The changing landscape of cancer research nursing

Research nurses play a unique role in cancer research, how is the work you undertake changing?

As a research nurse within cancer services the role has changed considerably, partly as in consequence of the COVID-19 pandemic and the changing nature of clinical trial delivery. During this time, research departments and research nurses had to look at methods of supporting social distancing regulations to ensure patient safety and to continue access to clinical trials during a catastrophic period for the NHS.

Many cancer research nurses during that period utilised technology and adopted clinical trial delivery along with GP practices and district nursing services.

One of the main changes was to adopt technology allowing patients to continue communicating and offering a different way of considering a clinical trial participation through online discussion and electronic consent. These practices evolved entirely as a consequence of the pandemic – and now research nurses can be more aware of how to improve access to clinical trials through the use of technology.

As clinic trials become more complex, in terms of trial design and the science behind the treatments being tested, I’ve seen a rise in the need for further educational resources that demystify the basic concepts to support patients make an informed decision. Within cancer research this can often be a life changing decision, patients may be giving up precious time to take part in clinical trial.

As a consequence research nurses play a more critical role than ever before in demystifying complex clinical trials into the patient friendly language. This allows patients and their loved ones to understand what taking part in a clinical trial may involve.

Within cancer research, nurses are more involved in holistically supporting patients to manage their own health if they decide to take part in a trial, and look at innovative ways of supporting patients to keep them physically and mentally healthier for longer.

It’s a role that really is the front line of patient contact for clinical trials – what would you like cancer researchers not hugely familiar with research nurses, or maybe even clinical trials, to know about the business end of getting drugs into patients?

In my view the cancer patients that take part in clinical trials are incredible. They give up what precious time they have to take part, knowing that in many cases they may have no benefit to them.

Patients who I’ve looked after often describe early phase trials as hope where there was none. Without cancer patient involvement in clinical trials, we simply wouldn’t be able to develop any new future treatments for cancer patients.

So, it’s absolutely critical that when patients take part in these trials we ensure trials are done in the safest manner. And ensure their journey within a clinical trial is the best it can be. Research nurses are specialists in their field, and are key in coordinating the care of patients taking part in a clinical trial. They balance the holistic needs of them patient, with the requirements of the trial protocol.

I think it’s critically important as well to say that as the rates of cancer are still high within the UK, there’s simply aren’t enough clinical trials open to offer every cancer patient the opportunity to take part in one.

Networking with others seems so important for the delivery of clinical trials – how do you think that could be improved?

Networking is incredibly important within cancer research and when developing the delivery of clinical trials… we just need to do it more.

A great example of this is the Senior Research Nurse network that Cancer Research UK funds, and the Experimental Cancer Research Nurse steering group.

In essence these networks work together, sharing best practise to improve cancer patients entire clinical trial journey; from being initially considered for a clinical trial, receiving an experimental treatment, to coming off trial.

This networked work stream includes nationally linked nurse-led research and service evaluation projects aiming to ensure cancer patients within clinical trials are physically and psychologically supported.

Currently the CRUK Senior Research Nurse network is working on a service evaluation project looking at patients’ comprehension of what clinical trials are. Through this evaluation we have been able to identify gaps in the education delivered within the NHS. This is key to the informed consent process within clinical trial and this work, once it’s completed, will lead onto the development of a national educational intervention program.

Delivering trials during the Covid pandemic was of course an immense challenge – have things got back to pre-pandemic levels, and what are the big challenges currently?

When the COVID-19 pandemic was first recognised in the UK in March 2020, the Medicines and Healthcare products Regulatory Agency introduced a temporary halt to non-COVID-19-related clinical trials. During this unprecedented period of health service upheaval, although cancer research nurses could maintain clinical research in some adult and children clinical trial centres, the halt to recruitment generally meant that many patients could not access potentially life-preserving or life-extending treatments.

Cancer research nurses faced many challenges in this period, including providing effective care and managing anxieties related to the pandemic and the safety of patients and staff.

However, many of the changes necessitated by the pandemic, such as remote appointments, electronic (online) consent and trial medicine delivery, are still being utilised today.

Post pandemic, from a personal perspective I have seen an increase the number of patients with advanced cancer being referred for early phase clinical trials. And the biggest challenge is having enough clinical trials open at cancer research centres to be able to offer these patients a clinical trial treatment.

In many cases early phase trials may be the last opportunity for these patients to get access to a treatment for their cancer. Often these patients are referred for discussions around taking part in an early phase clinical trial, when the cancer treatments they get through NHS have stopped working.

What are you excited about in terms of the future of trial delivery?

There are a lot of exciting developments within clinical research, such as utilising technology to improve clinical assess for patients.

Embedding technology within clinical research delivery will allow better access to clinical trials. Crucially, it’ll also allow patients to have online discussions and use electronic consent without leaving their homes. As well as being more environmentally friendly this also allows friends or family members from anywhere in the world to be part of those discussions and support loved ones, which I personally think dramatically improves the informed consent process.

Additionally, reducing patient visits has the potential to make trials more accessible for patients and reduce travel times and costs. From a clinical trial management point of view, technology will also allow clinical sponsors to monitor how a clinical trial to running remotely.

Patient and public involvement within cancer research is prioritised now more than ever. Having patients involved in shaping how clinical trials are designed and delivered will ensure future clinical trial designs are patient centric.

There is also a huge amount of work going to supporting research nurses to lead on their own research, which in terms of progressing the role of a research nurse is incredibly exiting.

As we start to make new developments in the use of artificial intelligence and other emerging technologies it will be really exciting to see how these innovations can improve trial delivery, patient recruitment and ultimately improve outcomes for patients.