Cancer is a major cause of death among the US population, after heart disease. According to CDC, every year, around 1.4 million Americans are diagnosed with cancer (2012). Cancer refers to an abnormal and uncontrolled division of cells in the body, which can invade other tissues or spread via blood and lymph to other organs of the body. A diagnosis of cancer is often accompanied by fear and anxiety on part of a patient regarding treatment procedures and possible outcome. Nurses can help alleviate the patient’s anxiety by being supportive, clarifying information, answering questions and encouraging patients and families to voice their concerns, so that they are able to make an informed choice about treatment options (Smeltzer, Bare, Hinkle & Cheever, 2009). This paper addresses the approach to the care of cancer patients, including diagnosis and staging of cancer, complications of cancer, side effects of treatment, and methods to lessen physical and psychological effects.
Diagnosis and Staging
Cancer can be wholly treated if it is discovered in its early stages. The process of cancer detection starts either with a patient’s complaint or by an abnormality detected during general physical examination by a physician. Some early warning signs of cancer include a change in bladder or bowel habits, growth of a lump, unusual bleeding or any other discharge, a non- healing sore, difficulty in swallowing or indigestion, a change in a mole or wart, hoarseness in voice, or a nagging cough (Ko, Dollinger & Rosenbaum, 2008).
A routine physical examination is a systematic and thorough check of a body to look for signs of abnormal function. Any suspicious finding during physical examination, like an enlarged lymph node or persistent coughing with blood, leads to a more thorough search with blood tests. Non-specific blood tests, like blood count, SGOT, SGPT, bilirubin, uric acid and creatinin etc, indicate the presence of disease in a specific organ. Specific blood tests detect the presence of tumor markers in blood. Tumor markers are certain chemicals produced by various types of tumors; for instance, tumors of breast, colon and lung produce CEA (carcinoembryonic antigen), and tumors of prostate gland produce prostatic acid phosphatase (PAP). These tests are done if the presence of one of these cancers is suspected. Abnormal findings in physical check and blood tests will lead to further investigation by imaging techniques like X-rays, angiography, MRI scan, and PET scan. A definitive diagnosis of cancer can be arrived at by doing a biopsy, in which a specimen of the affected tissue is obtained for cytological examination (Ko et al., 2008).
TNM system is a universal staging system for cancer. It defines the extent and spread of a tumor and provides an idea of the disease prognosis. It provides a universal criterion for practitioners and researchers around the world and is an important factor in determining the most appropriate treatment. T denotes the size and depth of the tumor, N denotes the degree of involvement of lymph nodes, and M stands for the presence or absence of metastasis. T0 denotes no evidence of primary tumor, TX means that the tumor is “in situ” (not yet invasive); T1, T2, T3 and T4 indicate progressively larger tumors with increasing depth penetrating the wall of the organ and invading the neighboring tissues. N0 means no involvement of lymph nodes while N1, N2 and N3 show deeper degrees of involvement of regional lymph nodes. M0 means the absence of metastasis while M1 means that metastasis has been detected (Ko et al., 2008)
Complications of Cancer
Some common complications of cancer include pain, infection, and fatigue. Up to eighty percent of patients in advanced stage of cancer experience significant amount of pain. The pain may be due to tumor infiltration, tissue destruction, pressure, or surgical procedures. In a cancer patient, pain leads to deterioration in the quality of life and causes anxiety, fear, loss of sleep and weakness. The pain may be due to the disease, due to the treatment or any other cause. Correct evaluation and diagnosis of pain is a challenge to a physician. So nurses’ observation and input can be very important to arrive at the correct diagnosis. Nurses and caregivers should have good communication with the patient and sharp assessment skills to judge the quality and intensity of pain. Pain is managed by prescription of non-opioid analgesics like NSAIDS. If they are ineffective, mild opioids like codeine are given, progressing to strong opioids like morphine, if required in later stages. Alternative measures like exercise, massage, listening to music, acupressure, acupuncture and transcutaneous nerve stimulation also help in controlling pain (Stubblefield & O’Dell, 2009).
