ECCO XII Copenhagen - the European Oncology Nursing Society

ColophonEditor in ChiefKarin Ahlberg, RN, MScEditorial Board:Jan Foubert, RN, MScCarol Krcmar, RN, MNEmile Maassen, RN, CRNThe goal of the EONS Newsletter isto inform nurses about EONS andEONS activities and to inspire nursesthroughout Europe to improve thecare of the cancer patient.The purpose of this Newsletter is toprovide:- Information on EONS activities- Practical information of interestfor the EONS members- A networking forum for cancernurses throughout EuropePrint run: 4.000 copies,Electronic version accessible by18.000 EONS membersEONS secretariatRudi BrikéAvenue E Mournier 83/4B-1200 Brussels, BelgiumTel.: +32 (2) 779 9923Fax: +32 (2) 779 9937E-mail: eons@village.uunet.beWebsite:www.cancereurope.org/EONS.htmlAll correspondence should beaddressed to the Editor-in-Chief:eons@village.uunet.beCover: photographs of Copenhagentaken by Helene EkforsEONS likes to acknowledge Amgenas sustaining member of our societyPrinted in HollandDrukkerij Trioprint Nijmegen bvHolland- NEWSLETTER SPRING 20032Dear Colleagues,Welcome to the fall 2003 issue of the EONS Newsletter, the Newsletter of the European Oncology NursingSociety! This special issue of the Newsletter will not only be sent to our regular readers but will be distributedat the ECCO 12 conference in Copenhagen as well. Participants at ECCO, and new readers, will findlots of information about EONS in this issue. For example, the article, Nutrition in Oncology - EducationalProgram (NOEP) describes a program developed to raise awareness of the importance of nutrition in cancercare. The program, funded by Nutricia, will be officially launched at a satellite symposium at ECCO 12 onWednesday September 24, 17:30 to 19:00. The symposium is designed as an interactive session to discussnutrition in oncology, present and discuss results of the needs analysis performed during the 3rd SpringConvention, and to discuss the positive outcomes of a program test implementation conducted in the CzechRepublic in June 2003. This cutting edge symposium shouldn’t be missed! There’s also exciting news aboutthe European Journal of Oncology Nursing, the official journal of EONS. It has been accepted by theNational Library of Medicine for inclusion in the Medline and PubMed abstracting and indexing services.Also in this issue is a paper on the changing role of the cancer nurse. Cancer nursing has always been aunique speciality within the profession of nursing. Now internal and external influences have brought aboutnumerous changes in how and where we practice; nurses are now care managers practicing in independentroles. Their pivotal role in the multi-professional team is gaining recognition. The author states that nurses incancer care have accomplished a great deal, in part because we have taken the initiative to control andinfluence issues which affect our practice. Our challenge, she argues, is to continue to develop our role toachieve personal and professional satisfaction and to better meet the needs of our patients. I urge you toread the article, reflect on its contents, and use it as a basis for discussions with colleagues. One of thetasks of the EONS Editorial team is to co-ordinate communications with EONS members. To know how thismay be done best, we need to hear your opinions! In this issue you can find a questionnaire with the aims tofind out your satisfaction and opinions about the EONS Newsletter and Website. Please take the time to fillthe questionnaire in. If you are attending ECCO 12, be sure to make the experience memorable! The nursingprogram includes topics of interest for everyone; clinical nurses, researchers, educators and managers. Talkwith colleagues, listen to interesting presentations and take time to visit the poster presentations. Be sure tostop by the EONS stand to learn more about the Society and chat with members of the Executive Board: aBoard member is always on duty to answer questions and has an ear open for your ideas and suggestions.My most important advice for ECCO participants; don’t forget to enjoy yourself!Karin Ahlberg, Editor-in-ChiefThe Right Balance between Commitment and Responsibilitywithin the Boundaries of PossibilitiesDuring my term as President of EONS, I was oftenconfronted with finding the right balance betweencommitment and responsibility within the boundariesof possibilities. The position of the President requiresa complete commitment to the society and its goals.It also means that you have to take the responsibilityto lead the Society in all aspects. To take the lead inthe Society means that you need to be available forthe members, societies, and a tremendous numberof organisations with whom the Society interacts.Despite these challenges, it was a great honour toserve as President and the experience has enrichedmy personal life and professional career. During mypresidency, I was in the position to influence theposition of oncology nurses in very different ways.EONS now plays a more important role as a fullmember society of the Federation of EuropeanCancer Societies and EONS is very often asked byother member societies to become involved inworking groups and European Projects. I have alsonoted with pleasure that the oncology nurse hasbecome a serious partner in the multi-professionalhealthcare team at the national level. When I lookback on my goals as President and the goals set outby the Board of Directors in 2001, I realize that weare in the middle of an important discussion relatedto influencing and directing the future of oncologynursing practice in Europe. This discussion was themain item of the Advisory Council Meeting inBrussels in March 2003. The outcome of this twodaymeeting illustrated that EONS needs to changeits current policy and strategy for the future.The proposals for the new goals will be discussedwith members during the General Meeting duringECCO12. Changing a policy and strategy takes timeand must be done very carefully. The proposedchanges will mean a greater involvement of nationalsocieties and individual members in activities andprojects. Personally I think that the involvement andcommitment is the base of changing the future.I believe in the new direction and goals and I willactively support them in the future. An impressiveexperience for me was meeting the representativesof the diverse national societies when I was visitingtheir national conferences and meetings. I enjoyedand prospered from being involved in their discussionsabout professionalisation and the position ofoncology nurses in different countries. I reallybelieve that we can learn from each other in thefuture when we listen to the real messages anddemands from our members. Sometimes it feels likefailing when you are not in the position to give all thesupport they need. It was at these times that I feltthe boundaries of possibilities: all problems cannotbe solved because there is still a lack of humanresources, financial support and time to improve thesituation.After two years as EONS President,I still cite my personal message: Creating your futurecan only done by yourself.Thank you for your confidence and friendshipduring my Presidency.Giel Vaessen

