Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION Miss. SHAHAJAHAN BANU I YEAR MSc NURSING MEDICAL SURGICAL NURSING YEAR 2007-2009. PADMASHREE COLLEGE OF NURSING GURUKRUPA LAYOUT, NAGARBHAVI BANGALORE – 560 072. 0 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE Miss. SHAHAJAHAN BANU AND ADDRESS I YEAR MSc NURSING PADMASHREE COLLEGE OF NURSING GURUKRUPA LAYOUT NAGARBHAVI, BANGALORE – 560 072. 2. NAME OF THE INSTITUTION Padmashree College of Nursing Bangalore 3. COURSE OF THE STUDY AND I Year M.Sc Nursing SUBJECT Medical Surgical Nursing 4. DATE OF ADMISSION 2nd June 2007. 5. TITLE OF THE STUDY A study to assess the effectiveness of planned teaching programme on knowledge regarding management of side effects of radiation therapy among oncologic clients admitted in selected hospital, Bangalore 1 6. BRIEF RESUME OF THE INTENDED WORK 6.1 INTRODUCTION Health care should encompass all aspects of keeping a person in a state of health. Nominally it is a form of prevention of sickness and a conscious effort to maintain a healthy life style. Cancer is a tumor, or an overgrowth of abnormal cells. These cells grow by multiplying or dividing to rapidly make new tumor cells. This ability to multiply without limits grows quickly and invades surrounding normal tissues makes cancer cells different from normal cells.1 The Magnitude of the problem of cancer in our society is only partially reflected by statistic on mortality and morbidity. Cancer is a major killing disease in the beginning of the 20th century, cancer was the 6th cause of death in industrialized countries, and today it stands as second leading cause of death.2 In 2005, 7.6 million people died of cancer out of 58 million deaths world wide. More than 70% of all cancer death can occur in low and middle income countries. Based on projection, cancer deaths will continue to raise with an estimated 9 million people dying from cancer is 2015, 11.4 million dying in 2030.3 Cancer rates in India is rising due to increase in life expectancy, changes in life style and increased migration from rural area to the cities, India is a vast country with diverse lifestyle and therefore have varying cancer patterns and incident rates.4 2 One way to stop the cancer from growing is to interfere with the cancer cells ability to multiply there are several methods being utilized, in which radiations, used at a high doses, causes changes in the cancer cells that stops the cells ability to multiply and eventually kills the cancer cells. Radiation therapy has been in use as a cancer treatment for more than 100 years with its earliest routes traced from the discovery of x-rays in 1895. The concept of therapeutic radiation was invented by German physicist Wilhelm Conrad Rontgen when he discovered that the x-ray was a powerful and effective tool to treat cancer. Radiation therapy is one of the four approaches to the treatment of cancer, the other three are surgery, chemotherapy and biological therapy. The most common type of cancer that radiation therapy is used for are brain tumors, head and neck cancer, breast cancer, lung cancer, prostate cancer, skin cancer, rectal cancer, cervix and uterine cancer, lymphoma and sarcoma. The doses of radiation are used to destroy cancer cells can also hurt normal cells, thus the side effects are directly related to the area of the body being treated. Most side effects are temporary; disappearing gradually after therapy is complete. If side effects become severe treatment may be put on hold to allow the tissue to heal before continuing. There are several methods being utilized for the prevention of radiation therapy side effects. These mainly include altering the manner in which radiation is delivered and administering drugs that protects normal cells from radiation damage. Two delivery methods that were originally used to reduce radiation side effects include dose fractionation, or splitting the total dose or radiation therapy 3 into multiple doses and physical shielding with lead blocks to reduce the area of exposure while preventing side effects from occurring. Sometimes side effects are inevitable, in these situations several types of drugs can be used to decrease the side effects of radiation 5. 6.2 NEED FOR THE STUDY Radiation therapy is becoming the more acceptable modality of cancer treatment; the use of Radiation Therapy leads to numerous side effects which effects patient’s physical, psychological and social status. This also impairs his or her life style and day to day activities. The cancer patients who are receiving this treatment modality should be familiar to side effects of radiation therapy and the measure to manage the side effects. Radiation therapy engenders many fears for patient, families and friends. Misinformation is common and patient, friends and families may reinforce these concerns due to erroneous assumptions and lack of accurate information. It is essential that radiation therapy nurses and physicians educate both the patient and family before a course of treatment. The function of the Nurse in cancer Radiation therapy has greatly expanded during the past decade. The Nurse meet Patient, who is receiving Radiation Therapy, helps the patient in copying with Radiation Therapy and also given information regarding management of side effects of Radiation Therapy. 