treatment, could be modified within the context on their experience that it is becoming a the national haematology context. therefore will also benefit from being of haematology/oncology struggle to find ‘suitably qualified’ nurses. This included an overview of the informed as to what this official MoH eg: to accommodate high temperatures This haematologist was at the meeting haematology nursing workforce, scopes position on this topic is. in the febrile neutropenic patient. and explained that she was referring to of nursing practice, and the current It was suggested that any modification nurses who were chemotherapy trained. landscape of training opportunities. 6. Iron infusions to clinical parameters is authorised This observation sparked a lively The following items were discussed: The HWG discussed a draft memorandum and documented by medical staff, and discussion among the HWG regarding Knowledge and Skills Framework 2014, developed by Richard Doocey (HWG on a case by case basis. the haematology nursing workforce in National Nursing Standards for anti- chair) re: Iron infusion delivery at general. Several haematologists remarked neoplastic drug administration in NZ, Haematology Departments in NZ 9. Hospital Pharmacological that they thought EviQ was now the ADAC: EviQ certification. hospitals. The memo is a position Society Intrathecal only chemotherapy training/certification It was highlighted to the group that it statement from the HWG, in response to Chemotherapy document used in New Zealand, but had since is imperative any discussion on the increasing demands placed on The HWG was attended by two been informed that although EviQ had haematology workforce planning hospital haematology departments to representatives (Kim Brackley and been adopted by many DHB’s, there (particularly in the current climate of the provide intravenous iron infusions. Maxine Handford) from the New Zealand may be some cancer treatment centres projected increased demand for BMT) The memo recommends that Healthcare Pharmacists Association. who are not using this platform. must also include consideration of the referrals for intravenous iron infusions The two pharmacists gave a short Several haematologists remarked on nursing workforce. for non-haematological conditions are presentation on their draft document the different nursing skill sets required transferred to more appropriate services titled: Recommendations for the safe 11. HAA/Blood 2020 in different clinical settings eg: busy such as gastroenterology, general administration of intrathecal oncology inpatient units/BMT units The Australasian Haematology medicine, and gynaecology. The memo chemotherapy in New Zealand. versus ambulatory/day ward clinics. conference ‘Blood’ (formerly called HAA) was endorsed by the group, and will be Whilst the project is being driven by The group of clinicians expressed will be held in New Zealand for the first sent to DHB’s nationally. the pharmacists association, the document has implications across the support for advanced nursing roles time in 2020. This was not possible until 7. Dental interventions in the MDT including medical and nursing staff. such as CNS, , and now, as a new conference facility is being context of Haematology The HWG provided verbal feedback. the emerging role of RN prescribing built at Auckland Sky City. This is a combined conference that encompasses The HWG discussed the draft document The general consensus from the group within the haematology context. titled: ‘NZ Haematology patients’ Dental was positive. Everyone was in A query shared by the haematologists medical, nursing, pharmacy and and oral health management’. agreement that evidenced-based appeared to be ‘What is the scope of laboratory disciplines. HSANZ will be Responses from the group indicated guidelines based on best practice was the CNS role?’. One doctor explained involved in forming a planning committee. variability in access and service provision a step in the right direction toward how she has been working alongside a EOI to join the committee can be of dental care for haematology patients patient safety. nursing colleague who has developed a addressed to HSANZ - Leanne Berkahn nationally. The group endorsed the Kim and Maxine explained they will CNS-led haematology clinic for a specific in Auckland is overseeing this. patient population. She went on to explain document, which will be send to DHB’s continue to develop the document 12. Next HWG Meeting nationally to provide best practise accordingly and indicated they may look that she is unclear on the distinction The next HWG meeting will be held recommendations accordingly. at establishing a work group that between an RN and CNS and was includes consultation with not only subsequently worried that she may in Wellington in November 2018 - 8. Early Warning Score (EWS) Chart pharmacists, but also representation have inadvertently caused her nursing specific date TBC. The HWG discussed the national roll out from medical and nursing sectors. colleague to be working beyond her Anita Wootton, of observation charts that include the This strategy was supported by the HWG. scope of practice? HWG Nursing Representative cancernet 9 DECEMBER 2017

the theme is: global actions: Working towards unity and excellence in Cancer Care

