264
Unit 3
Applying concepts from the nursing process
achieving a reasonable quality of life while undergoing poten-
tially toxic and life-saving modalities. Many patients seek a
more holistic or non-traditional approach, turning to comple-
mentary and alternative therapies while continuing to utilise
conventional medicine (Mumber, 2006).
The National Institute of Complementary Medicine
(NICM) in Australia considers complementary medicine to
be inclusive of historically used names such as alternative
medicine, natural medicine and traditional medicine, and
is concerned with both the maintenance of wellness and
the treatment of illness. In the U.S., the National Center
for Complementary and Alternative Medicine (NCCAM)
Institutes defines CAM as diverse medical and healthcare
systems, practices and products that are not presently consid-
ered to be part of conventional medicine. More recently, the
term ‘integrative medicine’ has been used, which denotes a
combination of conventional medicine and CAM that has
a strong scientific base for use and safety (NCCAM, 2009).
CAM is used by 28 to 85% of patients with cancer as
seen in the research presented in Chart 11-8. More impor-
tantly, patients are using CAM but not communicating this
to their healthcare providers either because they were never
asked about its use or because they withheld the information
fearing that their doctors would not approve (Chong, 2006;
Rojas-Cooley & Grant, 2006). Many of the CAM modalities
can be a source of comfort and emotional support for the
patient, but assessment of CAM use is important for patient
safety. Mind–body and biofield therapies have a holistic focus
on channelling positive energy, promoting relaxation and
reducing stress and have been reported as being beneficial
to patients as measured by wound healing and reduction
in pain, oedema and anxiety (Hibdon, 2005). There is,
Continuing care.
Referral for home care is usually indicated
to monitor the patient’s responses to treatment and to con-
tinue and reinforce teaching. During home visits, the nurse
assesses the patient’s and family’s technique in administering
medications. The nurse collaborates with doctors and other
healthcare professionals to help patients obtain optimal care
for home administration of BRM therapies. The nurse also
reminds patients about the importance of keeping follow-up
appointments with the doctor and assesses the patient’s need
for changes in care.
Gene therapy
As early as 1914, the somatic mutation theory of cancer
suggested that cancer develops as a result of inherited or
acquired genetic mutations that lead to a disturbance in
the normal chromosomal balance regulating cell growth
and reproduction. Technological advances and information
gained through intense study of genetics have assisted
researchers and clinicians in predicting, diagnosing and
treating cancer. Gene therapy includes approaches that
correct genetic defects or manipulate genes to induce tumour
cell destruction in the hope of preventing or combating
disease. Somatic cell (any cell not contained in an embryo
or destined to become an egg or sperm) gene therapy is
a publicly funded form of gene therapy in Australia and
New Zealand. This type of therapy involves the insertion
of a desired gene into the targeted cells. Human germ cell
manipulation is considered by many to be controversial and
a potential source of bioethical concerns (National Institutes
of Health [NIH], 2007).
Viruses have long been hypothesised as an ideal delivery
system because of the ease with which they cross the cell
membrane and enter the intracellular space; however, their
drawback includes their short-lived effect due to the strong
immune response. Viruses used as vectors include retroviruses,
adenoviruses (common cold virus), vaccinia virus (smallpox
vaccine), fowlpox (avian poxvirus), herpes simplex viruses
and Epstein-Barr viruses (Yang et al., 2007). Clinical research
studies are evaluating gene therapy across all cancer sites,
including melanoma, prostate cancer, breast cancer, pancreatic
cancer, head and neck squamous cell cancer, and non-small
cell lung cancer.
Three general approaches have been used in the develop-
ment of gene therapies, with adenoviruses showing effective
promise in each approach.
•
Tumour-directed therapy
is introduction of a therapeutic
gene (suicide gene) into tumour cells in an attempt to
destroy them. This approach is very challenging because
it is difficult to identify which gene would be the most
beneficial. In addition, patients with widespread disease
would require multiple injections to treat every site of
disease.
•
Active immunotherapy
is the administration of genes that
will invoke the antitumour responses of the immune
system.
•
Adoptive immunotherapy
is the administration of
genetically altered lymphocytes that are programmed
to cause tumour destruction (Yang et al., 2007).
Complementary and alternative medicine (CAM)
For many patients and their clinicians, a challenge in managing
their cancer treatments is in finding the balance between
Nurs ing Research Prof ile :
Evidence -based practice
Use of acupressure to reduce
chemotherapy-induced nausea
and vomiting
Summary
The purpose of this longitudinal randomised clinical trial study
(Dribble et al., 2007) was to compare the effectiveness of
acupressure, placebo acupressure and usual care in reducing
chemotherapy-induced nausea and vomiting (CINV) in
women with breast cancer through the use of acupressure.
A total of 160 women were randomly assigned to one of
three intervention groups, acupressure, placebo acupressure
and usual care.
Nursing implications
The results of this study suggest that acupressure
may be a valid addition to other interventions for the
management of CINV, including CINV that occurred 2 to
11 days after chemotherapy treatment. Acupressure offers
a non-pharmacological, alternative approach to care of a
significant problem for many patients. The technique is easily
learned without significant expense or prolonged training.
Future research might assess the role of acupressure in the
treatment of CINV in both genders and for other types of
cancer.
For more information on this study, see Nursing research
profile 11-8 in the related ancillary file for this chapter.
CHART
11-8
