This assignment discusses the experiences of cancer patients during their treatment. It includes a literature search and findings from scholarly articles. The experiences of different patient groups, such as LGBT individuals and young adults, are explored. The challenges and gaps in cancer care services are also highlighted.
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Running head: NURSING ASSIGNMENT Experience of people with cancer during treatment Name of the Student Name of the University Author Note
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1NURSING ASSIGNMENT Introduction- The word cancer is an umbrella term that encompasses several diseases, characterized by an abnormal proliferation and growth of cells present in the body, which in turn increases their potential of spreading to, or invading other regions of the body (Marcuet al.2019). According toWeiset al.(2017)physical effect of cancer and its treatment has been found to deteriorate the health related quality of life of patients, and also creates a negative impact on their emotional functioning. Patients who experience physical symptoms like nausea, fatigue, and pain are also subjected to emotional distress.Bandura (2017) also identified theneed of offering psychotherapeutic treatment for all cancer patients owing to the prevalence of helplessness among cancer patients who are affected both emotionally and physically. Thus, cancer predisposes the patients to several emotional conflicts.Genetic analysis for hereditary cancer disposition has progressed speedily in recent years with the detection of novel genes. Recent workshops conducted by the UK Cancer Genetics Group helped in the development of management proposals for screening patients across the nation, who were found to manifest pathogenic mutations in the cancer causing genes (Tayloret al. 2018).This assignment will discuss scholarly articles for exploring the experiences that cancer patients acquire, during their treatment. Literature search and findings- Search strategy forms an essential aspect of literature reviews and comprise of an organized structure encompassing key terms that are fed in electronic databases. These help in extracting relevant articles. The research question for the current assignment was as follows: What are the experiences of patients suffering from cancer, during their treatment? Relevant scholarly pieces of evidence were obtained from three electronic databases namely, CINAHL, MEDLINE, andOvid MEDLINE ALL. To offer a literature synthesis pertinent to contemporary cancer care and its experiences, the search of articles was restricted
2NURSING ASSIGNMENT to those published from January 2017 to February 2019. The search terms were ‘cancer’, ‘tumour’, ‘patient’, ‘experience’, ‘feelings’, and ‘survivors’. These terms were combined with boolean operators AND, OR, and NOT that either broadened or narrowed down the extracted hits (Martin, Hussain and Boyle 2017). The search focused on articles that included all people suffering from cancer (excluding those aged within four years, since they are not quite capable of expressing their experiences). Articles that focused on patients suffering from all kinds of cancer were taken into consideration, regardless of cancer stage, type, co- morbidty, and severity).20 articles had been extracted from the database.The search results are given below: DatabaseTotal hitsSources used CINAHL329 MEDLINE277 Ovid MEDLINE ALL244 Total8320 Table 1- Database search hits
3NURSING ASSIGNMENT References Research articles Abdollahimohammad, A., Firouzkouhi, M. and Naderifar, M., 2018. Lived Experiences of Iranian Cancer Patients After Survival: A Phenomenological Research.Journal of Patient Experience, pp.1-5. Aoki, T. and Inoue, M., 2017. Primary care patient experience and cancer screening uptake among women: an exploratory cross-sectional study in a Japanese population.Asia Pacific family medicine,16(1), p.3. Bolton,G.andIsaacs,A.,2018.Women’sexperiencesofcancer-relatedcognitive impairment, its impact on daily life and care received for it following treatment for breast cancer.Psychology, health & medicine,23(10), pp.1261-1274. Carduff, E., Kendall, M. and Murray, S.A., 2018. Living and dying with metastatic bowel cancer: Serial in‐depth interviews with patients.European journal of cancer care,27(1), p.e12653. Carrera, P.M., Kantarjian, H.M. and Blinder, V.S., 2018. The financial burden and distress of patients with cancer: Understanding and stepping‐up action on the financial toxicity of cancer treatment.CA: a cancer journal for clinicians,68(2), pp.153-165. Faller, H., Weis, J., Koch, U., Brähler, E., Härter, M., Keller, M., Schulz, H., Wegscheider, K., Boehncke, A., Hund, B. and Reuter, K., 2017. Utilization of professional psychological care in a large German sample of cancer patients.Psycho‐oncology,26(4), pp.537-543. Fish, J. and Williamson, I., 2018. Exploring lesbian, gay and bisexual patients’ accounts of theirexperiencesofcancercareintheUK.Europeanjournalofcancercare,27(1), p.e12501.
