LEARNING OUTCOMES CHAPTER 16-CANCER

1. DESCRIBE THE PREVALANCE, INCIDENCE, SURVIVAL, MORTALITY RATES OF CANCER IN THE UNITED STATES. AND

ALTHOUGH MORTALITY RATES FROM ALL CANCERS COMBINED ARE ON THE DECLINE, CANCER IS STILL THE SECOND MOST COMMON CAUSE OF DEATH IN THE U.S. (HEART DISEASE IS THE MOST COMMON). BOTH CANCER INCIDENCE AND DEATH RATES ARE DISPORTIONATELY HIGHER IN AFRICAN AMERICANS THAN IN WHITES AND OTHER MINORITY GROUPS. WHY? DUE TO MELANIN IN THEIR SKIN EXPOSES THEM TO A HIHER RISK OF SKIN CANCER. 2. DESCRIBE THE PROCESSES INVOLVED IN THE BIOLOGY OF CANCER. CANCER ENCOMPASSES A BROAD RANGE OF DISEASES OF MULTIPLE CAUSES THAT CAN ARISE IN ANY CELL OF THE BODY CAPABLE OF EVADING REGULATORY CONTROLS OVER PROLIFERATION AND DIFFERENTIATION. TWO MAJOR DYSFUNCTIONS PRESENT IN THE PROCESS OF CANCER ARE (1) DEFECTIVE CELLULAR PROLIFERATION (GROWTH) AND (2) DEFECTIVE CELLULAR DIFFERENTIATION. CANCER CELLS USUALLY PROLIFERATE AT THE SAME RATE OF THE NORMAL CELLS OF THE TISSUE FROM WHICH THEY ARISE. HOWEVER, CANCER CELLS DIVIDE INDISCRIMINATELY AND HAPHAZARDLY AND SOMETIMES PRODUCE MORE THAN TWO CELLS AT THE TIME OF MITOSIS. THROUGH DIFFERENTIATION, CELLS BECOME CAPABLE OF PERFORMING ONLY SPECIFIC FUNCTIONS. o PROTOONCOGENES ARE NORMAL CELLULAR GENES THAT ARE IMPORTANT REGULATORS OF NORMAL CELLULAR PROCESSES THAT KEEP THEM IN THEIR MATURE, FUNCTIONING STATE. o WHEN THESE GENES ARE MUTATED, THEY CAN BEGIN TO FUNCTION AS ONCOGENES (TUMOR-INDUCING GENES). TUMORS CAN BE CLASSIFIED AS BENIGN OR MALIGNANT. o BENIGN NEOPLASMS ARE WELL-DIFFERENTIATED AND CAPSULATED. o MALIGNANT NEOPLASMS RANGE FROM WELLDIFFERENTIATED TO UNDIFFERENTIATED AND NOT CAPSULATED.

