Critical care nursing
BASICS OF ONCOLOGY NURSING
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| 7. BASICS OF ONCOLOGY NURSING
Introduction Oncology as a term is no longer new to us. This topic is written to enable students gain more knowledge about oncology, oncology Nursing, history of oncology Nursing, basics of oncology, role of an oncology nurse and management of oncology. What is oncology? Oncology is a sub-specialty of medicine dedicated to the investigation, diagnosis and treatment of people with cancer or suspected cancer. It includes preventative medicine, medical oncology (chemotherapy, immunotherapy, hormone therapy and other drugs to treat cancer), radiation oncology (radiation therapy to treat cancer), surgical oncology (surgery to treat cancer), and palliative medicine. Oncology Nursing Oncology nursing is a nursing specialty that seeks to reduce the risks, incidence, and burden of cancer by encouraging healthy life- styles, promoting early detection, and improving the management of cancer symptoms and side effects throughout Oncology nurses advocate for people at risk for or with a diagnosis of cancer, coordinate care delivery, ensure safe delivery of cancer treatments, help manage symptoms, optimize quality of life, support people with cancer and their caregivers, advocate for the unique needs of people with cancer, and collaborate with the interprofes- sional team to improve outcomes and reduce the impact of cancer on people, families, communities, and populations. History of oncology nursing Marily bedside and comfort measures, to the development of oncology nursing as a specialty (Haylock, 2008) with a defined knowledge base, supported by research and expert practice. Without specialized education or training in oncology, early cancer nurses were often forced to be creative in caring for patients with various complications of cancer treatment, such as radiation burns and pain (Ferris, 1930). In the early 20th century cancer nursing was perceived as arduous, depressing and even dangerous work, as the prospects of cancer patients surviving were slim and nurses were often exposed to harmful chemicals (Barckley, 1985). Radiation was accepted as the therapeutic option for many forms of cancer by the 1920s. However, the way in which radiation was administered often left nurses in contact with dangerous substances, such as radium and radon (Haylock, 2008). Some nurses refused to take care of cancer patients, as they believed doing so posed a significant risk to their own health and ideas that cancer was contagious were well entrenched until the 1930s (Haylock, 2008). Another factor influencing the role of oncology nurses was the broader context of the shifting roles of women during World War I. As many men went off to war, nurses began to take on roles originally reserved for physicians, such as venipuncture (Haylock, 2011). Oncology nursing has developed and changed over recent decades. In the 1940s, nursing of people with cancer began to change with the introduction of oncology nursing as a specialty in the United States and the creation of specialized education and training for oncology nurses (Lusk, 2005). In 1947, the first university course in cancer nursing was offered at Columbia University and represented the beginning of a shift in oncology nursing education (Yarbro, 1996). By the 1950s, the full impact of cancer was starting to be realized, which led to the recognition that nurses required additional preparation to provide comprehensive care to those who had cancer (Peterson, 1954). Cancer care continued to change rapidly over the next few decades. According to Lynaugh (2008) “the period between 1950 and 1980 was a time of erratic, but fundamental change in every arena of nursing” (Lynaugh, 2008, p. 13). The 1960s saw an increase in the number of clinical trials in oncology and with this came the desire of care continuity from trial participants (Haylock, 2011). During this time of rapid change, the role of the oncology nurses evolved from a primarily task-oriented care role to integral member of the cancer care team, often serving as liaison between clinical investigators and other disciplines that were becoming common to cancer care teams (Haylock, 2011). During this time of change, nursing leaders in oncology saw the need and an opportunity to found societies and associations of cancer nurses across various countries to support nurses and share oncology nursing knowledge. The International Society of Nurses in Cancer Care (ISNCC) was founded in 1984 (International Society of Nurses in Cancer Care [ISNCC], 2018) and in conjunction, the first cancer nursing journal, Cancer Nursing: An International Journal for Cancer Care was established in 1978 (Cancer Nursing, 2018). Shortly after ISNCC, the Canadian Association of Nurses in Oncology (CANO/ACIO) was founded in 1985, by a unanimous vote of more than 300 Canadian oncology nurses, with the goal to create a professional body to support other Canadian nurses working with cancer patients and advocate for appropriate care for patients and roles for oncology nurses (CANO/ACIO, 2018). Basics of Cancer Cancer happens when normal cells become cancerous cells that multiply and spread. Cancer is the second most common cause of death in the U.S. But fewer people are dying of cancer now than 20 years ago. Early detection and innovative treatments are curing cancer and helping people with cancer live longer. Definition of cancer Cancer is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells, or tumor cells. These cells can infiltrate normal body tissues. Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, lung cancer, colorectal cancer). Cancer is not confined to humans; animals and other living organisms can get cancer. When a cell is damaged or altered without repair to its system, the cell usually dies. When damaged or unrepaired cells do not die and become cancer cells, uncontrolled division and growth occurs and a mass of cancer cells develops. Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastasis. For example, if breast cancer cells spread to a bone, it means that the individual has metastatic breast cancer to bone. This is not the same as "bone cancer," which would mean cancer had started in the bone.. It can occur in almost any tissue or organ and may lead to various health problems. Early detection and treatment are crucial for improving the chances of successful outcomes. Cancer research and medical advancements continue to provide hope for better prevention, diagnosis, and treatment options. It's essential to be aware of risk factors, undergo regular screenings, and maintain a healthy lifestyle to reduce the risk of cancer. Epidemiology of cancer Viruses, Bacteria, and Parasites Important discoveries of the past 30 years in cancer epidemiology relate to the carcinogenic effects of infectious agents. Recent estimates of the global cancer burden caused by specific viruses, bacteria, and parasites (Parkin, 2006) imply that about 20% of all cancers worldwide are caused by known infections. Helicobacter pylori, a chronic gastric bacterial infection that can cause gastric ulcers, is a major factor in the development of stomach cancer, accounting for an estimated 63% of all stomach cancers and 5.5% of all cancers world-wide. The evidence is particularly strong for noncardiac gastric cancers, which comprise more than 80% of gastric cancers. Helicobacter pylori is common in developed and developing countries, and more than half of all stomach cancers might be prevented if H. pylori could be eradicated. More than 100 human papillomaviruses (HPVs) have been identified, and DNA from a subgroup of sexually transmitted HPVs that includes HPV16, HPV18, and HPV45 is detectable in virtually all cervical cancers world-wide. These and other HPVs are also found in other anogenital cancers, and in some cancers of the mouth and pharynx. HPV vaccines are now available, but their long-term effect on overall cervical cancer incidence remains to be established. At present, the high cost of HPV vaccines precludes their widespread use in developing countries that lack the resources for organized cervical screening, where their potential impact is greatest. Their effect in countries that already have effective screening is unclear. They are only effective against specific HPV types, so they will not prevent all cervical cancers; they are unlikely to be effective in women who have already been infected; and vaccinated women may be less likely to participate in cervical screening, which is known to be very effective. The contribution of hepatitis B virus (HBV) to liver cancer in high-incidence regions has long been recognized, and the hepatitis C virus (HCV) is similarly carcinogenic.Hepatitis B infection is common in developing countries, and together with hepatitis C it accounts for 85% of all liver cancers worldwide (Parkin, 2006). The incidence of several virally induced cancers is further increased by specific cofactors such as salted fish (nasopharynx), smoking (liver and cervix), aflatoxin (liver), and malaria (the major cofactor with EBV for Burkitt's lymphoma in Africa). There is also strong epidemiological evidence for an infective etiology in childhood leukemia, but no specific pathogen has been implicated. Therapeutic immunosuppression causes a marked increase in the incidence of non-melanoma skin cancer and some virally induced cancers. The discovery that many other epithelial cancers are also increased by immunosuppression (Buell et al., 2005) suggests that unidentified viruses may be important in these cancers as well. The alternative is the long-standing but equally speculative theory that many nonviral cancers are normally kept in check by the immune system. Prognosis of cancer The prognosis of cancer is affected by Prognostic factors Favourable prognostic factors can have a positive effect on the outcome. Unfavourable prognostic factors can have a negative effect on the outcome. These are some important prognostic factors related to cancer. They are; 1. The type of cancer 2. The subtype of cancer based on the type of cells or tissue (histology) 3. The size of the tumour 4. How far and where the cancer has spread (stage) 5. How fast the cancer cells are growing (grade) Cancer most time have positive prognosis if identified and managed on time, it does not always lead to death. There is a remission state in treatment when the signs and symptoms of the cancer disappears. When this remission state lasts for more than five years it can be said to be cured, this happen in most cases when remission lasts more than five years and they continue with their normal life. Risk factors. It is known that there is no exact cause of cancer but there are factors that can lead to