The Nursing Process and Approach to Cancer Care

The Nursing Process and Approach to Cancer Care

Introduction

The nursing process is one of the few systematic techniques used in nursing to guide patient-centered care. It also proposes a course of action. Simply, the nursing process is a goal-focused approach to care that considers several steps, including assessment, diagnosis, outcome identification, planning, implementation, rationalization, and evaluation (Toney-Butler & Thayer, 2020). Today, nursing is increasingly used to assess and evaluate nursing interventions. This paper will specifically apply the nursing process to cancer care in the U.S., highlighting its diagnosis, complications, and side effects, as well as treatment methods, factors contributing to mortality and incident rates, the role of the American Cancer Society in giving support, and education, application of the nursing process across the life span of cancer patients, and the contribution of liberal arts and science studies in nursing.

Diagnosis and Staging of Cancer

Cancer Background

Cancer is a category of diseases symbolized by the rapid and uncontrolled growth of abnormal cells, destroying the normal body cells and altering the functions of these cells and organs in the process. These cells can metastasize or spread to neighboring cells, tissues, and organs. WHO (2020) ranks cancer as the second-most killer disease in the world, claiming the lives of more than 9.6 million people in 2018. Worldwide, approximately 1 in 6 deaths are associated with cancer. In terms of the types of cancers, lung cancer is the leading cause of mortality (2.09 million deaths), followed by breast cancer (2.09 million), colorectal cancer (1.80 million), prostate cancer (1.28 million), skin cancer (1.04 million), and stomach cancer (1.03 million) cases (WHO, 2018). In the U.S., the National Cancer Institute (2020) estimates that approximately 1,806,590 new cancer cases will be diagnosed, with 606,520 expected to succumb to the disease.

Cancer Diagnosis

A majority of cancers are diagnosed by examining patient symptoms and signs. A physician or any primary care provider will examine for lesions, skin changes, or any other symptoms presented by the patient to determine the presence of cancer. Medical screening is also accompanied by a physical examination when cancer is suspected. However, none of these techniques can provide a definite or conclusive diagnosis, meaning that suspected patients are subjected to tissue examination by a pathologist. Some medical screening techniques used to detect whether the suspected disease is cancer include endoscopy, CT scans, X-rays, and blood tests.

Examining biopsies from endoscopy can tell the category of the cancerous cells, the genetic abnormalities, the histological grade of the cells, and several other characteristics. This data is critical in assessing the prognosis and selecting the most appropriate therapeutic intervention for the patient. Immunohistochemistry and cytogenetics are also often used to examine tissues from endoscopy. Usually, these test results give key information about potential molecular and genetic changes (like chromosomal changes, gene fusions, and mutations).

Cancer Staging

The term staging generally refers to the process of determining the level/amount of cancer present in an individual’s body, as well as its location. After convincingly deciding that a patient has cancer, the physician must then find out the stage of the patient’s cancer. Cancer staging serves one important role: helping doctors determine the most appropriate therapy option for the patient. Physicians can use some of the screening methods mentioned above to stage cancer, including imaging tests (PET scans, ultrasound, MRIs, CT scans, and X-rays), endoscopy tests, pathological examination of biopsies, as well as laboratory tests.

Cancer can be staged based on the time of diagnosis or therapy. Usually, staging is done immediately after the cancer is diagnosed and before any therapy is administered, although it can also be done after treatment has been initiated. The different types of stages based on ‘time’ include the pathological stage, post-therapy (post-neoadjuvant therapy) stage, and retreatment or recurrence stage. The clinical stage refers to the rough approximation of the level of cancer judged based on biopsy tests, endoscopy exams, imaging tests, and physical exams. The pathological stage is the surgical stage of cancer, especially estimated following an operation. On the other hand, the post-therapy stage is the stage of cancer after the first therapy is administered. The last stage, recurrence, is when cancer progresses or reoccurs.

Globally, several systems are used in cancer staging. In the U.S., the most preferred and recognized by the AJCC (American Joint Commission on Cancer) is the TNM system. The TNM system has stipulated standard protocols to be followed by physicians and other health professionals for cancer staging. The letter ‘T’ stands for the primary/original tumor, ‘N’ for the level of spread (especially if it has reached the lymph nodes), and ‘M’ for metastasis (that is, how much it has spread to other body parts, away from the primary tumor). Several letters are also associated with each of these symbols. For example, TX denotes that there is no single information about the initial/primary tumor. T0 implies that the tumor is absent or cannot be traced (American Cancer Society, n.d.). The five main stages of cancer include zero (no cancer but just abnormal cells that can potentially become cancer), I (cancer is relatively small and restricted to one region), II & III (cancer has enlarged and encroached nearby lymph nodes and tissues), and IV (cancer has metastasized and spread to several regions of the body).