3. DIFFERNTIATE THE THREE PHASES OF CANCER DEVELOPMENT. THE STAGES OF CANCER INCLUDE INITIATION, PROMOTION, AND PROGRESSION. THE FIRST STAGE, INITIATION, IS A MUTATION IN THE CELLS GENETIC STRUCTURE RESULTING FROM AN INHERITED MUTATION, AN ERROR THAT OCCURS DURING DNA REPLICATION, OR FOLLOWING EXPOSURE TO A CHEMICAL, RADIATION, OR VIRAL AGENT. PROMOTION, THE SECOND STAGE IN THE DEVELOPMENT OF CANCER, IS CHARACTERIZED BY THE REVERSIBLE PROLIFERATION OF THE ALTERED CELLS. PROGRESSION, THE FINAL STAGE, IS CHARACTERIZED BY INCREASED GROWTH RATE OF THE TUMOR, INCREASED INVASIVENESS, AND SPREAD OF THE CANCER TO A DISTANT SITE (METASTASIS). METASTASIS IS A MULTISTEP PROCESS IN WHICH TUMOR CELLS TRAVEL TO DISTANT SITES VIA LYMPHATIC AND HEMATOGENOUS ROUTES. THE MOST FREQUENT SITES OF METASTASIS ARE LUNGS, BONE, BRAIN, LIVER, AND ADRENAL GLANDS. 4. DESCRIBE THE ROLE OF THE IMMUNE SYSTEM RELATED TO CANCER. SINCE CANCER CELLS ARISE FROM NORMAL HUMAN CELLS, THE IMMUNE RESPONSE THAT IS MOUNTED AGAINST CANCER CELLS MAY BE INADEQUATE TO EFFECTIVELY ERADICATE THEM. CANCER CELLS MAY DISPLAY ALTERED CELL SURFACE ANTIGENS, CALLED TUMOR-ASSOCIATED ANTIGENS, AS A RESULT OF MALIGNANT TRANSFORMATION. IMMUNOLOGIC SURVEILLANCE IS THE RESPONSE OF THE IMMUNE SYSTEM TO THESE ANTIGENS. THE PROCESS BY WHICH CANCER CELLS EVADE THE IMMUNE SYSTEM IS TERMED IMMUNOLOGIC ESCAPE.

ONCOFETAL ANTIGENS ARE A TYPE OF TUMOR ANTIGEN THAT CAN BE USED AS TUMOR MARKERS THAT MAY BE CLINICALLY USEFUL TO MONITOR THE EFFECT OF THERAPY AND INDICATE TUMOR RECURRENCE. 5. DIFFERENTIATE AMONG THE USES OF THE CLASSIFICATION SYSTEMS FOR CANCER. TUMORS CAN BE CLASSIFIED ACCORDING TO ANATOMIC HISTOLOGIC GRADING, AND EXTENT OF DISEASE (STAGING). SITE,

IN THE ANATOMIC CLASSIFICATION OF TUMORS, THE TUMOR IS IDENTIFIED BY THE TISSUE OF ORIGIN, THE ANATOMIC SITE, AND THE BEHAVIOR OF THE TUMOR (I.E., BENIGN OR MALIGNANT). IN HISTOLOGIC GRADING OF TUMORS, THE APPEARANCE OF CELLS AND THE DEGREE OF DIFFERENTIATION ARE EVALUATED PATHOLOGICALLY. FOR MANY TUMOR TYPES, FOUR GRADES ARE USED TO EVALUATE ABNORMAL CELLS BASED ON THE DEGREE TO WHICH THE CELLS RESEMBLE THE TISSUE OF ORIGIN. THE STAGING CLASSIFICATION SYSTEM IS BASED ON A DESCRIPTION OF THE EXTENT OF THE DISEASE RATHER THAN ON CELL APPEARANCE. ASSIGNMENT IS COMPLETED AFTER THE DIAGNOSTIC WORKUP AND DETERMINES TREATMENT OPTIONS. o THE CLINICAL STAGING CLASSIFICATION SYSTEM USES FIVE STAGES, FROM IN SITU TO METASTASIS. o THE TNM CLASSIFICATION SYSTEM USES THREE PARAMETERS: TUMOR SIZE AND INVASIVENESS (T), PRESENCE OR ABSENCE OF REGIONAL SPREAD TO THE LYMPH NODES (N), AND METASTASIS TO DISTANT ORGAN SITES (M). 6. DISCUSS THE ROLE OF THE NURSE IN THE PREVENTION AND DETECTION OF CANCER. YOU HAVE A PROMINENT ROLE IN THE PREVENTION AND EARLY DETECTION OF CANCER. THE GOAL OF PUBLIC EDUCATION IS TO MOTIVATE PEOPLE TO RECOGNIZE AND MODIFY BEHAVIOR PATTERNS THAT MAY NEGATIVELY IMPACT HEALTH, AND TO ENCOURAGE AWARENESS AND PARTICIPATION IN HEALTHPROMOTING BEHAVIORS. KNOW THE SEVEN WARNING SIGNS (CAUTION): CHANGE IN BOWEL OR BLADDER HABITS A SORE THAT DOES NOT HEAL UNUSUAL BLEEDING OR DISCHARGE FORM ANY BODY ORFICE