Cancer patients are highly susceptible to many infections like pneumonia, sepsis, urinary tract infection, colitis, and cellulitis. Severe sepsis causes one-tenth of the cancer deaths. Infection is accompanied by fever, fatigue, debility, and a general functional decline. A common cause of infection in cancer patients is neutropenia. It occurs mostly in patients undergoing chemotherapy or bone marrow transplantation. Due to reduced immunity, resistance of a body to fight infections reduces. Local sources of infection include urinary and venous catheters, improper care of wounds, metastatic obstructions and surgical procedures which compromise normal anatomical barriers (Stubblefield & O’Dell, 2009)
Around 90 percent of cancer patients are affected by fatigue. Fatigue refers to being tired even after sleeping or adequate rest. It affects patients’ quality of life and interferes with normal functioning. Besides being a side effect of treatment, fatigue in cancer can also result from depression, anxiety, pain, insomnia, stress or hormonal imbalance, such as hypothyroidism. When a patient is not able to perform daily tasks due to fatigue, extra rest is recommended. In this case, an exercise program is recommended to build up stamina for daily activities. Fatigue can also be managed by eating small, frequent meals high in proteins, by incorporating nutritional supplements in diet, drinking lots of electrolyte positive fluids, and accepting help with strenuous activities (Stubblefield & O’Dell, 2009).
Side Effects of Treatment
Chemotherapy and radiotherapy can produce a number of side effects in a body. The nature of side effects produced depends upon the drugs used, dosage, route of administration and individual reaction depending upon the physical and emotional circumstances. Caregivers should work with patients to educate them about all possible side effects before the start of the treatment. Likelihood and duration of the problem should be explained along with a description of why it is happening. A wide range of management options should be made available to the patient (Corner & Bailey, 2008)
Common short-term side effects of chemotherapy include extravasation of drug into tissues causing necrosis and sloughing, nausea, vomiting, stomatitis, loss of appetite, malnutrition, taste alteration, flu-like syndrome, secondary infections, diarrhea, constipation, swollen limbs. and allergic reactions. Long-term side effects of chemotherapy are bone marrow depression, hair loss, congestive heart failure, liver and renal dysfunction, sexual dysfunction, pulmonary toxicity and neurotoxicity which may cause tinnitus, hearing loss, tingling and numbness in the limbs (Corner & Bailey, 2008)
Side effects of radiotherapy differ from patient to patient depending upon the stage of cancer, dose of treatment, age of patient, adjuvant therapy etc. Some tissues are more sensitive than others, for example, ovaries, testes, lungs, and eyes. Common side effects of radiotherapy are weight loss, dry mouth, erythema, colicky abdominal pain, rectal bleeding, fistula formation, enteritis, and diarrhea. Sexual dysfunction, early menopause and sterility can also occur as a result of radiotherapy (Corner & Bailey, 2008).
Methods to Lessen Physical and Psychological Effects
Medications can be used to control nausea, vomiting, diarrhea, and constipation; a well-planned diet, adequate rest and regular exercise can sustain energy levels and maintain physical and emotional well-being. Good oral hygiene, anti-bacterial mouth washes and topical analgesics reduce the severity of stomatitis and ulcers. Hair loss can be particularly distressing for female patients. Nurses can offer support, provide information about hair loss and assist with practicalities, like cutting hair or choosing a wig. Sexuality and fertility are often affected by radiotherapy and the staff should talk to the patient about these issues prior to treatment to lessen anxiety and fear (Corner & Bailey, 2008).
Psychiatric disorders as well as social and psychological problems are common in cancer patients, and these interfere with treatment and rehabilitation. Depression and anxiety can be managed by use of anti-depressants and psycho-stimulants. In addition to pharmacologic management, alternative therapies, like art and music therapy, help patients deal with pain, fatigue and stress. Spiritual practices like yoga, meditation and breathing exercises are useful in restoring balance, increasing vitality, improving attitude, soothing anxiety, building stamina, and creating a feeling of general well-being. Acupuncture has also been successfully used to treat many cancer-related side effects. Strong social ties and support also aid better treatment compliance in patients and more effective management of distress (Holland et al, 2010).
Cancer affects the lives of patients as well as their families and friends. Anger, distress, fear, anxiety and denial are all part of the cancer process. During this time, patients and their family members need all the information and support they can get from the nursing staff. Knowing what to expect during treatment makes it easier for most patients. Managing side effects of treatment is as important as treatment itself, so that any patient can maintain a high quality of life and remain in positive spirits. Patients should be encouraged to take alternative therapy, like yoga and meditation, for wellness of mind. With new drugs, advanced medical techniques and good care, cancer patients have a brighter than ever chance of beating the disease and living long, productive lives.