the theme is: global actions: Working towards unity and excellence in Cancer Care the theme is: global atctions:ena koutou, Working t owardstena koutou, unity and etenaxcellence koutou in Cancer katoa Care tena koutou, tena koutou, tena koutou katoa tena koutou, tena koutou,the tena i koutounternational katoa society of nurses in Cancer Care DeaDlines the iREGISTERnternational society ( ofisn nursesCC) in is Cancer pleased Care to announce theDea 2018Dlines international the( isninternationalCC)ONLINE is pleased s ociety to announce of nurses the 2018in Cancer international Care DeaDlines (isnConferenceCC) is pleased on Cancer to announce nursingConference the (iCC 2018n 2018) international from on sunday Cancer nursing (iCCn 2018) from sunday Conference23 septemberNOW! on Cancer to Wednesday nursing23 ( i 26CC sns eptember2018) from 2018 sunday at to the Wednesday Call 26 forseptember abstraCts o 2018pens: at the Call for abstraCts opens: 23 sskyeptemberCity auckland to Wednesday Convention 26sky sCentre,eptemberCity auckland, a 2018uckland at n Z. the ConventionCall Centre, for abstra auckland,Cts opens: nZ. skyCity auckland Convention Centre, auckland, nZ. 1 January 2018 1 January 2018 iCCn is the world’s premiere meeting for leaders, and 1 January 2018 iCCn is the world’s premiere meeting for leaders, and future leaders, in cancer nursingiCCn research is the and world’spractice. premiere meetingregistration for o pens: leaders, and futureour leaders, conference in cancer provides nursing you research with the and opportunity practice. to registration opens: our conference provides you future with the opportunityleaders, in to cancer and practice. engage with leaders in cancer nursing from around the 29 January 2018 registration opens: engageglobe with and leaders to participate in cancer in onursing theur conversations conference from around that the will provides you with29 January the 2018 opportunity to globe and to participate in the conversations that will shape tcancerhe theme nursing is: research globalengage andactions: translate with Working evidence- leaders towards in cancer unity and nursing excellence from in Cancer around Care the 29 January 2018 shapebased cancer cancer nursing nursing research education, and practicetranslate and evidence- research Call for abstraCts Closes: based cancer nursing education,globe practice and and to research participate inCall the for conversations abstraCts Closes: that will into patient-centered care. into patient-centeredtena koutou, care. tena koutou, tena koutou katoa shape cancer nursing research and1919 f ebruaryfebruary translate 2018 2018 evidence- all ofall this of this twillhe will beinternational offeredbe offered in stylesinociety stylebased in ain ofuckland, anuckland,urses cancer n inew n CancerewZealand, Zealand, nursing Care education,Dea practiceDlines and research Call for abstraCts Closes: where( youisnCC) will is share pleased lively, to announce innovative the discussions 2018 international with where you will share lively, innovativeinto patient-centered discussions with care. abstraabstraCtC tn notifiotifiCCation:ation: newnew and and existingConference existing friends onfriends Cancer and and colleagues.nursing colleagues. 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Call for a bstraCts open noW! Visit the conference website at www.iccn2018.nz. Call for a bstraCts open noW! Visit the conference website at www.iccn2018.nz.

Call for a bstraCts open noW! Visit the conference website at www.iccn2018.nz.

Call for a bstraCts open noW! Visit the conference website at www.iccn2018.nz. OPPORTUNITIES FOR EDUCATION & PROFESSIONAL DEVELOPMENT cancernet 10 AUGUST 2018

Funding options to attend conferences or courses Funding to attend conferences or courses is becoming increasingly hard to source. Apart from your local DHB, here are some funding options that you may not have thought of. To apply for funding you need to be organised with many groups having funding rounds and deadlines throughout the year.

• For members, the NZNO offers several • The Cancer Research Trust NZ has various funding streams. These include NERF, award rounds throughout the year to support Florence Nightingale, Thomas Tippet award, health professionals working within cancer care just to name a few. For further information to attend courses or conferences. For further including criteria and closing dates: information on criteria and closing dates go to: Visit the Scholarships section on the Visit the Grant Application section on the