THICKENING OR A LUMP IN THE BREAST OR ELSEWHERE INDIGESTION OR DIFFICULTY SWALLOWING OBVIOUS CHANGE IN A WART OR MOLE NAGGING COUGH OR HOARSENESS 7. EXPLAIN THE USE OF SURGERY, CHEMOTHERAPY, RADIATION THERAPY, AND BIOLOGIC AND TARGETED THERAPY IN THE TREATMENT OF CANCER. THE GOAL OF CANCER TREATMENT IS CURE, CONTROL, OR PALLIATION. A NUMBER OF FACTORS DETERMINE THE THERAPEUTIC APPROACH TAKEN. o WHEN CURE IS THE GOAL, TREATMENT IS OFFERED THAT IS EXPECTED TO HAVE THE GREATEST CHANCE OF DISEASE ERADICATION AND MAY INVOLVE LOCAL THERAPY (I.E., SURGERY OR RADIATION) ALONE OR IN COMBINATION WITH OR WITHOUT PERIODS OF ADJUNCTIVE SYSTEMIC THERAPY (I.E., CHEMOTHERAPY). o CONTROL IS THE GOAL OF THE TREATMENT PLAN FOR MANY CANCERS THAT CANNOT BE COMPLETELY ERADICATED BUT ARE RESPONSIVE TO ANTICANCER THERAPIES AND CAN BE MAINTAINED FOR LONG PERIODS WITH THERAPY. o WITH PALLIATION, RELIEF OR CONTROL OF SYMPTOMS AND THE MAINTENANCE OF A SATISFACTORY QUALITY OF LIFE ARE THE PRIMARY GOALS RATHER THAN CURE OR CONTROL OF THE DISEASE PROCESS. MODALITIES FOR CANCER TREATMENT WITH ALL THREE GOALS INCLUDE SURGERY, CHEMOTHERAPY, RADIATION THERAPY, AND BIOLOGIC AND TARGETED THERAPY. SURGICAL THERAPY AS PRIMARY PREVENTION, SURGERY CAN BE USED TO ELIMINATE OR REDUCE THE RISK OF CANCER DEVELOPMENT IN PATIENTS WHO HAVE UNDERLYING CONDITIONS THAT INCREASE THEIR RISK OF DEVELOPING CANCER. TO SATISFY THE GOALS OF CANCER CURE OR CONTROL, THE OBJECTIVE OF SURGERY IS TO REMOVE ALL OR AS MUCH RESECTABLE TUMOR AS POSSIBLE WHILE SPARING NORMAL TISSUE. SURGERY CAN PRODUCE A CHANGE IN BODY IMAGE AND FUNCTION. IT CAN BE DIFFICULT FOR THE PATIENT TO COPE WITH THESE CHANGES WHILE ATTEMPTING TO MAINTAIN USUAL LIFESTYLE PATTERNS. CHEMOTHERAPY

