Gilbert Morgan:
Dear colleagues, welcome to this OncoAlert. VJOncology round table. We will be discussing some of the most exciting research that is being presented at the Oncology Nursing Society's Bridge meeting, which takes place on September 8th, 10th, 15th, and 17th. And of course the European Oncology Nursing Society meeting in September 19th to the 21st happening at the same time as the European Society for Medical Oncology meeting.

Gilbert Morgan:
Before I begin, I would like to introduce today's discussants, some amazing oncology nurses and researchers from the US and Europe, Darcy Burbage, Helena Ullgren, Christine Ladd, Merel Van Klinken, who could not be with us today due family emergency, but her slides will be presented. I'm your moderator, Gilbert Morgan. I'm a physician working in medical oncology and also the director of the OncoAlert Network. Today's round table will be as follows.

Gilbert Morgan:
Each discussant will pick a subject and we'll give a short four-minute presentation on the research that will be presented on that specific topic during ONS or the EONS Meeting. The discussion panel will then give their opinion and insights on that specific topic.

Gilbert Morgan:
The topics are as follows, innovative approaches to improve patient care, presenter Darcy Burbage. Precision medicine, Christine Ladd. COVID-19 and cancer, Helena Ullgren. Supporting informal carers, Helena Ullgren.

Gilbert Morgan:
At the end of the presentation, I will give a short presentation and how this research is important to the oncologist and all doctors involved in cancer care. So without any further delays, let's begin, Darcy.

Darcy Burbage:
Thank you, Gil and VJ Oncology for inviting me to present today alongside a few of my very favorite colleagues. As Gil mentioned, the ONS Bridge is the inaugural virtual conference of oncology nurses held in over four days where nurses can learn about the latest in cancer care. Sessions encompass clinical practice, leadership, management and education, and include topics such as navigating financial toxicity, the importance of self-care for oncology nurses, diagnostic oncology, plus a glimpse of the future of cancer care. And of course COVID-19 and cancer plus many others.

Darcy Burbage:
Based on all of that information, I just shared with you I had hard time selecting a topic as there were so many great sessions to choose from, but I kept coming back to this theme of nurse led innovations to improve patient care. And both of these programs, advanced practice registered nurses led the programs development, which included an interdisciplinary team.

Darcy Burbage:
As we know cancer treatments can have cardiac toxicities and those patients with pre-existing conditions or new cardiac comorbidities are at increased risk. In the cardio-oncology clinic nurses perform initial consults and manage follow up care in collaboration with the patient's treating oncology team, provide education on lifestyle and medications as well as triage urgent issues.

Darcy Burbage:
Preliminary data has shown improved patient outcomes as well as increased patient and clinician satisfaction. Because oncology care has shifted to a mostly ambulatory setting, there has been an increase need and volume of same day visits for treatment related effects, which has led to a high utilization of the emergency departments potentially exposing our immunocompromised patients to infectious diseases in the waiting room. Once again, advanced practice nurses led a task force to evaluate practice and establish guidelines for a visit in the oncology specific urgent care center. Preliminary data have shown that urgent care appointments have reduced emergency department visits and subsequent hospital admissions and led to increased patient and clinician satisfaction.

Darcy Burbage:
Having both of these programs available in community cancer centers improved access to high quality care, improved collaboration and communication with oncologists and were found to be cost effective. Another innovative approach to influence patient care are the oncology nurses role in research and evidence based practice. Nurses are leading the development of evidence based practice resources to assist in the management side effects related to cancer treatment and care.

Darcy Burbage:
ONS is moving to transition some of our Putting Evidence into Practice resources also called PEP resources to full clinical practice guidelines. Developed using a rigorous methodology the guideline recommendations can be utilized by nurses and other oncology healthcare professionals to improve care for patients with cancer. Guidelines developed thus far include cancer treatment related skin toxicity, hot flashes, and lymphedema. Those currently in progress are constipation and radio dermatitis. And finally priorities for the ONS research agenda have been identified. The ONS research agenda serves to identify gaps in the knowledge base needed to deliver quality cancer nursing care to patients and families. Three overarching priorities were also identified where new scientific knowledge is urgently needed. And there were several cross cutting themes that helped provide context for these priorities which included the aging population, survivorship as well as healthcare delivery. Examples of areas for further research include the development, testing and validation of patient reported outcome tools in patients receiving immunotherapy, examining the role of technology, including telehealth strategies to improve access to care, along with developing and testing interventions for culturally sensitive palliative and psychosocial oncology care. So stay tuned next week to learn more.