Carol R. Krcmar, RN, MNPolitical, economical, social and professional factors continuouslyinfluence changes in the role of the nurse in cancer care. Although notalways easy to accomplish, nor to accept, changes in practice areinevitable. If viewed positively, change presents an opportunity forpersonal and professional growth. Following is a discussion of some ofthe issues which are influencing change in the role of the cancer nurse.Changes in what we practice: direct careThe role and responsibilities of the nurse in direct patient care inhospitals is well-established. I once read: “a hospital withoutphysicians is a nursing home, a hospital without nurses is a hotel”.So significant is the presence of nurses in direct care, that the futureof cancer nursing is contingent on promoting, supporting,acknowledging and advancing the nurse’s role in this aspect ofpatient care. This includes fostering skill and knowledge acquisitionto develop the novice nurse into an expert. Strategies whichencourage development include strong mentoring in the clinical area,establishing clinical advancement programmes which legitimiselevels of practice, offering continuing education programmes andfostering collaboration with other disciplines in order to encouragethe recognition of nursing expertise (Whitley, 1992).In this light, more attention needs to be given to the retention ofexperts at the bedside involved in direct care. To retain experts,Whitley (1992) recommends providing a flexible practice environmentin which the expert can make exceptions to rules in order toindividualise care; providing incentives, such as career advancement;administrative and managerial support for the role of the expert; andoffering private and group psychological support.Roles in Cancer Nursing: Ever-changing“a hospital without physicians is a nursing home, a hospital without nurses is a hotel”Changes in how we practice: advanced practiceA change already occurring in cancer nursing is the extension andexpansion of conventional roles as a result of changes in practice,scientific advances and the increasingly complex technical care ofpatients. Nurses are not only expanding their practice settings, theyare also expanding the services they offer often entering intodomains traditionally occupied by other health care professionals.Debate concerning the definition of and educational criteria foradvanced practice is on-going in Europe. The joint EONS /EUROQUAN project on advanced practice identified the need forspecially prepared advanced nurses and the need for thedevelopment of an advanced cancer nursing education programmeacross Europe.Nurse involvement in genetic counselling bears mentioning as anexample of the expanded role of the nurse. The number of nursesinvolved in genetic counselling is steadily increasing world-wide.Nurse genetic counsellors are required to possess knowledge ofcancer genetics including implications for clinical practice and bewell versed on models of patient decision making, ethics, and issuessurrounding confidentiality (Hilton 1999).Changes in where we practice: ambulatory and home careDriven by the high-cost of health care, complicated treatments andprocedures are being performed with increasing frequency in theambulatory and home settings. A survey conducted in the UnitedStates (Buerhaus & Staiger 1997) indicated that highly skilled nurses,especially in the area of palliative care, pain management andpatient education are in high demand in home health care. If this isalso true for Europe, experienced and specially trained cancer nursesshould have no trouble changing their place of employment fromhospital to the home care setting. In addition to strong clinical skills,job opportunities in home and ambulatory care involve re-examiningone’s personal strengths and weaknesses; these positions oftenrequire flexible working hours, the ability to work independently,strong decision-making skills and assertiveness. Employmentopportunities are by no means confined to in-patient, out-patient andhome care. Rather, the options are extensive; limited only by thecreativity and entrepreneurial spirit of the individual nurse.Changes in who we are: personal developmentFurther development and refinement of two key personal skills,communication and leadership, is crucial if professional nurses areto meet the increasing demands expected of them. Wilkinson (1999)identifies communication, together with an ability to listen, as themost important aspect of practice. Effective communication providesa basis for the development of supportive relationships which helppatients cope with the effects of cancer (Northouse & Northouse1996). Excellent communication skills, both verbal and written,between members of the multi-professional team is essential intoday’s high tech and high paced care settings.Networking, a communication mode under utilised in nursing,provides nurses with the opportunity to discuss problems incurred ineveryday practice with colleagues. The personal and professionaladvantages of networking should not be underestimated.Stronger leadership skills are needed in nursing to handle thediversity and rate of changes occurring in health care. Hilton (1999)advocates that real change leaders capable of independent initiativesare needed at all levels of nursing to keep pace with changes inhealth care.External influences: technology and cultureNo other single item or event is having such a significant impact onthe way we think and act as the information highway. InformationTechnology should be taught in basic and post-basic programmesand traditional methods of information dissemination (i.e. writtendocumentation) need to be supplemented with material in digitalform. Scrutiny of publications on the world wide web is necessary toaccess valid information and direct patients to reputable sources.

