Chapter 11
Oncology: Nursing management in cancer care
271
2005). In addition, nurses and other healthcare providers often
fail to ask patients about sexual concerns, and patients may
be hesitant to discuss them. However, standards of oncology
nursing practice include the need for nurses to assess patients’
sexuality and to help patients and their partners achieve the
outcomes of importance to them (Wilmoth, 2006). Nurses
who identify physiological, psychological or communication
difficulties related to sexuality or sexual function are in a key
position to help patients seek further specialised evaluation
and intervention if necessary.
Assisting in the grieving process
Nurses assess the patient’s psychological and mental status as
the patient and family face this life-threatening experience,
unpleasant diagnostic tests and treatment modalities, and
progression of disease. The nurse assesses the patient’s mood
and emotional reaction to the results of diagnostic testing and
prognosis and looks for evidence that the patient is progressing
through the stages of grief and can talk about the diagnosis and
prognosis with family members.
A cancer diagnosis need not indicate a fatal outcome. Many
forms of cancer are curable; others may be cured if treated
early. Despite these facts, many patients and their families view
cancer as a fatal disease that is inevitably accompanied by pain,
suffering, debility and emaciation.
Grieving is a normal response to these fears and to
the losses anticipated or experienced by the patient with
cancer. These may include loss of health, normal sensations,
body image, social interaction, sexuality and intimacy. The
patient, family and friends may grieve for the loss of quality
time to spend with others, the loss of future and unfulfilled
plans, and the loss of control over one’s own body and emo-
tional reactions.
The patient and family just informed of the cancer diagno-
sis frequently respond with shock, numbness and disbelief. It is
often during this stage that the patient and family are called
on to make important initial decisions about treatment. They
require the support of the doctor, nurse and other healthcare
team members to make these decisions. An important role of
the nurse is to answer any questions the patient and family
have and clarify information provided by the doctors.
In addition to assessing the response of the patient and
family to the diagnosis and planned treatment, the nurse assists
them in framing their questions and concerns, identifying
resources and support people (e.g. spiritual advisor, coun-
sellor), and communicating their concerns with each other.
Support groups for patients and families are available through
hospitals and various community organisations. These groups
provide direct assistance, advice and emotional support.
As the patient and family progress through the grieving
process, they may express anger, frustration and depression.
During this time, the nurse encourages the patient and family
to verbalise their feelings in an atmosphere of trust and
support. The nurse continues to assess their reactions and
provides assistance and support as they confront and learn to
deal with new problems.
If the patient enters the terminal phase of disease, the nurse
may realise that the patient and family members are at differ-
ent stages of grief. In such cases, the nurse assists the patient
and family to acknowledge and cope with their reactions and
feelings. Nurses also assist patients and families to explore pref-
erences for issues related to end-of-life care such as withdrawal
patterns and sexual dysfunction treatment can threaten the
patient’s self-esteem and body image.
A creative and positive approach is essential when caring
for patients with altered body image. Nursing approaches for
addressing issues related to body image and self-esteem are also
included in the Plan of nursing care (see Chart 11-4). The
nurse serves as a listener and counsellor to both the patient and
the family. Possible influences of the patient’s culture and age
are considered when discussing concerns and potential inter-
ventions (Romanek, McCaul & Sandgren, 2006).
As a result of the underlying cancer, treatments and psycho
social responses to the experience, patients may experience
a variety of sexuality-based issues. Patients who experience
alterations in sexuality and sexual function are encouraged to
discuss their concerns. Major barriers to addressing sexual dys-
function in patients with cancer include the lack of assessment
tools and evidence-based interventions (Bakewell & Volker,
Assessment
Sources of fatigue in cancer patients
Pain, pruritus
Imbalanced nutrition related to anorexia, nausea, vomiting,
cachexia
Electrolyte imbalance related to vomiting, diarrhoea
Ineffective protection related to neutropenia,
thrombocytopenia, anaemia
Impaired tissue integrity related to stomatitis, mucositis
Impaired physical mobility related to neurological impairments,
surgery, bone metastasis, pain and analgesic use
Deficient knowledge related to disease process, treatment
Anxiety related to fear, diagnosis, role changes, uncertainty of
future
Ineffective breathing patterns related to cough, shortness of
breath and dyspnoea
Disturbed sleep pattern related to cancer therapies, anxiety
and pain.
CHART
11-10
Nurs ing Research Prof ile :
Evidence -based practice
Cancer-related fatigue
Summary
As more women are offered and receive adjuvant
chemotherapy for breast cancer, recognition grows of the
potential for acute and long-term symptoms and decreased
quality of life (QOL) among survivors whose five-year survival
rate is 97% for localised disease and 80% for regional
disease. This longitudinal, descriptive design (Byar et al.,
2006) aimed at identifying the differences in fatigue, other
physical symptoms, and psychological symptoms and their
relationship to quality of life (QOL) during chemotherapy and
as long as 1 year after.
Nursing implications
The findings of this study demonstrate that fatigue is
associated with other physical and psychological symptoms
that fluctuate during and after treatment. Higher fatigue
compromises QOL. Interventions targeting primary or cluster
symptoms can reduce the impact of adjuvant chemotherapy
on fatigue, other symptoms, and QOL.
For more information on this study, see Nursing research
profile 11-11 in the related ancillary file for this chapter.
CHART
11-11
