National Center For Cancer Care And Research Research Articles

What Are the Challenges and Facilitators for Implementing a 24-Hour Telephone Cancer Service in Qatar? A Literature Review.

Objective: To identify the challenges and facilitators for implementing a 24-h telephone cancer service. Data sources: English language articles were retrieved from Medline, Cumulative Index of Nursing and Allied Health Literature, and Ovid Nursing electronic databases published from 2000 to 2015. Study Design: The authors performed an integrative literature review. The qualitative and quantitative articles were evaluated using the Critical Appraisal Skills Program. All mixed-methods articles were evaluated using the Mixed Methods Appraisal Tool. Thematic analyses were used to synthesize the findings from the included articles. Findings: The literature of this review highlights the complexity of the decisions that accompany the consideration of implementing a teleoncology in Qatar. The literature review detailed challenges and facilitators for implementing 24-h call service for cancer patients. These were grouped as human, technology, documentary tools, and organizational domains. The core concept that integrates each of these domains is communication. Conclusions: If the telephone triage is to be implemented in National Center for Cancer Care and Research (NCCCR), more research is needed about the characteristics of cancer patients in Qatar. A more robust understanding of this population will inform decisions about the utility of developing a teleoncology service at NCCCR.

The lived experiences of smokers with lung cancer

Objective: The aims of this research were to learn about the lived experiences of patients with lung cancer who smoke tobacco and to provide nurses with more insights into complexities of people’s relationship with their smoking.Methods: Descriptive phenomenology was used to explore the lived experiences of smokers with lung cancer. An in-depth unstructured conversational style interview was used as a method for data collection. The study was conducted in the inpatient, outpatient, and day care units at the National Center for Cancer Care and Research (NCCCR) in Qatar. Purposive sampling was used to recruit five lung cancer patients who smoke. Colaizzi’s (1978) method was used to analyze data.Results: Participants described three related themes: (a) fate, (b) a socially acceptable addiction, and (c) self-blame and guilt.Conclusions: The findings of this study are of interest to nurses and physicians who work with lung cancer patients. The findings provide insight into experiences of patients who continue to smoke after their lung cancer diagnosis. Nurses within the smoking cessation clinic will also benefit from patients’ descriptions of what they consider useful and supportive in regards to an empathetic, coaching response to their relationships with tobacco. Future study is needed to elucidate nurses' perception on lung cancer patients who continue to smoke.

Depression screening in cancer patients: A narrative review

Depression is a significant and most common psychological symptom in cancer patients that causes a high risk of emotional and somatic consequences leading to poor quality of life. Despite the high prevalence of depression in cancer patients, the lack of screening and under-diagnosis of depression continues to be common. Numerous studies have shown that depression is a substantial complication in cancer patients that may lead to a variety of psychological and physical (somatic) symptoms. Presently, there are no depression screening practices at the Hamad Medical Corporation’s (HMC) National Center for Cancer Care and Research (NCCCR), which is the principle public healthcare provider in the State of Qatar. The aim of this narrative review is to explore depression in cancer and discuss the need for screening for depression and to recommend suggestions and implications for future practice and research.

Oncology nurses' perceptions of end-of-life care in a tertiary cancer centre in Qatar.

Nurses who work in oncology settings may lack the knowledge and skills required for end-of-life (EoL) care. A clear understanding of nurses' perceptions of EoL care is crucial for the successful improvement of care for terminally ill patients with cancer. Although many studies have underlined nurses' perspectives on EoL care, this is the first such study conducted on oncology nurses in Qatar. This study primarily sought to measure nurses' perceptions of EoL care at the National Center for Cancer Care and Research (NCCCR) in Qatar. A quantitative, cross-sectional, self-reported study. Nurses at the NCCCR reported their perceptions of EoL care using the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, which consisted of 30 items scored on a five-point Likert scale. Seventy-eight nurses working in oncology settings completed the tool. Approximately one third (33-35%) of the participants had positive perceptions of EoL care. The majority (67%) of the participants were uncertain or ambivalent regarding EoL events and situations. There was no significant relationship between the participants' profiles and their perceptions of EoL care. However, very few of them had completed educational courses in death and dying. Nurses have an important impact on EoL care, and continuous education is necessary to improve their confidence when they work with dying patients and their families. An in-house programme to help nurses cope with compassionate exhaustion and humanistic and relational care is highly recommended.

