Download Chain of Survival and EMSC

Chapter 8
Caring for the Cancer Survivor
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Cancer Survivorship



16 million cancer survivors in United States
An individual is considered a cancer survivor from the
time of diagnosis through the balance of his or her
life.
The major forms of cancer therapy—surgery,
chemotherapy, hormone therapy, biological response
modifiers (biotherapy), and radiation therapy—often
create unwanted long-term effects on tissues and
organ systems that impair a person’s health and
quality of life in many ways.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
2
Cancer Survivorship (cont’d)




Cancer is a life-changing event.
Evidence shows that there is a neglected phase of
cancer care.
Once treatment is completed, contact with a cancer
care provider often stops, and survivors’ needs go
unnoticed or untreated.
Despite the incredible advances made in cancer
care, many long-term survivors suffer unnecessarily
and die from delayed second cancer diagnoses or
treatment-related chronic disease.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
3
Effects of Cancer on Quality of Life

Seasons of cancer survival



Acute survival—Starts with the diagnosis of
cancer; diagnostic and therapeutic efforts
dominate
Extended survival—Patient goes into remission or
has ended the basic, rigorous course of treatment
and enters a phase of watchful waiting
Permanent survival—Roughly equated with “cure,”
but the experience permanently affects the
survivor
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
4
Case Study


Ms. Rosa Williams is a patient on the
oncology unit who is admitted for
complications related to treatment for ovarian
cancer. Ms. Williams is a 72 y/o African
American widow and mother of 5 children and
grandmother of 17 grandchildren.
Ms. Williams is admitted to the oncology unit
for treatment of a bowel obstruction
secondary to her pain medication regimen.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
5
Stress of Survivorship


Reluctance to report symptoms because of
fear of being ungrateful
Varying ability to adapt based on
predisposing factors:



Psychological status
Extent of diseases
Presence of disruptive signs and symptoms
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
6
Dimensions of Quality of Life
Affected by Cancer
Physical
Well-Being and
Symptoms
Psychological
Well-Being
Cancer Survivorship
Social
Well-Being
Spiritual
Well-Being
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
7
Case Study (cont’d)


Tyrone is the nursing student assigned to
care for Ms. Williams. Tyrone is in his third
semester of nursing school. Tyrone enters
Ms. Williams’ room, introduces himself, and
explains that he will be conducting a health
history and assessment to establish a
baseline for Ms. Williams’ care.
Ms. Williams tells Tyrone that he reminds her
of her eighth grandchild and agrees to comply
with his gathering of information.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
8
Physical Well-Being and Symptoms

General categories:






Functional ability
Strength/fatigue
Sleep and rest
Nausea
Appetite
Constipation
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
9
Additional Physical Effects




Cancer-related fatigue (CRF) and associated
depression
Associated sleep disturbances
Chemotherapy-related cognitive impairment
(CRCI)
Some cancer treatments cause painful
peripheral neuropathy.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
10
Late Effects of Chemotherapy







Osteoporosis
Heart failure
Diabetes
Amenorrhea in women
Sterility in men and
women
Impaired
gastrointestinal motility
Abnormal liver function





Impaired immune
function
Paresthesias
Hearing loss
Problems with
thinking and
memory
CRCI
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
11
Physical Risks of Survivorship


Increased risk for cancer (recurrence or a second
cancer)
Increased risk for a second cancer from:


Cancer treatment
Genetic factors or susceptibility


Interaction between treatment and susceptibility
Risk for treatment-related problems associated with:



The complexity of the cancer
Age
Underlying health status
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
12
Psychological Well-Being
Psychological Dimensions Affected
Control
Depression Anxiety Cognitive/
Attention
Distress of
Fear of
Enjoyment/
diagnosis and recurrence
leisure
treatment
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
13
Psychological Well-Being (cont’d)

Posttraumatic stress disorder



Older survivors show resilient social well-being,
spirituality, and personal growth compared with
younger survivors.
What creates the individual response to having
cancer is unclear.
Some long-term (10-year) cancer survivors have
impaired mood but demonstrate more aspects of
psychological well-being compared with a cancerfree comparison group.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
14
Effects of Cancer on the Family

The disabling effects of chronic cancer
symptoms:




Disrupt family and personal relationships and
impair individuals’ work performance
Often isolate survivors from normal social
activities
Change in each family member’s role
Difficult relationships; missing skills or support
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
15
Factors that Ease Psychological
Stress