4 This study will direct the nurse to form on patient education and teaching about some of the common side effect from Radiation Therapy and management of side effects with his or her available coping strategies so that the patient can be enable to lead a normal and better quality of life. Teaching and educating of the patient is extremely important part of the nurses, related to Radiation Therapy. Being a cancer itself is a painful experience for these patients and the discomfort due to the treatment adds to it. Hence it is essential for the patients to know about Radiation Therapy, its side effects and the relieving measures. In the light of above fact and personal experience of the investigator as a staff in the clinical area while caring for cancer patients receiving Radiation therapy, it was observed that most of the patients have lack of information related to management of the side effects of Radiation Therapy and were found to be almost Physically sick mentally depressed and socially isolated. Hence the research was interested in the above area and wanted to impact knowledge regarding the management of side effects of Radiation therapy. 6.3 STATEMENT OF PROBLEM A study to assess the effectiveness of planned teaching programme on knowledge regarding management of side effects of radiation therapy among oncologic clients admitted in selected hospital, Bangalore. 5 6.4 OBJECTIVES 1. To assess the pretest knowledge of oncologic clients on management of side effects of radiation therapy. 2. To evaluate the effectiveness of planned teaching programme on management of side effects of radiation therapy. 3. To associate post test knowledge of Oncologic clients with selected demographic variables. 6.5 OPERATIONAL DEFINITIONS 1. Effectiveness In this study effectiveness is defined as a significant increase in the level of knowledge after undergoing planned teaching programme related to management of side effects of Radiation Therapy for oncologic clients, measured from the difference between pre test and post test score. 2. Planned teaching programme Refers to a systematically organized teaching strategy for duration of 1 hour for oncologic clients on management of side effects of Radiation Therapy, provided by Verbal Interaction with the use of flash cards. 6 3. Knowledge It refers to awareness and understanding of oncologic clients regarding the management of side effects of radiation therapy, as measured by structured knowledge questionnaire. 4. Management Refers to conservative and therapeutic measures taken by oncologic clients in treating the side effects of radiation therapy such as nausea, vomiting, skin reaction, alopecia, and diarrhea. 5. Side Effects Undesirable effects such as hair loss, skin reaction, nausea, vomiting and fatigue produced by the radiation therapy among oncologic clients admitted in selected hospital, Bangalore. 6. Radiation therapy The use of high energy rays, damage cancer cells, stopping them from growing and dividing. In this study it refers to the oncologic clients receiving radiation therapy, admitted in selected hospital, Bangalore. 7 7. Oncologic Clients Are patients who are diagnosed of malignant growth of different types of cells of any body organ undergoing radiation therapy as a treatment and admitted in the selected Hospital. 6.6 ASSUMPTIONS 1. Oncologic clients may have inadequate knowledge regarding management of side effects of radiation therapy. 2. Planned teaching programme may improve the knowledge of patients regarding management of side effects of radiation therapy. 3. Clients knowledge may vary with the selected demographic variables 6.7 NULL HYPOTHESES Ho1 – There will not be a significant difference between the mean pre test and mean post test knowledge of clients receiving planned teaching programme. Ho2 – There will not be a significant association between the knowledge score of the clients and selected demographic variables. 8 6.8 REVIEW OF LITERATURE This chapter deals with the literature reviewed in the area of Radiation therapy, side effects of Radiation therapy and management of side effects of radiation therapy Literature review done for the study is presented under the following headings, General information on cancer. Cancer treatment and radiation therapy Side effects of radiation therapy Nurses role in management of side effects of radiation therapy Effectiveness of planned teaching or health education in improving the knowledge. 