The global burden of cancer treatment: reflecting clinical reality in cancer nursing research.

C ancer research is a global priority driven by a crushing clinical reality. The burden of cancer mounts daily, complexity of treatment escalates, and persistent and delayed effects of cancer and its treatment endure for millions of people worldwide. Cancer is now the third leading cause of death worldwide, with more than 12 million new cases and more than 7.5 million deaths estimated by GLOBOCAN for 2008. Those of us in resource-rich nations with research-intensive academic centers bear witness to the ever more rapid pace of discovery of minimally invasive procedures, targeted therapies, combined modalities, and outpatient treatment regimens. Those in less well-resourced societies and health systems might only hear of such new developments and wonder about the possibilities. The human scale of cancer is often difficult to grasp, but individual and family experiences, gaps in care, differences in practice, and the burden of cancer treatment and survivorship make the human scale of cancer palpable for nurse researchers as it is for our clinician colleagues. The global burden of cancer treatment and survivorship impresses me greatly. Sheer need and unanswered questions combine before my eyes to shape the arduous work that is oncology nursing practice. In the clinic, at home, and in the hospital, clinician colleagues attempt a delicate balance of evidence, expedience, and habit as they grapple with the practicalities of little time and great need. Some clinical oncology nurses benefit from abundant resources, but in most cases and to varying extents, many face a clinical reality informed by limited evidence and few resources. Oncology nursing researchValthough it boasts wonderful accomplishmentsVlags behind the clinical reality. Increasingly, molecularly focused treatment research drives the clinical environment with relatively swift diffusion and significant public interest. Cancer nursing research lags as specific populations of people affected by cancer grow in number, across diverse societies, facing often disparate and rapidly changing treatment regimens and patchy supportive care services. I attribute this lag to a composite impact of isolation of variables necessitated by positivist quantitative science and the fidelity of well-established research trajectories combined with disjunction between the clinical and scientific domains of nursing. Quantitative research values cleanly separated and defined variables and circumspect dissemination of findings once we have controlled what might confound and manipulated what might create effect. The challenge for us as cancer nurse researchers is that the burden of cancer treatment is not a separable human experience. Cancer treatment is a whole, encompassing experience among those for whom it is their experience. Similarly, the burden of cancer treatment is not an experience that waits. It is one of today for millions around the world. What can nurse researchers do with this conundrum? I suggest building on the elements of clinical science that we know get us closer to reflecting clinical reality in our research. I offer 5 specific ideas to achieve this: