Taking the lead: sharing best practice in intravenous bisphosphonate use in urological cancers.

PURPOSE: Bisphosphonates relieve metastatic bone pain, prevent, reduce and delay skeletal morbidity in metastatic bone disease and are recommended in European guidelines but safety concerns, specifically renal dysfunction and osteonecrosis of the jaw, necessitate specific precautions when administered intravenously. Pan-European guidance for nurses at the forefront of patient-focussed cancer care is required to minimise patient risk. METHODS: A panel of urology and oncology nurses from seven European countries collaborated to decide what constituted best practice for bisphosphonate administration when indicated for prevention of skeletal-related events in patients with advanced urological malignancies. RESULTS: The panel agreed that urology, oncology, and home-care nurses who are at the forefront of patient-focussed care are well placed to ensure best practice is followed but across Europe nurses have insufficient training on bisphosphonate administration for urological cancers. Based on extensive clinical experience in administering bisphosphonates the panel propose best practice for identifying those patients who could benefit, for example those with bone pain or at risk of fracture, and for minimising risk of adverse events by checking renal function, adjusting dosing, ensuring adequate hydration, and regularly assessing dental health, as well as providing information and support. CONCLUSIONS: Sharing this best practice across Europe could assist nurses who care for patients with urological cancers and bone metastases or indeed those caring for cancer patients in general, to take the lead, or at least be aware of what is the best practice that helps to ensure effective and safe IV bisphosphonates administration to patients under their care.

End-of-life care for people with urological cancer.

The National End of Life Care Intelligence Network has produced its first report looking at differences in where people with urological cancers die--at home, in hospital, hospices or nursing homes--depending on the type of cancer they have and other factors such as age, sex and socioeconomic status. This article summarises the key findings of the report and their implication so for urology nursing practice.

[National survey on stoma appliances]. / Enquête nationale sur les appareillages de stomie.

A stoma constitutes a surgical solution for diseases, most commonly cancerous, of the digestive or urinary systems or for inflammatory bowel diseases. In order to gain a better understanding of how people choose and use their stoma appliances, the French federation of stoma patients (FSF) carried out a survey of its members in 2004.

[Choosing an appliance adapted to each adult stoma patient]. / Choisir un appareillage adapté à chaque adulte stomisé.

A stoma, following a surgical procedure, is the connection of a section of the digestive or urinary system to the skin. It requires the patient to wear a collection device, appliance of which several types exist and which can be adapted to the stoma, the peristomal skin, the type of waste and the morphology of the person.

The development and audit of a nurse-led urology/oncology clinic.

People with cancer in the UK should have access to a full spectrum of services. The role of the clinical nurse specialist is an important part of this development. In the specialty of urology/oncology, this role is still a relatively new development although the incidence of urological malignancy readily compares with other site-specific cancers.

[Palliative cancer care is an important part of urology. A study of the last year of life of patients who died because of urologic cancer]. / Palliativ cancervård är en betydande del av urologin. Studie av det sista levnadsåret för patienter som dog av urologisk cancer.

A total of 330 in-patient episodes at the urology ward, with a mean duration of 9.8 days, were registered in a study of 100 patients who died from urological cancer. Twelve patients spent more than two months of their last year of life at the urology ward. As many as 82% of the admittances were on an emergency basis. A total of 101 operations were performed on 84 patients; 47 patients received palliative radiotherapy. This patient category needs a great deal of palliative care--at short notice--in order to get an optimal quality of life. Although many symptoms could have been alleviated outside hospital, the majority of patients needed specialised urological hospital care during their last year of life.

Multidisciplinary team working in urological cancer: one CNS's role.

The 'cancer journey' for a patient with urological cancer can be complicated, with many different specialists involved and many treatment options. The uro-oncology clinical nurse specialist's role in one multidisciplinary team is to provide support, information and a link between all the staff involved in the patient's care.

Telephone contacts with a cancer nurse specialist.

AIM: The objective of this study was to audit the nature of telephone consultations with a Macmillan nurse specialist. METHOD: All calls made to or by a Macmillan nurse over a period of 20 days were analysed in respect of three main areas: symptom management, psychological support and treatment. Information was recorded on a data sheet and then data were collected and descriptive statistics were produced. RESULTS: The mean length of call was eight minutes. Most calls were incoming and involved patients, followed by relatives and healthcare professionals. The majority of calls involved psychological support, followed by symptom management then treatment. CONCLUSION: The data show that the Macmillan nurse specialist spends a large amount of time in telephone work, mainly in consultation with patients.

Role of nurse clinician in urologic oncology.

The incorporation of single and combination chemotherapy into the therapeutic regimen for some advanced genitourinary tumors has greatly added to the myriad of medical and psychologic problems already present in these patients. Working closely with a urologist, a nurse clinician can be of significant help in the total care of this group of patients. Due to the seriousness and chronicity of the neoplastic process, the emotional and social impact as well as physical factors affect all phases of the patient's life, as well as the lives of family members. The incorporation of traditional nursing values into the medical education of nurse clinicians helps to prepare them to deal with these problems, and their participation serves to make the medical team more complete.