CANCER& MALNUTRITIONFOCUS ON FEEDINGNUTRICIA’S NUTRITIONAL THERAPYPART OF YOUR CANCER THERAPYMalnutrition is common in cancer patients and isassociated with reduced well-being and poorer clinicaloutcome. (1,2) It is, therefore, important to maintain oreven improve nutritional status before, during andafter cancer therapy. (1,2) Nutritionalsupport has been shown to beeffective in achieving this. (2,3)NUTRICIA’s range of clinicalnutrition products andFLOCARE medical devices willhelp to improve nutritionalintake, and as part of yourcancer therapy will be beneficialfor both you and your patients.(1)Nitenberg G, Raynard B. Crit Rev Oncol Hematol 2000;34:137-68.(2)Bozetti F. In: Payne-James et al (eds). 2 nd ed. London: GMM, 2001:639-80.(3)Den Broeder E et al. JPEN 2000;24:351-60.For more information, please contact:NUTRICIA - P.O. Box 1 - 2700 MA Zoetermeer -The NetherlandsTel: +31 (0) 79 353 96 00 - Fax: +31 (0) 79 353 96 50www.nutricia.com - e-mail: oncology@nutricia.com

EONS Newsletter and WebsiteSatisfaction SurveyThank you for helping us to serve you betterAs you may be aware, in 2002 the Executive Board set into existence an Editorial Team whose task it is to coordinate communication with EONSmembership through paper publications and the Internet. With this survey, we would like to solicit your satisfaction with the Newsletter and youropinions on the EONS website. We are also interested in your suggestions for future topics of interest and ideas to get more of the membershipinvolved in the two projects. Please take a few minutes to thoughtfully answer the following questions. We value your opinion and involvement.EONS Newsletter1. Have you read an issue of the EONS Newsletter? Yes No2. I read the EONS Newsletter on a regular basis. Yes No3. I regularly (4 times per year) receive the EONS Newsletter in paper form. Yes NoIf no, how many issues did you receive in 2002?4. I regularly (4 times per year) receive the EONS Newsletter in electronic (Pdf) form. Yes No5. I download issues of the Newsletter from my national societies home page. Yes No6. I download the Newsletter from the EONS web pages. Yes No7. How would you rate the overall quality of the Newsletter on a scale of 1-10,with 10 being the best possible quality/highest personal satisfaction with the Newsletter?highest 10 9 8 7 6 5 4 3 2 1 lowest8. Overall, I find the ‘look’ of the Newslettervery attractive 5 4 3 2 1 not attractive9. Please indicate which sections of the Newsletter you like/dislike. Like DislikeEditorialOur Colleagues from ...Feature articlesMeeting reportsEONS News10. The feature clinical article isalways helpful for my practice 5 4 3 2 1 never helpful for my practice11. Please rank order the following topics from 1 (high interest) to 5 (no interest).Treatment modalities:Chemotherapy Radiation therapy Surgical Oncology Biological therapyGene therapyDisease entities:Breast cancer Lung cancer Female GU cancer Male GU cancersLeukaemia Metastasis Gastric cancer Skin cancerColorectal cancer Head & Neck cancer Lymphoma and Hodgkin ’s diseaseSymptom management:Fatigue Nutritional support Body image Nausea and vomitingPain Grief and loss Psycho-social issues Care-giver supportCancer nursing:Documentation of care Role implementation Advanced practicePersonnel management Nursing shortage Professional issuesOther issues:NEWSLETTER SPRING 2003 -7

12. Have you ever contributed an article to the Newsletter,or do you think you would consider doing so in the future? Yes NoI have contributed in the past Yes NoI may consider contributing in the future Yes No13. Any other comments that would help us improve the EONS Newsletter?EONS Website14. I visit the EONS website 1 x per week 1 x per month 1 x every 3 months1 x every 6 months 1 x per year never visited the site15. I have never visited the EONS website because: I was not aware of its existenceI do not have Internet accessI prefer to obtain EONS information from other sources16. I visit the website to obtain information on: Membership information News updates(check all that apply) Educational materials Upcoming eventsAccreditation services17. In my opinion, changes at the website should include: adding an interactive section(check all that apply)providing more linksproviding information in various languagesimproving site navigationmore input from membersmore information on:Yes, I would like to become more involved with the EONS Newsletter, EONS website, both.Name:Address:E-mail:Area of interest:Please hand in your completed questionnaire at the EONS Stand or send in the completed questionnaire to the EONS secretariat.See the adress in colophon. Thank you!Satisfaction Survey, MembershipSeptember 2003- NEWSLETTER SPRING 20038

NOEP: Ready to launch in September!The Nutrition in Oncology - Educational Program (NOEP) which wasdeveloped in co-operation with Nutricia, will be officially launched atthe ECCO 12 in Copenhagen. A satellite symposium will be held onWednesday 24th September 2003 from 17:30 to 19:00 hours in room18/19. The symposium will provide an opportunity to discuss the lackof awareness that the role of nutrition has in oncology, to presentresults of the needs analysis performed during the last 3rd SpringConvention in Venice (which served as a basis to build NOEP) and todiscuss the positive outcomes of a program test implementation thatwas performed in Czech Republic in June 2003.Disease-related malnutrition (DRM)in CancerThe NOEP has been developed by the EONS, in partnership withNutricia, between April 2002 and June 2003. Following thedevelopment of the program, two test implementations were carriedout in Czech Republic and The Netherlands. Nurses in both countriesgave very enthusiastic and positive oral feedback and the programwas evaluated in very positive light (global evaluation of NOEP:9.44/10 in Czech Republic). Initial remarks from Czech nursesindicated that little attention is currently given to nutrition inoncology and that they have a key role to play in that respect.NOEP was considered to be a multidisciplinary project and thereforean oncologist, a dietary nurse and a psychologist gave the workshoppresentations and shared their experiences. In terms of adapting theNOEP to meet individual country needs, the Czech Republicimplementation demonstrated that the translation needs a high levelof attention to ensure correct interpretation and is a key factor indetermining the success of the program. Speakers at the testimplementations took the opportunity to add extra slides or adaptcase studies that they judged to be useful and essential for thecomprehension of the program. The program was very demanding onthe