Gilbert Morgan:
Any thoughts on Darcy's presentation?

Helena Ullgren:
My thought was... Thank you by the way, Darcy excellent summary. And I really feel I want to hear about this. And also one of the thoughts that I kept on thinking was that these really shows the need for advanced practices as well and how much as cancer nurses we can do.

Helena Ullgren:
So it gives me even more energy to think about how we need to develop more advanced practice also throughout Europe. But I think in US in that way you're a role model with the way you have developed advanced practice, because many of those things that you were raising it sort of requires you have advanced nursing practice to do those innovations. So, yeah. Thank you for that. It's really good.

Christine Ladd:
I agree with you Helena and Darcy. I absolutely love the idea of oncology focused urgent care centers. It really allows oncology nurses to act at that peak of their life insurance, their expertise and identify these critical situations and values. Implement evidence based solutions for the patient quickly. And it's a fantastic way to keep our very fragile patients out of the hospital emergency departments and out from having unnecessary hospitalizations, especially now when we have this pandemic going on. So very exciting information and innovation.

Gilbert Morgan:
Thank you very much, Christine. Okay. Well, moving on to our next presentation on precision medicine, Christine Ladd.

Christine Ladd:
Okay. Well, thank you for having me this morning. I'm going to talk a little bit about precision medicine, which to me is a little bit of an oxymoron. It seems like we talk about precision and we're narrowing down to focus treatments for patients, but it really is such a huge topic.

Christine Ladd:
So I struggled a little bit to narrow it down. So this was a very high level presentation for you. But when we talk about precision medicine, what are we really talking about? We're talking about using very specific information about a person's cancer to help diagnose, to treat, to prognosticate and provide appropriate surveillance throughout their cancer trajectory. It is rapidly revolutionizing cancer care and it's about developing and delivering the right therapy and the right approach for the right patient at the right time, whether that's diagnostic or therapeutic. Since right now, the greatest abundance of research and the most enthusiasm obviously is within cancer treatment.

Christine Ladd:
And there is a great potential that exists with precision medicine to cure more types of cancer, increased survival and improve overall patient care.

Christine Ladd:
So why is precision medicine so important to oncology nursing today? And what you need to understand obviously is that precision medicine touches every single aspect of oncology nursing care. From prevention methods to early detection all the way obviously through diagnostic and treatment modalities, and even supportive care. And while we tend to get really excited about new treatments and their potential to create longer progression free survival, overall survival for our patients, there's just so much more to it. So we really have to dig deep and understand the role that nurses play in positive patient outcome. In the US nurses have claimed the number one rank as the most trusted professionals in our country for 18 years in a row.

Christine Ladd:
So as nurses, we often get the privilege of spending more time in front of the patients than the oncologist does. It just fosters and creates this intimate relationship. It's just different from any other patient's healthcare provider relationship or nursing specialty. The patients tell us about their hopes. They tell us about their dreams. They also have questions that they may not have asked their oncologists because they felt uncomfortable. They tell us about side effects they're experiencing. And it's really because of this relationship that we are able to foster. Because of this relationship, this close patient oncology nursing relationship it impacts oncology nurses and what we can do and how we can impact across the board as far as precision medicine. Oncology nurses as a result, have a responsibility to learn about the science and initiatives it's supporting precision oncology.

Christine Ladd:
We are at the forefront of the cancer epidemic, battling it every minute of every day, all the way around the world. Delivering care, carrying out the clinical trials and advancing evidence based practice. This allows cancer nurses to provide clear patient education to increase their understanding that allows us to address challenges that the patients face. And this is actually what leads to better outcomes and quality of life for our oncology patients.

Christine Ladd:
The challenge with precision medicine as far as education is that it is a tremendous challenge in keeping up with this rapidly evolving concepts and findings. What we're seeing is that although precision medicine and genomics are moving forward very quickly, it's extremely difficult to keep up with genomic literacy, precision medicine literacy keep pace. So there's this huge pressing growing need for education in oncology nurses in terms of understanding and appreciating fundamental treatment modalities like CAR T therapy being an immunotherapies and a very specific side effects and known adverse effects that these therapies can elicit.

Christine Ladd:
The need for oncology education is really twofold so that the nurse can provide the patient education and therefore manage the side effects and promote regimen adherence and keep the patients out of acute care facilities, but also so that the nurse can quickly navigate and treat known adverse events like cytokine release syndrome and immune factor cell associated neurotoxicities when they happen.

