Cancer Screenings
Describe screening recommendations for breast cancer
Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so
Women age 45 to 54 should get mammograms every year.
Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer
BSE no longer recommended
BE by caregiver no longer recommended
Describe patient interviews related to cancer screenings
Ask about risk factors, symptoms, family hx
Ask about the warning signs:
Skin Cancer
A- asymmetric
B- borders
C- color
D- diameter
6mm
End of pencil eraser
E- evolving
F- funny looking
Seven Warning Signs of Cancer
C- Change in bowel or bladder habits
A- A sore that doesn’t heal
U- Unusual bleeding or discharge out of an orifice
T- Thickening or lump in breast or other tissue
I- Indigestion or inability to swallow
O- Obvious change in wart or mole
N- Nagging cough or hoarseness
What are the side effects of radiation and chemo? What are some therapies to help remedy these?
Bone marrow suppression
Infection
Hand hygiene is important
Monitor temperature routinely
If pt has temperature it is an emergency in those with neutropenia
Wash fruit & Vegetables, no flowers in pts room, stay away from those who are sick, monitor CBC levels, etc.
Hemorrhage
Avoid invasive procedures, avoid activities that place pt at risk for injury or bleeding
This is especially seen in those with thrombocytopenia
When count gets low may provide platelet transfusions
Overwhelming Fatigue
Get adequate sleep
No strenuous activity
Fatigue
Encourage conservation strategies
Rest before activity
Get assistance with activity
Remain active during periods of time patients feel better
Maintain nutritional and hydration status
Assess for reversible causes of fatigue
GI Disturbances
Nausea & vomiting, diarrhea, mucositis, dysgeusia, odynophagia, anorexia
Prophylactic administration of antiemetics
Pepcid, zofran
Assess for signs and symptoms of
Alkalosis, dehydration, and I & O
Watch I&Os
Nonirritating, low-fiber, high-calorie, high-protein diet
Look at food examples
Antidiarrheal, antimotility, and antispasmodic medications
Pts on chemo will be overhydrated to protect
No fatty or gas producing foods
Anorexia
Monitor carefully to avoid weight loss
Weigh twice weekly
Recommend small, frequent, high-protein, high-calorie meals
Encourage nutritional supplements
Integumentary & Mucosal Reactions
Skin reactions
Occur in radiation treatment field
Acute or chronic
Develop 1 to 24 hours after treatment
Generally progressive as treatment dose accumulates
Dry desquamation vs wet desquamation
Dry= common in radiation, found in skin folds
Avoid sun, avoid hot & cold compresses, etc.
No alcohol, no perfume
Use aloe vera and vaseline
Wet
Discharge
Keep clean
Vaseline soaked gauze
Want to prevent infection
Prevent infection
Facilitate wound healing
Protect irritated skin temperature extremes
Avoid constricting garments, harsh chemicals, and deodorants
Alopecia
Help patients deal with hair loss
Pulmonary effects
May be progressive and irreversible
Cough, dyspnea, pneumonitis, pulmonary edema
Treatment
Bronchodilators
Expectorants/cough suppressants
Bed rest
Oxygen
What is grief?
Complex and intense emotional experience that affects all aspects of life
Priority interventions provide for patients to express feelings.
Many factors shape the manner in which a person grieves.
Kubler-Ross — Five Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance
General goals for patient teaching include
Health promotion (Prevention)
Disease prevention (Detection and Prevention)
Illness management (Detection and Mitigation)
Selection and use of appropriate treatment options (Mitigation)
Need to be able to understand patients health literacy, what way they learn best, the resources available
Evaluate if they learned anything
Have them do teach back
Put everything at 5th grade level or lower in terms of material
Get an interpreter if needed
There is so much for this specific one
Describe screening recommendations for colon & rectal cancer
Starting at age 50, both men and women should follow one of these testing plans:
Tests that find polyps and cancer
Flexible sigmoidoscopy every 5 years*, or
Colonoscopy every 10 years, or
Seen most
Double-contrast barium enema every 5 years*, or
CT colonography (virtual colonoscopy) every 5 years*
Tests that mostly find cancer
Yearly guaiac-based fecal occult blood test (gFOBT)**, or
Yearly fecal immunochemical test (FIT)**, or
Stool DNA test (sDNA) every 3 years*
Describe the surgical care for pts with CRC including education to be provided
Postoperative care
Sterile dressing changes, care of drains, and patient and caregiver teaching about stoma
Management differs depending on type of wound
Type of management is individualized
Drainage must be assessed for amount, color, and consistency
Wound should be examined regularly
Record bleeding, excessive drainage, and odor
Monitor suture line for infection
Help with pain control
Be aware of phantom sensations
Provide sexual dysfunction education
Ambulatory Care
Psychologic support
Managing changes that result from cancer and cancer treatment
Ostomy rehabilitation
What are some more side effects of radiation & chemo? What are therapies to help with these?
