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  1. Yarbro, Connie Henke R.N., M.S., F.A.A.N.

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Anniversaries are cause for celebration. This year, 1998, marks several anniversaries important to us. Israel celebrates 50 years of statehood. The World Health Organization celebrates its 50th anniversary, and the International Society of Nurses in Cancer Care (ISNCC) celebrates the 10th anniversary of the International Conference on Cancer Nursing. As cancer nurses, we have much to celebrate. Every two years we gather to review the remarkable progress made in cancer nursing and cancer care. The International Conference on Cancer Nursing has provided a stage from which cancer nurses can describe what we do. As a part of this anniversary celebration, I would like to take you back to the first international cancer nursing conference and reflect on what cancer nurses reported 20 years ago.


In London in 1978, under the leadership and organization of Robert Tiffany, the first International Conference on Cancer Nursing was held with sponsorship by the Nursing Mirror and the Royal Marsden Hospital. This conference focused on nursing roles in caring for patients with cancer.


Twelve hundred nurses from 20 countries arrived in London to hear about developments in cancer treatment and nursing care. It was a time when technology in health care was exploding. Radiation therapy and extensive surgery such as radical mastectomy were the norm. Our armamentarium of chemotherapy agents was far more limited than it is today. At that time, the number of drugs under investigation was expanding on a daily basis, and combination drug regimens were being used more frequently. Curing the child with acute lymphocytic leukemia was the scientific breakthrough of that decade.


Drugs were reconstituted and administered by nurses and the management of chemotherapy side effects was a trial and error process. For nausea and vomiting, if one antiemetic did not work, another was tried. Combination antiemetic regimens were unheard of. Patient education materials were uncommon or nonexistent. Considerable time was spent by nurses with patients and families in overcoming the myths associated with cancer.


Many nurses around the world were caring for cancer patients who were not told their diagnosis because it was still a taboo topic in their countries. Cancer was still the most dreaded of all diseases, and most people thought it was rarely, if ever, curable and largely unavoidable.


Cancer nursing as a specialty was being debated in 1978. The nursing profession was concerned with educational preparation and about who we were and what we should be doing. However, changes in nursing practice and scientific advances were beginning to expand and extend nurses' roles. There was a critical need to provide expert, technically complex nursing care at a time when technology in health care was rapidly advancing. Thus the role of the clinical nurse specialist was developing.


In the proceedings of that first conference 20 years ago Robert Tiffany (1) wrote:


For too long we have witnessed an apparent dichotomy of interests between the nurse practitioner and nurses in supporting roles. I believe that nurses are willing to relook at their role and function. I also believe that for the provision of excellence in nursing care, we need a well-prepared clinical nurse supported by her colleagues in nursing research, education, and management. When this collaborative spirit exists, planning the delivery of nursing care becomes an integral part of the function of each discipline. (p. 23)


Robert Tiffany captured the essence of our first conference because nurses shared their experience in caring for cancer patients, hospice patients, and the dying. Unique nursing roles were highlighted throughout the week of the conference. For example, Linda White (2) talked about the extended role of nurses in diagnostic services and how nurses could participate in cancer prevention no matter what their setting and location in the world. Patricia Greene (3) shared her experience as a nurse practitioner, portraying what that role provided in the care of children with cancer. In the closing address, Vernice Ferguson (4) left the attendees with the theme "On Becoming":


On becoming reminds us that we have not yet reached that perfect state, and that is good.... We are always in the process of becoming-becoming wiser, becoming excellent as we translate that knowledge into a consistently dynamic and responsive nursing practice.


Nurses left that conference with hopes and visions of taking home the knowledge they learned and improving their care of the cancer patient.


In 1980, the Second International Conference on Cancer Nursing, again held in London, provided an update on cancer nursing. More than 60 speakers representing the viewpoints of many nations delivered papers on general and specific problems related to cancer care. An awareness of the different needs of patients in different environmental, political, social, and economic settings was emphasized. Indeed, oncology nursing, becoming well established as a specialty, was developing an international perspective. This conference was closed by Paula Pinkington (5), who urged us to develop professional excellence and move forward with our goals.


