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Advanced nursing roles should be ‘explored’ to improve cancer care in older patients

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Advanced practice nursing roles should be properly evaluated as a potential approach for improving outcomes for older people with cancer, UK researchers have suggested.

Along with voluntary support and the involvement of geriatric teams, specialist and advanced nursing roles were found to provide “some evidence of effectiveness” in the area, said the researchers.

“Advanced practice nursing is a candidate role for exploration and further consideration”

Study authors

They were the three most “promising interventions” for providing delivering high-quality targeted care to older people with cancer, suggested the study authors from the University of Southampton.

However, overall, they warned there was currently a dearth of research evidence on the effectiveness of workforce interventions for improving the outcomes for older people with cancer.

The study, led by Jackie Bridges, nurse and professor of older people’s care, looked at 24 pieces of research involving a total of 4,555 patients aged over 60.

They aimed to find out which workforce characteristics and interventions were associated with high-quality care and support to older people with cancer, from screening through to end of life care.

They highlighted that more than 60% of new cancers and more than 70% of cancer deaths now occurred in people over the age of 65 years in Europe and the US.

Overall, the researchers noted that the interventions that had been tried around the world were “diverse” but that the evidence base on them was generally “low quality”.

“One intervention which did improve survival used advanced practice nursing in home care support”

Study authors

Only of the two studies directly targeted workforce knowledge and skills, and just two addressed the nature of workforce features related to improved outcomes, said the study authors.

One of the latter, a qualitative study, considered the features of the nursing workforce that older patients felt were important in their care, while the other looked at the impact of health professionals’ communication on patient views about symptom management.

The remaining studies included in the Southampton review focused on improving older people’s outcomes via interventions involving a change in the workforce.

These included testing new roles – such as nurse navigator,depression care manager or nurse case manager – as well as extra support with existing workforce members – for example, a geriatrician,clinical pharmacist or dietitian.

University of Southampton

Nurse roles show ‘promise’ for improving older cancer care

Jackie Bridges

In two studies, a current staff member had a different function. In one a nurse provided targeted cancer screening, while in another a physiotherapist designed exercise and yoga programmes.

Three interventions used what the authors described as advanced practice nurses – one in a home care capacity and two in counselling roles. The role of multi-disciplinary teams featured in another three studies.

The review concluded that interventions focused on “discrete groups of older people with specific needs offering guidance or psychological support” were more effective than those “broadly targeting survival outcomes”.

In addition, the researchers said they found advanced practice nursing roles, voluntary support roles and the involvement of geriatric teams “provided some evidence of effectiveness”.

For example, they stated: “One intervention which did improve survival used advanced practice nursing in home care support post-surgery.

“Indeed, the role of advanced practice nursing in the future of older people’s cancer care has been acknowledged elsewhere in the literature, and this review indicates that this is a candidate role for exploration and further consideration,” they said in the journal BMJ Open.

peter griffiths

peter griffiths

Peter Griffiths

The authors, who included leading nursing workforce expert Professor Peter Griffiths, said more research was needed to establish what workforce developments were needed to support “this growing population throughout the cancer journey”.

“The most promising interventions for further study target assistance to individuals with complex needs who are at particular risk of undertreatment, and of problems arising from cancer treatment or its impact,” they said.

“Our review indicates that the impact of multi-professional teams, including geriatric physicians and advanced practice nursing, on patient outcomes from survival to quality of life, would be worthwhile to evaluate more definitively, as would the contribution of trained volunteers,” they added.

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