Christine Ladd:
Another challenge that precision medicine has brought about has to do with ethics. On top of the challenge of keeping up to date on new treatment modalities, precision medicines, creating new and evolving oncology nursing roles in the realm of ethics regarding privacy, confidentiality, fairness, and costs. Oncology nurses are uniquely qualified to provide insight into these issues faced by our patients. As I mentioned before, precision medicine presents those tremendous potential and tremendous challenges, and that's where our oncology nursing bridge comes in.

Christine Ladd:
So this is just a quick screenshot with some of the topics that are going to be coming up for ONS Bridge. I am just so excited about this new launch of new offering for Oncology Nursing Society. It's going to help connect oncology nurses with resources and education that will support us as we navigate the challenges and issues presented with rapid progression of precision medicine.

Christine Ladd:
So, like I said, these are just a few examples of content that are plans specifically pertaining to precision medicine, both in clinical practice in terms of professional practice areas and ethics and advocacies. As you can see, there are so many opportunities for oncology nurses to learn and earn contact hours. Nursing continuing professional education development, specific to precision medicine. There'll be live sessions where the nurses can interact with expert speakers and engage with other nurses within our profession. But what I think is exceptionally interesting, cool, however you want to phrase it there are over 500 E-posters and these is research by nurses, oncology nurses and what they've learned, what they've done, and the impact that they're having and how we can learn from them and do the same around the globe.

Christine Ladd:
So have opportunity to review over 500 of those as well. And attendees will have the opportunity to learn how they can leverage their leadership capabilities as well. And that is all I have, if anybody would want to reach out there's my contact information, but hopefully we will get to you on September 8th, 10th, 15th, or 17th, and then it will be available on demand as well after that, through the 17th of October. So thank you.

Gilbert Morgan:
Thank you so very much Darcy. Any thoughts?

Darcy Burbage:
Yeah. Thank you, Christine, that was a really great overview of precision medicine. And I was thinking when you were discussing about the importance of managing adverse effects from immunotherapy. As you touched upon it really calls upon for precision education of the patient as most immune related adverse effects are different than the usual side effects that patients may have experienced if they were on traditional chemotherapy prior to starting immunotherapy.

Darcy Burbage:
So as oncology nurses, it's important for us to perform a thorough baseline symptom assessment before patients start their immunotherapy treatment or CAR T-cell therapy. Which can also help facilitate discussions of these immune related adverse effects and side effects that they need to watch out for. And also the important of providing them with a card that they can carry with them that I know ONS has developed in some other organizations. So in case they... Or somewhere else that the clinician can know how to treat them and contact their medical oncologist to help manage these effects. So thank you. That was great.

Helena Ullgren:
I think you really highlighted Christine, thank you, the challenges. And as a council nurse in the era of precision medicine or personalized medicine, I see the challenge that we are used to with even more coming on stronger personalized care. Like how do we really get our patients to, for example, follow the self-care advice we give them.

Helena Ullgren:
It requires that you know them well, you see them a lot, you follow them throughout. And I think the symptom management in precision medicine has been taking us to a higher level of that because you can keep them on treatment longer if they contact us earlier which is sometimes not what patients do. They're scared to sort of reveal too many side effects and things like that. So I think you highlighted really well all the challenges and we have so much to learn I look forward to hear more. Thank you.

Gilbert Morgan:
Absolutely. And now moving on to the next presenter, Helena Ullgren who has the tough job of having her own presentation on COVID-19 and cancer, and then she will be taking on that Merel's presentation on supporting informal carers. So after she will do the COVID-19 and cancer presentation, we will take on thoughts and then we'll start off with supporting informal carers.

Helena Ullgren:
Thank you so much for reminding me Gil. And I'm excited to also hear that you're sort of sharing experiences and hot topics between US and Europe. And I think we have a lot of challenges that we really have in common now.

Helena Ullgren:
So I want to talk about briefly one of the hot topics in that we will also address in EONS13 session in September. And so how do COVID-19 affect our patients? And of course, it's just a few of the challenges I've been highlighting. Of course, we don't have enough knowledge. We don't have enough evidence. This came just down on us basically, and what we have seen so far, I think throughout not only Europe and Sweden, where I'm from throughout the world this delays in diagnosis and treatment. And not only because we needed the resources elsewhere because the patients were scared to come in to treatment and to come through the hospital. We're seeing unusual complications from treatments and we also see how isolated our patients are.

