Cancer is predominantly a disease of the older person: there are currently 1.3 million older people living with cancer in the UK.1 Overall, they report a positive experience of their cancer treatment and care.2
There is compelling evidence that older people with cancer have specific nursing needs3 that may not all be addressed by the generalist or specialist workforce. This remains a central problem for the design and delivery of cancer services; however, increasing emphasis upon person-centred approaches to care would seem to offer a means of addressing this problem.
Nursing care in the general setting
The majority of older people with cancer in the UK are cared for by nurses in general settings such as acute hospital wards, care homes and the community who do not necessarily have any specialist knowledge or training.4,5 The complexity of care in the general settings can be marked:6 Corner7 identified the need for advanced communication skills together with specific theoretical and practical knowledge of cancer. Yet there is evidence that these needs are often inadequately met,8-10 and nurses themselves concede that there is a requirement for ongoing professional development in treating and caring for older people with cancer.11 Meeting the educational and developmental needs of these nurses arguably represents the greatest contemporary challenge to the oncology nursing community.
Nurses working in specialist oncology settings
Specialist cancer care in the UK is provided by multiple professional teams in cancer units and cancer centres, or by specialist cancer services in the community. Nurses are required, as a minimum, to have an understanding of cancer and its treatment as well as skills in assessment, communication and care delivery. Whilst evidence suggests that the experience of older people is largely positive and they report confidence in their ward nurses,2 there are circumstances where nurses appear poorly equipped to respond to the wider health needs of older people.12
Person-centred approaches reflect changes in nursing practice and are consistent with the observation by Macmillan Cancer Support that older people are not a homogenous group,1 which was in response to the demonstration by Esbensen et al.13 of a wide variation in patterns of change in the functional ability of older people throughout their cancer experience.
Nursing the person with cancer
The nursing care of people with cancer can be stressful, challenging and emotionally demanding.7 The Nursing and Midwifery Council acknowledges that the same is true of the care of older people and emphasizes the importance of:
People (focusing on nursing competence, motivation and values).
Process (highlighting respect, teamwork, communication and assessment).
Place (appropriateness of place of care and resources, underlining a commitment to equality and ...