 Attendance at national nursing conferences has decreased in recent years, and this drop-off has been attributed to the high cost of travel, reduced (or eliminated) budgets for nursing education, and the emergence of alternative ways to update knowledge (eg, online programs). It’s understandable that some nurses are unable to go to nursing conferences, but what about all of the other nurses who can go, but choose to not attend?

	For these nurses, who have the support of their employers, it may be “too hard” to be away from family or work, or it may be “too far” to go to learn something new, or it may simply be “too complicated” to attend a conference. So, why should nurses attend nursing conferences?

	The most compelling reason, in my opinion, is that nursing conferences offer something that is only available at nursing conferences: human interaction. Nothing can take the place of networking with colleagues, participating in a live question-and- answer session following an educational program, or learning about new drugs and products firsthand in the exhibit area. Nursing conferences foster feelings of camaraderie and offer multiple opportunities to interact and connect with other attendees. These interactions may be fleeting or have long-lasting effects; many enduring friendships have sprouted and been renewed at nursing conferences.

	Nursing conferences are also highly rejuvenating. It’s a great feeling to head for home feeling inspired and armed with new information or insight, which can be brought back to the workplace and shared with others. Most conferences have multiple tracks or offer concurrent sessions on different topics; this allows nurses to customize their educational experience and tailor it to their individual needs. Conferences also help identify clinical resources, programs, and people who can be contacted in the future to help solve problems or answer patient care questions.

	The conference forum is also an easy way to earn continuing nursing education contact hours, which are required for state RN licensure renewal. The live educational sessions offer a more interesting and rewarding experience than print or online CE activities.

	As I mentioned earlier, conference exhibit areas can also be a valuable resource. With vendors gathered all in one place, exhibit halls make it easy to learn a lot in a short amount of time. In addition to offering promotional/marketing information about their drugs and products, vendors also offer medical information. This may be one of the most underutilized features of the exhibit hall. I jot down my non-urgent clinical questions throughout the year and ask my questions at the annual conferences that I attend. Further, the medical affairs department of drug and product manufacturers will often disseminate postmarketing information to conference attendees that is not in the package/product insert or otherwise readily available.

	It would be naïve to expect that every nurse can or should attend a conference. After all, some nurses are needed to stay behind and provide patient care while others go to the conference. Those unable to attend should take advantage of technological advances offering “virtual attendance,” that is, viewing archived conference sessions online. Gone are the days of purchasing audiotapes from the conference and hearing a presentation; now, the presentation can be viewed as well as listened to. Viewing an archived presentation is not quite like being there in person, but it is a reasonable alternative.

	Also very helpful are the nursing conference recaps that many websites and publications, including

 to watch the speakers’ interviews and learn additional information that can only be gained by listening to the speakers’ points of view. 

 also covers other conferences, such as those designed for oncologists and hematologists. Online coverage and reporting of these meetings allows nurses like me, who are unable to attend medical conferences in person, to view important new information that is critical to the care of our patients.

	If you have the opportunity to attend a nursing conference, take it. If the opportunity doesn’t arise, seek out other ways to update your knowledge, such as viewing online conference coverage and archived presentations. It’s now easier than ever to attend a nursing conference, and take it from me, you don’t know what you’re missing.

	Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN, is an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences Center in New Orleans, LA, and the editor-in-chief of OncLive Nursing.

Articles

Nurse's Notes

It's understandable that some nurses are unable to go to nursing conferences, but what about all of the other nurses who can go, but choose to not attend?

You Don't Know What You're Missing: Why Nursing Conferences Remain Relevant

	Cancer and Careers is the only program of its kind, dedicated to empowering and educating people with cancer to thrive in their workplace by providing expert advice, interactive tools, and educational events. Through a comprehensive website, free publications, career coaching, and a series of support groups and educational seminars for employees with cancer and their healthcare providers and coworkers, Cancer and Careers strives to eliminate fear and uncertainty for working people with cancer.

	Cancer and Careers offers a variety of tools and resources for those working during or after cancer treatment. 

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	For those who prefer in-person events, Cancer and Careers also offers nationally-held 

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Advocacy Spotlight

Cancer and Careers is the only program of its kind, dedicated to empowering and educating people with cancer to thrive in their workplace.

Advocacy Spotlight: Cancer and Careers

Oral oncolytic treatment offers benefits to both patients with cancer and oncology nurses. The self-administered medications empower patients with a level of control over their cancer treatment experience. Patients can conveniently administer oral therapies at home, reducing their time spent traveling to and receiving treatment at infusion centers. The reduction in clinical visits also frees oncology nurses to address their other clinical responsibilities.

	Along with these advantages, oral oncolytics present several challenges. With increased patient responsibility and reduced clinical oversight, treatment adherence and side-effect management become major concerns. The high costs of the medications also introduce reimbursement issues.

	Patient nonadherence and symptom mismanagement can lead to disease progression, unnecessary treatment changes, and increased toxicities. This creates an additional burden for clinicians with increased appointments and hospital admissions.

	With the continued escalation in oral oncolytic use (oral agents represent approximately 25% of the overall oncology research pipeline), oncology nurses must be prepared to facilitate proper use of the treatments. At the ONS 36th Annual Congress, OncLive Nursing discussed oral oncolytics with Susan Moore, RN, MSN, ANP, AOCN.

	Susan Moore, RN, MSN, ANP, AOCN, led a clinical practice session on adherence to oral oncolytics at the ONS Congress.

What are the advantages of oral oncolytic treatment compared with infusion therapy?