nurses in terms of hours of concentration, and it was concludedthat dividing the program into two days would provide a betteropportunity for nurses to exchange ideas and benefit from informationpresented in the case studies.In the coming weeks, final adaptations will be made to the programbased on the results of the test implementations, and keeping inmind that NOEP must provide a solid and structured content. Theseimprovements will also give the flexibility to add or adapt a fewslides. The folder including the complete NOEP will be available atECCO 12 at the Nutricia stand (H-089).Spain and Belgium have already expressed their interest in launchingNOEP before the end of 2003. The next steps will be to implementNOEP across Europe. As NOEP is a partnership between the EONSand Nutricia, local implementation plans must be discussed betweenOncology nursing societies and Nutricia at a country level. Pleasefeel free to contact your local Nutricia office to discuss theimplementation of NOEP in your country. Preliminary meetings willbe arranged to discuss your expectations of NOEP and to construct adetailed action plan including deadlines for translations, organisationof workshops, numbers of workshops, participants to the workshopsetc. After submission of this action plan, Nutricia will fund the costsof the translation and the organisation costs agreed in advance.Evaluation of NOEP will be made in order to determine whether it ismeeting the expectations of nurses in terms of education, and tohelp improve the program through the development of new andinnovative ideas.The 4th Spring Convention of the EONS in April 2004 will provide anopportunity to discuss the NOEP implementation across Europe anddraw conclusions. If you wish to receive information regarding yourlocal Nutricia contact person, please contact Jan Foubert at:jan.foubert@skynet.be or François Convenant at:francois.convenant@nutricia.comThe European Journal of Oncology Nursing accepted forInclusion in the Medline and PubMed Abstracting andIndexing ServicesThe National Library of Medicine has accepted the European Journal of Oncology Nursing (EJON) for inclusion inthe Medline and PubMed abstracting and indexing services. The Editor, Alexander Molasiotis, and the Publisher,Health Sciences ELSEVIER, put together a detailed application to Medline earlier this year and have nowreceived notification that the application has been approved. Medline and PubMed are among the mostfrequently used abstracting and indexing services of the international medical community. The citation willprovide EJON authors with substantial additional international profile and coverage of their articles. All issues ofEJON from Volume 7 Number 1 onwards will be included.NEWSLETTER SPRING 2003 -9

InvitationDear members of the European Oncology Nursing Society, you are cordially invited to the General Meeting at the ECCO conference. The meetingis scheduled for Tuesday 22nd of September at 11:30 until 13:30 hours in auditorium 10/11 at the Bella center. During this meeting the proposalfor the new Strategy Plan of our Society will be presented and discussed. Individual members who are not able to attend this meeting are invitedto send in written comments to the EONS secretariat in Brussels before November 1st 2003.EONS Mission StatementPROPOSALThe Strategic CARE planThe mission of the European Oncology Nursing Society is toadd value to the work of its individual members and societiesin delivering care to patients with cancer. It aims to assist inthe promotion of developing healthy communities throughinfluencing, research and education.Context of Strategic PlanEONS is a European citizen, it exists within many communities acrossEurope (both health and social) and not in isolation. It’s strength liesin co-operation and collaboration with a range of multi-professionalorganisations, helping to optimise the nursing contribution to cancercare. Underpinning this collaborative approach is the crucialrelationship EONS must continue to develop with National OncologyNursing Societies and individual nurses working with cancer patients.The Society recognises the diverse economic and multi-ethnicsociety across Europe and will strive to represent oncology nursing towork towards equitable training and development for nurses whowish to pursue a career in oncology. To this end, EONS supportsdiverse educational programmes through accreditation, andinstigates and supports clinical projects and research. This is inrecognition that cancer nurses will need a diversity of skills,competencies and related theory to work in novel ways within anintegrated health and social care model.1. CommunicationEONS, as the recognised representative of European oncologynurses at the Federation of European Cancer Societies (FECS),furthers and facilitates communication between EONS and itsmembership, as well as the communication between the differentmember societies.2. Influencing the Political Agendaa. EONS will assist and support members to lobby forrecognised/agreed standards of oncology training/education,through recognition of oncology nursing as a speciality withineach membership countryb. EONS will provide current information to (inter)nationalprofessional representatives to raise the knowledge andawareness of the contribution of cancer nurses in Europe3. ResearchEONS will collaborate with member societies and keystakeholders to raise the profile of oncology nursing research inEurope. It will have a facilitative role helping others to initiateresearch through guidance with funding issues, mentoring,publication and dissemination of results.4. EducationEONS will develop and implement, in collaboration with members,post basic education and continuing education designed toimprove knowledge and competence in agreed areas of cancernursing.SIOG / EORTC CollaborativeCourse receives EONS Certification10 - NEWSLETTER SPRING 2003The Accreditation Council recently granted the SIOG/EORTC sponsored course entitled ‘Practical Approachesto Elderly Patients with Cancer’ certification until August 2006. This course, which is targeted to a broadaudience, will have taken place September 5-6 2003 in Madrid. With the number of elderly cancer patientssteadily increasing, the two organisations recognised the need to teach nurses how to assess elderly patients.The course represents a first step in a pan-European initiative to develop reliable assessment and evaluationtools focusing on the elderly cancer patient. In addition, evaluations of this course will help SIOG and EORTC toplan future, more focused courses on the topic offered through regional education programs.