1. Literature related to general information cancer Although cancer is often referred to as a single condition, it actually consists of more than 100 different diseases. The diseases are characterized by uncontrolled growth and spread of abnormal cells. World wide there are over 10.9 million cases of cancer. Each year 4.7 million are reported in developed countries and nearly 5.5 millions are in the less developed countries. In developed countries cancer is 2nd most common cause of death and epidemiological evidence points to emergence of a similar trend in the developing country. Cancer is currently the cause of 12% of all death worldwide. 9 Approximately 20 years time the number of deaths annually due to cancer will increase from about 6 million to 10 million.6 Lung cancer has been the most common cancer world wide. Since 1985, and by 2002 accounted for 1.35 million new cases (12.4% of world total) and 1.18 million deaths (17.6%) of world total. Although it is most frequent cancer in men world wide. Lung cancer is second to prostate cancer incidence in developed countries. Breast cancer is by far the most frequent cancer of women, accounting for 23% of all cancers because of its high incidence and relatively good prognosis, breast cancer is the most prevalent cancer in the world, with an estimated 4.4 million women alive who have had the disease diagnosed within the last 5 years, compared to 1.4 million survivors men and women from lung cancer 7. In India the estimated number of new cancer per year is about 7 lakhs and over 3.5 lakhs people die of cancer each year, out of these 7 lakhs new cancer about 2.3 lakhs (33%) cancer are tobacco related 8. The national cancer registry project (NCRP) initiated in 1981-82 continued to collect authentic data on cancer occurrence in country. The data for the year 1996 showed a crude incidence rate (per 1,00,000) in the metropolitan cities from 53.7 in Bangalore to 79.6 in Chennai among men and from 68.7 in Bangalore to 93.6 in Chennai among women. A population revealed that the population of coverage of cancer cases was 72% in Bangalore, 100% in Chennai and 78% in Mumbai. The five year relative survival for female breast cancer was 46.8% in Bangalore, 49.5% in Chennai and 55% in Mumbai. 10 The age adjusted incidence rate of esophageal cancer in women in a Bangalore in one of the highest (8.3 per 100,000) in the world. In women, cancer of the cervix and breast together account for over 40% of cancer in urban women and 65% of cancer in the rural registry in Barshi 9. Cancer develops gradually over many years due to the result of a complex mix of environmental, nutritional, behavioral and hereditary factors. The exact cause of cancer is not known but certain life style choices can dramatically reduce the risk of developing most types of cancer. Not smoking, eating, eating healthy diet and exercising moderately for at least 30 each day reduce the risk of cancer by more than 60%. Statistic shows that men are more likely to develop cancer than women and some cancers are more prevalent in particular races than others for example. Bladder cancer is twice as common in white people as it is in black people. White women are more likely to develop breast cancer than are black women, but black women are more likely to die of the disease 10. 2. Literature related to cancer treatment and radiation therapy. The different modalities for treatment of cancer include surgery, chemotherapy, radiation therapy, immunotherapy and bone marrow transplantation. Radiation therapy has been in use as a cancer treatment for more than 100 years with its earliest routs traced from the discovery of x rays in 1895. The 11 concept of therapeutic radiation was invented by German physicist Wilhelm Conrad roentgen when he discovered that x-rays was powerful and effective tool with which to treat cancer. A study was conducted on radiation therapy effective against eye cancer. The researchers have been treating patients with malignant melanoma of uveal with radiation therapy. Study has done on 57 patients with uveal melanoma. With this treatment, a small metal shield containing radioactive needs is sutured to the out side of the eye over the tumor. The study found that a five year after radiation treatment, 90% of patients had their tumors controlled. Researchers said, the study results are very encouraging and these findings in this small series of patients with melanoma treated by radiation is effective in controlling the primary tumor, often with good visual out come 11. A study was conducted on laparoscopic management of kidney cancer; it has emerged as the preferred option for the surgical management of kidney cancer. The review of literature was compiled regarding the long term oncology results of laparoscopic radical nephrectomy. It has become the new standard of care for most patients. The finds revealed that laparoscopy is a minimally invasive option available to most patients with kidney cancer. The immediate benefits of laparoscopy include less blood loss. Decreased pain, shorter preoperative convalescence, and improved cosmoses 12. An article was written on current role of radiation therapy