And with the population of older Americans expected to increase as baby boomers reach retirement age, nurses specializing in treating patients with cancer—a disease that disproportionately affects those over 55—might be in especially high demand.
Unfortunately, the overall shortage of trained nurses could mean a decline in the quality of oncological care. Oncology nurses are a crucial component of quality cancer treatment across the spectrum of care. However, as the Oncology Nursing Society states, “the shrinking nurse workforce ultimately will result in fewer nurses who choose oncology nursing as a career, stay in oncology nursing, and become certified in oncology nursing. The quality of cancer care may be negatively impacted as a result.”This only proves how valuable nurses are to providing effective care to patients battling cancer, a disease that takes many shapes and continues to leave more questions than answers about its causes, treatments, and outcomes.
Cancer is a frightening diagnosis for most people to receive, and the job of the health care professional, particularly one specifically trained in cancer care, is to help the patient through the long process beginning with the initial diagnosis. This process will often include surgery, radiation, chemotherapy, alternative therapies, follow-up care, palliative care, or hospice. Throughout this long process, the oncological nurse will provide direct care to patients; educate patients and their families; coordinate care across the health care spectrum; and act as a consultant to other health care professionals.
Melanoma, Gastric and Ovarian Cancer Care: An Examination of Risk Factors, Prevention and Diagnosis
In most cases, there is no single cause of cancer. Although science has made great advances in understanding the underlying reasons why cancer forms in some individuals and not others, what has emerged is a list of risk factors, some of which are common to many cancers, but which don’t necessarily paint the complete picture. In most cancers, genetics plays a large role in determining one’s risk for developing the disease, but family history does not guarantee a cancer diagnosis. Likewise, many people with no genetic predisposition develop some form of cancer. General behavioral risk factors for cancer include smoking, drinking too much alcohol, being physically inactive, and having a poor diet. Exposure to certain substances, including ionizing radiation, certain chemicals, and UV rays from sunlight, can increase one’s risk for developing cancer. In some forms of the disease, infection with certain viruses and bacteria can lead to cancer.
Melanoma, a form of skin cancer, is formed in the melanocytes, or pigment cells, of the skin, and has a strong association with exposure to UV radiation from the sun or from tanning beds. People that have had a lifetime of sun exposure, such as those that live in sunny climates or high elevations, and people that have had at least one severe, blistering sunburn are at greater risk for developing melanoma. Those with fair skin and a large number of moles or freckles are also more likely than dark-skinned individuals to have melanoma. The use of sunscreen lotion with SPF of at least 15 has been proven to reduce the risk of developing most forms of skin cancer, including melanoma.
Melanoma is one form of cancer that is often visible to the naked eye, appearing either as a new mole on the surface of the skin or a change (of shape, size, color, or texture) in an existing mole. Advanced melanoma can appear to be scabby and ooze blood. Routine examinations, including self-examinations, of existing moles are important as early detection can prevent the spread of skin cancer to lymph nodes and other organs. Like many other forms of cancer, melanoma is more easily treated in its earliest stages.
Gastric cancer (or stomach cancer) is expected to be diagnosed in over 20,000 people in the United States in 2012, with the probable mortality rate for those suffering from the disease around 50%. There are a few known risk factors for developing stomach cancer, including the infection of the stomach with bacteria called Helicobacter pylori, which exists in the mucus coating the inside of the stomach in about two-thirds of the world’s population. Although it often causes no health problems for infected people, it can lead to peptic ulcers and other conditions that cause inflammation of the stomach and intestines. It is also associated with an increased risk of gastric cancer. It is also thought that diets high in cured or pickled foods and low in fresh fruits and vegetables can increase one’s risk for developing gastric cancer. Stomach cancer is usually not detected early because its symptoms are not immediately felt by the patient. Symptoms of later stage gastric cancer are similar to those of infection or ulcers: discomfort, nausea, weight loss, feeling full, and difficulty swallowing.
Ovarian cancer is expected to affect nearly 23,000 women and result in more than 15,000 deaths in 2012. Risk factors for ovarian cancer are less well understood; they include family history, personal history of other forms of cancer, and never being pregnant. Some studies have also shown that women who take estrogen without progesterone for 10 or more years are at higher risk for developing ovarian cancer. Like gastric cancer, early ovarian cancer can be hard to detect, but as the disease progresses symptoms might include tiredness; constipation, diarrhea, or bloating; and pressure or pain in the abdomen, back, upper legs, or pelvis.
Melanoma, Gastric and Ovarian Cancer Care: Treatment and Outcomes
Once the diagnosis of cancer has been made, a doctor will make a determination of how far the cancer has progressed. This staging process helps the patient’s medical team decide what might be the most appropriate treatment. In its early stages, cancerous cells can often be removed surgically. Chemotherapy and radiation therapy can be used in addition to surgery or by themselves when surgery is not possible. Other possible treatments include biological therapy (or biotherapy), which helps boost the immune system’s response to cancer and other diseases, photodynamic therapy, and complementary treatments such as acupuncture and meditation. Some of these treatments have very unpleasant side effects for patients, and if this is the case, palliative care is an essential part of the recovery process.
Because of its high rate of early detection, melanoma is often removed easily without a need for major surgery (in some cases, it can even be removed during the biopsy process). Those with more advanced melanoma might need additional treatment. Plastic surgery might be necessary if a lot of skin was removed from the cancerous area. Those who have had melanoma are at high risk for developing it again, so proper preventative measures and continuing follow-up care will be necessary for the rest of the patient’s life. Survival rates for melanoma are over 90% when the cancer is confined to the primary site, and considerably less (below 70%) when it has already spread to regional lymphnodes.
Treatment for gastric cancer almost always includes a partial or total gastrectomy. Chemotherapy and radiation therapy will probably be used in addition to surgery to help stop further spreading of cancerous cells. After stomach surgery, a patient’s diet will probably have to be altered to prevent gastrointestinal problems such as cramps, bloating, and nausea. Supplemental vitamin D, calcium, and iron might also be required. The survival rate for stomach cancer is just over 60% for early stage, localized cancer and under 30% for cancer that has spread.
In the case of ovarian cancer, a laparotomy will be performed and the ovaries, fallopian tubes, uterus, and nearby lymphnodes are removed. (For women that might want to become pregnant, less aggressive surgery might be appropriate if the cancer has not spread.) Post-operative symptoms for those who have had this procedure are similar to those of menopause due to the body’s sudden loss of hormones. Chemotherapy is often used in conjunction with surgery; radiation therapy is rarely used in cases of ovarian cancer. Survival rates for ovarian cancer when caught early are over 90%.
For each diagnosis of cancer, a team of health care professionals becomes responsible for the well being of a patient whose life has suddenly been changed forever. Oncology nurses, perhaps more than other members of the health care team, have a special role as an educator and advocate for patients and their families as they navigate the often difficult waters of cancer treatment. As hospitals and treatment centers find ways to cut costs, nurses are a critical part of maintaining quality of care for patients whose very life depends on the type of treatment they receive.
Finally, and perhaps most importantly, nurses often provide that intangible human connection that can be so important to a patient’s chance at a positive outcome. For all these reasons, oncology nurses are, and will continue to be, an invaluable part of cancer care in the twenty-first century.