No specific data sets exist to evaluate the workforce needs related to cancer nurses. It is known that the cancer care workforce and resources in LMIC and many countries in transition are, at best, inadequate with large disparities between high- and low-income countries [7]. The vast majority of patients with cancer in LMICs receive treatment in general hospitals, making it more difficult to estimate the actual number of oncology nurses globally. Cancer prevention, screening, and early detection are often addressed by generalist nurses working in public health systems who may or may not identify themselves as oncology specialists. The International Society of Nurses in Cancer Care (ISNCC) has 44 full members that are national cancer nursing associations, representing approximately 90,000 oncology nurses worldwide. The European Oncology Nursing Society (EONS) represents 22,000 oncology nurses and the Asian Oncology Nursing Society (AONS) represents over 30,000 nurses. Even if the actual number of nurses in oncology were 3 times higher than those represented by these member organizations, the needs of cancer patients globally would still not be met. In fact, the American Cancer Society estimated that 60 % of the 14 million yearly new cancer diagnoses occur in Africa, Asia, Central and South America [8]. Thus, efforts need to be scaled up significantly in order to meet the needs of patients with cancer as well as to meet the United Nations and Noncommunicable Disease (NCD) Alliance goal of reducing premature deaths by 25 % [9] and WHO Global Action Plan [10].

Despite some progress, patients in many LMICs still tend to receive a diagnosis of cancer at a late stage of the disease, and treatment options are scarce [7]. The emphasis in many of these countries has focused on prevention, early detection and, on the other end of the continuum, palliative care. There has been some progress in promoting prevention and early detection of cancer in LMICs [7, 11], and nurses have played key roles in ensuring that policies on cancer prevention are implemented. Evidence from nursing research has demonstrated the positive impact nurses have in improving access to services and information, but a need exists for a higher level of investment in nursing education [12].

The healthcare workforce in LMIC has also been affected by migration issues. Within LMIC, workers may leave rural settings for urban settings, where jobs are highest paying. Trained healthcare workers such as nurses may leave their home country for better paying jobs in other countries [4]. This migration is especially true in countries with conflict where personal and family safety is an additional concern, and nurses may leave to seek safer lifestyle as well as higher pay [13]. While the International Council of Nurses [14] has called upon governments to ensure the duty to care of nurses and other healthcare workers, there remains a significant safety concern for nurses caring for populations in these settings. This outward migration impacts the destination country, where education and training of nurses may differ and standards of care need to be met in the new job setting [15]. Language issues and variations in healthcare system may impact the safety of care delivery [16]. This is especially true in specialty care such as in oncology settings, where concurrent treatment regimens and complex medical issues make accurate communication essential to patient care and safety.

Vast documentation exists demonstrating a positive correlation between nursing care and patients outcomes in oncology in the outcome of patients in high-income countries [17, 18]. Furthermore, there is a growing body of evidence to demonstrate positive impact of nursing interventions on patient outcomes in LMICs [12]. In addition to improving clinical care, there is emerging evidence to suggest that evidence-based nursing care could lead to enhanced advocacy and policy development to improve cancer care delivery models and systems. For example, in Panama, nursing leadership and advocacy for improved palliative care and access to pain medication spearheaded a movement that resulted in a national palliative care program, one of the first in the region. Nurses play a significant role implementing this successful program [19]. This led Panama to propose a resolution to the World Health Assembly—the governing body of the World Health Organization—to ensure that palliative care is integrated into every national health services program, globally. The resolution was approved at the 67th Session of the World Health Assembly in May, 2014 [20] WHA, and also the Pioneros en Cuidados Paliativos de Panamá en la Organización Mundial de la Salud: Entrevista con el Dr. Gaspar Da Costa [21]. Importantly, a new White Paper is calling for strengthening the oncology nurse workforce in LMIC through education, research, policy, and evidence-based practice (EBP) [22].

Nursing care quality is of utmost importance to ensure optimal patient outcomes. The Quality and Safety Education for Nurses (QSEN) Project recently developed competencies to prepare nurses around the globe for the care they provide within the current dynamic healthcare environment. The competencies include patient-centered care, teamwork and collaboration, EBP, quality, safety, and informatics [36]. While discussion of all of these topics is beyond the scope of this chapter, EBP is essential as it relates to integrating evidence from research to best practices in nursing and advancing nursing knowledge and practice around the globe.

Evidence-based practice (EBP) is applying the best available research along with patient preferences to make decisions about health care. EBP has been shown to improve healthcare quality, reliability, and patient outcomes. The process of EBP includes five A’s: Ask, Acquire, Appraise, Apply, and Audit. Cultivating a spirit of inquiry and dissemination of results are two additional steps proposed by some authors [37] (see Table 31.2). Asking a question in a PICO (Population, Intervention, Control, Outcome) format is most helpful to focus the topic of interest and the literature review. International competencies on EBP have been developed for nurses and for those nurses in advanced practice roles and include essential elements of knowledge and skill among the seven steps. EBP should be used by nurses around the globe and within all healthcare settings including home health, ambulatory care, and inpatient care.

Unfortunately, evidence is often lacking for many nursing care practices. These gaps in knowledge provide opportunities for nursing research, which is the discovery of new knowledge that will enhance practice and patient outcomes. Oncology nurses can contribute to research by identifying gaps in knowledge which require investigation, collecting data for research studies, critiquing existing research for practice relevance, and integrating research into practice [23]. For nurses with research degrees, designing and conducting oncology nursing research and adding new knowledge to the field is a primary responsibility.

With the vast amount of gaps in knowledge that exist, determining a direction for research may be challenging. Fortunately, organizations throughout the world have developed research agendas and priorities that can help guide nurse scientists in order to improve cancer care globally [38–43]. Crosscutting themes among some of the world’s leading oncology nursing organizations include pain and symptom management and end-of-life and palliative care. These priorities reinforce the gaps in knowledge needed to optimize supportive care. Priorities also communicate strongly about the role of the nurse in supportive cancer care. Table 31.3 includes research priorities and goals for some of the world’s cancer nursing organizations.