Care of the Patient with Pain & Cancer

2 major dysfunctions in the process of cancer development

• defective cell proliferation (growth)

• defective cell differentiation

cancer development

can occur 2 ways, genetics or acquired during life

how can cancer be acquired during life

chemical, radiation, viral (hep or HIV)

process of cancer development

1. initiation (permanent DNA mutation)

2. promotion

3. progression

3 cancer classifications

1. anatomic site classification (tissue of origin)

2. histological grading (how abnormal)

3. clinical staging (speed of growth)

benign tumor classifications

• Local

• Cohesive

• Well-defined borders

• Pushes other tissue out of the way

• Slow growth

• Encapsulated

• Easily removed

• Does not reoccur

malignant tumor classifications

• Invasive

• Noncohesive

• Does not stop at tissue border

• Invades and destroys surrounding tissue

• Rapid growth

• Metastasizes to distant sites

• Not always easy to remove

• Can recur

7 warning signs of cancer

C - change in bowel/bladder habits

A - a sore that doesnt heal

U - unusual bleeding/discharge
T - thickening/difficulty swallowing
I - indigestion/difficult swallowing
O - obvious changes in wart/mole
N - nagging cough or hoarseness

4 cancer treatments

• surgery

• chemo

• radiation

• immunotherapy

4 cancer complications of treatment

• nutrition

• infection

• emergent

• pain

3 goals of cancer management

1. cure

2. control

3. palliation

primary factors that determine what therapy is used for cancer treatment

• cell type

• location and size

• extent of disease

• physiologic and psychologic status

• expressed needs and desires

role of surgery in cancer treatment

• prevention

• determine diagnostic and treatment plan

• cure and control

• supportive care

• rehabilitation

• palliation of symptoms

• diagnosis

chemotherapy

use of chemicals given as a systemic therapy for cancer and is usually for most solid tumors and hematologic cancers

chemotherapy can offer …

cure, control, or palliative care

cure and chemotherapy

mostly used for solid tumors and hematologic cancers

palliation and chemotherapy

relieve pain, relieve obstruction

prep and handling of chemotherapy agents

• may pose occupational hazards

• drugs may be absorbed through skin or inhalation

• only properly trained personnel should handle drugs

how can chemotherapy be administered

• oral

• IM

• peripheral IV

• central venous access device

• regional (Intraarterial, Intraperitoneal, Intrathecal/Intraventricular, Intravesical Bladder)

extravasation injury due to chemotherapy

happens when an intravenous (IV) fluid or medication accidentally leaks out of the vein and into the surrounding soft tissue

• must watch for this

• assess IV line patency and moniotor

• if pt states hurts or burns, STOP

role of radiation therapy in cancer treatment

• radiation is the emission of energy from a source and travels through space or some material

• different types of ionizing radiation are used to treat cancer

• technologic advances

radiation is used to treat a carefully …

defined area of the body

radiation therapy is not a … treatment for systemic disease

primary

radiation therapy may be used by itself or ..

with chemotherapy or surgery

9 nursing management/implications to watch for with chemo and radiation

• bone marrow suppression

• faitgue

• GI disturbances

• radiation skin reactions

• chemo skin reactions

• pulmonary effects

• CV effects

• cognitive effects

• reproductive effects

manifestations of bone marrow suppression with chemo and radiation

infection, hemorrhaging, anemia

nursing implementation/management of bone marrow suppression with chemo and radiation

monitor temp, S/S of infection, CBC, avoid invasive procedures/punctures, give RBC growth factors

manifestations of fatigue with chemo and radiation

affects ADL

nursing implementations/management of fatigue with chemo and radiation

rest/work periods

manifestations of GI disturbances with chemo and radiation

N/V, diarrhea, anorexia, mucositis

nursing implementations/management of GI disturbances with chemo and radiation

antiemetics, low residue diet, electrolytes, small frequent meals, nutritional supplements, good oral hygiene