THE GOAL OF CHEMOTHERAPY IS TO ELIMINATE OR REDUCE THE NUMBER OF MALIGNANT CELLS PRESENT IN THE PRIMARY TUMOR AND METASTATIC TUMOR SITE(S). A NUMBER OF FACTORS DETERMINE THE RESPONSE OF CANCER CELLS TO CHEMOTHERAPY. THE TWO MAJOR CATEGORIES OF CHEMOTHERAPEUTIC DRUGS ARE CELL CYCLE PHASENONSPECIFIC AND CELL CYCLE PHASESPECIFIC DRUGS. o CELL CYCLE PHASENONSPECIFIC DRUGS HAVE THEIR EFFECT ON THE CELLS DURING ALL PHASES OF THE CELL CYCLE. o CELL CYCLE PHASESPECIFIC DRUGS EXERT THEIR MOST SIGNIFICANT EFFECTS DURING SPECIFIC PHASES OF THE CELL CYCLE. CHEMOTHERAPEUTIC DRUGS ARE CLASSIFIED IN GENERAL GROUPS ACCORDING TO THEIR MOLECULAR STRUCTURE AND MECHANISMS OF ACTION. IT IS VERY IMPORTANT TO KNOW THE SPECIFIC GUIDELINES FOR THE SAFE PREPARATION AND ADMINISTRATION OF CHEMOTHERAPEUTIC DRUGS, SINCE THEY MAY POSE AN OCCUPATIONAL HEALTH HAZARD. CHEMOTHERAPY CAN BE ADMINISTERED BY MULTIPLE ROUTES; THE MOST COMMON IS INTRAVENOUS, THROUGH CENTRAL VASCULAR ACCESS DEVICES, PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS, OR IMPLANTED INFUSION PORTS. THE USE OF THESE MEANS REDUCES THE RISK OF EXTRAVASATION. REGIONAL TREATMENT WITH CHEMOTHERAPY INVOLVES THE DELIVERY OF THE DRUG DIRECTLY TO THE TUMOR SITE. THE MOST COMMON METHODS ARE INTRAARTERIAL, INTRAPERITONEAL, INTRAVESICAL BLADDER, AND INTRATHECAL OR INTRAVENTRICULAR. CHEMOTHERAPY-INDUCED SIDE EFFECTS ARE THE RESULT OF THE DESTRUCTION OF NORMAL CELLS, ESPECIALLY THOSE THAT ARE RAPIDLY PROLIFERATING SUCH AS THOSE IN THE BONE MARROW, LINING OF THE GASTROINTESTINAL SYSTEM, AND THE INTEGUMENTARY SYSTEM (SKIN, HAIR, AND NAILS). THE GENERAL AND DRUG-SPECIFIC ADVERSE EFFECTS OF THESE DRUGS ARE CLASSIFIED AS ACUTE, DELAYED, OR CHRONIC. SOME SIDE EFFECTS FALL INTO MORE THAN ONE CATEGORY. RADIATION THERAPY:

RADIATION IS THE EMISSION AND DISTRIBUTION OF ENERGY THROUGH SPACE OR A MATERIAL MEDIUM. SIMULATION IS A PART OF RADIATION TREATMENT PLANNING USED TO DETERMINE THE OPTIMAL TREATMENT METHOD BY FOCUSING ON ACCURATELY LOCALIZING THE TUMOR AND ENSURING SET-UP POSITION REPRODUCIBILITY. RADIATION IS USED TO TREAT A CAREFULLY DEFINED AREA OF THE BODY EITHER INDEPENDENTLY OR IN COMBINATION WITH CHEMOTHERAPY, TO TREAT PRIMARY TUMORS OR FOR PALLIATIVE CONTROL OF METASTATIC LESIONS. TELETHERAPY OR EXTERNAL BEAM RADIATION IS THE MOST COMMON FORM OF RADIATION TREATMENT DELIVERY. WITH THIS TECHNIQUE, THE PATIENT IS EXPOSED TO RADIATION FROM A MEGAVOLTAGE TREATMENT MACHINE. BRACHYTHERAPY, OR INTERNAL RADIATION TREATMENT, CONSISTS OF THE IMPLANTATION OR INSERTION OF RADIOACTIVE MATERIALS DIRECTLY INTO THE TUMOR (INTERSTITIAL) OR IN CLOSE PROXIMITY ADJACENT TO THE TUMOR (INTRACAVITARY OR INTRALUMINAL). THE PRINCIPLES OF ALARA (AS LOW AS REASONABLY ACHIEVABLE) AND TIME, DISTANCE, AND SHIELDING ARE VITAL TO HEALTH CARE PROFESSIONAL SAFETY WHEN CARING FOR A PATIENT WITH A SOURCE OF INTERNAL RADIATION. 8. IDENTIFY THE CLASSIFICATIONS OF CHEMOTHERAPEUTIC AGENTS AND METHODS OF ADMINSITRATION. METHOD ORAL: CYCLOPHOSAMIDE (CYTOXAN) ALKYLATING AGENTS; CAPECITABINE (XELODA) NITROSOUREAS AGENT; TEMOZOLOMIDE (TEMODAR) ALKLATING AGENTS METHOD INTRAMUSCULAR: BLEOMYCIN (BLENOXANE) ANTI-TUMOR AGENT