Cancer Complications, Side Effects of Treatment, and Treatment Methods to Lessen Physical and Psychological Effects

Cancer comes with a ton of complications. As a disease, the first complications of cancer are vomiting and nausea. Statistics show that nearly 20-30 percent of all individuals with advanced cancer experience nausea, a figure that rises to 70 percent during the last few days of life (Henson et al., 2020). On the other hand, 20 percent of cancer patients exhibit vomiting (36 percent for stomach cancer and 42 percent for uterine cancer). The second complication among cancer patients is a simulation of the sympathetic and vagal afferent systems. The common symptoms associated with this type of complication include intestinal obstruction, constipation, gastric stasis, hepatomegaly, bronchial secretion, and cough. The third complication that can arise from cancer is the stimulation of the higher center, such as anxiety and fear.

Besides complications arising from the invasive nature of cancer, the onset of treatment can also result in a new set of complications, most of which are associated with drug or therapy reactions and contraindications. For example, the use of cytotoxics and morphine can trigger chemoreceptor receptors, resulting in conditions like hypercalcemia and uremia. Hypercalcemia occurs when the parathyroid gland overreacts, releasing excessive calcium into the bloodstream. On the other hand, uremia is associated with higher urea levels in the blood due to enlargement of the kidneys caused by certain types of cancers. There is also a strong correlation between cancer and kidney disease (Shahinian et al., 2017). Cancer treatment can also result in weight loss, hair loss, and extreme fatigue.

Several treatment options are available to lower these psychological and physical impacts. Chemotherapy is the preferred tool for addressing these cancer therapy reactions. For example, haloperidol is the first-line drug physicians administer to patients exhibiting hypercalcemia and uremia. Levomepromazine is often used as a second-line treatment option if haloperidol is ineffective (Hardy et al., 2019).

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

Cancer is the second leading killer disease in the U.S. and around the globe. The National Cancer Institute estimates that approximately 1,806,590 new cancer cases will be diagnosed in the U.S. in 2020 alone, with 606,520 expected to succumb to the disease. Cancer prevalence and mortality rates are higher in the U.S. due to the higher risk of exposure and the lack of proper mitigation and treatment measures. According to the CDC (2020), many types of cancers are preventable, but Americans are increasingly exposed to infection. Some of the reasons for the increased risk include a high number of smokers, excessive exposure to ultraviolet radiation, excessive alcohol, and obesity and overweight – factors called modifiable risks. The American Cancer Society (2017) associates nearly 4-10 cancer mortalities (45 percent) and 42 percent of all cases to modifiable risk factors. In 2014 alone, 20% of the fatalities and 19 % of the cases diagnosed were associated with cigarette smoking. Excessive smoking (cases 7.8%, deaths 6.5%), alcohol drinking (cases 5.6%, deaths 4%), UV radiation (cases 5%, deaths 1.5%), and physical inactivity (cases 2.9%, deaths 2.2%) are the other modifiable factors identified by the ACS.

American Cancer Society (ACS)

The American Cancer Society (ACS) is the official government-sponsored institution that serves to educate and support patients on a 24-hour basis. The organization can do this primarily by disseminating critical information about cancer causes, symptoms, risk factors, prevention, and treatment to patients, their family members, or nursing patients. Whether newly diagnosed, undergoing treatment, or taking care of a patient with cancer, the role of the ACS is to ensure that all participants receive the right information to support nursing care efforts. One way of doing this is by providing a support center (website) where evidence-based information can be accessed, especially related to quitting tobacco, screening, prevention, clinical trials, pain control, medicines, coping, side effects, treatment options, and specific cancer types. ACS can also provide resources at the community level to cancer patients, such as quitline, financial programs, lodging, transportation, wigs and prostheses, medical equipment, social services, support groups, patient services, and so on. ACS can also publish and distribute to the public, professional journals, books, pamphlets, and brochures to aid patients and their families, as well as healthcare providers involved in care for cancer patients (American Cancer Society, n.d.).

