Prevention through health education and immunisation
Esther Green – International Society of Nurses in Cancer Care
There are whole issues about cancer and one of them is that you don’t really need to get it, Esther, what’s your take on this?
I think that there are many, many strategies that we have been putting into place that we need to really increase internationally, everywhere around the world, around prevention. What I mean by that is good health education, health education, health promotion strategies, working with the population about what healthy lifestyle is about, what healthy eating is about, good management, not abusive alcohol, abusive drugs, because we know all of those issues, alcohol abuse, for example, obesity, lifestyle issues, are related to many chronic diseases, cancer being one of them.
But industry and government are not listening to you, are they?
No, they’re not and the reason is because nobody in government sees more than a four year period of time where they can make a difference. However, I’d have to say many governments around the world now are taking tobacco cessation, tobacco control, very seriously and I’m sure, Peter, when you’ve travelled you’ve noticed no smoking in hotels, no smoking in restaurants and that’s part of the issue, right?
Now, North America has been a trail-blazer in discouraging people from smoking, that has been fantastic. But meanwhile the fast food industry is unharmed, unchecked.
That’s our next ploy that we need to really focus in on is the fast food industry. I’d say that there have been some gains in the developed countries but where we also need to make some gains is in the developing countries because what have we done? We’ve shifted tobacco into developing countries because, my gosh, it’s easy for them to find the cigarettes to smoke with. We’ve shifted some of the McDonalds etc, into some of the developing countries, it’s easy, it’s cheap and fresh fruit, fresh vegetables, fresh meat etc are not cheap for us to buy.
And salt and sugar are not illegal.
Exactly, and I’m not sure that we want to make them illegal but we certainly want to educate the public in more ways about what the consumption needs to be.
I want to ask you about what cancer clinicians should be doing because it must be difficult for them to get involved. But first, could I ask you about the definite messages that we know about, because smoking is a clear one with a good many cancers but food is implicated in a huge number of cancers. Then there is also the issue of exercise, isn’t there, so what are the clear messages that we can get over and then I want to ask you about how cancer clinicians can get involved.
Working with our partners in public health, working with our partners in primary care about the messages that need to be given to patients and frankly the whole public, messaging with media, for example, about what the influences are of alcohol, overuse of tobacco, tobacco cessation etc and so on. One of the things that the International Society of Nurses in Cancer Care has been doing is seeking funding for grants so that we can go in and work with member societies in countries such as China and elsewhere around smoking cessation teaching for cancer nurses. And I think that that’s a fantastic initiative, obviously I’m biased but it’s a fantastic initiative because we’ve got nurses engaged in prevention which is an essential element.
So you can get clinicians, nurses, doctors involved in actually implementing it in the community, that must be difficult in the family, in the school, for instance?
Not at all. If you reach children early enough you influence them around no smoking and how bad it is, how harmful it is. What they’re then able to do is go home and say to mummy and daddy, “Please stop smoking, this is the harms of it.” So they’re influencing their parents which is fantastic. I know that in North America, for example, we’ve got many restricted laws around where you can smoke and so on, having travelled in several parts of the world I can see the influences of governments elsewhere that have done exactly the same thing. So we’re getting that message out.
If you get screened, though, there is a wide belief that you don’t need to worry about much of this prevention. What about the balance between screening and prevention?
I’d like to say a little bit more about what screening does. The idea here is to detect something early enough that you’re going to have good outcomes when treated, so for breast cancer, for example. We also know that breast cancer rates are very high in some of the developing countries, why is that? What good health measures do we need to put into place with women around good health knowledge of the breast, knowledge of self-examination etc. So that’s one issue; the second issue is that we also know that there are some infections that ultimately lead to cancers. So stomach cancers with H. pylori, what is it that we can do to influence good healthy eating etc. We don’t have a screening methodology for stomach cancer at the moment but we do for cervical cancer, breast cancer I’ve already mentioned, and colorectal cancer. So if we’ve got those three, are we using them? Are those screening methodologies available in all of the developing countries? And the answer is not yet and that’s problematic because then men and women get cancer, it’s advanced cancer and well beyond good treatment methodologies but not good palliation methodologies and that’s important. So we really want to shift the focus from just treating because they’ve got advanced cancers to trying to detect early on.
And of course in something like cervical cancer there’s tremendous scope for eliminating it virtually with vaccines and also screening. That’s a place where clinicians can really get involved.
Absolutely. Good immunisation, Hep B for example, Hepatitis immunisation early on, what are the numbers of liver cancers that can be prevented with good immunisation? You’ve mentioned HPV immunisation, how is that being unfolded around the world? In some areas very well, in others it hasn’t even started.
Now, there’s a psychological dimension to all of this because effectively implementing prevention screening is really a psychological issue and your International Society of Nurses in Cancer Care is having a big meeting in September, tell me what sorts of things you’ll be raising and what are the answers to some of these questions?
We always have sessions with respect to supportive care and how important it is to treat the whole person, Peter. The whole person means absolutely treating their tumour but treating their emotional needs, their financial needs; giving them advice in terms of how some drugs might be funded for them; giving them advice in terms of returning to work after the treatment is completed; making sure they’ve got good palliative care with appropriate methodologies to be able to do that. Having cancer has an impact not only on the person’s emotion but also on their family members and friends. So it’s really important to say, “What is it that we can do as nurses to really support you through this journey and how can we help you to manage it better?”
And what can you do because clearly if people can live with their cancer and have joy, that’s a great thing, how can the nurses help?
I’ve found in my own work that often patients focus on the treatment modalities. It’s really important to get through the treatment but what they forget about is what the impact is on them psychologically. In fact I have one extremely interesting case where I’ve talked to a gentleman, like yourself and probably of the same age, who said, “Esther, I woke up one morning and I realised what had happened to me and I hadn’t paid any attention to what that meant to me as an individual and I felt I just had this black cloud hanging over my head because I hadn’t paid any attention to how I was really feeling, how stressful it was, how afraid I was that I was going to die.” And if we don’t do something about that early on in the treatment process, then we’re going to end up with patients, with individuals who have great emotional strain as a result.
And you’re saying, reassuringly, that the cancer carers and nurses can help.
Absolutely and that’s what I mean by whole person care.
Well Esther, thank you very much indeed.
Thank you very much, Peter.