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4NURSING ASSIGNMENT Fladeboe, K., King, K., Kawamura, J., Gurtovenko, K., Stettler, N., Compas, B., Friedman, D., Lengua, L., Breiger, D. and Katz, L.F., 2018. Featured Article: Caregiver Perceptions of StressandSiblingConflictDuringPediatricCancerTreatment.Journalofpediatric psychology,43(6), pp.588-598. Friese, C.R., Harrison, J.M., Janz, N.K., Jagsi, R., Morrow, M., Li, Y., Hamilton, A.S., Ward, K.C., Kurian,A.W.,Katz, S.J. and Hofer,T.P., 2017. Treatment-associatedtoxicities reported by patients with early-stage invasive breast cancer.Cancer,123(11), pp.1925-1934. Marcu, A., Muller, C., Ream, E. and Whitaker, K.L., 2019. Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool.Journal of Medical Internet Research,21(2), p.e12400. Martin, S., Hussain, Z. and Boyle, J.G., 2017. A beginner’s guide to the literature search in medical education.Scottish medical journal,62(2), pp.58-62. Nielsen, B.K., Mehlsen, M., Jensen, A.B. and Zachariae, R., 2017. Doctor, Ease My Mind! Associations between Cancer Patients’ Emotional Distress and Their Perception of Patient- Centeredness during Oncology Consultations.Open Journal of Nursing,7(07), p.788. Rogers,S.N.,Russell,L.andLowe,D.,2017.Patients’experienceoftemporary tracheostomy after microvascular reconstruction for cancer of the head and neck. British Journal of Oral and Maxillofacial Surgery,55(1), pp.10-16. Taylor, J. and Pagliari, C., 2018. # Deathbedlive: the end-of-life trajectory, reflected in a cancer patient’s tweets.BMC palliative care,17(1), p.17. Trinquinato, I., Marques da Silva, R., TiconaBenavente, S.B., CristineAntonietti, C. and Siqueira Costa Calache, A.L., 2017. Gender differences in the perception of quality of life of patients with colorectal cancer.Investigacion y educacion en enfermeria,35(3), pp.320-329.
5NURSING ASSIGNMENT Valpey,R.E.,2017.Cancer-RelatedCognitiveImpairment:ConsideringRiskFactors, Approaching Assessment, and Contemplating Treatment.The American Journal of Geriatric Psychiatry,25(12), pp.1427-1428. Weis, J., Tomaszewski, K.A., Hammerlid, E., Ignacio Arraras, J., Conroy, T., Lanceley, A., Schmidt, H., Wirtz, M., Singer, S., Pinto, M. and Alm El-Din, M., 2017. International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12).JNCI: Journal of the National Cancer Institute,109(5). Wen, K.Y., Smith, R., Padmanabhan, A. and Goldstein, L., 2017. Patient experience of taking adjuvant endocrine therapy for breast cancer: a tough pill to swallow.Patient Experience Journal,4(3), pp.104-114. White, V., Skaczkowski, G., Thompson, K., Bibby, H., Coory, M., Pinkerton, R., Nicholls, W., Orme, L.M., Conyers, R., Phillips, M.B. and Osborn, M., 2018. Experiences of Care of Adolescents and Young Adults with Cancer in Australia.Journal of adolescent and young adult oncology.https://doi.org/10.1089/jayao.2017.0104 Zhang, S., O’Carroll Bantum, E., Owen, J., Bakken, S. and Elhadad, N., 2017. Online cancer communitiesasinformaticsinterventionforsocialsupport:conceptualization, characterization,andimpact.JournaloftheAmericanMedicalInformatics Association,24(2), pp.451-459.
6NURSING ASSIGNMENT Non-research article Taylor, A., Brady, A.F., Frayling, I.M., Hanson, H., Tischkowitz, M., Turnbull, C. and Side, L., 2018. Consensus for genes to be included on cancer panel tests offered by UK genetics services: guidelines of the UK Cancer Genetics Group.Journal of medical genetics,55(6), pp.372-377. Wittenberg, E., Buller, H., Ferrell, B., Koczywas, M. and Borneman, T., 2017, December. Understanding family caregiver communication to provide family-centered cancer care. InSeminars in oncology nursing(Vol. 33, No. 5, pp. 507-516). WB Saunders.
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7NURSING ASSIGNMENT Books Bandura, A., 2017.Psychotherapeutic treatment of cancer patients. Routledge, New York.
