First, Michelle Hanan presented the specific considerations for older adults undergoing anti-cancer therapies. She emphasised that the lack of evidence to guide treatment decision-making and the fact that older adults are underrepresented on clinical trials, leading to both under and over treatments. She concluded that the benefits of comprehensive geriatric assessments are that they reveal problems that are not identified through traditional oncology assessments, and help reduce the risk of toxicity to older adults undergoing anticancer therapies.
Next, Martine Puts presented the draft of the position statement on oncology nursing care for older adults with cancer jointly developed by the International Society of Geriatric Oncology Nursing and Allied Health group (SIOG NAH), EONS and the Canadian Association of Nurses in Oncology (CANO). She addressed the main reasons why we need a new position statement. The number of older adults with cancer is increasing, and older patients are different from younger patients,: decline in most areas of physiological functioning, functional status, increasing cognitive impairment with increasing age, underrepresentation in clinical trials, different support systems and dependency on others. They may have unique and different needs to other cancer patients.
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The first speaker, Sara Colomer-Lahiguera from Lausanne, Switzerland, explained how immunotherapy works and the kinds of immune-related adverse events it can generate. Biomarkers such as cytokines, small molecules that mediate and regulate biological processes such immunity or inflammation, are associated with symptoms such as fatigue, pain or depression among others. Sara conducts a nurse-led project aimed at better understanding patients’ experience with immune checkpoint inhibitor treatments. Symptom questionnaires are filled in by patients every two weeks and blood samples collected to analyse biomarkers. This approach will help to gain knowledge on the evolution of symptoms and their underlying molecular mechanisms. Sara’s presentation was complemented by the last speaker in the session, Laura Bascuñana Sanchez, who spoke about new challenges in the management of immune therapy toxicities and how adverse events need responses and management by a multidisciplinary team. Algorithms have been developed to help manage the different adverse events from different toxicities depending on the organs affected.
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The final session of EONS13 focused on one of the most important campaign priorities for cancer nurses: the quality and safety of cancer patients and nursing safety. René Schwendimann opened the session with a focus on patient safety describing a study that found that that 1 in 20 patients are harmed by preventable events in healthcare. Some of these cases resulted in permanent disability and even death. In the Netherlands, a study of 32 Dutch hospitals found that 80% of healthcare workers have experienced harmful events. Sadly, these professionals feel ashamed and unconfident following such events even if they were out of an individual’s control. They need to talk and receive emotional support either from outside and/or from colleagues. Former EONS Board Member, Patrick Crombez then presented the results of the Cancer Nursing Education and Recognition in Europe survey, designed and carried out by the EONS Advocacy Working Group (AWG). Similarly, Helena Ullgren, co-chair of the AWG, presented the results of the EONS occupational and safety survey among cancer nurses across Europe. The survey consists of two parts: EONS questions and a validated tool on hospital safety. Some of the data has been used to create a Cancer Nursing Index © (CNI). So far 632 responses have been received from different countries showing there is great variation within and between countries in terms of safety. In many areas, guidelines are not well followed, creating potentially dangerous situations especially for pregnant cancer nurses. Lena Sharp, Helena’s co-chair of the AWG and EONS Past-President, described the CNI in more depth before EONS Board Member, Matt Fowler discussed how this data is providing the basis for EONS advocacy work on occupational safety, and plans for a potential project on accreditation of hospital wards. He cited this powerful poem:

Manuela Eicher, EONS Research Working Group Chair, welcomed everyone to the session. First, Claudia Witt talked about advising cancer patients about complementary medicine. She used the definition that explains integrative oncology as “patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimise health, quality of life, and clinical outcomes across the cancer care continuum, and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.” She spoke about systematic trainings and consultations and criteria for reputable providers in complementary medicine.
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Opening the session, Christine Bienvenue from Switzerland defined an e-patient as a person that tries to participate fully in his or her medical care by gaining information, seeking advice, and finding support about their condition via sources, such as the internet and social media. This definition includes individuals that do so on behalf of a family member or loved one. The 'e' in e-patient may stand for one of various characteristics describing such an individual with respect to their health and making healthcare decisions. E-patients are also more likely to empower themselves to recover making the best use of evidence-based information and working with academics and medical teams to find the best solutions for their illnesses. Christine went on to outline projects that promote this model such as the Swiss Cancer Patients Experience (SCAPE) project and the HUG project in Lausanne and Cancer Research UK’s Partnership and Experiential Knowledge Project.

