Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

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

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, 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 Nurs ing Research Prof ile : Evidence -based practice Use of acupressure to reduce chemotherapy-induced nausea and vomiting