METHOD INTRAVENOUS: MOST COMMONLY USED ROUTE DOXORUBICIN (ADRIAMYCIN) ANTI-TUMOR AGENT VINCRISTINE (ONCOVIN) CISPLATIN (PLATINOL) 5-FU PACLITAXEL (TAXOL) METHOD INTRACAVITARY (PLEURAL, PERITONEAL): DELIVERY OF CHEMO TO PERITOENAL CAVITY FOR TREATMENT OF COLORECTAL AND OVARIAN CANCERS AND MALIGNANT ASCITES. SILASTIC CATHETERS ARE PRECUTANEOUSLY OR SURGICALLY PLACED INTO THE PERITONEAL CAVITY FOR SHORT TERM ADMINISTRATION OF CHEMO. RADIOISOTOPES, ALKYLATING AGENTS METHOTREXATE ANTI-METABOLITES METHOD INTRATHECAL: THIS METHOD INVOLVES A LUMBAR PUNCTURE AND INJECTION OF CHEMOTHERAPY INTO THE SUBARACHNOID SPACE; MOST COMMONLY USED ON PATIENTS WITH BREAST, LUNG, AND GI TUMORS, LEUKEMIA, AND LYMPHOMA METHOTREXATE ANTI-METABOLITES CYTARBINE METHOD INTRAARTERIAL: DRUG DELIVERED TO THE TUMOR VIA THE ARTERIAL VESSEL SUPPLYING THE TUMOR. DTIC 5-FU METHOTREXATE METHOD: PERFUSION: ALKLATING AGENTS METHOD: CONTINOUS INFUSION 5-FU METHOTREXATE CYTARABINE METHOD: SUBCUTANEOUS CYTARABINE METHOD: TOPICAL 5-FU CREAM

9. DIFFERENTIATE BETWEEN TELETHERAPY RADIATION) AND BRACHYTHERAPY.

(EXTERNAL

BEAM

TELETHERAPY OR EXTERNAL BEAM RADIATION IS THE MOST COMMON FORM OF RADIATION TREATMENT DELIVERY. WITH THIS TECHNIQUE, THE PATIENT IS EXPOSED TO RADIATION FROM A MEGAVOLTAGE TREATMENT MACHINE. BRACHYTHERAPY, OR INTERNAL RADIATION TREATMENT, CONSISTS OF THE IMPLANTATION OR INSERTION OF RADIOACTIVE MATERIALS DIRECTLY INTO THE TUMOR (INTERSTITIAL) OR IN CLOSE PROXIMITY ADJACENT TO THE TUMOR (INTRACAVITARY OR INTRALUMINAL). THE PRINCIPLES OF ALARA (AS LOW AS REASONABLY ACHIEVABLE) AND TIME, DISTANCE, AND SHIELDING ARE VITAL TO HEALTH CARE PROFESSIONAL SAFETY WHEN CARING FOR A PATIENT WITH A SOURCE OF INTERNAL RADIATION. 10. DESCRIBE THE EFFECTS OF RADIATION THERAPY AND CHEMOTHERAPY ON NORMAL TISSUES. THE EFFECTS OF RADIATION ON THE BODYS TISSUES ARE CAUSED BY CELLULAR HYPOPLASIA (UNDERDEVELOPMENT OF AN ORGAN BECAUSE OF A DECREASE IN THE NUMBER OF CELLS) OF STEM CELLS AND ALTERATIONS IN THE FINE VASCULATURE AND FIBROCONNECTIVE TISSUES. THE CANCER SURVIVOR IS AT RISK FOR DEVELOPING SECONDARY MALIGNANCIES, SUCH AS LEUKEMIA, ANGIOSARCOMA, AND SKIN CANCER. SINCE THIS RISK IS MAGNIFIED BY SMOKING, YOU SHOULD COUNSEL ALL PATIENTS REGARDING SMOKING CESSATION. 11. IDENTIFY THE TYPES AND TARGETED THERAPY AGENTS. EFFECTS OF BIOLOGIC AND

