Psychosocial Needs of Cancer Patients

Cancer is a disease with no regard for age, gender, or ethnicity. In 2013 nearly 1,600 people a day died from cancer; and “cancer remains the second most common cause of death in the US” (ACS, 2013). There are twenty three cancer types currently identified. However, many people still do not understand what a diagnosis of cancer means, how cancer progresses, or the common complications with cancer. All valuable information that must be addressed before choosing a treatment option, discussing treatment side effects, and identifying the support systems a person will need while receiving treatment.

Despite advances in treatment and care the public continues to have a great deal of anxiety and fear when diagnosed with cancer. Partially because people do not understand what having cancer means. Every living organism is made up of cells. These cells divide at a controlled rate with a specific function and multiply to replace damaged cells. While cancer cells grow and multiply with no control, destroying healthy cells in its’ path, and ultimately invading parts of the body inhibiting its’ function.

Biologists have labeled cancer cells as any invading cell that can control proliferation and differentiation. Proliferation is the lifecycle of normal cells, to include regeneration of new cells as cells die. One of the phenomenon’s of normal proliferation is that the cells remain in their territory and do not inhibit cellular growth to surrounding cell membranes (Lewis, 2007). Differentiation is when a stem cell is coded to perform a specific function and under normal conditions these cells are unable to change their function. However, cancer is able to alter these naturally occurring processes.

Cancer begins are a mutation in replicating DNA, either by genetics or a chemical, radiation, or viral exposure. The mutated DNA then starts proliferation and develop mutated cells; however, these cells do not stay within the boundaries of its originating cellular territory like healthy cells. At this stage the cancer cells have not interrupted normal bodily functions and there are no clinical indications of cancer. However, as the cancer progresses it can form tumors, invade tissues and organs, and eventually travels to other organs in the body.

With a greater understanding of what cancer is, when do clinical indications and a diagnosis of cancer occur? As any disease spreads through the body it is known as staging, as a disease spreads it rises in stage; thus the higher the number the greater amount of cancer invading a person. Cancer has five stages and staging is accomplished during the diagnostic workup phase which enables physicians to provide the appropriate treatment plan. Diagnostic tools used to stage cancer include blood work, MRI, CT scan, PET scan, ultrasound, and biopsy of the affected cells.

Stage zero is known as cancer in situ, this is when the cancer is still new and remains in the originating tissue. Stage one indicates a tumor has developed, but it is localized in the original tissue, has not affected the lymph nodes, and has not spread to any surrounding tissues. Stages zero and one have the best treatment outcomes (ASCO, 2013). Stage two indicates the cancer tumor is larger, the cells have spread to the surrounding tissues to include the lymph nodes. Stage three is very similar to stage two, however, the size of the tumor and invasion of surrounding tissues is much larger.

While stage four occurs when the cancer has spread to multiple areas of the body and is considered advanced or metastatic cancer. When cancer has metastasized it means the cancer has traveled to another organ of the body it does not neighbor, such as from the colon to the liver or the pancreas to the brain. As cancer spreads it affects multiple body systems, this along with treatment can cause several complications. The most common complications include pain, fatigue, and nausea. However, as cancer progresses it can press on nearby nerves resulting in pain and loss of function to parts of the body.

Should the cancer involve the brain this type of nerve interaction can cause severe headaches and stroke like symptoms (Mayo Clinic, 2014). Some clients may develop paraneoplastic syndromes, this is when the body’s own immune system reacts to the cancer and begins to attack healthy cells. This paraneoplastic syndrome can present itself in a number of symptoms to include difficulty walking and seizures. Finally cancer can affect the chemical balance in the body. Which can present as excessive thirst, frequent urination, constipation and dementia.

A diagnosis of cancer does not only affect the originating tissues as it grows and during treatment it can affect the person as a whole. Cancer is treated differently depending on what researchers have found to be most effective for the given type of cancer. Common treatments include chemotherapy, radiation, bone marrow transplant, surgery, immunotherapy, and target therapy. Each of these therapies has complications that must be considered prior to treatment. Chemotherapy is the use of medications to destroy or stop the growth of cancer cells (ACS, 2014).