cancer and they include; Smoking. Age. Early menopause. Late child bearing. Hereditary. Excessive alcohol intake. Diet. Exposure to ultraviolet rays. signs and symptoms of cancer Fatigue or extreme tiredness that doesn’t get better with rest. Weight loss or gain of 10 pounds or more for no known reason Eating problems such as not feeling hungry, trouble swallowing, belly pain, or nausea and vomiting Swelling or lumps anywhere in the body Thickening or lump in the breast or other part of the body Pain, especially new or with no known reason, that doesn’t go away or gets worse Skin changes such as a lump that bleeds or turns scaly, a new mole or a change in a mole, a sore that does not heal, or a yellowish color to the skin or eyes (jaundice). Cough or hoarseness that does not go away Unusual bleeding or bruising for no known reason Change in bowel habits, such as constipation or diarrhea, that doesn’t go away or a change in how your stools look Bladder changes such as pain when passing urine, blood in the urine or needing to pass urine more or less often Fever or nights sweats Headaches Vision or hearing problems Mouth changes such as sores, bleeding, pain, or numbness Staging and grading of malignant tumour One of the most commonly used systems for staging cancer is the TNM system, which is maintained by the American Joint Committee on Cancer (AJCC). Cancer staging and grading are used to predict the clinical behavior of malignancies, establish appropriate therapies, and facilitate exchange of precise information between clinicians. The internationally accepted criterion for cancer staging, the tumor-node-metastasis (TNM) system, includes: Tumor size and local growth (T) Extent of lymph node metastases (N) Occurrence of distant metastases (M). 1. TNM System: Each letter in the TNM system is followed by a number (and sometimes a lowercase letter) that provides more details: T (Tumor): Describes the primary tumor's size and extent. Tx: Primary tumor cannot be evaluated. T0: No evidence of primary tumor. Tis: Carcinoma in situ (the tumor is still localized to its original location). T1-T4: Describes the size and/or extent of the primary tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. N (Nodes) Indicates whether the cancer has spread to nearby lymph nodes and to what extent. Nx: Regional lymph nodes cannot be evaluated. N0: No regional lymph node involvement. N1-N3: Increasing involvement of regional lymph nodes. Higher numbers indicate more nodes are affected or larger size of affected nodes. M (Metastasis) Indicates if the cancer has spread to other parts of the body. M0: No distant metastasis. M1: Distant metastasis is present. 2. Overall Stage Grouping: Once the TNM categories are determined, they are combined to assign an overall stage, typically using Roman numerals: Stage 0: Carcinoma in situ; cancer is localized. Stage I: Early stage, localized cancer; small and hasn't spread. Stage II & III: Locally advanced; might be larger or might have spread to nearby tissues or lymph nodes. Stage IV: Advanced cancer; has spread to other organs or parts of the body. 3. Other Systems: While the TNM system is widespread, some cancers have their own staging systems. For example, leukemia, lymphomas, and brain cancers have unique staging criteria based on the specifics of those diseases. 4. Restaging: Sometimes, staging is redone after initial treatment, especially if the cancer comes back. This is called restaging and might use the same criteria or different ones depending on the situation. Clinical stage is established before initiation of therapy and is determined by physical examination, laboratory findings, and imaging studies. Pathologic stage is determined evolved over 70 years to accommodate increasing knowledge about cancer biology. Molecular technologies such as genomic and proteomic profiling of tumors could eventually be incorporated into the TNM staging system. Staging is vital as it guides treatment decisions, helps predict a patient's prognosis, and allows for a consistent way to describe the cancer's status, facilitating communication among healthcare providers. Diagnosis of Cancer A cancer diagnosis is based on assessment of physiologic and functional changes and results of the diagnostic evaluation. Patients with suspected cancer undergo extensive testing to; Determine the presence and extent of tumor, Identify possible spread (metastasis) of disease or invasion of other body tissues, Evaluate the function of involved and uninvolved body systems and organs, and Obtain tissue and cells for analysis, including evaluation of tumor stage and grade. The diagnostic evaluation includes a review of systems, physical examination, imaging studies,laboratory tests of blood, urine and other body fluids, and surgical and pathology reports. Knowledge of suspicious symptoms and of the behavior of particular types of cancer assists in determining relevant diagnostic tests. Patients undergoing extensive testing may be fearful of the procedures and anxious about the possible test results. Nurses help relieve the patient’s fear and anxiety by explaining the tests to be performed, the sensations likely to be experienced, and the patient’s role in the test procedures. The nurse encourages the patient and family to voice their fears about the test results, supports the patient and family throughout the test period, and reinforces and clarifies information conveyed by the physician. The nurse also encourages the patient and family to communicate and share their concerns and to discuss their questions and concerns with one another. Roles of an oncology nurse 1. An oncology nurse is a registered nurse who cares for and educates patients who have cancer. 