This May, I had the privilege of attending the 9th Nursing Symposium on Cancer Care cum 1st Genomic and Genetic Nursing Forum, held on 22-24 May 2024. The event was a vibrant platform, organized by The Nethersole School of Nursing at the Chinese University of Hong Kong (CUHK), for sharing cutting-edge research and innovations in cancer care, focusing on the transformative journey from traditional cancer care to a future dominated by digital and genomic advancements. I was impressed by the variety of high quality speakers who graced this symposium. I am definitely honored to have been an invited plenary speaker among such established and high-caliber academics and cancer practitioners.

Symposium Highlights

Social Determinants of Health

The symposium kicked off with profound discussions on enhancing cancer prevention and screening in vulnerable populations. Professor Hae-Ra Han (School of Nursing, John Hopkins University) presented on the role of community-engaged research in advancing care among ethnic minority groups, highlighting successful strategies that could be modeled globally. Through a cluster randomized trial of various interventions for health literacy skills training among Korean immigrant women, it was shown that women with higher health literacy rates were more likely to undergo cancer screenings (e.g. mammograms, Pap tests) [1,2]. In addition, the satisfaction rates of participants in the intervention group were significantly better than control groups. Important social determinants of health included access to good quality education and healthcare, good social and community environments, as well as economic stability.

Telemedicine and AI in Dermatology

Professor Jo Armes from the University of Surrey, UK, delivered a compelling talk on digital health transformation in the cancer pathway, exploring both the challenges and opportunities that lie ahead (Figure 1). Providing her experience with an artificial intelligence (AI)-enabled teledermoscopy app (DERM app by Skin Analytics), she described how the app was able to identify high-risk skin lesions so that patients could be channeled for appropriate management, yet not overloading the healthcare system removing patients with low-risk lesions from urgent dermatology services, so that clinicians could spend more quality time with patients with complex conditions [3]. Despite the disadvantages of the mobile health (mHealth) app not being interoperable with healthcare systems, poor internet and the inherent bias of AI predictions towards Caucasians, patients and healthcare staff were still satisfied with the service, and acknowledged that AI could speed up the administrative process of consultations. The discussion was further enriched with examples of how digital health tools like Large Language Models (LLM) chatbots (e.g. ChatGPT) [4,5], patient portals [6], web-based symptom monitoring [7], mobile chatbots (e.g. Penny-GI) [8], and AI prediction risk models [9.10] could help in reshaping cancer care.

Integrating Medical Humanities into Cancer Care: The Role of Music and Progressive Muscle Relaxation

In one of the breakout sessions, I was excited to hear about the work done by Dr. Khanh T Nguyen on how she integrated an intervention combining music listening with progressive muscle relaxation training on women with cancer in an oncology hospital in Vietnam (Figure 2) [11, 12]. As part of her research, she had also conducted a systematic review and meta-analysis on how music therapy had been used in the cancer population [13]. The pilot randomized controlled trial described in her presentation used a suite of measurement scales to identify the perceived beneficial effects on participants’ psychological and physical health, including reductions in anxiety, depression and stress, which was sustained in their 6-week follow-up consultations. Furthermore, the participants were willing to practice the intervention techniques in the future. While this is an area that is still new to me, it is interesting to know that there is an increasing evidence base to elucidate the roles of medical humanities in the holistic care of patients. I believe that the medical humanities is an upcoming field, which will grow and become a mainstream complementary therapy to provide holistic support to patients – and fill an existing gap that pharmacological therapies cannot provide.

The PROMIS of Patient-Reported Outcomes in Cancer Care

I had the pleasure of listening to Professor Changrong Yuan’s (School of Nursing and the Director of the Global Research Center of Patient Experience, Fudan University) long-standing work on developing and translating patient-reported outcomes measures both in China and globally. Her enthusiasm and expertise on how the patient voice could be elucidated from the Patient-Reported Outcomes Measurement Information System (PROMIS) [14] was definitely inspiring! For those who are new to this field, PROMIS is a set of standardized measurement tools that is person-centered, which can be used to assess the physical, psychological and social health in individuals with chronic diseases. Established and validated through qualitative and quantitative research, the tool comprises of over 300 measures categorized into more than 20 domains that denote the physical, mental and social health of both adults and children (Figure 3). The interesting thing is that researchers do not need to use all 300 measures to determine the patient-reported outcomes that they want. They can actually adapt and tailor the measurement items to obtain the specific parameters that they need! Furthermore, this tool has been translated into more than 40 languages through a method known as forward-backward translation, and is now used globally in health outcomes research.

