Cancer and Approach to Care the Based on the Utilization of the Nursing Process

Answer

Cancer and Approach to Care the Based on the Utilization of the Nursing Process

            The purpose of this paper is to discuss diagnosis, management, and treatment of cancer with a focus on utilization of the nursing process. The scope of this paper includes a description of diagnosis, staging, complications, and cancer treatment side effects. Besides, the role played by the American Cancer Society (ACS) is prevention and management of cancer is also discussed. The nursing process is identified as important for informing assessment, diagnosis, planning, implementation and evaluation of cancer patients to promote delivery of holistic and patient-centered care. Knowledge derived from liberal arts can inform nursing process by enhancing important nursing skills such as creativity, critical thinking, holistic care, compassionate care and in utilization of effective communication.

Diagnosis and Staging of Cancer

            Early diagnosis of cancer promotes realization of better treatment outcomes. Cancer-associated deaths may be avoided if they are diagnosed and treated at early stages (ACS, 2017).  Different approaches for diagnosing cancer include performance of a physical exam, laboratory tests, imaging tests, and biopsy (McIntosh, 2019). Physical examination can identify lumps that may signal tumors and abnormalities such as reduced range of motion due to pain or enlarged organs and changes of the skin color. Laboratory tests may identify cancer biomarkers, disorders of blood cells, and perhaps indicators of organ or tissue malfunction. Imaging provides an opportunity for noninvasive approach for diagnosing cancer (McIntosh, 2019). New technologies have identified different micro RNAs as important biomarkers for diagnosing cancer. Other biomarkers include gene expression profiling and hemoglobin A_1C. Biomarers used in diagnosing pancreatic cancers include ERBB2, STK11, CDK6, KRAS, MSH2, PALB2, BRCA2, ERBB2, and PIK3CA. HER-2/NEU are utilized in diagnosis of esophagogastric cancer and BRCA1/2 are used in detection of prostrate, pancreatic, breast, and breast cancers (Selleck, Senthil, & Wall, 2017). Imaging tests for diagnosing cancer include bone scan, computerized tomography, positron emission tomography scan, magnetic resonance imaging, and X-ray. Biopsy includes collection of organ sections, tissues, and/or cells for tests or examinations such as microscopy, histology, and cytology (McIntosh, 2019; ACS, 2017). Biopsy is employed in diagnosis of cancers such as non-small cell lung cancer (Lim et al., 2016).

             Tumor staging based on anatomical alteration due to cancer is an almost universal criterion for staging cancers using Tumor, Node, and Metastasis (TNM) classification system (Brierley, Gospodarowicz, & O’Sullivan, 2016). T (Tumor) category includes description of size, extent of primary tumor, and depth of tissue invasion. N (node) category indicates presences or extent of tumor in regional metastasis. M (metastasis) category indicates presence or absence of distant metastasis (Brierley et al., 2016).  Using TMN classification system, cancer is classified from Stage I to IV. Stage 0 indicates no cancer. Stage I indicate early stage of cancer, small, and confined to one area. Stage II and III indicate relatively larger sized cancers and has invaded lymph nodes or nearby tissues. Stage IV indicates metastatic cancer that has spread to distant tissues and widely and is at its advanced stage (Muller et al., 2018). The stage of cancer determines treatment of intervention. Breast-conserving surgery with adjuvant radiation-therapy is employed in management of stage I or II breast cancer. In stage III, disease mastectomy may be the treatment of choice while stage IV is managed with chemotherapy and/or radiation therapy (Miller et al., 2019).

Complications of Cancer

            Complications of cancer depend on the type and stage of cancer. Major complications of cancer include disability and impairment, mental health and emotional problems, fatigue, impaired cognition, developmental problems, financial stress, and anxiety (Malik, 2014). In a study by Harrison et al. (2019) other complications such as abdominal pain, appetite loss and nausea, weight loss, and fatigue were identified.  