in the management of malignant brain tumors. The objective of this article is to explain how the current management of malignant brain tumors has evolved. Using the foundation of evidence based literature; it reveals that Radiotherapy plays a central 12 role in the multidisciplinary management of primary brain tumors and metastases. The techniques of radiation therapy continue to refine to optimize local control while minimizing potential treatment related neuro cognitive toxicities 13. A study was conducted among patients who received both radiation treatment and surgery. Findings revealed that 2.4% of the patients show reappearance of their cancer. But a group of Patients who have under gone radiation therapy before the surgery having the less chances of reappearance of the disease. Study conclude that radiation before surgery can improve local control of the disease 14. 3. Literature related to side effects of radiation therapy According to university of California medical center, the radiation will still kill some healthy cells in that area of the body. Radiation causes some various things to happen, it may cause skin changes such as redness or peeling, vaginal or rectal pain, nausea, loss of appetite, fatigue, diarrhea, hair loss and or softening of bones. A study was conducted on effect of radiotherapy on sexual activity in women with cervical cancer over a period of 3 to 12 months. The study sample was women who are under treatment for cervical cancer. Main outcome measured were changes of sexual activity in sexual desire, arousal, dyspareunia and satisfaction. The study was concluded that sexual activities were significantly reduced following radiation therapy 15. A study conduct on radiation therapy and chemotherapy induced oral mucositis. Current studies define oral mucositis has a very frequent and painful 13 inflammation with ulcer on oral mucosa. The incidence and severity of lesion are influenced by patient and treatment variable 16. An article states that radiation therapy induced fatigue is a common early and chronic side effect of irradiation. 80% of the patients reported this side effect respectively during radiation therapy and at follow up visits. The factors that cause fatigue and the exact mechanism responsible for its production, sustenance are not well understood. The findings revealed that patients who receive radiation therapy can induce fatigue 17. A study was conducted on radiotherapy induced nausea and vomiting as many as 40-80% of patients undergoing radiotherapy will experience nausea and or vomiting, depending on the site of irradiation fractionated radiotherapy may involve up to 40 fractions over a 6-8 weeks period, and prolonged symptoms of severity depend on radiotherapy related factors (dose, radiation therapy techniques) and patient related factors (such as gender, general health, age, psychological state, tumor stage) 18. An article reviewed on cardiac toxicity associated with cancer therapy. It may be life threatening. Limit the dose and duration of the treatment can adversely affects on short term and long term quality of life. A group of patients at risk of cardiac complication are patients with breast cancer. Hodgkin’s and non Hodgkin’s lymphomas and soft tissue sarcoma 19. A study was conducted on radiation induced skin fibrosis after treatment of breast cancer. Profilometric analysis of the skin of breast cancer patients undergoing radiotherapy was done 20 women’s, age 45-55 years old were enrolled 14 in the study 6-16 months after the end of treatment associating radiotherapy. Imprint using silicon rubber material were performed over treatment breast and the normal breast. The results were, the comparison of the imprint shows slight increase of skin roughness, increase of furrows depth along with an increase of the residual length. Study conclude that a breakdown effect of irradiation on the skin with the fibrous inducing by ionizing radiation 20. A population based retrospective cohort study was conducted to examine the association between radiation therapy for breast cancer and subsequent esophageal squamous cell carcinoma. 2,20806 women in whom breast cancer were diagnosed, who had received radiation therapy for breast cancer. The relative risk for esophageal carcinoma is increased in women who receive radiation therapy for breast cancer 21. 4. Literature related to nurses role in management of side effect or radiation therapy. When undergoing treatment for cancer, especially radiation therapy and chemotherapy, there are a number of complications, symptoms or side effects that patient may experience. The patient should inform any side effects which he comes across and the nurse plays important role in helping patient in managing the side effects. An article states on information source used to learn about side effects, why patients believe they will experience some side effects but not others,, and the meaning side effects have in terms of treatment efficiency. 