Well, for the patient, one of the advantages is that they can take this medicine at home, so they don’t have to schedule an infusion appointment to come in and be treated; they don’t have to [deal with] the…delays in traffic or delays [at] the clinic. They can take their medicine at home. So for some patients, taking oral agents gives them an increased sense of control—a sense that they’re somewhat in charge of their treatment. Now they’re not making decisions about the doses, we hope, and they’re following our instructions on how to take it. But it gives them…a little bit better control than having to be dependent on coming into the infusion center.

	Please discuss some of the available evidence of patient nonadherence to oral oncolytic therapy.

	The majority of the evidence at this point comes from women with early-stage breast cancer, who have been given, for example, a 5-year regimen of tamoxifen or an aromatase inhibitor that they take after they finish their surgery and any adjuvant chemotherapy that they had to have. And what we’re finding is that women tend to fall off of their therapy, sometimes as early as 2 or 3 years after starting, and so the incidence of nonadherence increases as the woman goes along in that 1-to-5-year range.

	View clips from the exclusive interview with Susan Moore on 

	And the second is easily—very easily&mdash;measured, and that’s in patients who are taking imatinib, or Gleevec, for chronic myelogenous leukemia, or CML. And [for] those patients, it’s relatively easy now to measure their BCR-ABL and see what their level is, and that will more or less tell us if the patient is being adherent with their therapy or not.

	So those are some areas where we do have definitive evidence. A lot of the rest of it is anecdotal, that people will say, “Well, my patient says she takes her medicine 90 percent of the time,” but we don’t really have good clinical studies at this point.

	"For some patients, taking oral agents gives them an increased sense of control—a sense that they’re somewhat in charge of their treatment."

	What are some indicators that a patient may have adherence issues with oral oncolytic treatment?

	Patients who tended not to follow instructions during the time of their adjuvant therapy [and] missed appointments. [Also, patients who] have a poor refill rate with their retail pharmacy— and those records are easy to get. If you’re the prescriber, you can call the pharmacy or get online with the pharmacy and find out if patients are refilling their prescriptions on time. So somebody who fails to do those things, or doesn’t call the clinic to tell the nurse or the physician that they’re having a particular side effect&mdash;they wait until it’s out of control, or they don’t report it until a visit 2 months later&mdash;that’s somebody that I would really want to think twice about putting on a chemotherapy where the side effects or the failure to adhere to the treatment could create some toxicities and problems.

	A sample of FDA-approved oral oncolytics 

		ALL indicates acute lymphoblastic leukemia; CML, chronic myelogenous leukemia; EGFR, epidermal growth factor receptor; GIST, gastrointestinal stromal tumors; NSCLC, non—small cell lung cancer; RCC, renal cell carcinoma; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor.

	What are some of the effects of patient nonadherence?

	Some of the effects can be non-efficacy, [or] a lowered efficacy. All of the data that we give a patient saying that we believe, let’s say, in early-stage breast cancer that if you complete this regimen of therapy that you have a 98 percent cure rate, well, that’s not based on the patient stopping the medicine after 2 years, or taking it for 6 months, and stopping for 3 months and [then] starting again. It’s based on taking the medicine every day or as it’s ordered for the length of time that it’s ordered. So one of the things that can happen is that we have decreased efficacy.

	The second can be if the patient doesn’t take the medicine the way they’re supposed to, we could have increased toxicities. So if someone takes more medicine than they’re supposed to, or they’re afraid to stop taking it when we ask them to hold it for a day or 2 because of a side effect, they can end up in the hospital or can end up with toxicities that are so severe that we actually have to stop the medication because of the toxicity, not because it’s stopped working.

	What can oncology nurses do to facilitate patient adherence to oral oncolytic treatment?

	Educate, educate, educate. That’s the key, and that’s what nurses are good at. We learned how to educate patients from our very first days in nursing school, and it’s something that we refine over the years. So we don’t want to use a script. We want to use a very individualized approach, tailored to that patient, and hopefully have another family member or a good friend there, because they may hear things a little bit differently than the patient does because of the patient’s anxiety. So that helps us to have a second person in the home or nearby that can help. But basically good patient education, and not just once, but educating the patient every time you have an encounter with them while they’re on this medicine, whether it’s in the clinic [or] over the phone. It takes 2 seconds to ask, “How is it going? Have you missed any medication? If you did miss them, why? And let me help you figure out how to get back on track.” So it’s a quick thing to do. It’s just something we have to do continually.

	5 oral oncolytics in late-stage clinical development 

		ALK, anaplastic lymphoma kinase; RCC, renal cell carcinoma; NSCLC, non—small cell lung cancer; PFS progression free survival; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor; VEGFR2, vascular endothelial growth factor receptor 2.

	What steps are involved with adapting a practice for use of oral oncolytic treatments?

	Probably the thing that’s the most difficult is for the physician to release the nurse for time for patient education. In most situations, it’s not a billable event and the physician sees this, especially in a small practice, as this is a nurse who’s spending an hour doing something for which I can’t bill, and she could be instead in the clinic giving an IV infusion, where I could bill for the medication and the nursing time to administer it. So that’s the first hurdle that most, especially small practices, have to get over.

	The second is if there is the money in the budget to hire a full-time clinical nurse specialist or nurse practitioner, some type of an advanced-practice nurse, within the practice. This really helps to make sure that education stays on key.

	And the other is to help the nurses to be able to do research on adherence, either themselves or to utilize research that’s out there to try to improve their education techniques. In the end, the message I always give to the physician is that the better your nurse is [at educating] the patient, the fewer hospital visits the patient will have, and the fewer phone calls you’ll have to make to try to resolve side effects or try to resolve problems of nonadherence. So it sort of pays you back if you let the nurse do his or her job.

Conference Highlights

Oral oncolytic treatment, a self-administered medication, empowers patients with a level of control over their cancer treatment experience.

Spotlight on Oral Oncolytics

Carlton Brown, PhD, RN, has been a member of ONS for 18 years and is in the second year of his 2-year term as president. He is also an assistant professor in the University of Delaware’s School of Nursing.