Side Effects of Cancer Treatment

 Cancer treatment is associated with some side effects. For example lymphedema of the arms tend to occur in 19.9% of female patients who have undergone lymph node dissection. Lymphedema also occurs in 5.6% of patients who have undergone a procedure referred to as sentinel lymph node biopsy. Irradiation of the lymph nodes of the arm may increase the risk of lymphedema. Other side effects of radiation and surgical treatment of cancer may include tingling, numbness, and/or tightness of the arms, chest wall, or shoulders. About one-third of women who undergo radiation of the breast tissue or breast cancer surgery tend to develop persistent pain after therapy. Chemotherapy, on the other hand, can increase risk of osteoporosis, impaired fertility, and may lead to premature menopause in women (Miller et al., 2018). Taxanes may cause neuropathy and HER2-targeted drugs and anthracyclines can cause congestive heart failure and cardiomyopathy. Aromatase inhibitors may cause arthralgia, osteoporosis, and myalgia. In addition, tamoxifen treatment may increase the risk of thromboembolic disease and endometrial. Hormonal treatment may cause menopausal symptoms such as night sweats, hot flashes, and atrophic vaginitis that may cause dyspareunia (Miller et al., 2018).

Methods to Lessen Physical and Psychological Effects of Cancer Treatment

            Methods that may be used to lessen the physical and psychological effects of cancer treatment include social support, counseling, providing the patient and family with necessary information, and referring patients for psychosocial therapies (Malik, 2014). On the other hand, cancer treatment side effects can be addressed through provision of patient education, scheduled follow-up, and adherence to issued guidelines. After treatment of cancer, follow-up care is fundamental for managing side-effects, maintaining good health, monitor treatment efficiency or detect, and to screen for onset of other types of cancer (Miller et al., 2019).

Factors Contributing to Incident and Mortality Rates of Various Cancers in Americans

            Different risk factors account for incidence and mortality rates of various cancers in the U.S. According to Centers for Disease Control and Prevention (CDC) (2020),  in 2020 new cancer cases of cancers among men in the U.S. is expected to increase by 24% (with more than 1 million cases per annum) and by 21% (with more than 900,000 cases per annum) compared to 2010 statistics. Cases of melanomas are projected to increase in White women and men. Cases of kidney cancer, prostrate, bladder, and liver cancers are projected to increase in men while breast, lung, thyroid cancers, and uterine cancers are to increase in women in the U.S. (CDC, 2020). 

            Factors that drive and will drive increased incidences and mortality rate of different cancers include cigarette smoking, particularly lung cancers, but can also cause or exacerbate other types of cancers. In addition, obesity and overweight account for increased risk of colorectal cancers, female breast cancer, uterine cancer, esophageal cancer, kidney cancer, and pancreatic cancer (CDC, 2020). In 2014, cigarette smoking among adults (≥30years) was associated with 82% and 81% of lung cancer cases and deaths, respectively; 74% and 72% of laryngeal cancer cases and deaths, respectively and 50% and 50% of esophageal cancer cases and deaths, respectively. It was also associated with 49% and 47% of oral cavity, nasal cavity, paranasal sinus, and pharyngeal cancer cases and deaths, respectively and 47% and 45% of urinary bladder cancer cases and deaths, respectively. It is also associated with significant cases and deaths of liver, cervical, kidney, renal pelvis, ureter, stomach, myeloid leukemia, colorectum, and pancreatic cancers (American Cancer Society, 2019). Weight-related cancers are expected to increase by 30% to 40% in 2020 compared to 2010, with exception of colorectal and breast cancers. Besides, infections are key factors that increase the incidence of cancers and cancer-related deaths in the U.S. Cases of infection-related cancers in the U.S. are expected to increase by 50% in 2020 compared to 2010; likely due to hepatitis infections. Besides, cases of human papillomavirus infections are expected to increase (CDC, 2020).

            In the U.S., cancer-related deaths are expected to increase by 8.1% in women and 15.2% in men in 2020 compared to 2007. However, the rate of cancer-related deaths per a 100,000 population is expected to go down. Compared to 2007, cancer-associated deaths in 2020 are projected to drop by 26.4% for prostate cancer, 23.4% for colorectal cancer, 21.3% for deaths lung cancer, 19.6% for female breast cancer, 16.0% for cancers of pharynx and oral cavity, 12.5% for cervical cancer, and 7.4% for melanomas (CDC, 2020).

