Chapter 11
Oncology: Nursing management in cancer care
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provide in-depth screening and follow-up for individuals who
are found to be at high risk for cancer.
Numerous factors, such as race, cultural influences, access
to care, doctor–patient relationship, level of education, income
and age, influence the knowledge, attitudes and beliefs people
have about cancer. These factors also influence the type of
health-promoting behaviours they practise. For example,
women from non-English-speaking backgrounds, Indigenous
women and women who report symptoms at the time of
first screening are more likely to not attend for second round
screening. Nurses can use this type of information in planning
education, prevention and screening programs as seen in the
research profiled in Chart 11-2.
Public awareness about health-promoting behaviours can
be increased in a variety of ways. Health education and health
maintenance programs are sponsored by government and com-
munity organisations. Although primary prevention programs
may focus on the hazards of tobacco use or the importance of
nutrition, secondary prevention programs may promote breast
and testicular self-examination and Papanicolaou (Pap) tests.
Health organisations conduct cancer screening events that
focus on cancers with the highest incidence rates or those that
have improved survival rates if diagnosed early, such as breast
or prostate cancers.
These events offer education and examinations such as
mammograms, digital rectal examinations and prostate-specific
antigen blood tests. Programs of this nature are often targeted
at individuals who require motivation to participate in preven-
tative aspects of their own health.
Similarly, nurses in all settings can develop programs that
identify risks for patients and families and that incorporate
teaching and counselling into all educational efforts, particu-
larly for patients and families with a high incidence of cancer.
Cancer councils and societies in Australia and New Zealand
provide information and recommendations to health profes-
sionals and the public focusing on nutrition, exercise and other
lifestyle-related activities shown to reduce the risk of cancer.
Nurses and doctors can encourage individuals to comply with
detection efforts as suggested by the National Health and
Medical Research Council (Table 11-3). The New Zealand
Cancer Society has similar recommendations for detection.
& Singh, 2005). By acquiring the knowledge and skills
necessary to educate the community about cancer risk,
nurses in all settings play a key role in cancer prevention.
Assisting patients to avoid known carcinogens is one way to
reduce the risk for cancer. Another way involves adopting
dietary and various lifestyle changes (smoking cessation,
decreased kilojoule intake, increased physical activity) that
epidemiological and laboratory studies show influence the
risk for cancer. Nurses use their teaching and counselling
skills to provide patient education and support public edu-
cation campaigns through organisations, such as the Cancer
Councils of Australia and New Zealand and the American
Cancer Society (ACS), that guide patients and families in
taking steps to reduce cancer risks through health promotion
behaviours (Chart 11-1).
Clinical trials are frequently undertaken to identify medi-
cations, such as tamoxifen, that may help to reduce the inci-
dence of certain types of cancer. The published findings of
the trials of tamoxifen clearly show that the drug can reduce
the risk of oestrogen receptor-positive (ER-Positive) breast
cancer. For example, large-scale breast cancer prevention
studies supported by the National Cancer Institute (NCI)
in the U.S. indicated that chemoprevention with the med-
ication tamoxifen (Nolvadex) can reduce the incidence of
breast cancer by 50% in women at high risk for breast cancer
(Fisher et al., 2005). Currently, the NCI (2008) lists 110
ongoing clinical trials exploring chemoprevention strategies.
Secondary prevention
The evolving understanding of the role of genetics in cancer
cell development has contributed to prevention and screening
efforts. Individuals who have inherited specific genetic muta-
tions have an increased susceptibility to cancer. For example,
individuals who have familial adenomatosis polyposis have an
increased risk for colon cancer. Women in whom the
BRCA-1
and
BRCA-2
genes have been identified have an increased
risk for breast and ovarian cancer. To provide individualised
education and recommendations for continued surveillance
and care in high-risk populations, nurses need to be familiar
with ongoing developments in the field of genetics and
cancer (Calzone & Masny, 2004). Some medical centres are
now offering innovative cancer risk evaluation programs that
Health Promotion
Risk factors
Taking steps to reduce cancer risk
When teaching individual patients or groups, nurses can
recommend the following cancer prevention strategies:
1. Increase consumption of fresh vegetables (especially
those of the cabbage family) because studies indicate that
roughage and vitamin-rich foods help to prevent certain
kinds of cancer.
2. Increase fibre intake because high-fibre diets may reduce
the risk for certain cancers (eg, breast, prostate and
colon).
3. Increase intake of vitamin A, which reduces the risk for
oesophageal, laryngeal and lung cancers.
4. Increase intake of foods rich in vitamin C, such as citrus
fruits and broccoli, which are thought to protect against
stomach and oesophageal cancers.
CHART
11-1
Adapted from American Cancer Society, 2013a.
5. Practise weight control because obesity is linked to
cancers of the uterus, gallbladder, breast and colon.
6. Reduce intake of dietary fat because a high-fat diet
increases the risk for breast, colon and prostate cancers.
7. Practise moderation in consumption of salt-cured, smoked
and nitrate-cured foods; these have been linked to
oesophageal and gastric cancers.
8. Stop smoking cigarettes and cigars, which are carcinogens.
9. Reduce alcohol intake because drinking large amounts of
alcohol increases the risk of liver cancer. (Note: People
who drink heavily and smoke are at greater risk for
cancers of the mouth, throat, larynx and oesophagus.)
10. Avoid overexposure to the sun, wear protective clothing
and use a sunscreen to prevent skin damage from
ultraviolet rays that increase the risk of skin cancer.