	Brown formerly served in the US Army, most recently as a clinical nurse educator at Walter Reed Army Medical Center (WRAMC) in Washington, DC. He also worked as a clinical head nurse and clinical nurse specialist at WRAMC.

	His most recent research includes “The Effect of an Oral Care Protocol on Oral Mucositis in Patients With Head and Neck Cancer Treated With Radiotherapy” and “The Lived Experience of Oral Mucositis in Head and Neck Cancer Patients Treated With Radiation.”

	At the ONS 36th Annual Congress, Brown spoke with OncLive Nursing about a variety of topics concerning the current and future state of oncology nursing.

 How will healthcare reform affect oncology nurses?

We know that there are probably 30 to 35 million Americans who right now are uninsured, and in 2014, when every person will have healthcare insurance, that’s obviously going to create a burden on nursing, on all of the healthcare providers. And so…it’s really frustrating when people say that we’re not really having a nursing shortage right now, because it’s kind of in disguise because of the economy, but healthcare reform is going to add more patients to the workload system.

	The good news is that there is a lot within healthcare reform to encourage nurses to get a more advanced degree, so maybe to go to become a nurse practitioner or clinical nurse specialist. There are loans for that. There are repayment plans for people who already have an education…There’s going to be scholarships. I think for any individual, now is a great opportunity to either become a nurse because of healthcare reform and the opportunities written into the law, but also it will be important for those who are currently practicing nursing to become more advanced in their practice.

	Will you discuss oncology nurses’ use of social media applications?

	Social media is something that I’m very proud that oncology nurses [are] doing. Of course, we have Facebook, Twitter, and LinkedIn, and we have done a really good job with [those]. I think it’s a good way to connect all nurses together, but in particular…those nurses that may be in less populated areas…I was asked at [the] opening ceremony yesterday to do a tweet that would connect all of the nurses who were following ONS, pulling them all in.

	[Also] the [ONS] Board just recently decided to add [technology as] a new pillar to our strategic plan…because I think that we really need to be thinking about what are the new things beyond social media. What are we going to be needing in 5 years and 10 years from now, trying to stay very pertinent to our members, and social media has been a good example of a way to reach out to our members.

	We started to discuss this topic earlier, but let’s explore it a little further. Is there a shortage in oncology nursing, and, if so, what strategies is ONS employing to address the issue?

	Well, I’d say that right now…the shortage not only in oncology nursing, but also in nursing [overall], is kind of in disguise. The economy has been very diffi cult, and so, in the past you may have had 3 or 4 wards or units that stayed at 50 or 60 percent capacity of patients, and you had nurses working on all of those. And I think that there are some hospitals that have closed a couple of wards and went to 100 percent capacity, and have kind of put those nurses out of jobs. And so I know that on both the east coast and the west coast, there are nurses who are having diffi culty finding jobs. However, in the middle of the country…there’re plenty of jobs for nurses. So the way it looks right now, it looks like we are in disguise of the nursing shortage.

	However, once the economy recovers, many of these nurses who may have wanted to retire in the last 5 years are going to retire. So we are going to be in a shortage of nursing, and, as I’ve already mentioned, we have 30-plus million more Americans that are going to be needing healthcare, and I think that we’re going to be in a world of hurt in 10 years. The problem, one of the major problems, because I’m a faculty member at a school of nursing, is that we have a faculty shortage. I mean we’re turning—when I say we, [I mean] here in the United States&mdash;we are turning nursing students away every year because we don’t have enough faculty to teach those students, and that’s because the pay for a faculty member is very sad. It’s very low. So I’ve been a nurse for 20 years and have a PhD in nursing. Any nurse who graduates can go to work in an emergency room on a nightshift and make more in her fi rst 6 months as a nurse than I’m making as a faculty member. And that’s kind of how it is with society anyway. We don’t pay teachers well…If you think about a high school teacher, it’s not something that you’re going to get rich at.

	So, yes, we have a nursing shortage. It’s going to get worse, and it’s going to be quite a problem, and [addressing the] faculty shortage is one of the solutions.

	[The Oncology Nursing Society is] working with schools of nursing to try to help attract nursing students to oncology nursing. We’re trying to fi nd ways to attract nurses that might be practicing in other areas to oncology nursing. It is on our mind. We are working with the American Nursing Association, as far as faculty issues are concerned. So it is in our foresight and we are working on it, but I think it’s going to be quite a problem. Probably 5 or 10 years from now, we’re really going to feel the effect of the nursing shortage.

	Carlton Brown, PhD, RN, addresses attendees at the ONS 36th Annual Congress.

	Beyond attracting faculty, are there other issues with oncology nursing education that need to be addressed?

	Lately we’ve been talking about [the fact that] there are 3 million nurses in the United States, and many of them don’t consider themselves oncology nurses, per se, but we know that many of them on a daily basis come into contact with an oncology patient— maybe in a home health arena, maybe in hospice palliative care, maybe in some kind of technology center [with a] mammogram. And so at the Oncology Nursing Society, we’ve been thinking about how can we better prepare those nurses who do not consider themselves oncology nurses? How do we get the content out to those nurses, so that they continue to provide quality cancer care to patients? And so if anything, that’s really the area where we will be doing work in the next 5 years, creating a portal online where information about oncology nursing is positioned, so that [a nurse] doesn’t necessarily need to be a member of ONS to get this access. It’s going to be free access. So that’s one of the areas that we’re working on.

	Please discuss the textbook you edited, A Guide to Oncology Symptom Management, and its focus on evidence-based practice?

	Thank you for mentioning my…textbook. It covers 20 symptoms, such as hair loss, nausea, constipation, and depression, and it is [written] from an evidencebased practice approach. In other words, we have sifted through all of the research to say, “What is the best way to treat a particular symptom?”