Upcoming Events4-8 October 2003, Basel, Switzerland.Gemeinsame Jahrestagung der Deutschen, Österreichischen undSchweizerischen Gesellschaften für Hämatologie und Onkologie.Nursing programme in German. Einsendeschluss für Abstracts 21.Mai 2003. Informationen: Onkologie-Hämatologie 2003, c/o AKMCongress Service, Postfach, Clarastrasse 57, 4005 Basel/Schweiz.Tel.: +41 61 686 77 11, Fax: +41 61 686 77 88, e-mail: info@akm.ch,Internet: www.akm.ch/onkologie-haematologie03.13-14 November 2003, Monte Carlo, Monaco.3rd European Conference: Perspectives in Breast Cancer.Information: : www.imedex.com/announcements/ebreast03.html.Contact: h.drew@imedex.com, Tel.: +1 770-751-7332, fax: +1 770-751-733414 November 2003, Maastricht (MECCC), The Netherlands.Dutch Oncology Nursing Society Annual Congress. Contact:www.vvov.org, e-mail: secretariat@vvov.org.28-31 March 2004, Barcelona, Spain.European Blood and Marrow Transplantation Group (EBMT). AnnualMeeting. Contact: www.ebmt.org/2RelatedMeetings/annual1.html.15-17 April 2004, Edinburgh, UK.4th EONS Spring Convention, Quality of life: The key in cancer care.The conference will focus on “The nursing contribution to qualitycancer care”. Teaching, plenary and workshop sessions will beoffered and geared to the beginner through advanced level. Deadlinefor abstract submission and early registration is 15 December 2003.Information: www.cancerworld.org/eons.8-12 August 2004, Sydney, Australia.13th International Conference on Cancer Nursing The conference isorganised in partnership between ISNCC and the Cancer NursesSociety of Australia (CNSA). For further information contact:Conference Office, +44 116 270 3309, Fax: +44 116 270 3673,e-mail: conference@isncc.org.21-22 November 2003, Rome, Italy.4th Meeting of SIOG, 8th International Conference on GeriatricOncology. A special nursing symposium with international speakersconducted in English with translation will be held in conjunction withthe conference. Internet: www.imedex.com.16-20 March 2004, Hamburg, Germany.4th European Breast Cancer Conference. Contact:www.fecs.be/conferences/ebcc4/index.shtml.NEWSLETTER SPRING 2003 -11

Treatment issues in the elderly:focus on antiemeticsNausea and vomiting following chemotherapy or radiotherapy canhave a detrimental effect on patients’ wellbeing, particularly in theelderly, who comprise the majority of cancer patients. 1 Older cancerpatients are prone to complications relating to:• impairment of major organs (heart, liver and/or kidneys)• comorbid conditions (e.g. cardiovascular and gastrointestinalproblems, arthritis)• multiple prescriptions for other conditions 2,3 and use ofover-the-counter medications.Cardiovascular, renal and hepatic impairmentHypertension and heart-related conditions occur in about 40% ofcancer patients aged 55 years and over. 4 In patients over 70 yearsthis figure can be as high as 60%. 5 The risk to the heart is furtherincreased if an elderly cancer patient is exposed to:• cardiotoxic chemotherapeutic drugs such as adriamycin(doxorubicin), mitoxantrone, paclitaxel, fluorouracil or high-dosecyclophosphamide• new biological agents (e.g. trastuzumab), which may inducecardiac side-effects 6• radiotherapy to the chest, which can cause coronary arterydisease, pericarditis, cardiomyopathy, valvular disease andconduction abnormalities. 7Care is therefore needed to ensure that supportive care treatment(e.g. antiemetics) does not exacerbate the cardiovascular risk. This isparticularly important since the prescribing information for severalsupportive care products carries cardiovascular warnings orprecautions. Since many elderly patients have declining organfunction, renal and hepatic impairment may further complicate thepicture. Some medications will require dose adjustment in elderlypatients with renal and hepatic impairment.Comorbid conditions and multiple medicationsAbout 80% of elderly cancer patients have co-existing conditions,such as arthritis and gastrointestinal problems, for which they requireprescription medications. 8 The risk of drug–drug interactionsincreases with each additional drug (Table 1). 9 Moreover, 90% ofpatients over 65 years also purchase over-the-counter medications. 3Taking multiple medications, together with declining liver function,compounds their risk of drug–drug interactions. The greatestpotential for drug interaction lies in the hepatic cytochrome P450enzyme system, which clears over 50% of the most commonly usedmedications. The isozyme CYP2D6 is genetically ‘polymorphic’,resulting in variation between individuals in enzyme activity andtherefore rate of drug metabolism. For example, individuals who arepoor CYP2D6 metabolizers may experience increased and prolongedplasma drug concentrations, potentially increasing the risk ofadverse effects and drug–drug interactions. Conversely, the durationof action of a drug, and hence its efficacy, may be shortened inthose who are ultra-rapid metabolizers. 10 Drug metabolism, potentialfor drug–drug interactions and risk of genetic polymorphism aretherefore important considerations in elderly patients, since thesepatients take the greatest number of medications.Table 1The more medications an elderly patient takes, the greater thelikelihood of drug–drug interactions. 