Helena Ullgren:
They come when they have to the hospital, and then they isolate at home, scared to get to COVID-19. Really this put a lot of strain and stress on our patients in addition. And also symptom assessment that are even more challenging I'd say, with this pandemic ongoing. So how can we learn? Of course we need a lot of research, but we also need to have things like this and share experiences between each other.

Helena Ullgren:
And I think one of the biggest challenges I'm facing is for example, what type of treatment is more risky if the patients are getting a COVID-19 infection. Is it immunotherapies, chemotherapy and the timing. And we do know too little about that. And we can only sort of now see some evidence coming on pointing towards that. It's not perhaps going better for patients on immunotherapy that perhaps people thought from the beginning it's adult comes out, even worse there, but we need so much more information on this. And how do we treat our patients safely, but perhaps need a treatment urgently, but they are testing positive for COVID-19.

Helena Ullgren:
And how do we assess and differentiate between a difficult symptom. For example, we have seen a few pneumonitis that we thought were COVID-19, but they were actually pneumonitis from the radiotherapy to the lungs, things like that. And also how we keep the patients safe and manage to include family caregivers. Despite that they can't come to the hospital, for example. I have also seen a lot of needs to be better in infection control and to educate our other health care professionals. And I think the nurses and I say staff nurses are experts on hygiene and infection control, but we need more education to everyone really.

Helena Ullgren:
And also as I think Darcy mentioned telehealth is coming on strong which is something we could use more. So in one way, I can see that the cancer nurses like coming in so clear to here, the need for holistic symptom assessment and support is so strong, even more now during COVID-19 pandemic I think. So I really hope you can join the session, it's four speakers that we talk about both the early research and quality assurance projects, and then we will have a live discussion. So I really hope you can tune in. And yeah, I look forward to perhaps see more of you there. Thank you.

Christine Ladd:
Yeah, I think what really has been challenging is the isolation that the oncology patients and their supportive members are facing as well as the oncology nurses. But when you already have a difficult situation, that's stressful, anxiety ridden. Patients aren't in a place to absorb information and education that's provided to them.

Christine Ladd:
So I think this has really brought to light how important it is to provide patients with clear and concise printed information that they can take home for reference later to look back at when they need it. But also to be able to give that to their caregiver so that the caregivers feel supported. It is the caregiver concrete material to review at home and just to create an extra layer of support. And the mental health needs really need to be continue point of focus and a brief start, particularly in this instance and how heightened stress and anxiety from the pandemic may even be contributing to decreased adherence to treatment regimens, especially if they're oral unless they're quality outcomes, I think is going to be interesting to see in the long run.

Darcy Burbage:
Thanks Helena. That was a great presentation. And I kept on thinking when you were talking about when cancer and COVID collide.

Darcy Burbage:
This experience with the pandemic, and I think we're just really beginning to understand how COVID-19 affected our patients and their family members as well as us as oncology nurses and other clinicians. So we're all trying to figure out how to keep them safe and then hearing from patients and their family members, how scared they were being dropped off at the cancer center for their treatment or surgery and being by themselves and perhaps if they were there for a six hour infusion. And we as the oncology nurses were providing them support the best we could trying to maintain social distancing all at the same time. And in addition to that the end of life care for patients when perhaps they were once again alone, or if only one family member were able to be present. So I think we really need to pay attention. And as both you and Christine touched upon these mental health issues need to be addressed now and ongoing as the pandemic continues. So thank you for bringing that up.

Gilbert Morgan:
Excellent. Now, we can move on to the second presentation and that's on informal cares.

Helena Ullgren:
I want to say this presentation was made by my colleague from the Netherlands, Merel Van Klinken, she couldn't be here today, but the topic she picked from the program, it was supporting Informal carers that would also be on the 20th of September. I think everything we talked about, we touched upon this topic, I guess. And that one of the things that Darcy was mentioning now that's even more sort of in the spotlight now is where the patients die. And dying at home we know from previous research that many patients really prefer to die at home. And that's one of the situations where to fund the caregivers or informal carers, whatever you call that you should to call them is something that we require a lot from them. And they need a lot from us, but I think that's why we fail sometimes. Many patients that doesn't have that type of support at home and if we fail to support the family caregivers, they spend their last days in hospital inside.