American Cancer Society

            ACS (2019) can provide public education and carryout sensitization campaigns on the prevention and early detection since it is the mission of the ACS to celebrate lives, save lives, and lead the struggle for a world free of cancer. Approximately 45% of cancer cases and 42% of cancer deaths in the U.S. are attributed to modifiable risk factors. ACS (2019) might provide public education about cancer risks such as tobacco smoking, alcohol use, excess body weight, inappropriate dietary habits, and lack of physical activity. About 90% of adult smokers started smoking before their 18^th birthday. Adolescents are more likely to be addicted to nicotine compared to adults (ACS, 2019). ACS (2019) can also provide public education on correlation between exposure to ultraviolet light (especially use of tanning devices) or infectious agents (especially human papillomavirus) and cancer to promote awareness and prevention.

            Services that can be offered by ACS (2019) may include cancer screening tests, which can facilitate early detection of cancer. Accessibility and availability of screening services can prevent thousands of further cancer deaths and new cases of cancer (ACS, 2019). Besides, ACS can advocate for policy change, legislation and enforcement. For example, the ACS can advocate for prohibition for indoor tanning or use of tanning devices by persons aged less than 18 years since it increases the risk of skin cancers. As of January 01, 2019 the District of Columbia and only 17 states had a law that ban use of indoor tanning devices among persons aged less than 18 years without exemptions. Therefore, more need to be done (ACS, 2019). In addition, ACS (2019) can provide or sensitive the public about vaccinations campaigns with the aim of preventing the development of cancer. It is a concern that human papillomavirus vaccination rates among adolescents remains low. In 2017, only 31% of boys and 42% of girls received two doses of human papillomavirus vaccinations before their 13^th birthday (ACS, 2019).

Utilization of Nursing Process across a Lifespan

            Nursing process is a systematic approach to care that uses fundamental principles of client-centered approaches to treatment, critical thinking, evidence-based practice, goal-oriented tasks, and nursing intuition. Scientific and holistic postulates are integrated, which provides the basis of quality-based care and compassionate care (Toney-Butler & Thayer, 2019). Provision of care for cancer patients should include five sequential steps, which include assessment, diagnosis, planning, implementation and evaluation. To promote delivery of holistic and patient-centered care, assessment ought to be extensive and thorough to capture all objective and subjective data. Critical nursing skills are essential and family and friends should be involved in the assessment.

Diagnosis involve utilization of clinical judgment skills to better inform planning process and implementation of patient care. Maslow’s Hierarchy of Needs should be utilized in the diagnosis process to inform prioritization of care, planning, and provision of patient-centered care.  Planning goals should include development of goals that are specific, measurable/meaningful, action-oriented/attainable, results-oriented/realistic, and time-oriented/timely (Toney-Butler & Thayer, 2019). Implementation process ought to include application of various nursing interventions such as evidence-based standards, oxygen therapy, cardiac monitors, medication administration, indirect and direct care, and/or standard protocols. In addition, reassessment and evaluation of care and nursing interventions to ensure that desired outcomes have been met. Intervention may be changed based on evaluation data with intent to provide holistic and patient-centered care (Toney-Butler & Thayer, 2019).

Contribution of Liberal Arts and Science Studies to Nursing Knowledge

            Liberal arts and science studies can inform the nursing knowledge and the nursing process. It can help sharpen nurse interpersonal and communication skills to enable them work with or engage patients, patient’s family and friends, and members of a multidisciplinary throughout processes of nursing which include assessment, diagnosis, planning, implementation and evaluation. Of particular interest is utilization of Maslow’s Hierarchy of Needs during diagnosis process to identify patient’s basic physiological needs, security and safety needs, love and belonging, self-esteem, and self-actualization needs (Toney-Butler & Thayer, 2019). Liberal arts and sciences are essential in nursing education and training required in the nursing process, which include creativity, critical thinking, and holistic care (Kooken & Kerr, 2018). In addition, knowledge derived from liberal arts and science studies can transform nurses into experts in provision of compassionate care and in utilization of effective communication (Vega & Hayes, 2019). Science provides nurses with necessary skills and evidence-based approaches useful in assessment and diagnosis of cancer (Black et al., 2015). Nurses might also utilize electronic health records systems to document findings and analyze data to facilitate making of accurate diagnosis (Lavin, Harper, & Barr, 2015).

            In conclusion, utilization of the nursing process can promote delivery of safe and effective care for cancer patients across a lifespan. The process can help in collection of both objective and subjective data during assessments, correct diagnosis, identification and management of cancer complications and treatment side effects, and other interventions that can promote delivery of holistic and patient-centered care. Important recommendation is that early detection and diagnosis of cancer can lower cost of care and promote realization of better treatment outcomes.