9Number of drugs Incidence of interactions (%)2 5.63 15.84 34.36 72.08 100.0Simplifying antiemetic treatmentThe ideal antiemetic for elderly patients will have provencardiovascular safety, straightforward metabolism, low potential fordrug-drug interactions and no need for dose adjustments inrenally/hepatically impaired patients. In addition, once-daily dosingprovides a simple and convenient regimen in elderly patients withfunctional or cognitive impairment, which can potentially influencecompliance and hence the outcome of treatment.So why not join EONS right now?For references please contact the EONS secretariat, see colophon.EONS? It’s all about oncology nursing!EONS is committed to developing cancer nursing throughout Europeand this by the advancement of education of nurses engaged incaring for patients with cancer and co-ordinating educationalprogrammes.Who can join the EONS?Oncology nurses, Societies, institutions and organisations can joinour society. Membership is composed of full and associatemembers.Why should you join EONS?1. By joining EONS, you would become part of a large Europeannetwork of cancer nurses, organisations and cancer institutionsand receive up to date information on oncology in Europe.2. The opportunity to influence the future shape of cancer nursingin Europe.3. Involvement in European educational and research activities.4. For full members: reduced registration rates for the EuropeanCancer Conference (ECCO) and EONS Spring Convention.5. Free copies of the EONS Newsletter.6. For full members: reduced subscription rate to the EuropeanJournal of Oncology Nursing.7. National member societies are eligible to nominate onerepresentative for the Advisory Council.So why not join the eons right now?For further information about EONS and your membershipapplication form, just contact the EONS secretariatAvenue Mounier 83/8 B 1200 Brussels, BelgiumPhone: 0032 2 779 99 23Fax: 0032 2 779 99 37E-mail: eons@village.uunet.be- NEWSLETTER SPRING 200312

The European Oncology Nursing SocietyThe European Oncology Nursing Society which was established in 1984 is comprised of individual cancer nurses, national oncology nursingsocieties and institutions and agencies in Europe involved in cancer care. EONS has a membership of over 50 organisations, which in turnrepresent approximately 15000 nurses in 25 European countries.Educational, consultative and research activities of EONS are aimedtoward promoting and improving the quality of care received by cancerpatients throughout Europe. The development and dissemination of aCore Curriculum for a Post-Basic Course in Cancer Nursing, recentlyrevised through support from the EU Europe against CancerProgramme, has been instrumental in improving cancer care throughspecialised nursing education. EONS collaborates on numerousinitiatives with multidisciplinary health care professionals. Workingrelationships have been established with the International Society forNurses in Cancer Care (ISNCC) the Oncology Nursing Society (ONS)various European nursing organisations and speciality groups, theWorld Health Organisation Regional Office for Europe, the AdvisoryCommittee on Training in Nursing (ACTN) and the Standing Committeeof Nursing of the EU (PCN). EONS is a full member of the Federationof European Cancer Societies (FECS). The working language of theSociety is English although every effort is made to provide translationof educational materials into the working languages of Europe and toprovide translation services at educational events.The organisational structure of EONSAn Executive Board, Advisory Council and the General Membershipmake up the organisational structure of EONS. These three bodiescollaborate to identify the goals and strategies of the Society and toimplement activities that support the mission of EONS.A General Meeting is held annually at either the Spring Conventionor the ECCO meeting. All members as well as observers are invitedto attend. The next General Meeting will take place in conjunctionwith ECCO 12 to be held in Copenhagen in October 2003.The Membership governs the Society through activities includingvoting on constitutional changes, discussion of strategic issues andnomination and election of members of the Executive Board. AnAdvisory Council meets once per year with the Executive Board toadvise on policy and the strategic development of the Society. Thiscouncil is composed of representatives of national oncology nursingsocieties (in Europe) who are full members of EONS. The previousAdvisory Council meeting took place in March 2003 at the EONSHeadquarters in Brussels. The Executive Board acts in the capacityof Trustees and conducts the affairs of the European OncologySociety (EONS) in accordance with the policies determined by theMembers and the Advisory Council.PublicationsEuropean Journal of Oncology NursingThe official publication of EONS is the European Journal ofOncology Nursing and seeks to address issues of importance tooncology nurses throughout Europe. The journal is published 4times a year and is a forum that provides information oncontemporary practice issues and the latest cancer research.Topics of importance in cancer care are addressed through theexchange of knowledge and experience. In an effort to addresslanguage differences and difficulties among European cancernurses, abstracts of articles appearing in EJON are published inEnglish, German and Spanish. The major articles are written inEnglish. EJON is listed in the Cumulative Index to Nursing &Allied Health Literature print index and the CINAHL database.EONS NewsletterThe EONS Newsletter is a publication that is distributed to themembership on a quarterly basis. The goal of the EONSnewsletter is to inform nurses about EONS and EONS activitiesand to inspire nurses throughout Europe to improve the care ofthe cancer patient. Further information on membership in EONScan be obtained by contacting the EONS Secretariat:EONS SecretariatMr. Rudi BrikéAvenue E. Mounier 83, B-1200 BrusselsPhone: +32 2 779 99 23, Fax: +32 2 779 99 37E-mail: eons@village.uunet.bewww.cancereurope.org/EONS.htmlMASCC SummaryStudy highlights need for clarification on anaemiamanagement in cancerA pilot survey conducted during the MASCC congress, held in June2003, suggests oncology nurses’ may need access to moreinformation about anaemia in cancer since key findings revealconfounding views. Over 50 nurses from 25 countries participated inthe survey.The survey revealed that 95% of oncology nurses that participatedwere aware that fatigue is a major problem for cancer patients andthat anaemia should be treated. In addition, most