Helena Ullgren:
And so I think a really key factor as an oncology nurse or all healthcare professionals and counselor care is to see the family caregivers and to really reach out to them and try to support them the best we can.

Helena Ullgren:
And we have many issues that we need to address because from previous research we have seen that their family caregivers actually do work similar to healthcare professionals at home. But without education and they coordinate care, they titrate medicines for the patients. They decide when to call us and things like that. So we need to work more systematic on the health literacy and to help them to care for each other or themselves, and also perhaps more evidence on how to support them. What is the evidence, what is the interventions that we need to do to support the family caregivers?

Helena Ullgren:
So I hope you can listen in on the program. And I think they really speak about the role of a nurse in terms of supporting the family caregiver, some to educate them. And perhaps I'm hoping to hear something on what type of interventions are suggested to really support them in the right way.

Helena Ullgren:
So it's the 20th of September and I hope you can join. There will also be a discussion on this. Thank you.

Darcy Burbage:
Thank you Helena and also Merel for putting these thoughts together and sharing them with us. And absolutely I am in awe of our family caregivers. I mean, what they do is just amazing and most of them have no healthcare background at all as we know. And I think it's really important. And you have touched upon that and how that we recognize the valuable role that cancer caregivers have and how valuable it is to the person living with cancer.

Darcy Burbage:
And as oncology nurses and Christine touched upon this on her presentation too, is that we spend a lot of time with the patients and their caregivers. So we're the first ones to see their distress and their stress. So we can really pick up on that and help them manage the care that they're providing to the patients. And also it's important that we remind them that they need to take care of themselves as well. And it's okay to ask for help. It's okay to accept help. And it's perfectly acceptable to take time for themselves as they very much should, it's eating healthy, exercising. So it's very important. We can also help facilitate interventions to help improve the health-related quality of life that they're experiencing.

Darcy Burbage:
So I think it's great that you touched upon. What are those interventions? And I've heard caregivers say it's hard to be on the sideline. So I think as you mentioned, we're really beginning to look at research and help define those interventions to help improve the quality of life of our caregivers, because they provide such a great source of support and care for their loved ones. So, thanks.

Christine Ladd:
I completely agree with you Darcy and Helena and Merel. What's really complicating for this right now is the very important aspects of psychosocial support of the measure that so many of our facilities are having to put in place right now to protect our fragile population during the pandemic.

Christine Ladd:
So here for us in Virginia, oncology practices and hospitals aren't allowing visitors to come into the facility at all out of just protection for the patient's protection for the health care workers and then the visitors as well. So this is creating a huge challenge for the oncology nurses, but those caregivers that aren't able to be there at the bedside when something critical is happening.

Christine Ladd:
So oncology nursing education is having to take an extra step to try to push our nurses to be innovators and work hard to find new ways to leverage our technology. For example, with FaceTime, Zoom meetings to ensure that the patients and the caregivers are well supported.

Christine Ladd:
So whether that means the oncology patient that's on their day one of treatment, and doesn't have somebody there with them to learn, but the nurse pulls up her iPhone and calls and has a three way conversation with everybody. So everyone feels supported and gets the information. Or if it's on Zoom, you're doing it in a way that's safe and at a safe distance. So I think it's not only important to really have those caregivers involved, but it's just a really big challenge right now that oncology nurses have really risen to the occasion and just found ways to get it done.

Gilbert Morgan:
Thank you so much, Christine. Thank you so much, everyone for great presentations. I have to say it's been quite hard to kind of hold my tongue. I have thoughts on everything. These are all... I mean, the meetings are going to be great with the subjects you guys have touched on. However, there are specific things that I would like to touch on. Of course coming from the oncology side one normally has a tendency to go into the treatments and the fancy drugs and everything that ends in -ab. But I'm going to try not to go there today because there's so much more than that. And there's so much that an oncologist could actually learn not just because it's an Oncology Nursing Society meeting, does not mean that the oncology physician cannot learn from it.

Gilbert Morgan:
And I think that is the one thing that I'm trying to get our colleagues to realize is that we are a team and we can learn a lot from each other. So I'm going to do my presentation, which is what I think an oncologist should be learning from the presentations that you all just gave.

Gilbert Morgan:
Thank you all so much for a wonderful presentations and that this is my take on what the oncologists can learn. And of course, the breakdown which we have already had are innovative approaches to improve patient care, precision oncology, COVID-19 and cancer, and supporting informal carers.

