Cancer Nursing:
doi: 10.1097/NCC.0000000000000096
DEPARTMENT: Insights

What Will It Take?

Kagan, Sarah H. PhD, RN

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Author Affiliation: School of Nursing, University of Pennsylvania, Philadelphia.

The author has no funding or conflicts of interest to disclose.

Correspondence: Sarah H. Kagan, PhD, RN, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia PA 19104 ( skagan@nursing.upenn.edu).

Accepted for publication August 10, 2013.

A decade ago, I spoke at the National Conference on Cancer Nursing Research here in the United States and published those remarks in the Oncology Nursing Forum,1 sharing my vision of a new perspective for our investigations of aging and cancer and the needs of older people with cancer centered on vast possibilities and clear opportunity. I recently took stock of where we are now…

In “Gero-Oncology Nursing Research,” I presented 2 phases in our growth and development. Awareness and inclusion, which I argued we had nearly completed, constituted the first phase. At that time, many nurse scientists recognized needs for research in aging and cancer and began including older people in their studies. I posited the beginning of a second phase as one of new language and different models. The term “gero-oncology” represented the new language, denoting health and function as domains in which we are expert. This unique term also differentiated our work from the medical specialty of geriatric oncology and announced my call for a shift in perspective from awareness to development of new models and more gerontological phenomena.

Ten years on, I apprehend a modest but important shift in our perspective. Certainly, we read ever more frequent reports in Cancer Nursing and other well-reputed journals involving older people and gerontological concepts. We have moved away from mechanistic approaches such as identifying 65 years of age as old. I wonder then how we can advance our work, constituting substantial change in perspective and resultant research. Investigations into phenomena including multimorbidity, functional outcomes, and family caregiving and care coordination as well as health services use are among the pressing issues in most healthcare systems today. We must plan strategically to examine such phenomena along with their demographic, epidemiologic, and system determinants among older people who have cancer.

The realities are sharp. We know that aging demographics are concerning the world over.2 The epidemiology of cancer parallels demographics, with most cancers diagnosed in older people and the majority of cancer survivors similarly aged.3–5 Healthcare systems around the world are trying to match growing demand with diminishing resources. Critically, supportive care needs and functional implications of cancer in late life generally remain underaddressed compared with need. The translation and implementation gaps are staggering—just look at the numbers of scientists claiming the field and of clinicians who declare the specialty.

Why do research and care for our majority patient population remain a minority interest for cancer nurses and—critically—for cancer nurse researchers? The United Nations, the World Health Organization, and the US Institute of Medicine, among other organizations, all remind us of the global imperative of rapidly aging populations, the intertwined and manifold epidemiology of chronic noncommunicable disease, and imperatives for evidence-based care to improve function, self-care, and well-being.6–10 What will it take to make the majority’s needs our first priority, shifting the minority approach of a specialty to overarching emphasis and major trend, drawing in other priorities such as community-based care and disparate outcomes?

We are making progress worthy of note. A search of Cancer Nursing citations, using the search term “elderly,” returns 75 results from the past 3 years and 34 from the past 12 months. Excitingly, most of these are original research reports. Nevertheless, I worry that we still do not think of ourselves as nurse scientists working in an aging world, looking at the implications of aging and being old in our daily work. We maintain a specialty perspective on majority concerns and imagine we can choose whether to concentrate on aging.

Perhaps we need to aim for a 2-tiered structure in which we have gero-oncology research generalists and gero-oncology research specialists. Most broadly, all nurse scientists must be sufficiently knowledgeable about aging and being old to undertake cancer and multimorbidity research that reflects current and projected demographics, epidemiology, and nursing need. Some of us may elect to become specialists and advance our knowledge of aging and being old in particular and innovative ways. Achieving the widespread competence needed to generate gero-oncology generalists requires rethinking training programs and developing accessible and effective continuing education. Supporting gero-oncology specialists will require even greater investments in training, collaboration, and infrastructure. I believe that we know what shifting our perspective takes—let’s take on this next step!

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References

1. Kagan SH . Gero-oncology nursing research. Oncol Nurs Forum. 2004; 31:(2): 293–299.

2. Vaupel JW . Biodemography of human ageing. Nature. 2010; 464:(7288): 536–542.

3. Bellury LM, Ellington L, Beck SL, Stein K, Pett M, Clark J . Elderly cancer survivorship: an integrative review and conceptual framework. Eur J Oncol Nurs. 2011; 15:(3): 233–242.

4. Tsai S, Balch C, Lange J . Epidemiology and treatment of melanoma in elderly patients. Nat Rev Clin Oncol. 2010; 7:(3): 148–152.

5. Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012; 62:(4): 220–241.

6. Institute of Medicine. Cancer in Elderly People: Workshop Proceedings. Washington, DC: Institute of Medicine; 2007; .

7. Institute of Medicine. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: Institute of Medicine; 2008; .

8. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: National Academies Press, Inc; 2008; .

9. United Nations Population Division. World population ageing: 1950–2050: United Nations Publications; 2001. http://www.un.org/esa/population/publications/worldageing19502050/. Accessed July 17, 2013.

10. UN General Assembly. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf

Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. 2011. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf. Accessed July 17, 2013.


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