Professor Manuela Eicher outlined the iterative mechanisms for the development and implementation of Patient Reported Outcome Measures in cancer care. She highlighted that while understanding the patient experience of disease indeed nothing new in the nursing manual, developing patient reported outcomes and patient reported outcome measures with the patients at the heart of the process is relatively new, and the facilitation of PROs still all too often leaves patients out. ePROMS – the collection and measurement of PROS using electronic means has the potential to allow for far more meaningful patient engagement through online access and applications.
Finally, Professor Theresa Wiseman presented a practical co-designed (with people affected by cancer) e-tool pilot that aimed to create a flexible, low cost and “easy to administer” wellbeing intervention with a combination of virtual reality with relaxation and compassionate mind training. Patients worked together with the team to create the Safe Space Virtual Reality tool in which patients could experience three settings on a beach, forest and mountain scenery to follow guided relaxation exercises. These were tested on patients and adapted following their feedback.

In the live Q&A session for this symposium, Professor Timo Schinköthe introduced the Cankado App that assists cancer patients and oncologists in the phases of cancer treatment. This innovation works based on patient-reported outcome data allowing an efficient patient-physician interface and is available here

The session began with Daniel Kelly from the UK who stressed the importance of this aspect of cancer care in the present day. He underlined that it was key to both improving the care and the safety of patients and he clarified the role that cancer nurses can play in ensuring safety and providing the best possible experience for patients. He defined why patient-reported outcomes (PROMS) are relevant in TKIs: in helping define the acceptability of TX vs anticipated or new adverse events, for use as evidence of the benefit between different TXs, to tailor dosage, to judge efficacy based on tolerance, to focus on the patient not just the cancer and to have a clear link with the role of the cancer nurse in provision of supportive cancer care. He stressed the importance of getting a balance in weighing up different factors and making judgements.
Next, EONS President Andreas Charalambous from Cyprus (who also chaired the session), shared his knowledge on treating cutaneous side-effects induced by immune-therapy in patients with lung cancer. He focused on issues around skin and dose-dependent toxicities and went on to describe the different grades of adverse events and the management of immune checkpoint inhibitor-related toxicities. Finally, he outlined useful and practical ‘things to remember’ when addressing these issues in patients.
The last speaker, Aileen O’Meara from Ireland explained rare adverse events in immune-oncology. She discussed rare immune mediated adverse events (AEs), focusing on myocarditis and nephritis and the clinical presentation and incidence of these. She reviewed the current guidelines for management of these AEs with reference to the American Society of Clinical Oncology, the National Comprehensive Cancer Network and ESMO.

First, Johan de Munter, EONS President Elect provided an insight on the University Hospital Ghent Cancer Centre nurse-led e-health support in cancer care during the SARS-CoV-2 pandemic by sharing the results of a single centre observation. He emphasised the need for continuous monitoring, analysing, flexibility and adapting of services due to the lack of experience with a real pandemic. Some of the challenges included maintaining delivering high quality care, infection prevention, delivering appropriate information and psychological support, preventing stress and anxiety among patients and caregivers and preventing a care gap in screening, diagnosis, treatment and follow-up. He added that during the pandemic modifications in hospital communication infrastructures were needed, with telephone consultations from/to patients. Tele-nursing became a norm and patients would send pictures to receive clinical (medical assessments), educational (sharing leaflets and information), psychological and administrative (referral to more specialist care) support. Physical meeting during the pandemic reduced but there was a massive increase in telephone support in his Centre.
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Another European Health Forum Gastein 2020 session entitled: “Universal health coverage and the role of the health workforce’’ also addressed health inequalities in terms of access to care. The panellists highlighted that vulnerable groups have been hardest hit by COVID-19 and the lockdown measures, which exacerbated already challenging conditions such as diabetes and working conditions.
Some of the main challenges for the health workforce included high levels of work and stress, lack of personal protective equipment, high numbers of patients and not knowing what to expect next due to limited knowledge about the disease. Education and training, as well as keeping the workforce happy and satisfied, are key elements in which national governments should invest, in order to cope with the threats of tomorrow. The COVID-19 pandemic has made it clearer than ever that health is a global issue, that the protection of vulnerable groups is vital to ensuring universal health coverage and that healthcare systems and the workforce must be supported.
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The European Code of Cancer Practice is a citizen and patient-centred statement of the core requirements for good clinical cancer practice needed to improve outcomes for all of Europe’s cancer patients. The Code of Practice has been co-produced by a team of cancer professionals, cancer patients and patient advocates, and endorsed by many professional and patient societies, including EONS. The European Code of Cancer Practice is focused on informing and assisting cancer patients at all stages of their cancer journey.
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