As a program director at the National Cancer Institute, I manage a portfolio of grants focused on the supportive care needs (symptom management, palliative care, and end-of-life care) of patients and their families undergoing treatment. The scientists who lead this laudable area of research represent a variety of disciplines, such as nursing, medicine, psychology, social work, and the basic sciences. I am often asked by nonnurse scientists, "What is cancer nursing research?" I've not had a ready answer, and the invitation to write this editorial affords me the opportunity to reflect further on the topic. As I searched for a precise definition, I pursued a number of avenues, such as the Merriam-Webster dictionary (http://www.meriam-webster.com), Googling the phrase, seeking information about PhD programs in nursing at various academic Web sites, perusing the National Institute of Nursing Research Web site (http://www.ninr.nih.gov/), and, lastly, examining the work of the nurse and nonnurse scientists in my portfolio and in the literature.
As anticipated, the dictionary yielded nothing, but if broken down into separate words, the following is found:
Nursing: "The profession of a nurse[horizontal ellipsis]" "[horizontal ellipsis]providing care for the sick and infirm[horizontal ellipsis]"
Research: "Investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws"
Cancer nurses would agree the definition of a nurse is quite narrow, and most would likely agree the definition of research is quite broad. By combining the 2 words, the definition suggests that nursing research is aimed at informing our practice to which we all would agree. This leads to more questions. Can cancer nursing research inform the practices of other disciplines? Is cancer nursing research only the domain of nurse scientists? And, finally, what are some specific examples of cancer nursing research?
Chasing the other avenues (except my portfolio and the literature) mentioned above yielded similar results; namely, cancer nursing research is aimed at developing or discovering knowledge to inform nursing practice. Moving on to my portfolio and selected published works of cancer supportive care researchers, I could not identify 1 study that will not ultimately inform nursing practice, as well the practice of most disciplines engaged in improving the lives of patients with cancer and their families. For example, Dr Patrick Mantyh, a basic scientist at the University of Arizona, is conducting an animal study to understand the mechanisms that drive prostate cancer-induced bone pain (R01 CA 157449). How can this information not inform our care? Is it nursing research? Could a nurse scientist lead this or a similar effort in the preclinical arena? To the last question, I say, absolutely! Dr Donna McCarthy, a nurse scientist at Marquette University, has conducted a number of preclinical studies in the area of cancer cachexia,1-6 a debilitating condition for which we have little to offer our patients. The lack of valid and reliable treatments can be attributed to our abysmal understanding of the mechanisms that underlie cancer-related cachexia. Findings from Dr McCarthy's work and that of her colleagues will move us toward evidence-based care for patients experiencing cancer-related cachexia.
Similar results were found when reviewing clinical studies. Dr Monique Cherrier, a neuropsychologist at the University of Washington, just completed a longitudinal study of men with early-stage prostate cancer, undergoing treatment with androgen deprivation therapy to determine the extent of cognitive impairment, as well as changes in mood and quality of life (CA 120933). The same questions from above are posed: how can these data not inform our care, is it nursing research, could a nurse scientist lead a similar effort? To the last question, my answer is the same: absolutely! Dr Catherine Bender, a nurse scientist, is conducting a longitudinal study of women with breast cancer undergoing anastrozole therapy to determine the long-term effects of this agent on cognitive function and whether cognitive function recovers at 1 year after the conclusion of the therapy (CA 107408). As with many other cancer treatment-related morbidities (peripheral neuropathy, mucositis, fatigue), we do not have a thorough understanding of the trajectory of neurocognitive impairment, who is at risk for experiencing it, and which agents are most culpable. There is no question data from both of these studies are needed to inform and improve nursing care of cancer patients experiencing neurocognitive changes.
Based on these examples, one could argue it is less about who is conducting the research and more about what is being researched; hence, the term "cancer nursing research" is misleading and ambiguous. Why is it necessary to insert the discipline in the term? No other area of research does. Is there such a thing as "physician cancer research?"
Perhaps it is a good thing that there is no precise definition for this phrase, as it leaves the world of cancer nursing research wide open to all scientists to discover and interpret facts, revise accepted theories or laws in the light of new facts, or practically apply such new or revised theories or laws (http://www.merriam-webster.com/dictionary/research) and ultimately improve the lives of patients with cancer. Is it time to move away from the imprecise and sometimes confusing phrase, cancer nursing research, and describe our research as multidisciplinary research aimed at improving the lives of cancer patients?
Ann O'Mara, PhD, RN, FAAN
Division of Cancer Prevention
National Cancer Institute, Bethesda, Maryland
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