Use of the Nursing Process across the Life Span

The nursing process is a framework that steers the delivery of patient-centered care. The intent is to assess, diagnose, plan, implement, and evaluate. There are several ways in which the nursing process is employed to deliver efficient, effective, and safe care to patients. The nursing process is essentially used to scrutinize the environment, diagnose problems, plan, roll out the plan, and evaluate nursing initiatives for cancer patients across their lifespans, including the distribution of resources. For example, for-profit and non-profit organizations (government and private) are leading in assessing the cancer environment in the U.S. and globally, from death and prevalence rates and risk factors to prevention.

Organizations like the CDC, WHO, and ACS constantly collect data about cancer across the lifespan. Various health institutions, such as HHS, and private investors, are also funding projects to collect data about the same. The second step of the nursing process, diagnosis, is also being widely undertaken to ensure proper cancer care planning. Diagnostic criteria from accredited institutions, such as the North American Nursing Diagnosis Association, supply nurses with current diagnostic methods and criteria for cancer. Similarly, the HHS and other stakeholders use Maslow’s Hierarchy of Needs and other methods to plan and prioritize cancer care based on the outcomes. Setting SMART (specific, measurable, attainable, realistic, and time-oriented) goals is also helping in the planning process, including the distribution of resources, such as cancer funds. For implementation, various organizations are seen taking action or launching various proposed interventions and projects to help in the cancer fight. For example, the ACS invested nearly $147 million in cancer research in 2018, while $269 was allocated to patient support initiatives and $104 million to education and prevention (ACS, n.d.). The last step of the nursing process, evaluation, plays a vital role in monitoring and keeping track of the implemented projects, such as in scrutinizing the utilization of allocation funds.

Contribution of Liberal Arts and Science Studies to Nursing

Liberal arts and science education, especially the undergraduate program, plays a fundamental role in equipping nursing students with the basic skills, knowledge, and experience needed to work with patients, particularly cancer patients when they enter the field. It improves nursing students’ communication skills and allows them to think critically and make informed decisions that enhance the delivery of quality and safe care (Kooken & Kerr, 2017). In the wake of globalization and the rise of technology, a course in liberal arts and sciences is more likely to give nursing students that multidirectional thinking ability.

References 

ACS. (n.d.). Facts about the American Cancer Society. Retrieved from https://www.cancer.org/about-us/who-we-are/fact-sheet.html

American Cancer Society. (n.d.). Cancer staging. Retrieved from https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html

CDC. (2020). Cancer: Fast facts: Preventable risk factors and CDC’s response. Retrieved from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/cancer.htm#:~:text=Fast%20Facts,and%20drinking%20too%20much%20alcohol

Hardy, J. R., et al. (2019). Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: A randomized, double-blind controlled trial. BMJ Open, 9(9), e029942. doi: 10.1136/bmjopen-2019-029942

Henson, L. A., et al. (2020). Palliative care and the management of common distressing symptoms in advanced cancer: Pain, breathlessness, nausea, vomiting, and fatigue. Journal of Clinical Oncology, 38(9), 905-914. doi: 10.1200/JCO.19.00470

Kooken, W. C., & Kerr, N. (20170. Blending the liberal arts and nursing: Creating a portrait for the 21^st century. Journal of Professional Nursing, 34(1), 60-64.

Mendez, E. (2017, November 21). More than 4 in 10 cancers and cancer deaths are linked to modifiable risk factors. American Cancer Society. https://www.cancer.org/latest-news/more-than-4-in-10-cancers-and-cancer-deaths-linked-to-modifiable-risk-factors.html

National Cancer Institute. (2020). Cancer statistics. Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics

Shahinian, V. B., et al. (2017). Considering renal risk while managing cancer. Cancer Management and Research, 9, 167-178.

Toney-Butler, T. J., & Thayer, J. M. (2020). Nursing process. Treasure Island, FL: StatPearls Publishing.

WHO. (2018). Cancer: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/cancer

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The Nursing Process and Approach to Cancer Care

The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the healthcare needs of an individual and provide personalized care.

Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:

1. Describe the diagnosis and staging of cancer.
2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
3. Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.
   

   The Nursing Process and Approach to Cancer Care

4. Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?
5. Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the lifespan. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.
6. Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area.

You are required to cite a minimum of four sources to complete this assignment. Sources must be published within the last 5 years appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

• 2.1: Incorporate liberal arts and science studies into nursing knowledge.
• 3.1 Utilize the nursing process to provide safe and effective care for patients across the lifespan.

RUBRIC

• Maximum Points: 250.0