31 Ovarian cancer 15 patients and 81 men and women with variety of cancer diagnoses completed a questionnaire prior to their treatment assessing their expectations about experiencing specific side effects of radiation therapy and information source used. The findings revealed that the doctors or nurse was the most frequently cited source of side effects information, with readings as the second 22. A descriptive study was done to evaluate how patients diagnosed with uterine cancer, experience fatigue, psychological distress, coping resource and functional status before, during and after treatment with radiation therapy. 60 women taken as a sample, receiving radiotherapy. Data were collected through self report. Findings were patients fatigue scores increased significantly. Nurses mist inform patients receiving radiation therapy about the expected changes in fatigue and functional status.23 A study was conducted on ionizing radiation: safety for patients, visitors and staff. Diagnostic radiology and sealed and unsealed sources of radiation therapy are valuable in the treatment of cancer. However, unwanted consequences can result from excessive exposure to ionizing radiation. Therefore, nurses involved in patient care. Nurses should be aware of the safety issues in the diagnostic and therapeutic use of ionizing radiation so that they can work safely and confidentially 24. A review of literature published from 1979 to 1990 on information, education and communication needs of patients with cancer and their families. This review incorporate a sample of 66 articles published from 1990 to 1997, of these 44 articles address the information, education and communication need of patients with cancer and their families. The discussion focuses on how health 16 professionals can maximize patients comprehension and retention of information, encourages patients participation in health decision making, and for set dialogue with patients and families. The findings revealed that steps should be taken within health care organization to ensure that ongoing informational need assessment and education are a routine part of comprehensive cancer patient care25. A study was reviewed on current applications of radiotherapy in the treatment of persons with lung cancer, providing the scientific basis for nursing management of disease and treatment effects. Nurses have a major responsibility in patient’s family education, and in providing the supportive care and self help techniques needed for patients treated with radiation therapy 26. A study was conducted on impacting quality of life (QOL) for patients with cancer with a structured multidisciplinary interception: randomized controlled trial. The clients were randomly assigned to an 8 session structured multidisciplinary intervention arm with 5 domains of QOL including cognitive, physical, emotional, spiritual and social functioning. The study concluded that participants maintained and actually improved their QOL during radiation therapy; a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment 27. A study was conducted on the prevention and management of acute skin reaction related to radiation therapy. The method that was in used is a systemic review of literature on this topic. 28 trial meeting the inclusion criteria of the 23 trials that evaluated preventive method, washing practice prevented skin reaction. Some evidence suggested topical steroid cream or dressings. The study was concluded that skin washing with plain water, use of non scented, lanolin free 17 hydrophilic cream may helpful in preventing radiation reaction. In addition, a low doses corticosteroid cream may be beneficial in the reduction of itching and irritation 28. 5. Literature related to effectiveness of planned teaching or health education in improving the knowledge. According to world health organization, health behavior is a major target of teaching and it is ensured that teaching helps in changing behavior through cognitive and effective behavior changes. Each individual is responsible for the maintenance of his or her own health. Moreover each individual has self cares which are potential in assuring their responsibility. Thus the personal health approach involves face to face education. A study was conducted to evaluate the effectiveness of a planned reaching programme regarding prevention of nutritional anemia in adolescent girls of selected rural pre University College at Mangalore. The study revealed that planned teaching programme increased the knowledge regarding prevention of anemia in which the post test knowledge score was 84.4% with the pre test score being 43.88% 29. A study was conducted to asses the effectiveness of planned teaching programme on knowledge about management of side effects for cancer patients undergoing chemotherapy at oncology OPD of MSRMTH, Bangalore. The study revealed that planned teaching programme increased the knowledge of the patients regarding the management of side effects of chemotherapy in which the post test knowledge score was 68% with the pre test score being 32%30. 