Gilbert Morgan:
Now, when talking about innovative approaches to improve patient care, these are all great approaches. It was a wonderful presentation and we need to adopt these to care better for our patients. However, the topics that I'm very glad were addressed were the topics on palliative care, psychosocial care, and health disparities.

Gilbert Morgan:
This is something that everyone in oncology should be championing from oncologists to oncology nurses, to patient advocates. We have had many studies that have indicated that early introduction of palliation or a palliative team can lead to better quality of life. And I'm very glad that we are trying to remove that stigma and that we're coming along with palliation. So there's a lot of really good research that can be done and that it's coming out within this area.

Gilbert Morgan:
In terms of health disparity, this is something that is hitting close to home. As minority populations have a higher total incidence of cancer and a higher total death rate. I see this or I saw that in my home state of Texas. I now live in Sweden. I've done some for 10 years. However, I have done some research there and that definitely around South Texas where I'm from that it's predominantly Hispanic there is a lot of these disparities. So I think a lot needs to be done here in terms of screening. And of course the inclusion of more minorities in clinical trials. And we're very happy that this is something that it's gaining traction due to a lot of support from NCI, from other societies that are really taking this on. So I'm very excited to have this kind of research being presented at these meetings.

Gilbert Morgan:
Talking about precision oncology, I know everybody's thinking I'm going to hop onto how wonderful these drugs are and they are pretty awesome. I work in oncology you do have to be a little bit of a nerd and I am, so we're living in a very fantastic time where certain targets that worked before we thought were undruggable. Now, we actually have FDA approved medications that actually it's a big deal because not so long ago we thought that this is something that it was a dead end.

Gilbert Morgan:
And we're seeing that with the technology, it's making it possible to start treat these alterations and not just based on the cancer type, but based on their genome. So, however, the other side of the coin is the financial toxicity that comes with these kinds of treatments.

Gilbert Morgan:
So although novel doesn't necessarily mean expensive, it almost always does. We need to be advocates for our patients. I remember that money to pay for medication has to come from somewhere. Some patients have to travel very long distances, pay hotels, parking, childcare, you name it. So although we as doctors are very much cheerleaders for these therapies, we also have to take a step back and act as facilitators in helping patients address these kinds of problems. So I'm very happy that all this research and precision medicine is happening. And I really liked that that I saw in there about financial toxicity, because I think this is something that we all need to start addressing because it's really affecting our patients.

Gilbert Morgan:
In the area of COVID-19 and cancer, it's been amazing how we have been able to adapt under a very short time. Countries have learned from each other's experiences and many things have been implemented. Some things are very much here to stay, such as the case with telehealth.

Gilbert Morgan:
However, one of the things research has taught us, or what we have seen is that we can expect a large boom in cancer and avoidable cancer deaths as a result of this pandemic because of the delays in screening. So this is something that we're going to have to prepare ourselves, and we're going to have to have different plans. So this is good that we're already thinking ahead and figuring out how we're going to take care of our cancer patients in the future. Not only that if we are in the middle, I guess one could argue if we're in the middle of a second wave, or if it's been just one big wave, but we can adapt so that we can decrease this. Or if this happens again after we get over this so that we don't fall into the same trap and our cancer patients that are vulnerable do not fall victim to this.

Gilbert Morgan:
So now in supporting informal carers this is, I went a little bit off of a tangent here, but this is a reason why. So for me, it's amazing what an oncology nurse can actually do in the life of a patient. Even, especially in the life of a doctor. Here in Sweden, the role of the oncology context nurse is essential. An oncology professional who has constant contact with a patient who knows that person's situation in real time. And this allows us to work in a team. There are a lot of things that a contact nurse can solve. However, in cases where it requires for an oncologist to be involved, there are always available times there because the contact nurse has taken a lot of the work.

Gilbert Morgan:
So as an oncologist, you can hop in. Because it's been kind of triaged the thing that you're going to take on. Now, the reason I say this is because just the same kind of importance that we put on the contact nurses, that information that that contact nurse can give to the informal carers is just gold. Because they are the ones that are in constant communication with those informal carers. They're the ones that know exactly what they can recommend that those carers do. And that gives our patients a big sense of security.

Gilbert Morgan:
So I think this is something that definitely we need to focus a little more on this because we are going to rely on informal cares more and more as this pandemic continues. And of course, later on, if it happens again.