BIOLOGIC AND TARGETED THERAPY CAN BE EFFECTIVE ALONE OR IN COMBINATION WITH SURGERY, RADIATION THERAPY, AND CHEMOTHERAPY. BIOLOGIC THERAPY CONSISTS OF AGENTS THAT MODIFY THE RELATIONSHIP BETWEEN THE HOST AND THE TUMOR BY ALTERING THE BIOLOGIC RESPONSE OF THE HOST TO THE TUMOR CELLS. TARGETED THERAPY INTERFERES WITH CANCER GROWTH BY TARGETING SPECIFIC CELLULAR RECEPTORS AND PATHWAYS THAT ARE IMPORTANT IN TUMOR GROWTH.

BONE MARROW DEPRESSION AND FATIGUE ARE ASSOCIATED WITH BIOLOGIC THERAPY. CAPILLARY LEAK SYNDROME AND PULMONARY EDEMA ARE USUALLY ACUTE OR DOSE LIMITED AND MAY REQUIRE CRITICAL CARE NURSING. 12. DESCRIBE THE NURSING MANAGEMENT OF PATIENTS RECEIVING CHEMO, RADIATION, BIOLOGIC AND TARGETED THERAPY. TEACH PATIENT ABOUT THEIR TREATMENT REGIMEN OF CHEMO AND OR RADIATION, SUPPORTIVE CARE OPTIONS (E.G., ANTIEMETICS, ANTIDIARRHEALS), AND WHAT TO EXPECT DURING THE COURSE OF TREATMENT TO HELP DECREASE FEAR AND ANXIETY, ENCOURAGE ADHERENCE, AND GUIDE SELF MANAGEMENT. PROBLEMS FROM TARGETED THERAPY ARE DIFFERENT FROM OTHER FORMS OF CANCER THERAPY. THESE EFFECTS OCCUR MORE ACUTELY AND ARE DOSE LIMITED (MEANING EFFECTS RESOLVE WHEN THE AGENT IS DISCONTINUED). CAPILLARY LEAK SYNDROME AND PULMONARY EDEMA ARE PROBLEMS THAT REQUIRE CRITICAL CARE NURSING WITH TARGETED THERAPY. PROBLEMS WITH BIOLOGIC THERAPY ARE BONE MARROW SUPPRESSION WHICH IS GENERALLY MORE OBSERVED AS TRANSIENT, AND IT IS LESS SEVERE WHEN OBSERVED WITH CHEMOTHERAPY. FATIGUE CAN BE SEVERE AS WELL. 13. DESCRIBE THE NUTRITIONAL THERAPY FOR PATIENTS WITH CANCER. THE PATIENT MAY DEVELOP COMPLICATIONS RELATED TO THE CONTINUAL GROWTH OF THE MALIGNANCY INTO NORMAL TISSUE OR TO THE SIDE EFFECTS OF TREATMENT. THE PATIENT WITH CANCER MAY EXPERIENCE PROTEIN AND CALORIE MALNUTRITION CHARACTERIZED BY FAT AND MUSCLE DEPLETION. SUGGEST THE NEED FOR A NUTRITIONAL SUPPLEMENT TO THE HEALTH CARE PROVIDER AS SOON AS 5% WEIGHT LOSS IS NOTED OR IF THE PATIENT HAS THE POTENTIAL FOR PROTEIN AND CALORIE MALNUTRITION. MONITOR ALBUMIN AND PREALBUMIN LEVELS. TEACH PATIENT TO USE NUTRITIONAL SUPPLEMENT IN PLACE OF MILK WHEN COOKING OR BAKING. DIET: MILK, EGGS, CHEESE, MEAT, POULTRY, & FISH.