8NURSING ASSIGNMENT Experiences of cancer patients-Fish and Williamson (2018) analysed the accounts of British cancer patients who identified themselves as lesbian, gay or bisexual, in order to determine their experiences of cancer care that they received in the UK. A comprehensive analysis of the data collected from in‐depth individual interviews helped in the formulation of three distinct themes namely, (i) difficult choreography around revelation, (ii) creation of sense of sub‐optimal cancer care, and (iii) hostility from typical psychosocial cancer support. Utilisation of the Meyer's Minority Stress Theory helped the authors in determining that cancer patients belonging to the LGBT community often experienced prejudice from the society, in terms of their treatment and the much needed support for the terminal disease. This called for the need of enhancing the training provided to healthcare professionals for ensuring commitment to treatment equality. The same was affirmed by Whiteet al.(2018) who conducted a cross-sectional self- report survey among207 young adultsandteenagerpatientswho had beenrecently diagnosed with cancer. Although most of their responses could be correlated with positive experiences allied to delivery of care services, they highlighted the absence of the much necessary emotional support and supportive care experiences. The patients also stated that the provision for information at the end of cancer treatment was considerably low, with as much as 60% of them not obtaining appropriate treatment summary, and 50% not being provided and accurate written care plan for follow up. This helped in recognizing the gap that exists in the delivery of cancer care services and adoption of a person centered care approach. In the words of Wenet al.(2017) substantial improvements have been brought about in the mortality rates by Adjuvant Endocrine Therapy (AET) amid survivors of breast cancer. Nonetheless, despite the effectiveness of this therapy, there a high rates of non-adherence to thetreatmentstrategy.Conductionofsemi-structuredinterviewsamongbreastcancer survivors who had been prescribed for AET,resulted in the generation of several key themes
9NURSING ASSIGNMENT namely, (i) positive beliefs in the treatment experiences, (ii) adverse effects of the therapy, (iii) uncertainty regarding long-term adherence to the therapy, (iv) potential intervention format,(v)difficultyinculturallycopingwiththeapproach,and(vi)forgettingand remembering. Though majority of the patients tried to show compliance to the treatment, some of them highlighted the negative impacts that adverse effects create and also reported emotional distress that they endure, while seeking cancer treatment services. Aoki and Inoue (2017) also conducted an exploratory cross-sectional study among the Japanese population to determine patient experiences and clinical quality of cancer screening. Findings from the main survey suggested that patient experiences related with primary care were predominantly connected with the uptake and obedience to breast cancer screening, among the target population. The researchers recognized the significance of patient experience, in addition to patient safety and clinical quality, for determination of healthcare quality. This helped in supporting the hypothesis that experiences of patient, in accordance to primary care and the clinical advancement of preventive care for breast cancer screening, are allied with one another. Taylor and Pagliari (2018)tried to gain a sound understanding of the psychosocial and physical illness trajectories for all cancer patients who received supportive and palliative care. Upon conducting an exploratory study where they determined the Twitter feeds of several cancer sufferers and a physician, it was found that most of the tweets focused on psychological and cognitive symptoms (N= 213),physical symptoms (N= 270),care giving needs and economic demands (N = 85), social relationships and support (N= 85),hopes and expectations (N= 51), and spiritual principles (N= 7). Hence, it was concluded that cancer patient’s narrative largely focused on the end-of-life dimensions where most of the patients needed community support for managing the terminal illness.
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10NURSING ASSIGNMENT Bolton and Isaacs (2018) identified the fact that several patients who were subjected to treatment for breast cancer often reported symptoms that were recognized as cancer related cognitive impairment (CRCI), also referred to as chemofog or chemobrain. Owing to the lack ofinformationontheseverityandprevalenceofthesesymptoms,theyconducteda qualitative study and concluded that chemotherapy for breast cancer often made it difficult for the patients to remember spellings of words, and in recalling tasks that could be done easily, prior tobeing diagnosed with the disease. Chemobrain symptoms also comprised of challenges in completing new errands, and prevented the patients to stay focused on different chores, in addition to creating an economic and psychosocial impact on their lives. The findings ofCarduffet al.(2018) elaborated on the longitudinal experiencesof patients who were living and dying with irrepressible metastatic colorectal cancer. An analysis of patient responses collected from serial interviews suggested that most patients’ typically experienced colorectal cancer in three phases namely, (i) cancer diagnosis and early treatment, (ii) deterioration of health condition and social isolation, and (iii) dying and death. It was also found that several patients initially hoped to survive the disease, nonetheless, they had the apprehension that their death was looming. Palliative chemotherapy and trials of retrieving private interpretations of patient familiarity was found to constrain care planning, thereby preventing the patients from gaining benefit from dynamic holistic palliative care strategies. According to Trinquinatoet al.(2017) colorectal cancer patients who were subjected to chemotherapy for their treatment often reported a decline in their cognitive function. Impairment in cognitive functioning resulted in a decrease in the general health related quality of life, with greater effects among males, in comparison to females. Lower quality of life due to chemotherapy were directly associated with abdominal pain, poor body image, and dry mouth. Furthermore, cancer treatment also led to sexual impotency, foetal incontinency, and sexual arousal, thus affecting the lives of the patients. Abdollahimohammad, Firouzkouhi