manifestations of radiation skin reactions with chemo and radiation

dry or wet of desquamation

nursing implementations/management of radiation skin reactions with chemo and radiation

avoid perfumes, skin irritants, use aloe, protect skin and keep clean

manifestations of chemo skin reactions with chemo and radiation

alopecia

nursing implementations/management of chemo skin reactions with chemo and radiation

support body image disturbances

manifestations of pulmonary effects with chemo and radiation

can cause irreversible and progressive lung disease

nursing implementations/management of pulmonary effects with chemo and radiation

depending upon effects to lungs

manifestations of CV effects with chemo and radiation

affects ADL/functioning of heart

nursing implementations/management of CV effects with chemo and radiation

baseline/follow up echocardiograms

manifestations of cognitive effects with chemo and radiation

chemo brain

nursing implementations/management of cognitive effects with chemo and radiation

patients can have thinking and memory problems

manifestations of reproductive effects with chemo and radiation

potential infertility and sexual dysfunction

nursing implementations/management of reproductive effects with chemo and radiation

prossible pre treatment spem and egg

immunotherapy

uses the immune system to fight cancer

• some types called biologic therapy

• boost or manipulate the immune system and create an environment not conducive for cancer cells to grow

• attack cancer cells directly

immunotherapy side effects

Flulike symptoms

Fatigue, malaise, weakness

Anorexia/weight loss

Nausea/vomiting

Problems with CV system, neurological

Problems with renal and hepatic systems

nursing management with immunotherapy

Side effects occur more acutely and are dose limited

Can influence patient decision to continue therapy

May not be reported for fear treatment may be stopped

coping with immunotherapy

• Assist in planning

  • Transportation, nutrition, emotional support

• Teach symptom management to maintain quality of life

• Offer community resources

patients with cancer may develop complications from …

continual growth of the malignancy into normal tissue

cachexia

malnutrition; fat and muscle depletion that needs nutritional counseling

primary cause of death with cancer

neutropenia

usual sites of infection with neutropenia

• lungs

• genitourinary tract system

• mouth, rectum

• peritoneal cavity

• blood

oncologic emergencies of cancer complications

• life threatening

• occur as result of disease or treatment

• emergencies can be obstructive, metabolic, or infiltrative

2 obstructive oncologic emergencies with cancer

1. superior vena cava syndrome

2. spinal cord compression

superior vena cava syndrome

obstruction by tumor or thrombosis

signs of superior vena cava syndrome

• facial and periorbital edema

• distention of veins of head, neck, and chest

• seizures

• headache

• neurological symptoms

spinal cord compression

tumor in epidural space of spinal cord

signs of spinal cord compression

• intense, localized, persistent back pain

• motor weakness

• sensory paresthesia and loss

• change in bladder or bowel function

5 classifications of pain

1. acute

2. chronic

3. breakthrough

4. central

5. phantom

patient report of pain with cancer should always be believed and accepted as _______ _____ for pain assessment data

primary source

under treatment of cancer pain causes…

• needless suffering

• decreased quality of life

• increased burden on family and caregivers

management of cancer pain

Fear of addiction is unwarranted

Numerous drug options for pain management

Nonpharmacologic interventions, including relaxation therapy and imagery, can be used effectively

psychologic support with cancer pain

• Emphasis is placed on maintaining optimal quality of life

• Positive attitude of patient, family, and health care providers can have a positive impact on the patient’s quality of life

  • May also influence prognosis

common fears of pt’s with cancer

Disfigurement, emaciation

Dependency

Disruption of relationships

Pain

Financial depletion

Abandonment

Death

late and long-term effects of cancer

• secondary cancer

• increased risk for comorbidities

• psychosocial effects

healthy behaviors for cancer survivors

• good nutrition

• regular exercise

• appropriate health screenings

culturally competent care for pts/families with cancer

• Underserved populations are at risk for late-stage disease at time of diagnosis

• You need to know how to

  • Assess for cultural differences

  • Identify barriers to care

  • Adapt care to meet specific cultural needs