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Chapter 11

Oncology: Nursing management in cancer care

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. 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

& 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 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 Health Promotion Risk factors

and use a sunscreen to prevent skin damage from ultraviolet rays that increase the risk of skin cancer.

Adapted from American Cancer Society, 2013a.