To Explore to
Innovative Care for
Oral Anticancer Treatment

With the advancement of medical care for cancer, new methods of treatment are being developed day by day. But the symptoms of the side effects and the psychological reactions to these new treatments are something only patients’ experience.
Medical care providers must not only understand the pain of the patients objectively and predictively,but should also understand their pain from a professional perspective by listening to what patients have to say about the pain they are experiencing and its significance.
Associate Professor Yagasaki’s research is designed to realize better cancer nursing by listening to what patients have to say about the total pain that they are going through.

  Recent Trends in Oral Anticancer Drugs

Medical care for cancer is making rapid progress, and as soon as a new clinical treatment commences, the patients are faced with the symptoms of the side effects, or side reactions, of the new drug and the related difculties in treatment. When new treatment methods and drugs are clinically tested, we must come up with new methods of care as soon as possible.

In recent years, the frequency of the use of oral anticancer drugs in cancer treatment has been rising. As oral anticancer drugs principally target recurrence cancer patients and patients with metastatic cancers, medication periods tend to become protracted, and the end point of the treatment may become unclear. Furthermore, as treatment with oral anticancer drugs is provided as outpatient care, the initiative of the cancer patients themselves is tested.

Among oral anticancer drugs,molecularly-targeted drugs are often used for cancer treatment. These drugs are designed to treat cancer by targeting specic molecules of cancer cells and controlling their functions.

Many patients tend to think that oral anticancer drugs have fewer side effects than conventional anticancer drugs administered via intravenous drip. It is true that orally-administered molecularly-targeted therapeutic medicines do not entail the same pain as those delivered via intravenous drip.

However, orally-administered molecularly-targeted drugs may have almost equivalent, or in some cases more, serious side effects as compared to conventional anticancer drugs or molecularly-targeted drugs-administered via intravenous drip.

  Barriers for the Use of the Guideline

My area of research is cancer nursing including chemotherapy nursing. As a part of research activities in this area, I drew up the “Guideline for Outpatient Cancer Chemotherapeutic Nursing” in 2009 as a primary investigator of Dean and Professor Hiroko Komatsu of Keio University. However, we received comments that the Guideline contained some points that were difficult to make use of clinically in actual nursing circumstances. Thus, we conducted qualitative research through a focus group interview of the certified nurse in cancer chemotherapeutic nursing in FY2008-2010 for more effective clinical utilization of the Guideline.

As a result of this qualitative research, we became aware of preconditions required for wider clinical utilization of the Guideline. The preconditions are categorized into those relating to individuals, organizations, health care providers, and the Guideline itself. The Guideline forms the foundation for medical care and nursing and is necessary in order to improve conventional and practical clinical operations. However, it became apparent that there are barriers within the preconditions that hamper the spread and utilization of the Guideline. For example, even when nurses want to make use of the Guideline, they confront the cost-consciousness of hospitals (organizations), or they cannot obtain the consent of doctors or pharmacists (multidisciplinary team member).

  Challenges in Cancer Chemotherapy Nursing
That Are Shifting to Outpatient Clinical Practices

At present, clinical practices for cancer treatment are shifting to outpatient therapy. As an increasing number of treatments using anticancer drugs are being performed as outpatient therapy, patients continue to take the oral anticancer drugs at home under self-supervision. Previously patients received cancer treatment in a hospital under the supervision and health care professionals, at present, however, it is necessary for the cancer patients themselves to administer the oral anticancer drugs while manage the symptoms of the side effects and monitoring them to keep them from worsening. With patients burdened with ever-increasing roles and responsibilities, it is important to support them in a way so as to prevent a decline in the Quality Of Life (QOL) of cancer patients under self-supervised treatment.

Bearing these issues in mind, we conducted research entitled “Clarification of the Status of Medication of Patients Who Receive with Oral Chemotherapy at Home and the Development of the Support Model for Safe and Appropriate Medication” in FY2011-2014. This research has made it clear that in the current environment of outpatient-centered cancer treatment it is necessary for nurses themselves to proactively reach out to the patients taking oral anticancer drugs and to get involved in providing care for them. Furthermore, the research highlighted the problem of patients’ adherence (*) to their medication and clearly showed that there is the gap between patients’ subjective perception of their medication behaviors and their objective medication behaviors.

