Nurses have been instrumental in addressing the needs of patients with HIV/AIDS worldwide. This is particularly true in rendering care to patients in low- and middle-income countries (LMICs).1 Oncology nurses have similar potential to make a difference.
Cancer care in LMICs is constrained by numerous variables. An inadequate number of nurses to care for the sick is a factor as is the lack of available specialty training. Additionally, the scope of nursing practice is frequently limited by government agencies and the medical hierarchy. Screening and early detection efforts are minimal and prevention education is virtually nonexistent. I saw this firsthand in Vietnam several months ago where I volunteered as part of an international interdisciplinary team focusing on gynecologic malignancies.
I was struck while in Vietnam by the pervasive incidence of widely advanced cervical cancer in very young women, lung and hepatocellular cancers, and head and neck malignancies in men in their forties. Hence, a major potential role for oncology nurses in underdeveloped countries is that of prevention.
More than one-third of all cancer diagnoses can be avoided by reducing risk factors such as tobacco use, alcohol consumption, and exposure to radiation, and work setting carcinogens. Tobacco use alone is associated with one of every five deaths from cancer. Additionally, immunizations against hepatitis B and C viruses and the human papillomavirus (HPV) are also preventive strategies. Educating the lay public about prevention of infection with Helicobacter pylori and schistosomiasis also have preventive potential.2
Appropriately trained American oncology nurses have significant potential to share their knowledge and skills with our resource-poor nurse colleagues.3 Programs that target screening with flexible sigmoidoscopy, colposcopy, and clinical breast exams, can help downstage the presentation of solid tumors. This has been demonstrated in countries such as the Philippines, Indonesia, and Malaysia where routine mammography for breast cancer does not exist.
The other potential focus of international intervention in LMICs relates to end-of-life care. It is estimated that of the 20 million people needing palliative care at the end of life, approximately 80% live in LMICs.4 This is in large part due to the heightened cancer mortality rates (72% to 75%) in these countries.5
While everyone cannot spend weeks or months volunteering overseas, other efforts can be considered. Major cancer centers can “adopt” a hospital in an LMIC, where monthly teleconferences take place or patient care discussions are done via Skype. Fundraising efforts by ONS local chapters can identify basic equipment needs, dressings, and other materials to send yearly to an oncology nursing cohort in an LMIC. We also can solicit community engagement by asking for translation help in providing teaching materials to foreign nurses about the specifics of oncology nursing practice.
The burden of cancer is increasing worldwide.6 Do those of us who have benefited from the availability of formal and continued education, who have access to mentors, and can nurse in an environment free from overwhelming health hazards, have a responsibility to share our wealth of experience with colleagues who do not have these resources? I think we do.
- Callaghan M, Ford N, Schneider H. (2010). A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health, Mar 31;8:8.
- World Health Organization: Cancer. (2015). Cancer Fact Sheet.
- Challinor JM, Galassi AL, Al-Ruzzieh MA, et al. (2016). Nursing’s Potential to Address the Growing Cancer Burden in Low- and Middle-Income Countries. Journal Global Oncology.
- World Health Organization. (2013). Strengthening of palliative care as a component of integrated treatment throughout the life course.
- Farmer P, Frenk J, Knaul FM, et al. (2010). Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet, Oct 2;376(9747):1186-93.
- Fitzmaurice C, Dicker D, Pain A, et al. (2015). The Global Burden of Cancer 2013. JAMA Oncol, Jul;1(4):505-27.