respondents (88%)said they felt epoetin, in some form, is the most effective treatmentfor cancer-associated with anaemia. However, only 10% of thosesurveyed felt anaemia should be treated early, at cancer diagnosis. Asthe awareness of anaemia is high, this is surprising and it is temptingto ask ‘If patients received treatment for anaemia early on in thecourse of their cancer, would this be of added benefit?’Benefits of early treatment of anaemia are undisputed and supportedby clinical research. Oncology nurses have a key role to play in themanagement of patients with cancer at all stages of their condition.This small pilot survey suggests that awareness initiatives are neededto increase the management of patients’ anaemia as early as possible.This study was supported by an unrestricted educationalgrant from Roche.1. MASCC 15th International Symposium: Supportive Care in Cancer,18th-21st June 2003, Berlin Germany. Anaemia management in cancerpatients-A nurse’s survey-Roche Pharmaceuticals.NEWSLETTER SPRING 2003 -13

News UpdateCongratualtions to Newly Elected Members of the Executive BoardThe Nominating Committee is pleased to announce the results of theelection for positions on the Executive Board for the term 2003 –2005. The following persons will be installed into office at theGeneral Meeting to be held at ECCO:President Jan FoubertPresident-elect Yvonne WengströmPast-president Giel VaessenBoard Members Karin Ahlberg, Paz Fernandex, Sara Faithfull,Catherine Miller, Alexander Molassiotis, HildaVorlickovaCongratulations are extended to these newly and re-elected membersof the Executive Board. The membership, through its election of thesepersons, demonstrates confidence that the Board will carry out itsduties to contribute to the on-going success of EONS. EONS GeneralMeeting at ECCO: Tuesday 23 September from 11.30-13.30A general meeting of the Society will take place during the ECCOConference. The meeting time is given above, the meeting place isAuditorium 10/11, Bella Center A/S. Highlights on the agendainclude: A report on the financial status of the Society; Anintroduction to the President’s Report focusing on EONS activitiesand projects to date; A report on progress made in revising andimplementing the EONS Strategic Plan; and dismissal of old BoardMembers and installation of new Board Members to serve in officefrom 2003 through 2005.Time has been allocated during the meeting for open discussionbetween members and the Executive Board. This is an excellentopportunity for members (and interested potential members) to bringtheir questions and concerns to the attention of the Society and tohave important matters discussed in an open forum. Mark the dateand time in your conference planner – it will be time well spent.Board Members extend ‘Thank You’ to Amgen for GenerousSupportThe EONS Executive Board wishes to take this opportunity to publiclythank Amgen for a generous grant which has enabled severalmembers of the Board to attend ECCO 12. This one time grantprovided support to cover travel, accommodation and other expensesincurred by the Board in conjunction with their attendance at theECCO conference.4th EONS Spring ConventionEdinburgh is the site of the 4th EONS Convention which will takeplace from 15-17 April 2004. The theme of the convention is thenursing contribution to quality of care that will be addressed fromvarious perspectives in teaching, plenary and workshop sessions.Participatory sessions will be offered at the basic and advanced levelsgiving participants the opportunity to select the session level that isappropriate to their learning needs. A joint EONS-ONS session willtake place as well as satellite symposia. A special highlight of the 4thEONS Spring Convention will be the celebration of the 20thanniversary of EONS. Don’t miss this special occasion.Early registration forms and abstracts should be submitted by 15December 2003. Late registration is available until 1 April 2004.Complete conference information is available atwww.cancerworld.org/eons or by contacting the EONS Secretariat.Cancer Nursing Research Day at the Spring ConventionFor the first time, a pre-conference research workshop will takeplace on 15 April in Edinburgh. Participants will be given theopportunity to present their work and discuss their proposals withpeers and a faculty of experts. Teaching sessions will address thetheoretical background to qualitative and quantitative researchapproaches including possibilities and pitfalls using differentapproaches when conducting research. Participants are expected toactively participate in the discussions.A maximum of 20 applicants will be accepted for this workshop.The registration fee is € 100,-. Together with the registration form,applicants must provide a short summary of their research project.More information and detailed application procedures are availableby contacting the EONS Secretariat or atwww.cancerworld.org/eons.2003 President’s ReportThe best way to find out about EONS projects and activities is toread the 2003 President’s Report. The report provides informationabout educational and research initiatives as well as collaborativeprojects. Also included in the report is an update on administrativeissues and annual summaries provided by the chairpersons ofstanding committees. Pick up your copy at the EONS stand duringECCO or download the information from the EONS website.Educational ResourcesDid you know that over the years EONS has produced numerouseducational resources that are available to members? Teams ofexperts have developed the materials and most are available free ofcharge and in different languages.The revised Core Curriculum for a Post-Basic Course in CancerNursing is available on the EONS web site for downloading. Thecurriculum has been translated into 9 languages. Also available on theweb site is ‘A practical guide to managing patients with breast cancerwho are treated with Herceptin’ and ‘Biological Therapies and Cancer:A training manual for nurses’. The training manual is verycomprehensive and includes 7 modules. The Nursing in ColorectalCancer Initiative (NICCI) is an EONS project sponsored by anunrestricted educational grant from AstraZeneca. The packageincludes educational and audit components and is available in English,French, Italian, German and Dutch. This comprehensive guide tocolorectal cancer is available on the web or from the Secretariat.Satisfaction Survey: we want to hear your opinion !Inserted into this issue of the Newsletter you will find a short survey.With this survey, the EONS Editorial Team hopes to receive input onthe Newsletter and web site which will then help them to furtherdevelop these communication tools to better meet the needs ofmembers.Please take a few minutes to give thought to the questions.Completed surveys can be returned to the EONS stand or mailed tothe EONS Secretariat. Thank you for helping us to serve you better.‘Bring a Friend’ Membership DriveThe strength of EONS is grounded in its membership. The diversity ofthe membership provides the Society with a wealth of knowledgeand experience upon which it can draw to improve cancer nursing inEurope. The Membership Committee is offering a special deal tomembers:Bring along a new EONS member and you will receive the EuropeanJournal of Oncology Nursing (EJON) for free at your next membershiprenewal! And if you can propose a 2nd EONS member, even better:you will have your next membership for free! Further details andregistration forms are available at the EONS stand at ECCO or bycontacting the EONS Secretariat.NEWSLETTER SPRING 2003 -15

Nausea PreventionAround the Clock 1Kytril ® (granisetron) Brief Prescribing Information. Indications Prevention or treatment of nausea and vomiting induced by cytostatic therapy and prevention and treatment of postoperative nauseaand vomiting. Dosage and Administration Kytril ampoules are for intravenous administration only. For details of administration including suitable infusion fluids, please refer to the full prescribing information.Cytostatic-induced Nausea and Vomiting Intravenous Adults including elderly: 3mg given either in 15mL infusion fluid as an intravenous bolus over not less that 30 seconds or diluted in 20to 50mL infusion fluid and administered over 5 minutes. Prevention: In clinical trials, most patients have required only a single dose of Kytril over 24 hours. Up to two additional doses of 3mg may begiven within a 24-hour period. Patients have received daily administration for up to 5 consecutive days in one course of therapy. Kytril should be given prior to the start of cytostatic therapy. Treatment:Dosage as for prevention, with additional doses at least 10 minutes apart. Maximum daily dosage: Do not exceed three doses (9mg) within 24 hours. Efficacy may be enhanced by the addition ofdexamethasone. Children: Prevention: 40mcg/kg body weight from the ampoule (up to 3mg) diluted in 10–30mL infusion fluid administered over 5 minutes prior to the start of cytostatic therapy.Treatment: Dosage as for prevention. Within a 24-hour period one additional dose of 40mcg/kg (up to 3mg) may be administered at least 10 minutes apart from the initial infusion. Oral Tablet formulationonly indicated for prevention of cytostatic induced nausea and vomiting. Adults including elderly: Prevention: One tablet (1mg) b.i.d. or one tablet (2mg) q.o.d. during cytostatic therapy. Firstdose given within 1 hour before start of cytostatic therapy. Efficacy may be enhanced by the addition of dexamethasone. Children: There is insufficient evidence to base appropriate dosages for childrenunder 12 years old. Paediatric liquid is only licensed for prevention of cytostatic induced nausea and vomiting. Children: Single dose of 20mcg/kg bodyweight (up to 1mg) twice daily for up to 5 daysduring cytostatic therapy. First dose given within 1 hour before start of cytostatic therapy. For details of administration please refer to the full prescribing information. Post-operative Nausea and VomitingAdults including elderly: Prevention: 1mg Kytril diluted to 5mL with normal saline and administered as a slow intravenous injection over 30 seconds. Complete administration prior to induction of anaesthesia.Treatment: Dosage as for prevention. Maximum daily dosage: Two doses (2mg). Children: No experience, therefore not recommended in this age group. ContraindicationsHypersensitivity to granisetron, or related substances, or any of the other constituents. Precautions Monitor patients with signs of subacute intestinal obstruction. Pregnancy and LactationNo experience in human pregnancy: do not give to pregnant women unless compelling clinical reasons. Breast feeding should be stopped during therapy. Side-effects Generally well tolerated. Mild tomoderate headache or constipation most frequent. Rarely hypersensitivity reactions (occasionally severe), other allergic reactions including minor skin rashes. In clinical trials transient increases inhepatic transaminases, generally within the normal range, have been seen. Overdosage No specific antidote. Treat symptomatically. Legal Category POM. Presentations Kytril Tablets 1mg, each containing1mg granisetron. Kytril Tablets 2mg, each containing 2mg granisetron. Kytril Infusion, each ampoule containing 3mg granisetron in 3mL isotonic saline. Kytril Ampoules, each containing 1mggranisetron in 1mL isotonic saline. Kytril Paediatric Liquid, each bottle containing 30mL of 200mcg granisetron in 1mL solution. Marketing Authorisation Numbers Kytril Tablets 1mg PL00031/0591,Kytril Tablets 2mg PL 00031/0592. Kytril Infusion PL 00031/0594, Kytril Ampoules PL 00031/0595. Kytril Paediatric Liquid PL 00031/0593. Kytril is a registered trademark. Date of PreparationJanuary 2002. Please contact your local Roche company for the full prescribing information. Reference 1. Perez EA, et al. Cancer J Sci Am 1998;4:52–8.