2. The oncology nurse must be able to understand pathology results and their implications, and have an in-depth knowledge of the expected side effects of cancer treatments. 3. The oncology nurse plays a part in ensuring each cancer patient is educated about their disease, its treatments and expected side effects. 4. Oncology nurses are responsible for organizing relevant referrals for patients to other healthcare providers such as dieticians, social workers or speech and language pathologists. 5. Oncology nurses are often responsible for the administration of chemotherapy drugs to patients. They must be educated on safe handling, cytotoxic spills and management of allergic reactions. Medical management of cancer Surgery: Surgical removal of the tumor or affected tissues is common for solid tumors. . The goal of surgery is to remove the cancer or as much of the cancer as possible. Radiation therapy: High-energy rays are used to target and destroy cancer cells. Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation treatment can come from a machine outside your body (external beam radiation), or it can be placed inside your body (brachytherapy). Chemotherapy: Drugs are used to kill cancer cells or stop their growth. Chemotherapy may be administered orally or intravenously. Immunotherapy: Immunotherapy, also known as biological therapy, uses your body's immune system to fight cancer. Cancer can survive unchecked in your body because your immune system doesn't recognize it as an intruder. Immunotherapy can help your immune system "see" the cancer and attack it.These drugs enhance the body's immune system to target and destroy cancer cells. Targeted therapy: Medications are designed to target specific molecules involved in cancer cell growth.it focuses on specific abnormalities within cancer cells that allow them to survive. Hormone therapy: Used for hormone-sensitive cancers to block or alter hormone production or reception. . Some types of cancer are fueled by your body's hormones. Examples include breast cancer and prostate cancer. Removing those hormones from the body or blocking their effects may cause the cancer cells to stop growing. Stem cell transplant: Can also be called bone marrow transplant. Your bone marrow is the material inside your bones that makes blood cells from blood stem cells. Your own bone marrow stem cells or those from a donor can be used. A bone marrow transplant allows your doctor to use higher doses of chemotherapy to treat your cancer. It may also be used to replace diseased bone marrow. Replacing diseased bone marrow with healthy stem cells may be necessary in certain cases. Cryoablation: This treatment kills cancer cells with cold. During cryoablation, a thin, wand like needle (cryoprobe) is inserted through your skin and directly into the cancerous tumor. A gas is pumped into the cryoprobe in order to freeze the tissue. Then the tissue is allowed to thaw. The freezing and thawing process is repeated several times during the same treatment session in order to kill the cancer cells. Radiofrequency ablation: This treatment uses electrical energy to heat cancer cells, causing them to die. During radiofrequency ablation, a doctor guides a thin needle through the skin or through an incision and into the cancer tissue. High-frequency energy passes through the needle and causes the surrounding tissue to heat up, killing the nearby cells. Clinical trials: Clinical trials are studies to investigate new ways of treating cancer. Thousands of cancer clinical trials are underway. Pharmacotherapy The pharmacotherapy of cancer can be divided into four different groups according to the medication impact mechanism: cytostatics, hormonal therapies, targeted drugs and immunologic drugs. Cytostatics: Cytostatics or cytotoxic drugs (also called cytotoxic chemotherapy) are drugs used to destroy cancer cells. Cytotoxic drugs inhibit cell division and in this way cause cancer cells to die. Cytotoxic drugs are transported in the bloodstream throughout the body. They achieve this by influencing cell metabolism during the cell cycle so that cell division and cell reproduction is inhibited. Cytostatics can be classified according to their action mechanisms and their points of attack. Examples are: Busulfan, chlorambucil, dacarbazine, ifosfamide, melphalan, mitobronitol, mitomycin, procarbazine. Hormonal therapy: Hormone therapy is a cancer treatment that slows or stops the growth of cancer that uses hormones to grow such as some prostate and breast cancers. Hormonal therapy is also called hormone treatment, or endocrine therapy. For example, the testicles may need to be removed to reduce testosterone levels as part of prostate cancer treatment. This procedure is called a bilateral orchiectomy. Another example is when the ovaries are surgically removed to stop estrogen production as part of breast cancer treatment. Targeted drugs: Targeted cancer drugs work by 'targeting' those differences that a cancer cell has. The changes in genes that cause one cancer type are often different to the genetic