18 A study was conducted to evaluate the effectiveness of planned teaching programme on complication of intravenous therapy among first year basic BSc nursing students in KTG College of nursing, Bangalore. The study revealed that planned teaching progremme increased the knowledge of the students of first year BSc nursing regarding the complications of intravenous therapy in which the post test knowledge score was 72% with pre test score being 48% 31. A study was conducted on effectiveness of planned teaching programme on Bio medical waste management among staff nurses working in selected hospital at Mangalore. The study revealed that planned teaching programme increased the knowledge and awareness among staff nurse regarding the management of biomedical waste in which the post test knowledge score was 83% with pre test score being 46%32. 19 7. MATERIALS AND METHODS 7.1 SOURCE OF DATA The data will be collected from oncologic clients undergoing Radiation therapy admitted in selected hospital in Bangalore. 7.2 METHODS OF COLLECTION OF DATA i. Research design Experimental design: Pre-experimental: One group pre-test and post test design ii. Research Variable Dependant variable: Level of knowledge of clients regarding management of side effects of radiation therapy. Independent variables: Planned teaching programme on management of side effects of radiation therapy Demographic variables: It includes baseline information of Oncologic clients such as age, sex, educational status, occupation status, economic status, type of cancer, stage of cancer, kind of radiation therapy and duration of radiation therapy. 20 iii. Settings KIDWAI MEMORIAL INSTITUTE OF ONCOLOGY, BANGALORE. iv. Population In the present study population comprises of the clients who are diagnosed to have cancer of any kind and receiving radiation therapy in selected hospital, Bangalore. v. Sample Oncologic clients who fulfill the certain inclusion criteria will be considered as sample and sample size is 50. vi. Criteria for sample selection. Inclusion criteria - Oncologic clients who are diagnosed to have cancer of any of the body system and undergoing radiation therapy in selected hospital. - Oncologic clients who are willing to participate in the study. - Oncologic clients, who are able to read, write and understand Kannada or English Language. Exclusion criteria - Oncologic clients who are admitted other major systemic complications such as congestive cardiac failure, renal failure, and pulmonary edema. - Oncologic clients who are in immediate post operative period. - Oncologic clients who are not willing to participate in study. 21 vii. Sampling technique Non Probability convenient sampling technique. viii. Tool for data collection Section A Demographic proforma of Oncologic clients consisting of items on age, gender, educational status occupation, economic status, type of cancer, stage of cancer, kind of radiation therapy and duration of radiation therapy. Section B Structured questionnaire to assess to the knowledge of oncologic clients management of side effects of radiation therapy used to assess the knowledge level of clients. Section C It consist of planned teaching programme regarding management of side effects of radiation therapy administered to oncologic clients with the use of flash cards to improve their knowledge and to help the client to cope with the side effects of radiation therapy. ix. Methods of data collection After obtaining the permission from the concerned authorities and informed consent from the samples, the investigator will collect the data pertaining to the demographic variables. Phase I Assess the existing knowledge of oncologic clients with the help of structured questionnaire. 22 Phase II Planned teaching programme on management of side effects of radiation therapy will be given to the Oncologic clients per about 1 hour, using flash cards. Phase III After a period of one week, post test level of knowledge will be assessed within the same group using same questionnaire. x. Plan for data analysis The data collected will be analyzed by means of descriptive and inferential statistics. Descriptive statistics: Frequency, percentage distribution, mean and standard deviation will be used. Inferential statistics: Paired ‘T’ test will be used to determine the significance of the difference between the mean pre test and post test knowledge scores. Chi-square will be used to determine the association between pre test knowledge level and selected variables. xi. Projected outcome The study will improve the knowledge of clients on management of side effects of radiation therapy among oncologic clients. This could help to create awareness regarding the proper care and management of side effects of radiation therapy, prevent further complication among oncologic clients. 