	And so…my textbook…presents all of the options out there, and then works through the evidence to say, “What is the best evidence practice for each of those symptoms?”

	There’s a second textbook [A Patient’s Guide to Cancer Symptom Management] out now that just came out 2 months ago, and we took [the fi rst] textbook and…wrote [another] textbook…at the fi fthand sixth-grade level for patients. So now a patient can sit down and read it and say [for example] “I have nausea. Let me read up on what that means.”

	View clips from the exclusive interview with Carlton Brown on 

	Oral oncolytics and genetic testing will be major factors in oncology going forward. What is ONS doing to prepare oncology nurses for this future?

	Oral medications [are] a big area. [Treatment is now] very focused…In the old days, let’s say you had a lung cancer. There was a standard group of chemotherapies that every lung cancer patient… received. And now we’ve been able to genetically look at that cancer and say, “What’s specifi c about it?” and then give some of these oral chemotherapy agents. Genetic testing is another big area. Now that the human genome has been mapped, we will eventually be able to look at genes and say, “You’re at risk for pancreatic cancer,” long before you’re diagnosed.

	So we talk a lot about adherence [to] oral medication, because [maybe] you’re somebody that’s never had to take a medication in your life, and now you’ve got to take this medication 4 times a day at a particular time. So we’re looking at ways…to help patients to remember to take it…We are doing research around adherence.

	And then we have our own genetics program. ONS has published a couple of genetics textbooks. Genetics really [will] be the wave of the future, as I said, because of the [mapping of the] human genome…We can even now see who is [at a] higher risk for nausea. We can see who…is [at a] higher risk for hair loss. So we have not even begun to tap cancer care from the genome approach.

	[And going back to] healthcare reform. In the old days you [had] to be worried about genetic testing. Let’s say that you do genetic testing and you’re at risk for colon cancer, and that information falls into the hands of the…insurance company, and they just say, “Okay, here’s somebody that’s at risk for colon cancer. Let’s cancel their insurance because that way we don’t have to pay for their care.” And that’s always been the big fear. Well, as of 2014, [with] healthcare reform, it’s illegal to cancel a person’s insurance either by a preexisting condition, if you’ve had cancer before, or if you’re diagnosed with cancer in the future. So that will open it up so that people will be more likely to have genetic testing, and then allow it to be used for their future care, almost like a preventative focus.

	"It takes the right person to do it, but [being an oncology nurse] is a great job, and I think there are going to be incredible economic opportunities."

	What would you say to an undergraduate nurse to convince him or her to become an oncology nurse?

	People think that oncology nursing is sad, but to me, it’s a great job. I think that a nurse is meant to work in a particular area. For instance, I’m not a pediatrics person. I can’t work with children. I just would want to sit down and cry with them, if they’re in pain or something like that. It takes the right person to do it, but [being an oncology nurse] is a great job, and I think there are going to be incredible economic opportunities.

	You know, the one thing I’ve not mentioned is there’s also a shortage of medical oncologists, and so that’s going to [create openings] for more advanced practice nurses literally taking care of more and more patients.

	So it’s not a sad job, but everybody can’t do it. Patients are experiencing…one of the worst times in their life, and it’s an honor to be there and to help and improve that, and for many of those patients, it means cancer survival. You know, we’ve got 12 million cancer survivors right now. Cancer is no longer…a death sentence…

	So I…encourage nursing students to go and work on an oncology ward for a couple of weeks to see if [they] like it. Maybe it isn’t for [them], but, as you can see, with [ONS having] 37,000 members, there [are] a lot of nurses that actually do like it, and it’s a great job.

Recently there have been several retrospectives on the War on Cancer. Are we winning the War?

	I guess that depends on what day you ask me and what patient I’m taking care of at the time. We certainly are winning the War on Cancer…[There are] 12 million cancer survivors. We are really making inroads; the incidences of cancers are down. Are we where we want to be? I mean we can’t really rest until no other patient is diagnosed with cancer. Will that happen in my lifetime? I’m not sure, but as long as we are having people who are smoking, people who are not doing proper preventative situations, we are going to continue to see cancer.

	But, there are several cancers that we have really stopped…[the] number of incidences, so I think that we’re winning. Some days it feels like we’re not winning, that we take a step back, but I think it’s one of those [things where we] take 2 steps forward and [then] take a step back…If you’re diagnosed with cancer now, as opposed to 20 years ago, your opportunities for long-term survival are so much better. And…the other question [is] how do you defi ne winning? [For example] is it quality of life for patients? So I think that we’re winning, [but] we still have a lot of work to do.

	What take-home message(s) do you have for nursing attending the ONS Congress?

	Get active in your local legislation. We have new laws for healthcare reform that will protect patients with cancer, and it’s going to be the nurse’s responsibility to educate them about what those new changes are. I would tell them to get involved with legislation, understand these new laws, and get that information out to patients, so patients can understand that an insurance company does not have a right to cancel [their] insurance because [they’re] diagnosed with cancer. So…get involved, learn about healthcare reform legislation, and start sharing that [information] with patients.

Carlton Brown, PhD, RN, has been a member of ONS for 18 years and is in the second year of his 2-year term as president.

Interview Series: Carlton Brown, PhD, RN ONS President

 Nurse scientist Donna Berry, PhD, RN, received the 2011 ONS Distinguished Researcher Award, which recognizes a nurse researcher whose work has enhanced the science and practice of oncology nursing. Berry is the director of the Phyllis F. Cantor Center for Research in Nursing and Patient Care Services at the Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School in Boston, Massachusetts. Berry discussed several of her research topics with 

, including patient adherence to oral oncolytic therapy, symptom management, patient quality of life, and patient decision making in cancer treatment.