changes causing another. For example, the changes that make a lung cancer grow can be different to ones that make a breast cancer grow. The four main targets for drug action are: Receptors, ion channels, enzymes, carrier molecules. In each of these four cases, most drugs are effective because they bind to particular target proteins. Examples of targeted therapies include lapatinib for breast cancer; crizotinib for lung cancer; bevacizumab for lung and colon cancer; and sorafenib for liver and kidney cancer. Immunological drugs: Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer. The immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them. Complications of cancer: Pain: Pain can be caused by cancer or by cancer treatment, though not all cancer is painful. Medications and other approaches can effectively treat cancer-related pain. Fatigue: Fatigue in people with cancer has many causes, but it can often be managed. Fatigue associated with chemotherapy or radiation therapy treatments is common, but it's usually temporary. Difficulty breathing: Cancer or cancer treatment may cause a feeling of being short of breath. Treatments may bring relief. Nausea: Certain cancers and cancer treatments can cause nausea. Your doctor can sometimes predict if your treatment is likely to cause nausea. Medications and other treatments may help you prevent or decrease nausea. Diarrhea or constipation: Cancer and cancer treatment can affect your bowels and cause diarrhea or constipation. Weight loss: Cancer and cancer treatment may cause weight loss. Cancer steals food from normal cells and deprives them of nutrients. This is often not affected by how many calories or what kind of food is eaten; it's difficult to treat. In most cases, using artificial nutrition through tubes into the stomach or vein does not help change the weight loss. Chemical changes in your body: Cancer can upset the normal chemical balance in your body and increase your risk of serious complications. Signs and symptoms of chemical imbalances might include excessive thirst, frequent urination, constipation and confusion. Brain and nervous system problems: Cancer can press on nearby nerves and cause pain and loss of function of one part of your body. Cancer that involves the brain can cause headaches and stroke-like signs and symptoms, such as weakness on one side of your body. Unusual immune system reactions to cancer: In some cases the body's immune system may react to the presence of cancer by attacking healthy cells. Called paraneoplastic syndromes, these very rare reactions can lead to a variety of signs and symptoms, such as difficulty walking and seizures. Cancer that spreads: As cancer advances, it may spread (metastasize) to other parts of the body. Where cancer spreads depends on the type of cancer. Cancer that returns: Cancer survivors have a risk of cancer recurrence. Some cancers are more likely to recur than others. Ask your doctor about what you can do to reduce your risk of cancer recurrence. Your doctor may devise a follow-up care plan for you after treatment. This plan may include periodic scans and exams in the months and years after your treatment, to look for cancer recurrence. Prevention and Control of Cancer About 30 – 50% of all cancer are preventable (WHO, 2023). This prevention can be achieved through a combination of factors which are as follows: 1. Lifestyle changes: Tobacco control - According to World Health Organization, Tobacco use is the single greatest preventable risk factor for cancer mortality worldwide (2023). Avoiding or quitting smoking and limiting one’s exposure to second hand smoke is one of the measures for preventing cancer. Alcohol consumption - Globally, 1 in 20 breast cancers is attributed to alcohol consumption (WHO, 2023). Limiting or avoiding alcohol consumption is a very important approach to preventing cancer. Diet - Maintaining a healthy diet that includes plenty fruits and vegetables and limit processed foods and red meat. Physical activity – Engaging in regular exercise to maintain a healthy weight. This will reduce cancer risk. 2. Screening and early detection: regular cancer screenings can help detect cancer at an early, and more treatable stage. 3. Vaccination: certain vaccines can help prevent cancers caused by infectious agents. For example HPV vaccine can protect against several types of cancers, including cervical cancer, and the hepatitis B vaccine can reduce the risk of liver cancer. 4. Sun protection: This involves protecting one’s skin from the harmful effect of Ultraviolet radiation from the sun. This prevention factors including wearing sunscreen, protective clothing, and avoiding excessive sun exposure. 5. Environmental factor: Reducing exposure to carcinogens in the workplace and the immediate surrounding is a crucial factor in preventing cancer. Safety measures and environmental regulation can help minimize these risks. 6. Education and awareness: Public health campaigns and education about cancer risk factors, symptoms, and the importance of early detection can help raise awareness and encourage healthier behaviours. 7. Treatment and support services: For those diagnosed with cancer, access to quality treatment, supportive care, and palliative care are essential for improving outcome and quality of life. Download 98.49 Kb. Share with your friends:
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