*Adherence means that a patient proactively participates in making a decision on treatment policy and receives treatment in accordance with that decision.

  Seeking to Enhance Care for Skin Reactions

I have been engaged in research entitled “Initiative of Cancer Patients under Oral Molecularly-Targeted Therapy . Usefulness of Skin Reaction Prevention and Management Program” since FY2015. Regarding skin reactions that emerge with the use of molecularly-targeted drugs, it is believed that the benefits of treatmentand the degree of the skin reactions are correlated. In this sense, the emergence of skin reactions signifies the presence of treatment benefits. On the other hand, skin reactions can significantly degrade the QOL of cancer patients and in some cases lead to the suspension of medication. The objective of this research is to enhance the QOL of cancer patients by manage the side effects of skin reactions while continuing medication using therapeutically-effective molecularly-targeted drugs.

The period of research is set to last until FY2018. I am currently conducting interviews with the patients taking molecularly-targeted drugs regarding what self-care measures they are taking for their skin reactions and what difficulties they are experiencing. I intend to shed light on what they are going through by conceptualizing the results of the interviews. After this I plan to conduct a prospective cohort study（*） on the actual conditions of their skin reactions. Subsequently, based on the outcome of these research activities, I plan to hold discussions among dermatologists, nurses and other specialists for the development of specialized care for the skin reactions associated with the use of molecularly-targeted drugs.
※A study where a survey commences before the subjects contract diseases.

  Delivering and Responding to the Patients’ Voices

In cancer treatment,molecularly-targeted drugs are often administered to relapsing patients and patients with metastasizing cancers. Cancer patients stand at a crossroads in their life prognosis with each drug,depending on whether it is effective ornot. When they become unable to continue with medication using effective drugs due to skin reactions or other side effects, patients are placed into very “uncertain circumstances,” such as regarding whether or not alternative drugs are available.

Therefore, from the standpoint of cancer treatment, it is undesirable to discontinue or to suspend medication using anticancer drugs due to skin reactions. However, that possibility cannot be entirely ruled out in terms of maintaining the QOL of patients.

This is exactly why it is necessary to control skin reactions in order to enable patients to take the molecularly-targeted drugs that are effective in treating their cancer for as long as possible. From this perspective, the experiences of the patients themselves are of particular importance.

Care should be provided in a manner so as to respond to the genuine needs of patients. To that end, when a new method of treatment commences, the only way to grasp patients’ needs is to listen to their voices. In other words, the important thing is to develop care together with the patients.

I strongly believe that our mission is to deliver the patients’ voices to the world and to carry out innovative research and care in order to respond to their voices.

  Major Initiatives in Cancer Nursing

• 

  Enhancement of the QOL of Cancer Patients

  Began research entitled “Initiative of Cancer Patients under Oral Molecularly-Targeted Therapy – Usefulness of Skin Reaction Prevention and Management Program” in FY2015. The objective of this research is to enhance the QOL of cancer patients by mitigating the side effects of skin reactions while continuing medication using therapeutically-effective molecularly-targeted drugs.

• 

  Development of the Guideline and the Realization of its Effective Utilization

  As a part of research on chemotherapy nursing and cancer nursing, the “Guideline for Outpatient Cancer Chemotherapy Nursing” was developed in 2009. Subsequently, with the purpose of developing more effective utilization of the Guideline in clinical practices, another research project entitled “Gap between EBN and Clinical Practices in Cancer Treatment and the Development of the Propagation Model” was begun.

• 

  Proactive Nursing Care for Cancer Outpatients

  Carried out research entitled “Clarification of the Status of Medication of Patients Who Continue with Oral Chemotherapy at Home and the Development of the Support Model for Safe and Appropriate Medication.” This research has made it clear that in the current environment of outpatient-centered cancer treatment, it is necessary for the nurses themselves to proactively reach out to patients taking oral anticancer drugs and to get involved in providing care for them.