Chemotherapy is used to destroy caner, shrink tumors for surgical removal, enhance the cancer killing effects of radiation, and palliative care. Since chemotherapy affects the rapidly dividing cells it also effects healthy cells. Common side effects include anemia due to lack of RBC’s, bleeding disorders due to a lack of platelets, hair loss, GI upset, organ damage, and a high risk for secondary infection related to a lack of WBC’s. Radiation is the use of strong x-rays to kill cancer cells specifically at the tumor location (ACS, 2014).

By administering radiation to the tumor you can kill the rapidly dividing cells without damaging cells throughout the body. Yes, the treatment will kill healthy cells in the treatment area, however healthy cells are more prepared to repair themselves than cancer cells. Side effects may differ depending on the affected area, however common side effects include radiation dermatitis, fatigue, and a decreased blood count. Bone marrow transplants (BMT) replace diseased cells with noncancerous stem cells that can grow into healthy new cells.

BMT is only used when the chances of a cure with chemotherapy alone is very low (ACS, 2014). Common side effects of BMT are anemia, thrombocytopenia, mucositis, secondary infection, and graft vs host disease. Surgery is the procedure of physically removing cancerous tumors from the body. Surgical intervention is greatly impacted by the size, location, type, and extent of the cancer. Primary complications include constipation, headaches, nausea, and pain. Immunotherapy is using the body’s own immune system to fight the cancer.

During this therapy patients are given biological response modifiers which naturally enhance the body’s ability to fight cancer. Common side effects are typical flu like symptoms. Finally target therapy is the newest approach to fighting cancer. This therapy uses medications to stop important roles in cancer growth like blocking blood supply, interfering with cancer cell replication, and stopping the interaction with healthy cells (ACS, 2014). Side effects are typically milder than chemotherapy, but do include allergic reactions.

With this many treatment options it is important to be patient during the diagnostic phase and truly consider treatment options before jumping into therapy. Finally psychological support during cancer therapy is essential to maintain a positive attitude towards treatment and sustain a high quality of life. There are several fears that come with a diagnosis of cancer to include disfigurement, disruption of relationships, pain, financial depletion, abandonment, and death. Having a strong support system will aid patients as they cope with the many fears they will encounter throughout therapy.

Thankfully nurses play a major role in patient and family education when it comes to a healthy support system; not to mention nurses themselves are a patient resource for support. Remind families that it is important to be available and to continue to be available for the person especially during the difficult times. Be caring, listen to their fears and concerns, and offer relief to their distress whenever possible. Maintain a relationship based on trust and confidence this will make it easier to provide essential information regarding their cancer and treatment.

Assist the person in reaching their short term and long term goals, as well as maintaining their current lifestyle. Finally always maintain hope; hope can relieve pain, provide motivation, and offer peace of mind. As nurses and family members there are several survivor resources available including the Cancer Survivorship Network, Life After Cancer Care, Live Strong Survivor Care, and the American Cancer Society. As with any disease prevention is the best medicine. Educating the public on the warning signs, early detection, and prevention are the keys to cancer survival.

Preventing cancer can be accomplished by limiting alcohol consumption, exercise, having a normal body weight, avoiding tobacco, using sunscreen, and eating a healthy diet. The seven warning signs to cancer can be spelled out as CAUTION: Changes in bowel or bladder, A sore that does not heal, Unusual bleeding or discharge, Thickening skin or a lump, Indigestion or difficulty swallowing, Obvious changes in a mole, and Nagging cough or hoarseness (Lewis, p282). These simple warning signs warrant a swift visit to a physician.

Finally early detection is important in catching cancer during its’ early stages with the use of mammograms, colorectal screenings, blood testing, and routine physical examinations. With modern technology and the resources available public education about cancer has been on the rise and early detection has followed right behind it. Hopefully by educating the public on what cancer is, how it affects the body, treatment options, and ways of prevention the public will have tools necessary to help lower the number of deaths per year from cancer.