11NURSING ASSIGNMENT and Naderifar (2018) also unravelled the noteworthy issues encountered during cancer treatment by conducting a phenomenological study and concluded that this form of treatment was related to uncertain and dark future, altered body images, mood swings, and selection of a solitary lifestyle. Owing to the fact that cancer patients are subjected to different forms of emotional trauma, the patients reported signs of social isolation, stress, nervousness, anger, worthlessness, despair, and depression. This helped in identifying the fact that cancer patients and their family members generally found it difficult to cope effectively with their disease, its treatment, adverse effects, and responses from the society and community that accompanies a cancer diagnosis. Temporary tracheostomy is commonly performed in patients who are subjected to reconstruction, following ablation of oral cancer, with the aim of providing feasible access to secured airways, if hematoma develops. Results from a study indicated that cancer patients typicallyreportednegativeexperiencesregardingtheimplementationoftemporary tracheostomy, and also stated that they wanted to avoid the procedure if possible. Some of the common challenges that the patients encountered which in turn influence their response were lack of communication, constant fear, problem with discomfort and choking. The patients were also apprehensive that they would attract attention and would face problem during sleeping, after tracheostomy (Rogers, Russell and Lowe 2017). Findings from another study suggested that 45% patients suffering from breast cancer reported toxicities that were associated with their treatment, with 9% of them reporting un-scheduled visits to the clinic for management of toxicity. An investigation of the patient responses highlight the fact that receipt of chemotherapy, receipt of radiotherapy in combination with chemotherapy, and Latin ethnicity were some of the major factors that contributed to toxicities among breast cancer patients, thus worsening their health (Frieseet al.2017).
12NURSING ASSIGNMENT Recommendations- Regardless of the stage and severity of cancer, necessary support is imperative for the survival of the patients. Owing to the fact that people diagnosed with cancer, and their family members often suffer considerable financial challenges, there is a need to lead and advice the patients on different ways of managing and tracking their diagnostic tests, treatments, bills, paperwork and miscellaneous records (Carrera, Kantarjian and Blinder 2018). It should also be noted that decline in cognitive functioning is one major side effect of chemotherapy that is considered as the mainstay treatment for cancer (Valpey 2017). Hence, efforts must be taken by the healthcare service providers to suggest referrals for organisations that would provide assistance to the patients in conducting activities of daily living. This would reduce their stress and help them cope with regular life. While taking into account the sufferings and distress of the cancer patients, their caregivers such as, family members and kin are often neglected (Fladeboeet al.2018). Providing care to cancer patients, while balancing existing roles is a difficult task. Hence, necessary support and guidancemustalsobeprovidedtothecaregiverstoeffectivelymanagetheirduties (Wittenberget al.2017). Continuous quality improvement has been recognised as a core concept in cancer treatment. Thus, all healthcare organisations and personnel must be persistent and vigilant in observing and refining the treatment processes and measures. Care should be provided in a way that is effective, safe, timely, patient-centred, equitable, and efficient (Nielsenet al.2017). Cancer patients must also be subjected to screening for determining the presence of emotional distress. Equal access to necessary psychological services must also be promoted in order to help the patients cope up with the negative effects of cancer on their psychological wellbeing (Falleret al.2017). The patients should also be referred to support groups that would provide them necessary assistance for encountering the cognitive impairment that they face due to cancer treatment (Zhanget al. 2017). This in turn would help them improve their coping skills and enable adaptation to
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13NURSING ASSIGNMENT impairment, for lowering rates of depression or anxiety amid the patients. Such assistance would also strengthen the feelings of competency amid the patients and partners. Conclusion- To conclude, cancer survivors typically report several exclusive short- term and long-term trials to their family functioning, mental and physical health, and preservation of healthy lifestyles.The assignment identified different research articles that elaborated on the experiences of individuals who have been diagnosed with cancer, and are currently going through a plethora of treatment like chemotherapy and radiotherapy. The articles suggested that impacts of cancer treatment usually persist during the course of the lifetime of a cancer patient and subsequently decreases the health related quality of life. The literature review suggested that most cancer patients face a considerable decline in their cognitive faculties, while being subjected to treatment strategies. They also face emotional, psychological, and financial stress. Hence, it has been recommended thatwhile addressing the physical aspects of this disease, the healthcare professionals must not neglect the emotional and cognitive issues related with cancer. Creating a supportive environment will also prevent the patients from feeling afraid of disclosing their feelings and experiences to their doctor, especially those that involves worries.