Guidelines for Clinical Oncology Practice

Professor Wui-Jin Koh (Senior VP and Chief Medical Officer, National Comprehensive Cancer Network, NCCN) was one of the distinguished speakers who gave an impressive presentation about NCCN’s global program to support access to high quality, high value cancer care through collaborative approaches. I was wowed by the detailed guidelines development process at NCCN (Figure 4)! Although it is a known fact that NCCN guidelines are one of the most authoritative in oncology practice [15], the tremendous amount of work that goes into developing and updating the many guidelines by the review panels was really an eye-opener for me! His talk brought me back to the good old days when I was busy reading up and using the guidelines for my pharmacy practice and e-oncology research. I have definitely gained a new perspective and a renewed respect for the people at NCCN developing and upkeeping all the various guidelines. Kudos to all the members of the various specialty panels in the organization! It is no wonder that the NCCN guidelines are used internationally as authoritative guides for cancer and supportive care.

Genetic and Genomic Transformation in Cancer Care

Day 2 of the symposium was dedicated to the transformative power of genomic and genetics in nursing (Gallery 1). The line-up of speakers was definitely a treat! Professor Kelly Metcalfe (Lawrence S. Bloomberg Faculty of Nursing, University of Toronto) and A/Professor Emma Tonkin (Faculty of Life Sciences and Education, University of South Wales) talked about their experiences in building up programs and capacity in cancer genetics for the nursing workforce in Canada and UK. The benefits of using genetic profiling to screen for cancers and empowering patient decisions were discussed. Furthermore, the focus on the integration of genetics and genomics in nursing practice emphasized the crucial role nurses play in clinical genetic practices, from patient education to managing personalized treatment pathways. An example of the competencies of genetic nursing practice from Japan was shared [16]. The local speakers from Hong Kong – A/Professor Josephine Chong (Department of Paediatrics and Department of Obstetrics and Gynaecology, CUHK), Dr Annie Chu (Hong Kong Genome Institute) and Dr Brian Chung (Hong Kong Genome Institute) – gave very interesting and compelling talks on the genomic landscape in the country, and through several case studies, demonstrated how clinical geneticists could play a role in a multidisciplinary team to manage patients with cancer. The talks were not only informative (especially to a novice like me), but also inspiring, showcasing the potential of genomic advancements in impacting patient outcomes.

Immersivity of Extended Reality Technologies for Cancer Care

I had the pleasure of speaking in the same plenary session as A/Professor Jojo Wong (The Nethersole School of Nursing, CUHK), who showcased her pioneering work in immersive technologies in CUHK (Figure 5). As a renowned expert in extended reality (XR) at CUHK, it was enlightening to finally engage with her in person and hear about her diverse VR projects aimed at enhancing supportive care for cancer patients. A/Prof. Wong detailed her various innovative VR applications in oncology practice during her presentation, which include alleviating pain and anxiety in pediatric cancer patients [17], combating chemotherapy-induced nausea and vomiting [18], reducing pre-operative anxiety for elective surgery patients [19], and introducing mindfulness interventions through VR. Her impressive work exemplifies the cutting-edge integration of XR technologies in healthcare, providing critical support to patients with cancer in a holistic manner that cannot be fulfilled by traditional pharmacological therapies!

Telehealth Adoption for Oncology Services in Hong Kong

In the same plenary session, Dr. Dominic Chan (Department of Oncology, Princess Margaret Hospital) delivered an insightful presentation on the advancements in tele-oncology services in Hong Kong, particularly during the COVID-19 pandemic. His discussion highlighted the integral role of the HA Go telehealth app developed by Hong Kong’s Hospital Authority. This multifunctional app not only streamlines the process of booking clinic appointments and viewing queue numbers but also facilitates direct communication with clinic staff and enables payment for health services — all in one platform (Video 1 below)! Additionally, through a brief online exploration into the app, I realized that it had a comprehensive suite of features, even encompassing various aspects of health administration and management [20]. The HA Go app bears many similarities to Singapore’s HealthHub app, which suggests that there is a potential for mutual learning between the 2 countries to better enhance patient and caregiver experiences.

Concluding the Symposium: Powering Cancer Care Through Digital Health Innovations

I had the honor of delivering the closing presentation at this incredible symposium [21], and I was determined to leave a memorable impression with a presentation that was both captivating and light-hearted. My talk was centered around Digital Oncology Trends, therefore I decided to take an innovative and unconventional twist by weaving in elements from one of my favorite fictional universes — that of Ironman (Gallery 2)!

Embracing the wisdom of Spiderman’s mantra, “With great power comes great responsibility,” I took it upon myself to provide an eye-catching presentation by drawing parallels between the awe-inspiring capabilities of Ironman’s technology and the cutting-edge advancements in digital oncology. My presentation included trends ranging from AI-assisted imaging and robotic surgeries to precision oncology, data warehouses, and the potential of virtual tumor boards and patient networks. In addition, I talked about extended reality (XR) technologies and virtual care with embedded sensors, which aligned with the talks of the other speakers.

Moreover, I touched upon the future of healthcare with insights into blockchain cybersecurity and the intriguing possibilities of quantum healthcare. And yes, I had to introduce the audience to the latest in AI — GPT-4o — to provide some food for thought about the rapidly expanding capabilities of technology and healthcare. Though I exceeded my allotted time, the goal was to inspire and energize — hopefully to conclude the symposium with a “big bang”. I am immensely grateful for the opportunity to contribute to such a groundbreaking event and hope my talk left a lasting impact on everyone present.