Nurses’ perceptions regarding using the SBAR tool for handoff communication in a tertiary cancer center in Qatar

Background : Communication failure has been reported in the literature as the primary source of medical errors and patient harm. Among various methods of handoff communication, Situation, Background, Assessment, and Recommendation (SBAR) is a reliable and efficient framework that nurses worldwide use. The investigators sought to assess the perceptions of nurses with regard to using the SBAR tool for hand-off communication at a cancer hospital in Qatar. Methods : A cross-sectional descriptive study was carried out to assess perceptions regarding the use of SBAR among 117 staff nurses working in inpatient units of National Center for Cancer Care and Research (NCCCR). A handover evaluation tool was used, enabling nurses to self-report their perceptions. Results : The majority of staff nurses opined that SBAR followed a logical sequence, with a reduction in communication errors after its use. Also, 53.9% of the nurses reported that they would always recommend the SBAR framework in other areas. The majority (87.3%) of the nurses had good perceptions regarding the use of the SBAR framework, and none of them had poor perceptions regarding the same. The mean duration of handovers reduced after their use of SBAR. There was no association between perceptions and demographic variables. Conclusions : SBAR is safe and efficient, and it can be recommended for all healthcare settings. The SBAR communication technique provides an organized logical sequence and improved communication that has been proved to ensure patient safety.

Clinical commissioning of the INCISE™ multileaf collimator for cyberknife M6™ system

Introduction The National Center for Cancer Care and Research (NCCCR) at Hamad Medical Corporation in Qatar is amongst the first institutions in Asia and Europe to have the CyberKnife® M6 FIM system (Accuray, Inc., Sunnyvale, CA, USA) including Fixed Collimators, Iris Variable Aperture Collimator and InCise™ Multileaf Collimator. Purpose To report our commissioning experiences of the CyberKnife M6 InCise™ Multileaf Collimator system. Materials and methods Accuray guidelines were used to conduct measurements. A detailed description of the equipment used, the mechanical alignment, the verification procedures, and the alignment of the detector motion with the radiation beam is described. Incise MLC testing was conducted as per Accuray procedure. Further MLC tests were developed to verify its feasibility under certain clinical settings. Results Our results were within the manufacturer specifications. Results for both the Sun Nuclear Edge detector and PTW SRS diode 60018 were found to be comparable. Measurement conditions specified by Accuray were sufficient; however the use of a reference chamber introduced additional noise for the continuous profile acquisitions. As compared to fixed and IRIS collimators, the incise MLC produced acceptable results with an average of 20% decrease in treatment delivery time. Conclusions Our results are amongst the first set of data reported on the InCise™ MLC and were within the manufacturer specifications. These results will be used to develop a benchmark reference for periodic Quality Control (QC). Disclosure Authors have nothing to disclose.

KRAS as a prognostic marker for metastatic colorectal cancer: Qatar experience

Colorectal cancer (CRC) is the third most common cancer worldwide and in Qatar. Kirsten Ras (<em>KRAS</em>) mutation occurs in 30%–50% of CRC cases in different geographical areas. A total of 104 metastatic CRC cases were tested for <em>KRAS</em> mutation from 2009–2013 at the National Center for Cancer Care and Research (NCCR), Qatar. The incidence of <em>KRAS</em> mutation was 42% versus that of the wild-type (58%). Wild-type <em>KRAS</em> metastatic CRC (mCRC) patients tend to have better survival and this was especially evident after they received anti-epithelial growth factor receptors targeted therapy. Meanwhile, mutant-type <em>KRAS</em> mCRC patients receiving anti-vascular endothelial growth factor were more inclined to have poor survival outcomes. To confirm the observation, more studies with larger sample populations and a longer follow-up duration are needed. To our best knowledge, this is the first known report of <em>KRAS</em> status and its impact on the prognosis of metastatic colorectal cancer.

Nurses' perceptions of and satisfaction with the use of automated dispensing cabinets at the Heart and Cancer Centers in Qatar: a cross-sectional study.