NZNO website Cancer Research Trust NZ website

• Roche provides individual “Roche Education • The Blood Cancer NZ and the Cancer Society Grants” to nurses working in the fields of offer grants for health professionals to Oncology and/or Haematology to support attend conferences or courses. They usually their attendance at appropriate medical have funding rounds. For further information education events paid for in 2018. The key contact the Cancer Society or Leukaemia goal for these grants is to support nurses in and Blood Cancer NZ. accessing continuing education opportunities If you are aware of other funding streams in their field of expertise and to share the that are available and you want to publicise Now you can information gained with their colleagues. them, please contact us on Visit the Grants & Awards section [email protected]

on the NZNO website

National Cancer Online cancer learning Programme update www.cancerlearning.gov.au The Ministry leads a national The Cancer Nurses College committee work programme which www.cnsa.org.au INVITES ALL MEMBERS to join us on the new provides a strategic focus www.ons.org ‘Cancer Nurses College NZNO’ Facebook Group. for cancer control and for National Cancer system-wide improvements Programme Ask questions, share thoughts, ideas, research, innovative practice, Work Plan 2013/14 www.isncc.org across the spectrum of or concerns. cancer services. www.eviq.org.au Click here to visit the page... Keep up to date on www.nccn.org

the National Cancer Click the ‘Join Group’ button and one of our lovely Admins will add you. Programme www.asco.org Easy as that! Hope to see you there! cancernet 11 AUGUST 2018

A Google search for cancer brings up over GUIDELINES FOR CONTRIBUTING TO CANCERNET... 570 million results.

Why contribute? Why publish? Submitting your work For patients with specific cancers - where’s a good place to start? • To share knowledge • Articles should be submitted in Microsoft • To advance your field of practice Word via email to [email protected] • To disseminate key findings or opinions • Acknowledgement of receipt of your submission will then • To contribute to policy debates cancerinfo.co.nz • Acknowledgement of receipt of your Introduction submission will be sent by email. Blood Cancer Breast Cancer Ovarian Cancer

Cancernet is a newsletter that is published Bowel Cancer Cervical Cancer Skin Cancer three times a year by the New Zealand Nurses Word count Brain Cancer Lung Cancer Stomach Cancer Organisation Cancer Nurses College. Opinion articles should be between Cancernet aims to inform and encourage 700–1000 words long. However, clinical-based nurses managing people with cancer to articles and literature reviews and advanced share opinion, resources, clinical practice and study articles, these can range from between continuing professional development. 1,500 and 3,500 words, including references.

Types of articles Illustrative and images All types of articles are welcomed and Authors must obtain permission for the use of can include; illustrative material or images and ensure that - Opinion this material is labeled and captioned. - Clinical practice - Case studies Referencing - Continuing practice development A recognised referencing system to be used. - Literature review If the reference list is long, the reference list is

- Advanced study (e.g. BSc or MSc) write-ups available on request from the author. ID2397/TAPSNA8683/2016OCT cancernet 12 AUGUST 2018

Important diary dates The 2017-18 Cancer Nurses College Cancer Nurses College badges 24th-25th August 2018, Queenstown COMMITTEE are now available New Zealand Society for for purchase for $8 each. Oncology (NZSO) Conference They can be purchased from CNC Find out more information committee members or by emailing the committee on [email protected] and 18th - 20th September 2018, Wellington using internet banking. NZNO Conference and AGM 2018 Find out more information Cancer nurses 23rd-26th September 2018, Auckland International Society of Nurses committee in Cancer Care ICCN Conference [email protected] Find out more information CHAIRPERSON CO-EDITOR Back row Left to right: Judith Warren (ACTING) & 2nd-3rd November 2018, Auckland Fiona Sayer, Sarah Ellery, Judith Warren, Moira Gillespie 021 475 876 CONSULTATIONS Melanoma Summit 2018 Front row left to right: Sarah Ellery Kate Whytock, Joseph Mundava, Kirstin Unahi, VICE 027 502 7534 Find out more information Felicity Drumm (insert bottom right) CHAIRPERSON/ CO-EDITOR MEMBERSHIP Kirstin Unahi & GRANTS 3rd-4th November 2018, Auckland 027 403 1814 Felicity Drumm Introducing Aromatherapy in 021 983 829 Palliative Care SECRETARY Joseph Mundava COMMITTEE Find out more information 021 145 6106 MEMBER Kate Whytock We welcome contributions to Cancernet. VICE-SECRETARY 5th November 2018, Auckland Interesting stories, notices and photos relevant Moira Gillespie PROF NURSING 027 447 3775 ADVISOR Aromatherapy for Emotional and to our nursing community are always Spiritual Care Anne Brinkman appreciated. Email us at TREASURER 04 494 8232 Fiona Sayer Find out more information [email protected] 027 200 1923