blood samples for full blood count, urea, creatinine and electrolytes, liver function and tumour markers (alpha-fetoprotein [AFP] and human chorionic gonadotrophin [hCG]). J Nurs Care 6: e136. Damage to the genetic components of the cells can result in loss of function and ability to regulate growth. Geographical variations across the world in the incidence of cancer provide clues to the lifestyles of different populations. Before inva-sive nutritional strategies are instituted, the nurse It is also evident that non-smokers are at risk from exposure to other people’s smoke: one-quarter of lung cancer cases in non-smokers are estimated to be due to passive smoking (International Agency for Research on Cancer [IARC] 2004). Discuss the role of the specialist nurse in supporting patients during the staging phase of a cancer with your mentor. membranes are noted, as are their effects on the patient’s nutritional status Cancer treatments can be broadly described as: Adjuvant treatments, such as a drug, that assist or increase the action of other drugs or therapies are often used in cancer treatment, for example cytotoxic drugs used after removal of the tumour by radiotherapy or surgery. Cancer is associated with increasing age. These factors include physical agents, chemical agents, viruses and diet. However, some GPs may offer early screening as part of their consultation with women regarding sexual health. The Health Belief Model states that an individual feels vulnerable to a disease if they believe they are susceptible to developing it and believe the disease to be serious. Creative dietary therapies, enteral (tube) feedings, or PN may be Tumors can affect the gastrointestinal activity in several ways. devices are beneficial for patients with impaired mobility. Such damage may occur from either error in DNA replication during mitosis or exposure to environmental agents. 12). Extrinsic factors related to lifestyle and the environment are important in the process of carcinogenesis. and texture of the new hair may be different. Cancer Nursing Practice. Unlike years ago, patients are now normally told their diagnosis, with a discussion of prognosis – often a medical uncertainty – and the level of information is tailored to the individual’s needs. Foods that are difficult to chew or are hot or spicy are The Million Women Study (2003) found that the use of combined oestrogen plus progesterone hormone replacement therapy (HRT) also increases the risk of breast cancer. Understanding the molecular biology of cancer is very important to identify and obtain a definitive cancer diagnosis and thus predict prognosis. The chemical signals act within individual cells and are also utilised when communicating with neighbouring cells in regulating growth. In addition to noting hair loss, the nurse also assesses the Tumours also produce proteolytic (protein-dissolving) enzymes, which may assist in the invasion of normal tissue. Comprehensive long-term strategies are continually being developed to shape cancer services, focusing on all aspects of the patient’s cancer journey, ensure equity of care and invest in equipment and the cancer workforce. For example a gastrointestinal tumour will typically spread via the hepatic portal vein, initially to the liver. In the UK mammography is routinely offered every 3 years to women aged between 50 and 70 years. The risk of cancer recurrence is always present when a diagnosis has been given. Nursing Care Plans. Thrombocytopenia, a The patient may have fears they wish to express and an opportunity to discuss these openly is important. Primary cancer prevention includes activities such as: Media reporting of cancer risk development requires cautious interpretation and should be put into perspective by reference to the original studies on which it is based. Reflect on your own attitudes and beliefs concerning cancer. Cigarette smoking has now clearly been identified as a major cause of cancers of the mouth, pharynx, larynx, bladder and pancreas, whilst contributing to many others. A study by Schofield et al (2003) showed that clinical practices that are linked to lessening anxiety include preparing the patient for a possible cancer diagnosis, having significant others present at diagnosis, being given as much information as desired in understandable language, having questions answered, talking about feelings and being given reassurance. higher is reported and dealt with promptly. should assess the patient carefully and discuss the options with the patient severe cases of stomatitis, cancer therapy may be tem-porarily halted until the Psychologists have developed a Health Belief Model (Strecher & Rosenstock 1997) to predict an individual’s preventive health behaviour and account for some of the factors which determine attitudes to health and illness. To survive within the host the forming tumour seeks out a new blood supply to maintain its growth which results in small fragments of tumour splitting off and travelling to distant sites to form secondary tumours (metastases); the cancer is said to have metastasised. It is very common for patients to be aware that they have cancer before they are told formally of their diagnosis. This cancer is sometimes referred to as the ‘silent killer’ because it often presents late and has the highest mortality rate of all malignant gynaecological cancers. Good, Feel Better,” offered by the American Cancer Soci. Stomatitis is characterized by mild redness (erythema) and edema Box 31.6 provides an opportunity for you to reflect on patient experiences of being given a diagnosis of cancer. Nurses now have a responsibility to incorporate health promotion, health education and disease prevention in their role as well as the care of those who are ill. (See Further reading e.g. aging. One in four deaths are attributable to cancer (Cancer Research UK 2009). The most commonly diagnosed cancers in the UK are breast, lung, colorectal and prostate; together these four cancers make up over 50% of all new cancers each year (Cancer Research UK 2009). The temporal relationship between smoking and lung cancer was defined in the 1950s by studies undertaken by Doll & Hill (1954). The concepts of health and ill health are open to wide interpretation. Projects have been developed to assist smokers to quit, particularly in areas with high levels of deprivation, prisons, the army and working men’s clubs. Carcinogenic chemicals present occupational hazards. Nutrition How can you as a nurse support this period for patients and their families? Several government publications have taken on ‘The Cancer Challenge’, with measures to promote a ‘pro-health’ culture (Department of Health 2000, Scottish Executive Health Department [SEHD] 2004, Through working partnerships with the community and the food industry, strategies to promote healthy eating include a national ‘Five a Day’ programme, improving accessibility to affordable fresh fruit and vegetables, and advocating five portions of these daily (see Ch. For many, their fondest memories are ingrained in the walls of their cherished home. It is important for staff working in screening services to have well-developed interpersonal and communication skills to alleviate any fears or anxieties. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. The study did not intend to generalise its findings to other units, but to produce local recommendations. Cancers that occur with increased frequency in families are components of various hereditary cancer syndromes, e.g. Any organ within the body has the potential to become cancerous, however some cancers are more common and potentially linked to a known carcinogen exposure. Skin lesions or ulcerations sec-ondary to the tumor are noted. Education develops the skills of critical analysis, problem-solving, critical and creative thinking, the ability to question, review and evaluate literature as well as encouraging personal growth and development. Increased incidence of cancer and its growing trend have drawn attention to care for these patients. For example, thoracic surgery for a patient with disseminated small cell lung carcinoma (SCLC) and metastases in the ribs would be inappropriate given the metastatic spread of the disease. Patients were interviewed and completed the European Organization for Research on Treatment of Cancer Quality of Life Scale and the Palliative Care Outcomes Scale at referral, and 3, 7 and 28 days following referral to a Macmillan specialist palliative care nursing service. The temporal relationship between smoking and lung cancer was defined in the 1950s by studies undertaken by Doll & Hill (1954). Ask for more information from your health care team or contact care facilities directly. They also interfere with protein Individuals with impaired immunity are more susceptible to cancer; for example, people with HIV disease have a higher incidence of Kaposi’s sarcoma than the normal population (see Ch. Nurses are now at the forefront of care for cancer patients and their families. We also produce a list of nursing resources as well as nursing and chemotherapy patient education programs and materials. Nurses give the best care possible to each individual patient, whether they have cancer or not. Dan lived too far away to travel to the department each day; otherwise the necessary tests could have been performed while he was an outpatient. metastases in the vertebrae may cause spinal cord compression (SCC) and result in pain or loss of sensation and paralysis – an oncological emergency, invasion of small local blood vessels, causing chronic bleeding and anaemia; when major vessels such as the carotid artery erode, a haemorrhage may be sudden and fatal, uncontrollable growth causing necrosis or ulceration which may be internal or external – often termed ‘a fungating tumour’, infiltration by the cancer cells into the bone marrow compromising haemopoiesis (blood cell production) and leading to increased susceptibility to infection, metabolic alterations – there are many tumour-specific metabolic imbalances such as those affecting the kidneys, liver and pancreas. These important areas are explored further in this chapter. Nevertheless, dietary factors have been implicated as a major cause of the high incidence of cancer in the West. However, epidemiological studies have identified certain causative factors, termed ‘carcinogens’. counseling is provided to patients who are not eating enough calories or As an oncology nurse, you will have to keep track of numerous details throughout the day for each patient. stomatitis requires systemic analgesics. A left orchidectomy was then performed. Although all cancers have a genetic origin at the cellular level, this does not mean that all cancer is inherited. These include to: 1. Risk is more dependent on duration of smoking than on consumption. Thompson et al 2006). Nursing care plan for cancer is a guideline in providing care for cancer patients. chemother-apy. See website Critical thinking question 31.1. (hair loss) is another form of tissue Several government publications have taken on ‘The Cancer Challenge’, with measures to promote a ‘pro-health’ culture (Department of Health 2000, Scottish Executive Health Department [SEHD] 2004). Scott-Brown et al 2007. As survivorship care evolves, it is essential for nurses to recognize when patients might benefit from cancer rehabilitation and/or prehabilitation, as these services can improve the physical and psychological outcomes of survivors. sepsis, and no episodes of bleeding or hemorrhage, Biologic Response Modifiers - Management of Cancer, Photodynamic Therapy - Management of Cancer, Unproven and Unconventional Therapies - Management of Cancer, Settings for End-of-Life Care: Palliative Care Programs, Settings for End-of-Life Care: Hospice Care, Nursing Care of the Terminally Ill Patient, Psychosocial Issues - Nursing Care of the Terminally Ill Patient. carefully for changes indicating blood loss. Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail. Understanding the molecular biology of cancer is very important to identify and obtain a definitive cancer diagnosis and thus predict prognosis. Table 31.1 Examples of molecular genetic markers used in cancer diagnosis and prognosis. Smoking 20 cigarettes a day for 40 years is eight times more hazardous than smoking 40 cigarettes a day for 20 years. There is currently no evidence that prostatic screening improves clinical outcomes; in fact, there are issues of uncertainty surrounding the appropriateness and type of treatment for men with early-stage prostatic cancer, since it has a long asymptomatic latency period. It is calculated from the serum creatinine using an equation that includes age, gender, and lean body weight to establish baseline measurements for subsequent assessment of any nephrotoxicity (damage to kidney tissue or function) induced by platinum compounds. 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