Over the past decade, reference to "translational research" has increasingly dominated our research semantic. There are multiple definitions of translational research, but the most commonly understood is the transfer of biomedical knowledge from bench to clinical trial and from clinical trial to bedside as a component of usual care.1 Translational research, conceptualized as a series of distinct stages (T1 through to T5),2 reflects a continuum from development of knowledge in the basic sciences, to clinical testing of new treatments and their implementation into everyday practice and healthcare policy.2

Global policy and position statements on the imperative of translational research in a cancer context are all but silent on the potential and contribution of nursing.3-6 As an international community of cancer nurse clinicians, researchers, educators, and leaders, it is our collective responsibility to redress this omission. Below, the ways in which cancer nurses can, and already do, contribute to knowledge translation are considered.

Cancer Nurses Across the Translational Research Continuum

Nurses have long been a tour de force for translation. Since the earliest clinical trials, nurses have been the vehicle by which new therapies enter practice, from coordination and implementation of clinical trials to translating the voice and experience of our patients back into fragmented healthcare systems. The review of Salman et al7 of barriers to minorities' participation in cancer clinical trials demonstrates the potential of nursing to ensure that new knowledge generated through trials can be translated with confidence to broad groups across society.

Cancer Nurses as Critical Success Factors in the Genomic Revolution

With almost a quarter of the new, targeted anticancer agents in the pipeline proposed to be oral agents, their arrival into our healthcare centers will demand the construction of new models of care and a massive investment in the enablement of patient self-management. In their analysis of nursing implications of personalized and precision medicine, Vorderstrasse and colleagues8 demonstrate the requirement for advanced knowledge acquisition to ensure that nurses take their place as leaders of excellent patient care in the genomic revolution. Maximizing readiness of the system through early engagement of cancer nurses and cancer nurse researchers will secure excellent return on investment for these phenomenal therapies.

Cancer Nurses: The Essence of Excellent Cancer Care

Innovations in chemotherapy, surgery, and radiation therapy deliver new opportunity and challenges to our patients and health systems daily. What are the needs of patients, previously ineligible for radiation therapy because of the limits of technological precision, now eligible as a result of image-guided or stereotactic radiation therapy? What are the needs of patients previously ineligible for surgery because of the extent or location of tumor infiltration, now eligible for surgery because of advances in surgical robotics? As demonstrated in a randomized controlled trial of an evidence-based nursing path for improving the quality of care of pediatric neuroblastoma patients,9 nurses are critical to closing translational research gaps3 and to delivering data on the value, benefit, and impact of innovations in care.

Cancer Nurses: Using What We Already Know

Perhaps one of the greatest opportunities and requirements of cancer nurses in the translational research agenda is to turn our attention to the vast amounts of unused evidence available in patient care. Approximately 40% of cancer patients do not receive adequate pain relief10; at least 60% report debilitating fatigue11; 70% to 80% experience nausea12; 60% to 70% experience opioid-induced constipation13; and approximately 40% report significant distress.14 There are many examples of the benefits to patients and the health system when nurses embrace evidence. For example, implementation of an evidence-based nurse practitioner-led service was shown to deliver reduced rates of hospitalization, chemotherapy dose deviations, and increased chemotherapy completion in patients receiving intensive chemo-radiotherapy for oropharyngeal cancer.16 Investment in implementation science is one of the single most important contributions that nurses can make to the translational research agenda.

Cancer Nurses, Translation, Advocacy, and Equity

Cancer nurses are ideally situated to seek out and understand the requirements of the disadvantaged across all domains of healthcare, enabling us to target our translational efforts to those with greatest need. With greater numbers of patients presenting with ever increasing complexity, actively seeking out those at risk of suboptimal outcomes is essential. The work of Downing et al17 powerfully demonstrates the achievements of nurse-led evidence translation to address disparity and inequity.

Cancer nurses have a critical role to play in the translational research agenda. We need to elevate our voices if we are to robustly demonstrate our contribution to the vision and intent of the translational research movement-to transform human health. How will you use your voice?

- Mei Krishnasamy, PhD, MSc, DipN, BA, RN

Department of Nursing

School of Health Sciences

University of Melbourne and

Cancer Experiences Research Group,

Peter MacCallum Cancer Centre, Melbourne

- Raymond J. Chan, PhD, MAppSc (Research), BN, RN, FACN

Cancer Nursing Professorial Precinct

Queensland University of Technology and

Royal Brisbane and Women's Hospital Brisbane,

Queensland, Australia

References