: What are some of the challenges oncology nurses face when patients take oral oncolytics?

 Nurses have to prepare [patients] to give themselves chemotherapy, or give themselves their anti-tumor therapy, whereas traditionally, the nurse was right with the patient, giving an IV chemotherapy or an IM, intramuscular injection. But now the patients are going to do this at home…and…without adequate understanding, the patients may not take the medication as prescribed and they can get in big trouble. Their blood counts could go down. They could get really sick—have gastrointestinal side effects. So patient education becomes critical for these drugs, and nurses don’t always have that kind of time scheduled into their visit.

	So one of the ways that we’ve started to address that, not just at Dana-Farber, but at other cancer centers as well, is to provide a very systematic way of preparing people to take oral oncolytics, and that begins with the prescription, when the patient makes a decision…with their cancer specialist, to take the oncolytic and to receive the prescription. Then we teach them about the side effects, but we know very well they’re not hearing everything we’re saying.

	So we’ve designed and tested 2 different projects, one led by our nurse practitioner, Robin Sommers, and I’ve mentored her to do this on the project, to teach the patients as we get the prescription and follow up with a 72-hour phone call that takes them through a series of questions to teach and inquire at the same time—teach and inquire about everything that’s happening. “Where do you keep your medication? How often are you taking it? Have you experienced anything new since you’ve been taking that pill?” And that way, at 72 hours after [the patient begins treatment], we get some really good information, and it is the critical time that we can tweak what might not be quite right.

	We [also] ask the patients to keep track at home, using a diary of how often they’re taking [the medication], and they do really well using the diary. When we pilot tested it in the first 30 [patients], 27 of them did a really great job of keeping track of things with their diary. What we did notice is that many of them didn’t know what to do about their side effects, so we have continuing work to do and we’re following up on that.

	Then we have another project…in the gastrointestinal treatment center…We have another project with our patients with lung cancer taking erlotinib [Tarceva], which is one of our oral oncolytics. And we’re doing a very similar process, only this time it’s the feasibility of can this [adherence intervention] actually happen without, say, a research nurse involved?

	It’s not a study. It’s actually what’s going on in real practice. Do the nurses have time to go over this? Do they make the phone calls? Is it possible? Is it practical? We’re taking the evidence that these follow-up phone calls and these written instructions work, and we’re testing whether it’s practical in a busy cancer clinic.

	So that’s how we’ve gone about it. We’re not using any high technology or anything fancy yet. We’re simply looking at it practically to do this systematic teaching, systematic follow up with this questionand-answer inquiry and asking patients to track it. And it looks good. It looks really good so far.

	Dana-Farber Cancer Institute, Boston, Massachusetts

	What is the current and future status of evidence-based practice in oncology nursing?

	That’s a really excellent question because the future is where we’re going very rapidly. We have a practice in oncology that has traditionally stood shoulder to shoulder with our physician colleagues. And during the last few decades, our physician colleagues have developed monumental treatments for cancer that have changed the cure rates. And we have been right there, alongside the physicians, as they’re treating these tumors, working on that with them.

	Now, as our nursing science and our nursing interventions have evolved, it’s time for us to be right beside each other, nurse scientist and clinical nurses, and bring those interventions that nurse scientists have developed into the practice, and that’s where we’re poised, right at [this] time, to do that.

	The future is going to be eliminating the science and practice gap. I say, “Scrap the gap.” Don’t put a bridge over it because if you bridge it, it stays there. You have to scrap it, fi ll it in. We have to have clinical nurse scientists doing research in our clinical settings on a daily basis. We have to have clinical [nurses] that know [what’s] happening on a daily basis. And then we have to have the nurse scientist engaged in helping practitioners build it into practice.

	That doesn’t mean that we need huge clinical trials that cost $1.4 million, like we do for the original research studies. We need feasibility studies, like I told you about with the oral oncolytics. We need application studies, evaluation studies. But in order for that to happen, the people who know how to do [these studies] have to be involved…Nurse scientists like myself have to be involved, and we’ve got to fi nd a way to do that… The future is to bring it together.

	How does the Symptom Management Excellence Initiative facilitate the implementation of an evidence-based standardized approach to cancer symptom control?

	Well, the Symptom Management Excellence Initiative is possible because the Cantor Foundation, and Mr. Richard Cantor, who’s the president of that, he truly believes that nurses need to have resources to raise the bar on their practice to a level that they’re using evidence every day, that the best evidence for interventions is at their fingertips. And so he has sponsored us to do the Symptom Management Excellence Initiative.

	What we do is…bring together data from patients, from nurses, from physicians, and when I say data I mean, “What are the most pressing symptoms that we need to deal with? What do our patients tell us that bothers them the most? What do they have more commonly? What are the symptoms that aren’t being regulated by The Joint Commission [in the same way that] pain is [regulated]?…Where can we make the most improvement?” That’s what our Symptom Management Excellence, SME, Initiative is all about.

	View clips from the exclusive interview with Donna Berry on 

	We started with fatigue. It was the most common [symptom], one of the most important to manage, and had evidence, strong evidence that an activity-based intervention could make a difference in mitigating or reducing fatigue. So with our patients that hit a moderate level of fatigue, we’re going to be implementing a home-based walking program with them. We’re going to give them the opportunity, using our electronic monitoring system, to track their steps [using] a pedometer, their fatigue levels, [and] how many minutes they spend walking. We’ll start them out with 10 [minutes] and move them up to 30 minutes each day for at least 5 days a week, and help them graph that electronically over time or on paper.