14. DIFFERENTIATE AMONG THE ASSOCIATED WITH ADVANCED CANCER.

VARIOUS

COMPLICATIONS

CANCER PATIENTS MAY DEVELOP COMPLICATIONS RELATED TO THE CONTINUAL GROWTH AND THE MALIGNANCY INTO NORMAL TISSUE OR TO THE SIDE EFFECTS OF TREATMENT. INFECTION IS THE PRIMARY CAUSE OF DEATH IN A CANCER PATIENT. THE PATIENT WITH CANCER MAY EXPERIENCE PROTEIN AND CALORIE MALNUTRITION. ONCOLOGIC EMERGENCIES CAN RESULT FROM THE CANCER OR CANCER TREATMENT. THEY ARE CLASSIFIED AS OBSTRUCTIVE, METABOLIC, OR INFILTRATIVE. THESE COMMONLY INCLUDE: SUPERIOR VENA CAVA SYNDROME, SPINAL CORD COMPRESSION, SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION, HYPERCALCEMIA, TUMOR LYSIS SYNDROME, DISSEMINATED INTRAVASCULAR COAGULOPATHY, AND CARDIAC TAMPONADE. 15. DESCRIBE THE PSYCHOLOGIC SUPPORT INTERVENTIONS FOR CANCER PATIENTS, CANCER SURVIVORS, AND THEIR CAREGIVERS. YOU ARE IN A KEY POSITION TO ASSESS THE PATIENTS AND FAMILYS RESPONSES AND SUPPORT POSITIVE COPING STRATEGIES. YOUR NURSING CARE CAN FACILITATE THE DEVELOPMENT OF A HOPEFUL ATTITUDE ABOUT CANCER AND SUPPORT THE PATIENT AND THE FAMILY DURING THE VARIOUS STAGES OF THE PROCESS OF CANCER. ADAPTATION AND COPING WITH A CANCER DIAGNOSIS MAY BE INFLUENCED BY A VARIETY OF PATIENT FACTORS INCLUDING DEMOGRAPHIC FACTORS, PRIOR COPING SKILLS AND STRATEGIES, SOCIAL SUPPORT, AND RELIGIOUS AND SPIRITUAL BELIEFS. ASSESS THE PSYCHOSOCIAL CONCERNS AND EMOTIONAL RESPONSES OF PATIENTS AND THEIR FAMILIES SO YOU CAN CONNECT PATIENTS WITH APPROPRIATE SUPPORTIVE CARE RESOURCES. CANCER SURVIVORS EXPERIENCE A VARIETY OF LONG-TERM AND LATE SEQUELAE FOLLOWING TREATMENT, INCLUDING A GREATER RISK OF FUNCTIONAL IMPAIRMENT, NONCANCER-RELATED DEATH AND CO-MORBIDITIES, INCLUDING HEART DISEASE, DIABETES, OSTEOPOROSIS, AND OTHERS.

THE IMPACT OF A CANCER DIAGNOSIS CAN AFFECT MANY ASPECTS OF LIFE, WITH SURVIVORS COMMONLY REPORTING FINANCIAL, VOCATIONAL, MARITAL, AND EMOTIONAL CONCERNS LONG AFTER TREATMENT IS OVER. THE PSYCHOSOCIAL EFFECTS CAN PLAY A PROFOUND ROLE IN A PATIENTS LIFE AFTER CANCER, WITH ISSUES RELATED TO LIVING IN UNCERTAINTY BEING FREQUENTLY ENCOUNTERED.