23 7.3 Does the study require any investigations or interventions to the patients or other human beings or animals? Yes, planned teaching programme will be administered as intervention for the oncologic clients. 7.4 Has ethical clearance been obtained from your Institutions? Yes permission will be obtained from the concerned authorities in the selected cancer hospital. 24 LIST OF REFERENCES: 1. WHO, Cancer statistics. WHO GENEVA; 1999: Available from http://www.who.org// 2. Park K K Park’s text book of preventive and social medicine. 17th ed. Jabalpur, India. 2 M/s Banarasidas Bahnot; 2002: 285-86. 3. ACS. Research cancer. American Cancer Society; 2006: Available from http://www.cancer.org/ 4. Rajiv Raman Prasad, Dilip Kumar Yadav. Journal of the Indian Medical Association. Volume 3, Sept 2005: 483-85. 5. CCC. History of radiation oncology. Comprehensive Cancer Center; 2003: Available from http://www3.ccc.uab.edu/ 6. WHO, Cancer statistic. WHO GENEVA; 2002: 4-6 7. Parking DM, Bray F, Pisani P. Global Cancer statistics; 2002:74-108. 8. Dr k Ramachandra Reddy, Dr PP Basy. Population based cancer registry. Kidwai Memorial Institute of Oncology.Bangalore: Available from http://www.icmr.nic.in/ 25 9. NRCP. Indian Council of Medical Research; 2002: 10-12 10. ASC.Cancer statistics. American cancer society; 2007: Available from http://www.cancer.org/ 11. Craig Greven, Kathryn Greven. Radiation therapy effective against eye cancer. Radiation Oncology. Wake Forest University. New Jersey. USA. 12. Al-Qudah, Rodriquez AR, sexton WJ. Laparoscopic Management of Kidney cancer: Update review. Cancer Control. 2007; 14(3): 218-30. 13.Tam Truong M. Current role of radiation therapy in the management of malignant brain Tumor. Hermatol Oncology Clinic North America. 2006; 20(2): 431-53. 14. Dr Ellen kapid. Radiation before surgery cuts cancer reappearance. Lei den University Medical Centre. New Jersey. Available from http://www.biomedicine.org/. 15. Sarwongs, Choobun T. Effects of Radiation therapy on Sexual activities in human with cervical cancer. East African Medical Journal. 2007; 84(1) 24-30. 16. Volpato LE, Sakai VT. Radiation Therapy and Chemotherapy induced oral mucositis. Revised British otorrinolarigol.2007; 73(4): 562-8. 26 17. Turri Zianni A, Montrac, Ferro M. Radiotherapy related fatigue. Rays. 2005; 30(2): 197-203. 18. Fever Pch, Maranzano E, Clark Snow RA, Roisa F. Radiotherapy induced nausea and vomiting. Support Care Cancer. 2005; 13(2): 122-8 19. Larkol, Mazur G, Wrobel T. Cardiac toxicity in cancer. Polmerkur lekarshi. 2002; 13(73): 79-85. 20. Bourgeois JF, Gourgon S, Kramar A. Radiation induced skin fibrosis after treatment of breast cancer. Skin Research Technology. 2003; 9(1): 39-42. 21. Habibul ahsan, Neugent. Radiation therapy for breast cancer and increase risk for esophageal carcinoma. Annal of International Medicine.15 Jan 1998; 128(2):114-117. 22. Nair M G, hickok J T, Roscer J A. University of Rochester Centre, New York, USA. 23. Aulberg K, Ekman T.fatigue Psychological distress, coping resourses, and functional status during radiation therapy for uterine cancer. Oncology Nursing Forum. 2005; 32(3): 633-40. 24. Hart S. Lonizing Raidations: Promoting safety for patients, visitors and staffs. Nursing Standards. 2006; 20(47): 47-57. 27 25. Harris K A Patient education Branch, National Cancer Institute, Bethesda Mary Land, USA. 26. Hiderley CJ. Radiation Therapy for Lung Cancer. Semin Oncology Nursing. 1996; 12(4):304-11. 27. Rummans JA, Clark MM, Sloan J A. Imparting Quality of life for patients with advanced cancer with a structured multi disciplinary intervention and randomized control trial. Journal of Clinical Oncology. 2006; 24(4):635-42. 28. Bolderston A, Holden L, Robb Bleu. The prevention and management of acute skin reactions related to radiation therapy. Support Care Cancer. 2006; 14(8): 80217. 29. George Reena. Evaluate the effectiveness of planned teaching programme regarding prevention of nutritional anemia in adolescent girls of selected rural pre university college at mangalore. Rajiv Gandhi University of Health Science; 2003: NNMN00055. 30. Cherian Christeena. Effectiveness of planned teaching programme on knowledge about management of side effects for cancer patients undergoing chemotherapy. Rajiv Gandhi University of Health Science; 2004: NNMSN0092. 31. Joseph Merlin. Effectiveness of planned teaching programme on complication of intravenous therapy among first year basic BSc nursing students in KTG college of nursing, Bangalore. Rajiv Gandhi University of Health Science; 2005: NNMSN00110. 28 32. Rani Ruby. Effectiveness of planned teaching programme on Bio medical waste management among stff nurses working in selected hospital at mangalore. Rajiv Gandhi University of Health Science; 2006: NNMSN00130. 29 9. Signature of the candidate : 10. Remarks of the guide : 11. Name and Designation of : 11.1 Guide : 11.2 Signature : 11.3 Co-guide (if any) : 11.4 Signature 11.5 Head of the Department : 11.6 Signature : 12.12.1. Remarks of the principal : 12.2. Signature : 30