Chapter 28 Cancer

Introduction Second leading cause of death in persons aged 65 years and older Probability of developing cancer increases with age Incidence/prevalence Role of the gerontological nurse: Prevention Diagnosis Treatment

Question The single most important risk factor for cancer is Environment Age Poverty Carcinogens

Answer B. Age Rationale: The National Cancer Institute (NCI) acknowledges that age is the single most important risk factor for cancer.

Aging and Cancer Unique challenges for older persons with cancer: Advanced stage when initially diagnosed Multiple health conditions Increased risk of complications, disability, and death Treatment challenges

Question Is the following statement true or false? Older adults have the highest rate for any age group of receiving early detection tests for cancer.

Answer False Rationale: Despite having the highest rate of most cancers, older adults have the lowest rate of receiving early detection tests for cancer; thus, their disease may be in an advanced stage when diagnosed.

Aging and Cancer (cont.) Explanations for increased incidence of cancer in older adults: Two major theories: Biological age-related changes that impair the ability to resist diseases Prolonged exposure to carcinogens over the years Reduction of risk factors is beneficial

Risk Factors, Prevention, and Screening Many cancers can be prevented by healthy lifestyle practices that minimize risks Avoid the use of and exposure to tobacco products Limit exposure to the sun Eat a diet rich in fiber, fruits, and vegetables Maintain weight within an ideal range Protect against exposure to known carcinogens

Risk Factors, Prevention, and Screening (cont.) Many cancers can be prevented by healthy lifestyle practices that minimize risks (cont.) Limit alcohol consumption Discuss chemoprevention with your physician if family history increases the risk of cancer Women Increased age Genetic factors Ovarian and breast cancer Other risk factors

Gerontological Nurses Promote positive health habits Understand evidence-based risk factors Preventive measures Educate individuals regarding appropriate cancer screening Early detection can improve prognosis

Treatment Conventional treatment: Plan of treatment depends on the specific cancer Surgery, radiation, chemotherapy, and biologic therapy Unique risks for older adults Impact of advanced age

Treatment (cont.) Complementary and alternative medicine (CAM): Prevalence Special diets, psychotherapy, spiritual practices, vitamin supplements, and herbal remedies Healing philosophies and approaches Treatment of not just the disease, but caring for the whole person

Treatment (cont.) CAM practitioners offer: Relationship-centered care Support Healing partnerships Comfort Hope Need to weigh risks and benefits

Question Which of the following roles provided by a CAM practitioner best describes the healing partnership? Empowerment, facilitation, and support Options to offer hope Acceptance and understanding High touch to relieve stress and discomfort

Answer A. Empowerment, facilitation, and support Rationale: Healing partnerships allow CAM practitioners to honor patients’ rights to control their care and their lives, while seeing their role as empowering, facilitating, and supporting patients in the healing process.

Nursing Considerations for Older Adults with Cancer Providing patient education Increase awareness of measures that can prevent cancer Understanding of warning signs of cancer CAUTION mnemonic Self-examination instruction Cancer screening tests

Question Warning signs of cancer are identified in the mnemonic CAUTION, in which the U is a reminder of which sign of cancer? Swallowing difficulty Nonhealing sores Lumps in the body Bleeding or drainage that is abnormal

Answer D. Bleeding or drainage that is abnormal Rationale: C: Change in bowel or bladder habits A: A sore that does not heal U: Unusual bleeding or drainage T: Thickening or lump in the breast or elsewhere I: Indigestion or swallowing difficulty O: Obvious change in a wart or mole N: Nagging persistent cough or hoarseness

Nursing Considerations for Older Adults with Cancer (cont.) Promoting optimum care Choice of treatment facility Clinical trials through the NCI Care after radiation and chemotherapy with knowledge of the increased risks related to age- related changes Knowledge of common age-related risk factors that increase likelihood for certain conditions

Nursing Considerations for Older Adults with Cancer (cont.) Prevention of complications Knowledge of certain types of cancer Assure patients that pain can be managed Regularly assess for pain and develop plans for prevention/management

Nursing Considerations for Older Adults with Cancer (cont.) Providing support to patients and families Diagnosis may be overwhelming and stressful Fear Cost of treatment Change in plans and future pursuits

Nursing Considerations for Older Adults with Cancer (cont.) Assess patient and family understanding: Clarify misconceptions Offer explanations Allow expression of feelings Consult with a physician