Recognising the essential role of clinical research nurses

A huge part of the success of clinical research is the relationship between participating patients and the clinical research nurses who look after them during their treatment journey. And yet, their role often goes uncelebrated.

Clinical research nurses are at the heart of delivering vital research, helping patients access the fruits of scientific discovery, spotting opportunities for change and innovation, and ultimately improving the care and outcomes of people affected by cancer.

We spoke to Rosie and this year’s Excellence in Cancer Research Nursing Award finalists about their work.

2021 Winner of Excellence in Cancer Research Nursing RCN Nursing Award – Rosie Lomas and the Early Phase Clinical Team

Rosie is a research nurse at the Early Phase Clinical Trials Unit, Centre and Haematology Centre, Churchill Hospital, part of Oxford University Hospitals NHS Foundation Trust.

 Rosie and the team developed and introduced a mental wellbeing assessment for patients at the Early Phase Clinical Trials Unit in Oxford.

When I helped start this project, I did some reading around palliative care for patients on early phase trials and found there was very little literature available, even less so from a nurse’s perspective. It’s an area that hasn’t been fully explored; those on early phase trials experience a worse symptom burden than other cancer patients, and so it’s essential that all forms of support are easily accessible.

We now complete a thorough and holistic assessment at the screening stage which gives us a clear baseline and most importantly, helps build a relationship between nurses and patients that is open and supportive. We want our patients to know that they can talk to us about their fears, worries or issues and that we have options for them – they aren’t just a ‘guinea pig’ for treatment.

In the future, I would like to help develop a pathway or policy that could be used more widely within the early phase network – and part of that is understanding more about how other sites are managing palliative care support. We’ve seen that with the earlier introduction and support of palliative care, our patients’ symptoms are addressed more effectively – and there’s evidence to suggest this could help with adherence to treatment which may allow patients to stay on the trial for longer.

In addition, our research nurses are confident they have the support of the wider team for help with alleviating symptoms, which in turn helps to instigate difficult conversations. Altogether, I feel this really improves our treatment of the patients in the Early Phase Clinical Trials Unit in Oxford and could be adapted to other sites.

Highly Commended – Irene Debiram-Beecham

Irene led on the rapid clinical implementation of the Cytosponge test.

Irene is principal research nurse at the CRUK Cambridge Centre.

At the height of COVID-19, patients were not being seen for routine gastroscopy and hence there was quite a backlog of patients with reflux symptoms not receiving any endoscopic investigations.

Rapid implementation of the Cytosponge test was a good choice for this group of patients. Its low aerosol generation combined with the fact it only requires one person to do the procedure (compared with endoscopy) meant it could be done in an outpatient room with good ventilation. Since most endoscopy suites had reduced the number of procedures being carried out, it also meant that these nurses were available to take on a new skill.

As part of this initiative I provided a new robust training programme for nurses, clinicians and health care professionals across the UK. Having developed a system to sign them off as competent to carry out the procedure, I also provided a 24-hour support service for my colleagues if they had any questions.

As a research nurse, it makes me proud to see that something I have been working on for many years has finally made it into clinical practice. The Cytosponge test will help us improve the pathway for patients being referred for gastroscopy, and we are keen to make it as accessible as possible. I am currently working on delivering the test in a mobile unit as a part of the DELTA trial and patients seem to favour this as it is more convenient and less daunting than coming to the hospital.

We need to bring trials to the patients, and we may find that we get better uptake if we have walk in centres or strategically placed venues where it is convenient for patients to attend. It could also increase interest in research and the early adoption of new technology. We need to reach out to different socio-economic and ethnic groups to encourage and educate them on why research is so important. We also need to reach out to rural communities so that we get better uptake from this cohort – mobile units could help here.

Overall, I think the role of nurses will evolve and they will play a bigger part in health education and running clinics autonomously as part of mobile units or walk in centres. Nurses are starting to lead and shape research as well as to facilitate it.

Tracey Camburn, Lucy Willsher and the oncology research team at Broomfield Hospital

Tracey is lead research nurse and Lucy (pictured) is an oncology research nurse at Broomfield Hospital, part of Mid and South Essex NHS Foundation Trust.

The team took on the delivery of a chemotherapy research trial for patients diagnosed with mesothelioma after it was suspended due to the pandemic.

The continuation of this trial has allowed patients with mesothelioma to receive treatment that they wouldn’t have otherwise had access to during the pandemic.

There were several challenges, including the need to relocate the service so treatment could be administered in a COVID-secure way. But we’ve successfully managed to recruit the same number of patients in a year that would usually be recruited in a three-year period. We’ve learnt so much through adapting to different clinical environments and ensuring immuno-compromised patients were protected.

The early detection of mesothelioma has been challenging as some of the symptoms are similar to the COVID-19 virus. Awareness of mesothelioma, further education and training, and screening could potentially help people to recognise symptoms earlier. The research nurse role is often about education and our team is spending more of time updating and educating our colleagues on the research we do.

We have also been involved in the SYMPLIFY trial which assesses the Galleri multi-cancer detection blood test, a potential game-changer for diagnosing cancer. We’ve become the biggest recruiter for this trial in the UK thanks to a coordinated approach.

Evelyn Dolan and the research nursing team at The Christie

Evelyn is a CRUK senior research nurse and lead research nurse at The Christie NHS Foundation Trust.

The team ensured continued patient access to several complex cancer trials during the pandemic.

Although the difficult decision was taken to pause all trial recruitment at the start of the pandemic, our research nurses were instrumental in re-opening cancer trials in a very short space of time.

Through the hard work of the whole team, all recruiting studies were back up and running by April 2020 and this meant everything to those patients. The team’s efforts in providing safe access to hospital and essential support for patients has been critical.

Alongside setting up and delivering COVID-19 studies, we also increased access to the national physiological impact of COVID-19 study and supported another local hospital with its COVID-19 vaccine research. We also worked hard to deliver ground-breaking advanced therapy medicinal product (ATMP) trials, with the Advanced Immune and Cell Therapy Team recruiting and treating the first patient from Europe to a particularly complex CAR-T study.

I am so proud to be a research nurse, and proud to work at The Christie with such an amazing group of research nurses and practitioners. The pandemic has highlighted the importance of research and brought the role of the research workforce to the forefront. Every single research nurse works tirelessly as part of their team, across the organisation and as individuals, because we are all passionate about ensuring our patients have every possible opportunity to access world-class research trials.

Biruk Asfaw and the haematology research team at Queen Elizabeth Hospital Birmingham

Biruk is a senior research nurse at the Queen Elizabeth Hospital in Birmingham

The team created a blueprint for effectively and safely operating trials in the face of future restrictions.

Having introduced a number of new initiatives including home delivery of trial medication, remote consultation and remote source data verification, our team became more efficient.

During the pandemic, we took swift action and opened trials where hospital attendance could be reduced, that were in the patients’ best interests and, wherever possible, didn’t place further pressure on staff and services.

One such trial was a CAR T-cell therapy trial providing a potentially life-saving novel treatment that wasn’t yet available on the NHS. There were many challenges to overcome along the way, but the trust shown by our patients has been something else. These are patients who have been diagnosed and have exhausted all treatment avenues. We were privileged to be able comfort them and offer them the opportunity to take part in a trial despite the fact it may not provide any direct benefit.

Patients have commented that we allowed them to spend Christmas with their family and that we looked after them when their life was turned upside down. We just think we’re doing our day jobs to the best of our abilities, but there is nothing more satisfying than hearing comments like this from patients and their families.