Cardiovascular effects
Patients with preexisting coronary artery disease are more vulnerable
Radiation-induced heart disease is more likely in patients given high doses of radiation and doxorubicin
Herceptin is cardiotoxic
Reproductive effects
Inform patient of expected sexual side effects
Use appropriate shielding
Encourage discussion of issues related to sexuality
Sexual dysfunction can occur
Refer to counseling if needed
Late Effects:
Increased risk for leukemias and other secondary malignancies
Secondary malignancies, other
Multiple myeloma
Non-Hodgkin’s lymphoma
Cancers of the
Bladder, kidney, ureters, osteosarcoma of rib, scapula, clavicle, humerus, sternum, ilium, and pelvis
Fibrosarcomas have been reported several years after radiation therapy
Cataracts, endocrine problems, cognitive problems, arthralgia, etc.
Smoking may significantly increase the risk of secondary malignancies
Secondary malignancies are usually resistant to therapy
Describe anticipatory grief
In anticipatory grief the death is expected and grief begins long before the death of the person/pt
Describe screening recommendations for cervical cancer
Cervical cancer testing should start at age 21. Women under age 21 should not be tested.
Women between the ages of 21 and 29 should have a Pap test done every 3 years. HPV testing should not be used in this age group unless it’s needed after an abnormal Pap test result.
Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called “co-testing”) done every 5 years. This is the preferred approach, but it’s OK to have a Pap test alone every 3 years.
Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing goes past age 65.
A woman who has had her uterus and cervix removed (a total hysterectomy) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.
All women who have been vaccinated against HPV should still follow the screening recommendations for their age groups.
Describe the emotional needs of a cancer patient
Facing a possible diagnosis of cancer is a stressful time for the patient and caregivers. Patients may undergo several days to weeks of diagnostic studies. During this time, fear of the unknown may be more stressful than the actual diagnosis of cancer. Patients may feel overwhelmed or confused by the need for multiple diagnostic studies and consultations. Help coordinate care among multiple specialists. Explain the purpose of required tests and any special preparation needed.
While patients are waiting for the results of diagnostic studies, actively listen to their concerns. Anxiety may arise from myths and misconceptions about cancer (e.g., cancer is a “death sentence,” cancer treatment is “horrible”). Correcting those misconceptions can help lessen their anxiety.
Learn to manage your own discomfort during difficult conversations. Avoid communication that hinders exploration of feelings and meaning. These include providing false reassurances (e.g., “It’s probably nothing”), redirecting the discussion (e.g., “Let’s discuss that later”), and generalizing (e.g., “Everyone feels this way”). These strategies deny patients the opportunity to share the meaning of their experience. They can jeopardize your ability to build a trusting relationship with your patients.
During this time of high anxiety, the patient may need repeated explanations of the diagnostic plan. Include as much information as needed by the patient and caregivers. Give clear, understandable explanations and reinforce them as needed. Avoid using overly technical language. Written information is helpful to reinforce verbal information.
What is the safety measure used with patients undergoing cancer treatment, especially chemo?
Need to be careful with issues such as extravasation
Prevent infection
More likely to experience myelosuppression with chemotherapy
Wash hands
Keep stuff sterile
Wear proper equipment to prevent spread of radiation
Inform patient of side effects and how to prevent them
Only persons specifically trained in chemotherapy handling techniques should be involved with the preparation and administration of cancer drugs.Cancer drugs may pose a hazard to health care persons who do not follow safe handling guidelines. A person preparing, transporting, or giving chemotherapy may absorb the drug through inhalation of particles when reconstituting a powder or through skin contact from exposure to droplets or powder. There may be some risk in handling the body fluids and excretions of people during the first 48 hours after they receive chemotherapy. We follow guidelines developed by the American Society of Clinical Oncology for the safe handling of chemotherapy.
Describe adaptive grief
This form of grief is considered “good grief” as it helps the person accept the reality of death
It is a healthy process and revealed in positive memories and seeing good from the death
Describe screening recommendations for lung cancer
The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. But, we do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you are all of the following:
55 to 74 years of age
In good health
Have at least a 30 pack-year smoking history AND are either still smoking or have quit within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)
Screening is done with an annual low-dose CT scan (LDCT) of the chest. If you fit the list above, talk to a health care provider if you want to start screening.
What are the risk factors for cancer, including skin cancer?
First degree relative with it
Genetics
Age
Tobacco use
Obesity
Viruses & bacteria
Alcohol consumption
Smoking
Environmental (Skin Cancer)
Sun exposure
Irritants and allergens
Radiation
Sleep
Exercise
Hygiene
Nutrition
Describe dysfunctional grief
Prolonged Grief Disorder
This is unhealthy
Recurrent and severe distress
Denial of the loss for longer than 6 months
Affects about 1 in 5 bereaved people
Describe screening recommendations for prostate cancer
Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment.
Starting at age 50, men should talk to a health care provider about the pros and cons of testing so they can decide if testing is the right choice for them.
If you are African American or have a father or brother who had prostate cancer before age 65, you should have this talk with a health care provider starting at age 45.
If you decide to be tested, you should get a PSA blood test with or without a rectal exam. How often you’re tested will depend on your PSA level.
What changes do you look out for with skin cancer?
A- asymmetric
B- borders
C- color
D- diameter
6mm
End of pencil eraser
E- evolving
F- funny looking
Describe grief support
Bereavement programs are available to help those who have lost their loved ones
This should be integrated into the plan of care before and after death