Cancer Health Promotion
- tobacco use - causes lung cancer
- excess body fat
- lack of physical activity
- unhealthy eating habits
- exposure to the sun – skin cancer
What are health promotion activities for:
- Lung - smoking cessation, decrease use of cleaning products,
- Prostate –digital rectal exam mid 20s 30s with a blood test
- Breast – self exam: look for changes or breast exam by a health care worker yearly 50-55 yo mammogram q2years
- Colorectal-eat healthy low fat, high fiber, fecal occult blood test
Carcinogenic Agents and Promoters
Carcinogenic Agents
- Chemical {tobacco, soot, asbestos, red dye #40}
- Environmental {sun radiation (UV rays), air pollution & tobacco smoke}
- Genetic {BRCA 1 & 2, colorectal polys}
- Viral {HIV, Hep. B & HPV}
PROMOTERS:dietary fats, obesity, cigarette smoke and alcohol consumption
- Reduction of these factors can reduce cancer development!
Prevention and Detection
- Be a non smoker
- Eat 5-10 servings of fruits and vegetables/day (fiber)
- Be physically active
- Protect self and family from sun: SLIP, SLAP, and SLOP
- Follow cancer screening and testing guidelines
- Visit doctor or dentist if change in health status
- Follow health & safety instructions at home/work when using hazardous chemicals
How to do health teaching during anxiety
Key is the right information at the right time to help patients develop realistic problem-solving skills, and to promote healthy lifestyle
- Repetition & reinforcement of information
- Opportunities to ask questions and clarify understanding of treatment
- Explanations should be clear and tailored to meet specific needs.
- Content that is threatening or detailed may overwhelmed patient and must be presented with sensitivity and at the level that the patient is able to absorb
- If written information is given it must be at the literary level of the patient
Goals of Treatment of Cancer
Cure: the treatment offered is the one that is most likely to succeed
- Risk of recurrence differs with tumour type
- Risk of recurrence is greatest after treatment & ↓gradually overtime
Control: not to eradicate but control, similar to chronic disease, repeated treatments
Palliation: for relief or control of symptoms and optimization of quality of life
Different drugs used and drug principles
Alkylating agents: cell cycle phase-nonspecific agents
- Chlorambucil (Leukeran)
- Cyclophosphamide (Cytoxan)
Antimetabolites: cell cycle phase-specific agents
- Methotrexate
Antitumor antibiotics: cell cycle phase-nonspecific agents
- Mitomycin (Mutamycin)
Plant Alkaloids (mitotic inhibitors): cell cycle phase-specific agents
- Vinblastine (Velban)
Corticosteroids: cell cycle phase-nonspecific agents
- Cortisone (Cortone)
- Hydrocortisone (Cortef)
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Principals of drug choice
- Known to be effective against said cancer
- Drugs in combination have synergistic effect
- Drugs have different mechanism of action
- Drugs have different toxic side effects
- Drugs combination causes** nadir(lowest level of blood count secondary to bone marrow depression caused by chemotherapy) to occur at different time intervals
Problems with Chemo
- Will not distinguish between normal and cancer cells
- Chemo will affect all fast dividing cells: therefore side effects and drug toxicity occur together
- Fast dividing cells most affected:
- bone marrow, GI tract & integumentary system
- The body’s response to the products of cellular destruction in the circulation may cause fatigue, anorexia and taste alteration
Toxicities may be:
Acute, delayed, and/or chronic
Acute = Vomiting, allergic reactions, dysrhythmias
Delayed = mucositis, alopecia & bone marrow suppression
Chronic = damage to organs like the heart, liver, kidneys, & lungs
Adverse Effect vs Toxicty
Adverse effects are an unexpected, unintentional, undesired or excessive response to a medication given at therapeutic dosage
- Therapeutic effect = the desired or intended effect of a particular drug
- If a substance is known to be therapeutic this implies that under normal conditions the drug is sufficiently nontoxic for it to cure
Toxicity
Toxicity is the production of adverse bodily effects because of poisonous qualities
- It is to make sure that the doses needed to treat will not produce toxic effects worse than those of the disease
- Example: cardio-toxicity is a broad term used to describe conditions ranging form benign forms of arrhythmias to potentially fatal conditions
Management for all Treatments
_Educate patient: _ about treatment, management of side effects & disease symptoms
- Important is differentiating between toxic effects of treatment & progression of malignant process
- Nurse must distinguish between tolerable side effects and acute toxic effects of chemo
Major Side Effects/Toxicities
- Fatigue r/t anemia
- Anorexia r/t n/v, canker sore
- Bone Marrow Suppression causes fatigue
- Skin Reactions
- Mucosal Reactions
- Pulmonary Issues
- GI Problems
- Reproduction
Bone Marrow Suppression
- Myelosuppression common with chemo (rare with RT)
- Related to life span of blood cell type
- Suppression related to dose of drug or specific rad field
- Closely monitored
- Neutropenia is most common and places patient at risk for infection/sepsis
- Thrombocytopenia may cause bleeding/hemorrhage
- Hemoglobin can also drop and cause anemia
Skin Reactions
- Erythema is an acute response followed by dry desquamation
- If rate of cellular sloughing is faster than the ability of new epidermal cells to replace dead ones, the patient will develop wet desquamation which is exposed dermis with oozing of serum.
Desquamation
- Dry = uncomfortable and results in pruritus
- Wet = discomfort and draining
- Skin needs to be protected from extreme temperature & prevent any trauma
Alopecia/hair loss
- RT is restricted to field (can be temporary or permanent)
- Chemo is everywhere, but regrowth 3-4 weeks after therapy finished
Oral, Oropharyngeal & Esophageal Reactions
Mucosal lining of GI tract is very sensitive to RT and chemo (fast dividing cells on surface skin)
- May cause problems for nutrition
- May have ↓ saliva flow
- Taste loss progressively during therapy
- Thick saliva will not moisten food
- Difficulty swallowing
- Must have meticulous oral hygiene (saline solution)
- Food is soft, room temp, no tobacco, no alcohol
Pulmonary Reactions
- the lung is magnified since no reduction of dose through tissue
- May develop pneumonitis (acute inflammation)
- Reactions often asymptomatic but patient develop cough
- With chemo you get cough, pulmonary edema, interstitial fibrosis (may upset patient since same symptoms as disease)
- Cough can become more productive since alveoli that were blocked by tumour are now opening
- Cough can become dry because mucosa is being dried by RT
GI Reactions
- Most radiosensitive tissue
- Radiation alters gastric secretions by direct cell injury therefore secretion of mucus, hydrochloric acid & pepsin ↓
- N/V & D are early responses to irradiation
- Chemo causes direct injury to epithelial cells
- Use of antiemetics (best practice guidelines)
- Must monitor I & O
Female and Male Reproductive Reactions
Female
- Chemo will stop menses of women under 40 years (will be dose sensitive)
- There is no repairing of ovarian function
- Other problems will resemble menopause
- (loss of lubrication, vaginal shortening, loss of elasticity)
- Potential of infertility can be significant
- (harvesting of ova may be considered)
Reproduction: Male
- Testes are sensitive to RT and need to be protected
- May have permanent aspermia (no sperm present)
- If RT used is appropriate and testes shielded, often have full recovery
- Reproductive function maybe problematic due to ED (from vascular or neurological effect of treatment)