BackgroundAutomated dispensing cabinets (ADCs) were introduced in 2010 and 2012 at the Heart Hospital (HH) and National Center for Cancer Care and Research (NCCCR), both run by Hamad Medical Corporation in Qatar. These medication distribution systems provide computer-controlled storage, dispensing, and tracking of drugs at the point of care in patient care units. The purpose of this study was to assess nurses’ perceptions of and satisfaction with the use of ADCs at HH and NCCCR.MethodsA cross-sectional study was conducted in the two institutions in May and November 2012 using a piloted, validated, online, and anonymous questionnaire. The questionnaire consisted of four parts: nurses’ sociodemographic and practice characteristics, 21 questions about their perceptions, one question about their overall satisfaction, and one about the system’s ease of use. The self-administered survey was distributed to 503 nurses working at HH and NCCCR over three weeks using Survey Monkey®.ResultsThe survey response rate was 80 % (n = 403). No significant difference was found in perception scores between the two institutions (p = 0.06). Ninety-four percent (n = 378) of nurses agreed that the medication delivery system allowed them to do their job more safely, and 90 % (n = 363) nurses agreed that they now spent less time waiting for medication from the pharmacy than they did before the ADC system was introduced. Eighty seven percent (n = 349) nurses agreed that they were able to administer medication more efficiently with the ADC system. The overall satisfaction rate (either “very satisfied” or “satisfied”) for the two hospitals was 91 %.ConclusionsThe nurses’ perceptions of and levels of satisfaction with the ADC system were very good over the 6 months after complete implementation and integration at HH and NCCCR. ADCs appear to increase efficiency in the medication process and should therefore improve the quality of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0121-7) contains supplementary material, which is available to authorized users.

Studying the Impact of Presence of Alpha Acid Glycoprotein and Protein Glycoprotein in Chronic Myeloid Leukemia Patients Treated with Imatinib Mesylate in State of Qatar

BackgroundDespite the efficacy of Imatinib Mesylate (IM) in treating Chronic Myeloid Leukemia (CML), a high degree of resistance has already been noted. Alpha acid glycoprotein (AGP) may reduce drug efficacy through its ability to interact with IM and blocks it from reaching its target while Protein glycoprotein (PGP) may reduce the intracellular concentration of the drug via an active pump mechanism. In our cohort of patients with the highest rate of resistance to IM globally, we investigated if the level of AGP and PGP could be correlated with CML resistance/response to IM? and if so, could they be employed as biological markers for CML resistance to treatment?MethodsTo answer these questions, the 26 CML patients who were enrolled into our previous study between November 2006 and December 2011 were investigated for AGP and PGP levels at diagnosis and during treatment. Serum samples were analyzed to determine AGP level via an Immunoturbidimetric assay and up-regulation of PGP level was determined via Flow cytometry analysis of Peripheral Blood (PB) and Bone Marrow (BM) samples.ResultsA total of 100 serum, 40 BM & 100 PB samples were collected from the 26 CML patients (22 CP & 4 AP) treated at the National Center for Cancer Care and Research (NCCCR) in Qatar. Samples from 10 healthy volunteers were collected as a control.AGP resultsAt Diagnosis11/22 CP patients had elevated AGP (mean 1.5 ±0.11 g/l) while 3/4 AP patients had elevated AGP (mean 1.8 ±0.3 g/l).During follow-upThe mean AGP values among the 14/26 patients who failed IM treatment were (1.05 ±0.09 g/l) while the values for the 12 patients who responded to the treatment were not significantly different (1.1 ±0.06 g/l) (p =) > 0.05.The 10/14 resistant patients who were previously reported to have mutations/Additional Chromosomal Abnormalities (ACAs) as underlying mechanisms of resistance, showed a mean AGP level of 1.06 (±0. 09) while the 4/14 patients with no mutations/ACAs showed no significant difference (AGP leve1.04 ±0.08) (p =) > 0.05.The mean value of the 10 healthy individuals who were enrolled as a control group was 0.71 ±0.04 g/l.The mean AGP levels were 1.2 (±0.12), 1.61 (±0.38), 1.05 (±0.09), 1.1 (±0.06), and 0.71(±0.04) g/l for 22/26 CP, 4/26 AP, 14/26 failed treatment, 12/26 optimal responders and controls respectively and the differences between patients groups and the control group on other hand were significant (p) 0.001, 0.03, 0.003, and 0.005 respectively.There was no a significant difference or correlation between AGP levels amongst the different groups of patients and there was no significant correlation between AGP and other biomarkers such as Platelets (PLTs), White Blood Cells (WBCs), Absolute Basophils (Abs. Baso) and Lactate Dehydrogenase (LDH) of CML patients in the responders group.However, the group who failed treatment showed a strong correlation between elevated AGP and LDH (p = 0.0001), WBCs (P =0.002) and Abs. Baso (p=0.03)PGP resultsOn the other hand, the mean PGP level was 1.25 (±0.06), 1.17 (±0.02), 1.21 (±0.03), 1.2 (±0.04) for AP, CP, responders and resistant patients respectively. Flow cytometric analysis showed no significant difference in the fluorescence intensities of the blast cells incubated with CD 243 and the blast cells incubated with isotypic control among the different groups of patients.Discussion and ConclusionWith a significant difference in AGP levels between patients and controls in our cohort of CML cases, combining AGP with others markers showed significant correlations during different disease stages that may be employed as a warning sign for resistance of CML to Tyrosine Kinase Inhibitors (TKIs).PGP expression, on the other hand did not differ in patients presenting in chronic phase or accelerated phase and showed no specific pattern for those who resist or respond to IM treatment.However, neither AGP nor PGP could be employed as an independent marker for disease progression as the noticed resistance in our CML patients could not be correlated to AGP or PGP levels and regardless of response or resistance to treatment, there was no significant pattern of AGP or PGP expression. DisclosuresAl-Dewik:Qatar National Research Fund (QNRF): Other: sponsorship.

Assessing prescribing patterns for the prevention of chemotherapy-induced nausea and vomiting in the national center for cancer care and research

Purpose: Chemotherapy is the mainstay of cancer treatment; however, chemotherapy treatment may cause nausea and vomiting, which could cause 25–50% of patients to consider delaying or refusing further cancer treatment. Chemotherapy-induced nausea and vomiting (CINV), can be prevented in 70–80% of patients with evidence-based anti-emetic regimen. The purpose of this study is to assess prescribing patterns with regard to prevention of CINV, in the national center for cancer care and research (NCCCR), and develop and implement a standardized evidence-based guideline for the management of CINV. Methods: 25 anti-emetic prescriptions were audited to assess their conformity with either of the published guidelines; Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), or the National Comprehensive Cancer Network (NCCN), to establish baseline data. A multidisciplinary team of clinical pharmacists and oncologists developed and implemented a guideline for the prevention of CINV. The guideline was promoted using a variety of strategies; education, pocket cards, academic detailing and pharmacist intervention. Physician anti-emetic orders were audited by pharmacists, to assess their conformity with NCCCR anti-emetic guidelines. A data collection form was developed to capture relevant information including; patient demographics, type and emetogenic level of chemotherapy, and the conformity of anti-emetic order with NCCCR guidelines. SPSS statistical software was used to analyze the data. Results: The conformity of anti-emetic physician order with NCCCR anti-emetic guidelines increased from 0% baseline in June 2008 to an average of 60.006% (n=331) by December 2010 and consistently increased reaching 94.3827% (n=792) by December 2013, (p value 0.0002). Conclusion: The introduction of anti-emetic guidelines succeeded in standardizing CINV management, toward an evidence-based approach.

Knowledge, Attitudes and Practices of Oncology Nurses towards Complementary and Alternative Medicine for Cancer Care in Qatar

Aim and objectives: The aim of this study is to investigate the knowledge, attitudes and practices of oncology nurses towards CAM in cancer care in Qatar. Background: CAM is widely used by patients with cancer worldwide. Given the wide use of CAM in cancer treatment, cancer authorities have called for an increased awareness of CAM modalities among healthcare professionals with a focus on safety and efficacy. Among healthcare professionals, nurses play a vital role in the integration of CAM into cancer care. Few studies have explored the attitudes, practice and knowledge of nurses towards CAM in cancer care. Design: Descriptive cross-sectional study. Research variables: CAM attitude; knowledge and professional practice. Methods: An anonymous survey of a sample of 156 random oncological nurses was conducted at the National Center for Cancer Care and Research (NCCCR) in Doha, Qatar. A semi-structured novel 17-item questionnaire was administered to 156 participating oncology nurses. The questionnaire collected information on: respondents’ knowledge of complementary therapy; perceived benefits and harm of complementary therapy; history of CAM recommendation to patients; and finally, interest in complementary therapy educational opportunities. Results: Our study showed that 11% of respondent oncological nurses had never heard about CAM therapy. Most nurses had a positive attitude towards CAM and were interested in CAM education opportunities. Conclusion: There is a need for increased knowledge about CAM by oncology nurses; given their vital role in the overall management of cancer patients. This can be achieved through structured and comprehensive education/ training programs as well as through the integration of CAM therapy into cancer care guidelines. Relevance to clinical practice: To ensure safe, efficacious and holistic cancer treatment, it is important for nurses to be knowledgeable of complementary therapy; to candidly discuss this topic with patients; and when possible, to offer CAM resources to patients.