Challenges and Ethical Considerations

The symposium did not shy away from discussing the challenges associated with digital health innovations. Concerns about the “black box” nature of AI systems, potential biases in machine learning, and the ethical implications of digital diagnostics were discussed throughout the symposium. These discussions highlighted the need for transparency and ethical frameworks in the deployment of AI technologies.

Concluding Thoughts

The 9th Nursing Symposium on Cancer Care and 1st Genomic and Genetic Nursing Forum was indeed an eye-opening experience, showing the dynamic and innovative ideas that can potentially shape the future of oncology nursing. The integration of digital health, telemedicine, genetic and genomic advances, as showcased through the diverse presentations, underscores a pivotal shift towards more personalized and accessible cancer care. This symposium not only highlighted cutting-edge research and innovations, but also set the stage for ongoing collaboration and learning. As I shared in my presentation (Video 2 below), the rapid advancement of AI will bring about the blending of technology and humanistic care. As AI becomes more human, it is more crucial than ever that nurses and other HCPs remain sensitive to the human touch so as to enhance treatment outcomes and the patient experience.

References

1. Han H-R, et al. Breast and cervical cancer screening literacy among Korean American women: A community health worker-led intervention. Am J Public Health 2017; 107(1): 159-165.
2. Hwang DA, et al. Recruitment and retention strategies among racial and ethnic minorities in web-based intervention trials: Retrospective qualitative analysis. J Med Internet Res 2021; 23(7): e23959.
3. Skene S, et al. AI in Healthcare Award – Final report: Skin Analytics (DERM). Report by University of Surrey. [DOI: 10.15126/901081].
4. Jeblick K, et al. ChatGPT makes medicine easy to swallow: an exploratory case study on simplified radiology reports. Eur Radiol 2024; 34: 2817–2825.
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7. AJMC staff. Web-based patient reporting of symptoms shown to improve survival in patients with metastatic solid tumors. AJMC 2017; 23(SP8).
8. Kelsey S. Lau-Min, et al., Pilot study of a mobile phone chatbot for medication adherence and toxicity management among patients with GI cancers on capecitabine. JCO Oncol Pract 2024; 20: 483-490.
9. Papachristou N, et al. Network analysis of the multidimensional symptom experience of oncology. Sci Rep 2019; 9(1): 2258.
10. Harris J, et al. Development and internal validation of a predictive risk model for anxiety after completion of treatment for early stage breast cancer. J Patient Rep Outcomes 2020; 4(1): 103.
11. Nguyen KT, et al. Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial. PLoS One 2023; 18(11): e0293060.
12. Nguyen KT, et al. A qualitative study on stress, coping strategies and feasibility of music intervention among women with cancer receiving chemotherapy during COVID-19 pandemic in Vietnam. Sci Rep 2023; 13(1): 542.
13. Nguyen KT, et al. Effects of music intervention on anxiety, depression, and quality of life of cancer patients receiving chemotherapy: A systematic review and meta-analysis. Support Care Cancer 2022; 30(7): 5615-5626.
14. National Institutes of Health. Patient-Reported Outcomes Measurement Information System (PROMIS) – Program snapshot. Available at: https://commonfund.nih.gov/promis/index.
15. National Comprehensive Cancer Network. NCCN Harmonized Guidelines^TM. Available at: https://www.nccn.org/global/what-we-do/harmonized-guidelines.
16. Arimori N, et al. Competencies of genetic nursing practise in Japan: A comparison between basic and advanced levels. Jpn J Nurs Sci 2007; 4(1): 45-55. (Translated reprint in English)
17. Wong CL, et al. Virtual reality intervention targeting pain and anxiety among pediatric cancer patients undergoing peripheral intravenous cannulation: A randomized controlled trial. Cancer Nurs 2021; 44(6): 435-442.
18. Wong CL, et al. Effects of immersive virtual reality for managing anxiety, nausea and vomiting among paediatric cancer patients receiving their first chemotherapy: An exploratory randomised controlled trial. Eur J Oncol Nurs 2022; 61: 102233.
19. Chiu PL, et al. Virtual reality-based intervention to reduce peroperative anxiety in adults undergoing elective surgery: A randomized clinical trial. JAMA Netw Open 2023; 6(10): e2340588.
20. Hong Kong Hospital Authority. Features: HA Go – What’s in? Available at: https://www2.ha.org.hk/hago/en/features.
21. Yap KY. When J.A.R.V.I.S. meets oncology: Powering cancer care through digital health innovations. (24 May 2024) Invited talk at The 9th Nursing Symposium on Cancer Care cum 1st Genomic and Genetic Nursing Forum, Held at Henry Cheng International Conference Centre, Cheng Yu Tung Building, The Chinese University of Hong Kong (CUHK), Shatin, New Territories, Hong Kong. Available at: http://dx.doi.org/10.13140/RG.2.2.36037.87525.