	And hopefully, we’re doing this without research staff. This is all clinical staff. It’s nurse practitioners. It’s physicians. It’s nurses who are already working in the clinic, direct-care nurses, not researchers. Can we do it? Can we make this happen? If we can’t, [with] where we are at Dana-Farber right now, I think it’ll be a long time before we can do it, because we’re doing it very systematically and really keeping track of how well it works.

	How does the Electronic Self-Report Assessment for Cancer (ESRA-C) system facilitate communication between oncology nurses and patients to improve management of patients’ quality-of-life concerns?

	So the ESRA-C, the Self-Report Assessment for Cancer… [provides] a series of questions about symptoms, side effects, and quality-of-life concerns…and then of those things [it asks] what are the most important… to deal with today. The program [then] automatically creates a color-graphic summary. It’s 2 pages. Within 60 seconds, the nurse or the physician specialist looks at it, says, “Those are the 4 problems my patient [is] having.” And it’s a 60-second glance. It’s not a 10-to- 15-minute interview of yes-no questions, you know, the 20-question, “How’s that, how’s this, how are you doing?” It is a 60-second glance. [A] big red bar tells you where to start with the patient because that’s where they’re having the most trouble.

	So what we found in our research is that if you provide that summary to a clinician, that the symptoms and quality-of-life issues are discussed more often than when that’s not available. That’s really, really important, but that’s just the first step. That just means [the issues are] talked about. So in the next phase of our study, not only are we providing the summary so that symptoms and quality-of-life issues get talked about, we’re [also] coaching the patients to [describe] specific [details] about the symptoms. “It started 2 days ago. It’s worse than when I saw you last. On a scale of 0 to 10, it’s about a 7.”

	We [then] give them tips on how to handle these symptoms at home with reputable sources, and we help them understand [that] they’re not alone. They’re not the only person that’s experienced this. We give them real-time data on what percent of our patients have experienced that symptom either before or after treatment. So they get that message, “You’re not alone. There’s something to be done about it. Here’s what you tell your clinical team and [here are] self-care tips on what you can do.” At the end of the day, we hope…these patients will experience lower symptom distress.

 Berry is studying the feasibility and efficacy of an oncology nurse— led verbal and written patient educational program designed to facilitate patient adherence to oral oncolytic therapy. The intervention includes a follow-up phone call within 72 hours after treatment begins and patient diaries for self-monitoring treatment progress and symptoms.

Symptom Management Excellence (SME) Initiative

 The program combines patient-reported data, multidisciplinary input, and evidence-based practice to implement standardized approaches to cancer symptom management.

Electronic Self Report Assessment-Cancer (ESRA-C)

 A computerized patient self-reporting program involving a touch-screen survey that assesses symptoms and quality-of-life issues. The system generates a report that helps clinicians better address patient needs.

 A Web-based decision support system that helps men with newly diagnosed localized prostate cancer make treatment decisions. Individuals complete a touch-screen survey and receive multimedia treatment information and guidance tailored to their responses.

	Please discuss the Personal Patient Profile-Prostate system and how it facilitates treatment decisions in men with localized prostate cancer?

	So prostate cancer, there is no other cancer that occurs more often at an early stage in more Americans than prostate cancer, and it also has the most uncertainty in outcome per treatment. So, we don’t know if a man has surgery versus having radiation versus…active surveillance… we don’t know if there’s a difference in survival between doing any of those treatment approaches. So medically, we can’t say to a man, “You should do this.” What we say is, “Here’s the list of what you can do…now go off and decide.”

	Wow, that’s a lot of decision making on somebody who’s not ready. You know, you don’t spend your life preparing for a cancer treatment decision. It kind of comes on you suddenly. So what I’ve discovered in my research over the years is men use personal factors to make their decision because there’s no medical factor that tells them what to do. So I knew that I needed to develop something that would facilitate decision making for men, based on [both] personal factors and medical factors.

	So we put this [program] together, and we’ve tested it for a number of years now, and it’s designed to assess those personal factors and coach men to talk about those factors to their doctors. In preparation for the decision, they receive this intervention, and then they go in for the specialist consult. They know they have cancer. They receive what’s called the Personal Patient Profile-Prostate intervention, and then they go see their doctor.

	And what we found out in a national trial that we’ve just completed the analysis for is that if men use it, their decisional conflict is lower over 6 months after the time they come into the study. It’s the first time that any intervention has been tested nationally, in a study of men…[in] every demographic group, and it’s made a difference. They have lower decisional conflict after [the intervention].

	What does winning the ONS Distinguished Researcher Award mean to you?

	The Distinguished Researcher Award means an incredible amount to me because my peers recognized my work and wanted to celebrate it with me…And they’re specialty peers, so that’s an incredible honor. They’re people that know better. They’re people that know what it’s all about that nominated me for the award…I’m so incredibly honored.

	What advice do you have for oncology nurse researchers who are just starting their careers?

	My advice to new oncology nursing researchers [is] twofold. [First] stay close to practice. Even in an academic setting, even as a professor in a university, you can stay close to practice. Even if you’re a lab scientist, a nurse scientist…I have colleagues at the University of Washington, where I was, [who] are nurse lab scientists, and they stay close to practice by working with other clinicians, and so that would be my advice.

	My other advice is never, ever, isolate yourself. Volunteer to be on other people’s studies, even if they can’t pay you. You will gain so much in the experience that it will be way more [worth it] than the $2000 a year they might have paid you in salary. Volunteer to be involved in other’s research—start small and build, and get help, get mentorship. That’s my advice.

Donna Berry presented abstracts 1052526 and 1052849 at the ONS 36th Annual Congress.

Nurse scientist Donna Berry, PhD, RN, received the 2011 ONS Distinguished Researcher Award, which recognizes a nurse researcher whose work has enhanced the science and practice of oncology nursing.

Donna Berry, PhD, RN 2011 ONS Distinguished Researcher Award Winner

Singer, songwriter, and cancer survivor Charlie Lustman brought his 

	For Charlie Lustman, a suspicious finding at a routine dental appointment in 2006 led to the discovery that he had osteosarcoma, a primary bone cancer. After 2 major surgeries and a year of adjuvant chemotherapy, Lustman was left without 75% of his upper jaw. During the difficult treatment process, Lustman, an accomplished musician, began writing songs about his cancer experience. He eventually recorded a 13-song album and pop operetta entitled 

. Now, Lustman has embarked on what he calls the 

	Through the campaign, Lustman is journeying across America to bring his songs and positive survivorship message to hospitals, clinics, wellness centers, and schools. As part of the campaign, Lustman headlined the keynote session at the ONS Congress. With his trademark optimism, Lustman opened up to OncLive Nursing about his experiences and goals for his noble campaign. To view our complete video of Lustman, go to 

	“Do what you love, love what you do.” It’s my motto. I think you get that pretty strong after you get a cancer diagnosis, and then you go through the whole process, and you recover and you come out of it. You’re like, “Hey, I just want to do what I love to do because life is very, very fragile.”

	What kind of hit me halfway through my cancer experience was, “I’m going to get through this, and being a composer, I’m going to write songs about this.” And then I’m going to travel all over the world and sing songs about hope and survival with people going through the ultimate challenges. And that’s kind of [what] turned out to be what I love to do, so I do what I love and I love what I do, and along the way [I hope to] make a difference in people’s lives.

. The mission? Anybody listening? To make cancer survival popular! That’s it. That’s what we’re doing. The em>Musical HOPE Campaign is a journey across America and the world, bringing songs to hospitals, clinics, community centers, wellness communities, spiritual centers, and schools that will open up the conversation about cancer. Let’s talk about cancer. Let’s get it out in the open. The more we’re out in the open, the less we’re afraid of it.

	Osteosarcoma is the most common form of primary bone cancer. The tumor usually originates in osteoblasts, the cells that form new bone tissue. Osteosarcomas occur most frequently in adolescents. The tumors form at the end of long bones in areas such as the knee, hip, and shoulder; however, the tumors can occur in any bone.

	Treating osteosarcoma often involves multiple treatment mechanisms, including adjuvant chemotherapy, surgery, and postoperative chemotherapy. Radiation therapy is also used when surgery is not possible.

	As with most cancers, targeted therapies are being developed for osteosarcomas and other sarcomas. For example, ridaforolimus, an mTOR inhibitor, recently reached its primary endpoint of progression-free survival in a phase III trial in patients with either soft-tissue or bone sarcomas.

	For more information on osteosarcoma and other sarcomas, visit the 

	So with music, all of a sudden it becomes more accessible, more open. It’s just a great excuse to get those lyrics in there somehow, because you’re playing these pop songs, and people like it, and then [they] realize, “Hey, he’s singing about chemotherapy.”

	And to take the edge off of it means you’re going to have a better experience in the treatment. You’re going to bring more people around you who are not as afraid as you are, because they see you freaked out, so they’re freaked out. If you’re a little less freaked out, they’re a little less freaked out. And guess what? Then you can hug each other more, and you can empathize with each other, and it makes the whole process a little easier. So music tends to have a way of releasing, and in the release there’s healing.

	And I’m not necessarily saying healing [as a physical] cure. You know, there’s no cure for humanity. We are what we are. It is what it is. And, yes, we will search for different types of cures, but I’m talking about more in a spiritual sense. The cure is sharing, being open, hugging each other more and loving each other more. That’s the cure. And then whatever comes along, whatever that obstacle is in your life, it opens up an idea that maybe there’s something positive here. Maybe there’s a possibility here. But to get to that, we have to be able to kind of let go of all the other first reflections and reactions to a certain situation.

	Charlie Lustman performs his one-man pop operetta, Made Me Nuclear.

	Of course, when you get a cancer diagnosis—when I got mine&mdash;there’s the, “Why me? Why me? Oh, my God, why is this happening to me?” And then you’re like, and I was like, “Well, why not me?” Who should get this? My pregnant wife? My wife was pregnant at the time. My two-year-old child? My father, my mother, my sister, my brother, my best friends? Who should get this? Okay, you gave it to the right guy. At least, you know, I can take that. I’ll deal with that. At least everybody’s okay. You know, I’ve always been a caregiver kind of guy, so, okay, tag, I’m it. You know?

	And somewhere along the line, I’d say within the first 3 months, I came upon a very powerful book called 

 by the late O. Carl Simonton, and it really gave me the idea that I can kind of, okay, I have this negative thought of everything, and I’m very down on it and everything, but that, I realized, and according to this book, that that’s a choice. You can choose to feel that way. Yes, it comes naturally to most of us to feel that way, especially when you have cancer. But once you kind of go like, “Wait a minute, that’s a choice to think that way,” what’s the opposite of that thought? Well…it’s hope, life, appreciation, opportunity, possibility. That’s the opposite of, “Oh, my God, am I going to die? What is my wife going to do?” and all these things. Sure, again, we have to go through those feelings. You can’t suppress that. But once you kind of run [through] that like a million times… all of a sudden you’re kind of like [sighs], you’re a lot better, and you start to kind of learn more about what’s going on, and that kind of takes the edge off of it—knowledge is really good&mdash;and you realize that there’s some possibilities out there, things that you would’ve never even thought of if you hadn’t even gotten the cancer diagnosis. And for me it was to write a pop album about surviving cancer.

	Songs take you through the experience. And I [went] out and [found] a spunky, cool love guitar, and started singing these songs for people, and it’s just like this is a release for me, and everybody starts to feel like they’re supported and understood through these songs, and it’s become my life’s mission. And what happened to me is that this cancer diagnosis now has defi ned my entire life’s work, and I’m able to do things I’d never thought possible. For God’s sake, I just sang for 5000 oncology nurses at the coolest convention you can ever think of. The love, the appreciation for each other, the work they do to help humanity, it’s like what an audience! Who would have ever thought?