A survivor who sees cancer as a challenging
experience and a controllable threat has less
stress.
Patients who use problem-oriented, active,
and emotionally expressive coping processes
manage stress well.
Presence of social and emotional support
systems
Maintenance of open communication with
their treatment providers
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
16
Social Well-Being

Social effects by developmental stage

Adolescence and young adulthood
• Social skills, sexual development, and body image are affected.
• Ability to think about and plan for the future
• Postponement of natural separation from parents
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
17
Social Well-Being (cont’d)

Social effects by developmental stage
(cont’d)


Adults
• Family roles, sexuality, and fertility
• Employment, health-related work limitations
• Economic burden, even worse if uninsured
Older adults
• Decreased work hours or retirement
• Costs affect social options.
• Isolation
• Disability
• May require ongoing caregiving support
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
18
Spiritual Well-Being



Relationships with God, a higher power,
nature, family, or community are critical for
survivors.
Cancer isolates survivors from meaningful
interaction and support, which then threatens
their ability to maintain hope.
Long-term treatment, recurrence of cancer,
and lingering side effects of treatment all
create a level of uncertainty for survivors.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
19
Quick Quiz!
1. When performing an assessment of a cancer
survivor, you need to explore:
A. Nutrition problems.
B. Psychosocial problems.
C. Mobility problems.
D. Economic problems.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
20
Cancer and Families



Cancer affects all members of a family.
Family caregiving is stressful: physical and
psychological demands
Family distress:



Hiding feelings increases adverse psychological
outcomes.
Family members struggle to maintain core
functions.
Functions become fragmented, leading to
uncertainty about roles.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
21
Implications for Nursing: Survivor
Assessment





Explore patient’s history of cancer.
Ask general, open-ended questions
Discuss symptom management
Explore the patient’s psychological, social,
and spiritual needs and resources.
Acknowledge that cancer often does
influence the patient’s body image sexuality,
sexual response and sexual roles and
relationships.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
22
Case Study (cont’d)
While conducting a survivor assessment of
Ms. Williams, which question asked by
Tyrone is most appropriate?
A. “My grandmother died of cancer last year. It’s
a terrible disease, don’t you think?”
B. “How long have you been sick?”
C. “What are the biggest problems you face
with regard to your cancer?”
D. “Would you like more pain medication?”

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
23
Cancer Family Caregiving
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
24
Implications for Nursing: Patient
Education

Self-care vs. care from a family member



Continuum: Self-care, collaborative care, family
care
Plan care based on the survivor’s and the
family’s perceived disease-related problems.
If you teach patients and family caregivers
about the potential for treatment effects, they
are more likely to report their symptoms.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
25
Case Study (cont’d)

Tyrone prepares to educate Ms. Williams
about her pain medication routine and how to
avoid constipation and bowel obstructions in
the future.

What is the most important aspect that Tyrone
needs to determine about Ms. Williams before
conducting the education?
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
26
Implications for Nursing: Patient
Education (cont’d)


Patients need education about lifestyle
behaviors that improve the quality of their
lives.
It is the nurse’s responsibility to teach
patients and their families about the effects of
cancer and its treatment:



Initial diagnosis
Ongoing screenings
Don’t attribute symptoms to aging.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
27
Implications for Nursing: Providing
Resources




Cancer-related hospitalization and
ambulatory care are not standardized.
A National Cancer Institute–designated
cancer center offers the most comprehensive
and up-to-date clinical care.
Voluntary organizations: ACS, Lance
Armstrong Foundation, NCCS
National Agencies: Cancer Support
Community, Sisters Network, Witness
Program
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
28
Survivorship Care Plan

Institute of Medicine (IOM)-recommended
components:




Prevention and detection of new cancers and
recurrent cancer
Surveillance for cancer spread, recurrence, or
second cancers
Intervention for consequences of cancer and its
treatment (e.g., medical problems, symptoms,
psychological distress)
Coordination between specialists and primary care
providers
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
29
Case Study (cont’d)

Upon Ms. Williams’ discharge from the
oncology unit, Tyrone provides Ms. Williams
with information regarding several cancer
resources.

True or False: Tyrone does this because cancerrelated hospitalization and ambulatory care are
not standardized.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
30
Survivorship Care Plan (cont’d)


Care summary: Diagnostic tests and results,
tumor characteristics, dates and types of
treatment, support services provided, contact
information, key point contact
Follow-up plan: Prognosis, surveillance for
recurrence, possible late and long-term
effects, interventions for consequences of
cancer and its treatment, additional resources
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
31