After this conference the sponsors held a two-day meeting, attended by 21 people representing international cancer nursing interests, to discuss plans for future conferences. The decision was made to conduct an International Conference every two years beginning in 1984 (6). That decision ensured our continuing journies to future conferences.


In 1984 we traveled to Melbourne, Australia, where 900 nurses from 25 countries heard presentations about cancer nursing in the 1980s and held discussions on our future course. On the closing day of the conference, I noted that we had passed through the period of becoming, through the period of being, and were now "coming of age." "And, as we come of age, let us continue the communication made possible by these International Cancer Nursing Conferences. Let us link together the whole world" (7).


The Fourth International Conference on Cancer Nursing in New York was dedicated to the theme of "An International Perspective." This was a timely theme because the International Society of Nurses in Cancer Care had been launched in 1983 in response to the need to facilitate the dissemination of information on developments in cancer nursing throughout the world (8).


For the fifth conference, we traveled to London with the theme of "A Revolution in Cancer Care." It was a fitting theme for that conference because cancer nursing had indeed undergone a revolution since 1978. We were honored at a Service of Thanksgiving at Westminster Abbey for the Development of Cancer Nursing. This was symbolic of our international recognition as a nursing specialty that was influencing cancer care.


In 1990, we opened the new decade in Amsterdam with presentations that reflected initiatives across the entire spectrum of cancer care. Our theme was "The Balance." Many of us in attendance will long remember the group from the Republic of South Africa, who demonstrated the role of song and dance in cancer education in Africa and the debates on nurses responsibilities to assess symptoms and the role for euthanasia in cancer care (9).


"Changing Frontiers" was the theme of the Seventh International Conference on Cancer Nursing held in Vienna Austria, where we heard about what cancer nurses were doing around the world (10). The Eighth conference was held in Vancouver, where nurses spent a week sharing their worlds. More than 450 nurses offered either paper or poster presentations revealing the continued growth of our specialty (11). In 1996, we were brought back together in England to face the issues of cancer care in the next century with the theme "Creating Our Future."


This long journey has brought us to the Tenth International Conference on Cancer Nursing and the appropriate theme of "Cancer Nursing: Hope and Vision." As I perused the proceedings of these past conferences, the words hope and vision predominated throughout. These themes from past conferences are not just words (Table 1). They are the dynamic representation of change showing us the visions of our predecessors. Thus this present conference carries on our hopes and visions for the future.

Table 1 - Click to enlarge in new windowTABLE 1. International conferences on cancer nursing

Hope is the wish for something with the expectation of its fulfillment. Hope embodies confidence and trust. Nurses give hope to patients with cancer just by being with them, by taking time to talk to them, by being positive, honest, and compassionate (12). Oncology nurses do make a difference.


It was my privilege to review the travel scholarship applications submitted for this conference from nurses from developing countries around the world. How wonderful it would have been if all of them could have been here with us today. Let me share with you some of their comments:


One applicant said: "The patient has to deal with a disorder for which so much has been done in the international scene, but so little is known about it in my country, even among health professionals." Another nurse wrote: "I hope to learn more about prevention, treatment, and care, to learn how to provide information to nurses and patients, to discover how nurses in other countries communicate with nurses and other health care workers." Another nurse shared her hope by writing: "What I need is more knowledge and more power. The knowledge I get with your help, and power partially with your help and partially with my willingness to act for improvement." These nurses shared their hopes. And from these hopes spring the visions for a better world.


Vision is intelligent foresight, a mental image produced by our imagination. How appropriate that hope and vision are used together in the theme of this conference. O.S. Marden (13) said "There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow."