	"And what happened to me is that this cancer diagnosis now has defined my entire life’s work, and I’m able to do things I’d never thought possible. For God’s sake, I just sang for 5000 oncology nurses at the coolest convention you can ever think of."

	I’ll never forget when I used to go room to room years ago. This was way before my cancer diagnosis. I actually went to the cancer centers and I played songs, going room to room. And I remember I walked into this room, and this man was, he was pretty close to the end of his journey…and I fi nished the song, and he looked me in the eye and he said, “You know, I’m a very lucky man.” I said, “Yes.” Like, I wasn’t sure what he was getting at because he was almost at the point of leaving the planet. And he said, “If I wouldn’t have gotten cancer and been in this position, I would have never had an artist like you come into my room and sing a song for me.” [Sigh]. That’s stayed with me ever since, and I think it’s 10 years now.

Cancer Survivor Charlie Lustman Lives to Tell His Story

	That’s the kind of powerful connection that people going through this can have, and that people not going through this can have. It’s a choice. If you take a moment and just look out the window and go, “Wow, this sight is cool. This is really something else. This is great. I’m alive, and there are people in my world that love me and I love them. And whatever I do in between the love is what I do in between the love, but it’s about the love.” And that’s what my mission is about, 

, my collection of songs about surviving cancer and my 

	Come to Facebook and look for Charlie Lustman [

]. Let me know who you are and join the campaign, and we’re going to bring a message of hope to the planet Earth. So, we’ll see you there.

Singer, songwriter, and cancer survivor Charlie Lustman brought his Made Me Nuclear album and Musical HOPE Campaign to the ONS 36th Annual Congress.

Nurses Go Nuclear

	Cynthia Nixon, award-winning actress and breast cancer survivor, hosted the ceremony.

	At the ONS 36th Annual Congress, Honorary Mistress of Ceremonies Cynthia Nixon kicked off the festivities for the 2011 

 magazine Extraordinary Healer Award for Oncology Nursing with a rousing tribute.

	“Nurses are the foot soldiers in the battle against cancer, but sometimes, as in the case of our honorees today, they can also be generals disguised as foot soldiers— strategizing, making battle plans, boosting morale, and making sure the home front is receiving the support they need,” said Nixon, an Emmy, Grammy, and Tony awardwinning actress and breast cancer survivor.

	The Extraordinary Healer contest invites patients, survivors, caregivers, and peers to submit essays nominating oncology nurses for their outstanding dedication, knowledge, and compassion in treating a patient with cancer. The ceremony marked the 5th straight year that 

 has announced the winner at the ONS Annual Congress. This year’s award was sponsored by Amgen Oncology and its 

	Rita Stoddard [right] reads her nominated essay about Rebecca Wojtecki, RN, BSN [left]

 chose 3 finalists out of nearly 200 submissions to read their essays at the ceremony, which was attended by more than 800 oncology nurses. The recognized nurses appeared alongside the authors as they read their pieces.

	Following an emotional program, Marie Hayek, RN, Columbus Community Hospital, Texas, was awarded the first-place prize. Martha Hastedt, who was diagnosed with multiple myeloma in 2002, wrote the award-winning essay, “My Marie,” about the remarkable care Hayek provided in the community-based setting.

	“Her compassion, expertise, and helpfulness are especially remarkable because she must wear so many hats at a 40-bed acute care rural medical and surgical facility,” said Hastedt. “Treatments are always given in an accurate and professional manner, but she somehow manages to make me smile and be comfortable, no matter what the procedure,” she added.

	Corinne Gray [right] reads her nominated essay about Robert Martinez, LPN [left]

	“Marie doesn’t work for a large cancer center or hospital…She exemplifies extraordinary nursing each and every day. Whether that means raising money to buy a chair designated for the hospital’s cancer patients, dropping lab reports off at patients’ homes, or making sure she calls Martha when the hospital cafeteria is serving fried chicken or turkey—this woman does it all,” said Susan McClure, the publisher of 

	“We congratulate Marie Hayek on her outstanding work to care for patients and salute the Extraordinary Healer Award for providing this important forum to recognize the contributions made by oncology nurses everywhere,” added Stuart Arbuckle, vice president and general manager, Amgen Oncology.

	Martha Hastedt [right] reads her award-winning essay about Marie Hayek, RN [left]

	The 2 runners-up were Robert Martinez, LPN, Bon Secours Cancer Institute at Memorial Regional Medical Center, Mechanicsville, Virginia, and Rebecca Wojtecki, RN, BSN, Melodies Center for Childhood Cancer and Blood Disorders at Albany Medical Center, New York.

	Corinne Gray nominated Martinez for the outstanding nursing care he provided to her husband, Leigh. Martinez took a unique path to becoming an oncology nurse. After retiring from a 33-year career in a different fi eld, he decided to join his daughter when she started nursing school.

	Finalist Rita Stoddard brought the audience to tears as she described Wojtecki’s exceptional care for her son, Keith. Being diagnosed with cancer as an adolescent made it diffi cult for Keith to relate to his oncology care team. The younger Wojtecki was able to connect with Keith and became both his nurse and his friend. Demonstrating extraordinary compassion, Wojtecki also comforted Rita when Keith passed away.

	The 3 recognized essays, along with an interview with Marie Hayek, will appear on 

) at the end of June. Additionally, the summer 2011 issue of 

Honorary Mistress of Ceremonies Cynthia Nixon kicked off the festivities for the 2011 CURE magazine Extraordinary Healer Award.