Gilbert Morgan:
So my take home messages that we need to include more minorities in clinical trials and introduce earlier palliative care, which I think some of the research that is going to come out is going to tackle, although new innovative treatments are great. We cannot forget the financial toxicity they generate for our patients. We need to be able to deal with the increase of cancer cases that come as a result of delayed screening and treatments. And the role of the oncology nurse is very important to improve the well-functioning of an oncology team, but also what that nurse can give to the informal care. And with that, I thank you very much.

Christine Ladd:
I will just say that it seems appropriate to me that 2020 has been deemed the year of the nurse. And we got a pandemic as our gifts. But what I would say is oncology nurses within ourselves we recognize ourselves as nurse scientists, researchers, and innovators.

Christine Ladd:
But outside, they don't know that everybody always sees that as well. So I really thank you for this opportunity to really just show how nurses are part of that team and how they make such a big difference as far as research and innovations because they really are superstars. The challenges that were brought on by COVID-19 really just magnified the extraordinary talent, the skill, the innovativeness of our oncology nurses across the globe. I've seen firsthand time and again, oncology nurses rise to the challenge. So I invite you again to come and learn more with us at the Oncology Nursing Society Bridge program in September 8th, 10th, 15th, and 17th. But thank you for having us.

Gilbert Morgan:
Thank you, Christine. Helena any parting thoughts?

Helena Ullgren:
Yeah, I mean, of course I want to thank you all. And it was very inspiring to hear in a way, you're refreshing, you're not alone in many of your challenges and you can help each other. And I think one good thing that came out from this pandemic is things like face we've been much better with actually doing webinars and meetings like this.

Helena Ullgren:
So I think that's very good. And then in terms of what you said, Gil, of course, I agree with all your points and I think what we show and ultimately make today here is we should have more sessions in the future together, I think, and address topics for more and multidisciplinary. I mean, we have the EONS, ESMO conference at the same time in the same venue if we met. And now when we are virtual we have them during the same dates, but we should have also sessions together and address issues like, for example, the precision medicine or family caregivers together.

Helena Ullgren:
Same for you guys in US. I mean ASCO ONS we should address issues together much more than we do. And I think that's one of the things that really struck me when I heard you sort of wrap up and comment from the oncologist perspective. Thank you.

Gilbert Morgan:
Thank you Helena. From the oncology side, if I might add I was in an EONS, ESMO session last year. I believe it was the second or third day of the Congress. And it was a wonderful experience to be able to share the stage with some our oncology nursing colleagues, because you're able to give the whole spectrum. It's a 360 view. Now, the wonderful thing about oncology is that there is no hierarchy.

Gilbert Morgan:
We all do a job. We do it for our patient and we have very different jobs. So all we're doing is just giving our different bits of our jobs of how it comes together into a whole to actually help the patient in the best way. So it's something that I can only advocate for that tighter, compact, and tighter, not only communication, but also working together between the oncology nursing and the oncologist because I think a lot of good can come to that. So I really liked that part of EONS and the ESMO Congress is that it's bringing us together and I've even seen a lot more oncologist showing up to the tracks that are branded as the oncology nursing sessions, but there's still a lot that we can learn. So I urge all my colleagues out there to just break the mould a little bit and step into a session that is not labelled immunotherapy for oncologists, Darcy.

Darcy Burbage:
Great point and may I just add Gil that with this pandemic came opportunities. And I've seen more collaboration between oncology nurses, oncologists as well as patients, because we've all had to work together and we're all in this together and we're getting through this together.

Darcy Burbage:
So this really has, although it's kind of absurd to all of us across the globe it really has brought us together to improve patient care and be part of that, really see each other as team members. And I think this is only the beginning of perhaps a pandemic positive if there could be such a thing and collaboration more with quality improvement, research between the disciplines and also bringing in our patients who are living with cancer. And finally I think the importance of, and what I love about ESMO and EONS is that you guys are together.

Gilbert Morgan:
Perfect. Well, with that being said, we thank you all for joining us today. Thanking our colleagues, Darcy, Helena, Christine, and thanking Merel very much for contributions to the program and sending her well wishes. Hope everyone is tuning in for the ONS Bridge and the EONS meeting. Remember that we're all part of the same team. And just because something is labelled as oncology nursing track does not mean that the cancer physician cannot learn something from that. So encouraging all our oncology MDs to tune in and watch this great science that is coming out of the two meetings. Of course, a big shout out to all of our oncology nursing colleagues and hope you all enjoy this wonderful meetings. Thank you all.