Visions are our hopes for the future. We all have visions and dreams. I had the honor of presenting the Robert Tiffany Lectureship last year at the Royal Marsden Hospital, where I discussed visions of our preferred future (14). We have visions about our organizations, personal visions, professional visions, and visions about the quality of care our patients deserve. Our visions will lead us to our preferred future. The World Health Organization envisions Health for All in the 21st Century. The vision of the Oncology Nursing Society is to lead the transformation of cancer care. Visions of the ISNCC are to reach and interact with all cancer nurses, to serve as a voice for cancer nurses worldwide, and to position the ISNCC as a worldwide leader in cancer nursing. We are moving forward to meet these visions.


The International Society of Nurses in Cancer Care is evaluating ways to reach and support our membership better throughout the world. The bylaws committee has evaluated our constitution to discover how we can better meet the future needs of the Society. These recommendations will be presented at the membership meeting. The ISNCC is working to become the voice of cancer nurses worldwide. Position statements on tobacco and pain will soon be released to make our voice influential on these important matters.


We are positioning the ISNCC as a worldwide leader in cancer nursing. A task force has been established to revise the Core Curriculum for a Postbasic Course in Palliative Nursing. This important document prepared by the Society in 1981 and approved by the World Health Organization (WHO) and the International Council of Nurses (ICN) will be revised so it has a much greater impact from a global perspective.


Research is another way we are positioning ourselves as a worldwide leader in cancer nursing. I am pleased to announce that the ISNCC will be offering its first research grants. Thanks to the generous support of Bristol Myers Squibb, two $5,000 grants will be available. The newly established research committee will be developing the guidelines and submission details for these grant requests. Lucille Joel (15), first vice president of ICN noted that "Research may prove to be the tie that binds the international world of nursing." The specialty of cancer nursing needs to be revitalized constantly by the infusion of new information generated by research, and this is being accomplished in many countries. However we have the responsibility to look at how we can expand cancer nursing research to multinational studies.


We are living in times of chaos, political unrest, and change. The challenges confronting nurses are numerous. There has been progress in our war against cancer. More than 20 million persons with cancer survive 5 years after diagnosis (16). We now have the first drug to prevent breast cancer among women at high risk for the disease. New findings about genetic defects are guiding the development of new treatments and methods for prevention and detection. Our high technology is capable of sophisticated approaches to cancer.


However, from an international perspective, what does all this mean for countries with limited resources? Moreover, the number of new cases of cancer will double in developing countries during the next 25 years. How can we help our colleagues in these countries where there is a limited understanding of cancer, where preventive measures do not exist, and where treatment and supportive care are inadequate? How can we support our colleagues, who may not have a strong voice in their health care systems, to deliver the quality of care they desire to give? What can we do that will contribute the most and cost the least?


If I had to identify one problem that I would assign top priority, that problem would be tobacco. The twentieth century has been the cigarette century with a tremendous surge in smoking, and the increase in lung cancer deaths corresponds with the surge in smoking. Tobacco causes at least 3 million deaths each year, primarily from lung cancer. Nothing kills like tobacco. Smoking was once a problem of developed countries. Now it is a worldwide problem and growing worse every day.


When I lectured in China, every public place was packed with smokers. The paradox is that when a developing nation increases its economic well-being, one of the first things people do with their new money is buy cigarettes. "We have an obligation to all the people of the world to see that this murderous plant developed in the New World by settlers from Europe is not allowed to wreak the havoc in the developing countries that it has already produced in the developed world" (14). If you smoke, the most important, the most caring thing you can do for your patients and your potential patients is to stop smoking.


From all across the globe we have come here to Jerusalem to celebrate our achievements, to strengthen our resolve to meet new challenges, and to discuss our hopes and visions for cancer nursing and the care we provide to cancer patients. Our hosts and the scientific planning committee have prepared a week that will provide us the opportunity to share our visions and hopes. The plenary and parallel sessions will provide us with the knowledge and power we can take back home to our practices. We will discover new ways to communicate the needs of our patients to health care delivery systems. We will learn better ways to help each other help patients. May you be energized this week by the information you will learn and return home with your hopes and visions for cancer nursing and care and share these with your colleagues. In doing so, you spread the voice of cancer nurses worldwide, and you move forward our visions and hopes for the future.




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