Benchmark – Applying the Nursing Process to Cancer Care

Applying the Nursing Process to Cancer Care

Cervical cancer is one of the most common malignancies diagnosed amongst women. Proper nursing care is effective in the care of the patients by ensuring positive outcomes of the diagnosis. The purpose of this paper is to describe the available screening methods, diagnostic methods, staging, complications of the cancer, and side effects of the treatment. The paper will also discuss the incidence rates, preventative measures, the role of the American Cancer Society (ACS), an interdisciplinary research approach, and the nursing process for cervical cancer. 

Available Screening Methods

The available screening methods for cervical cancer aim at detecting a pre-malignant lesion referred to as Cervical Intraepithelial Neoplasia (CIN) and cancerous lesions in women. The most common screening test for cervical cancer is the Papanicolaou (PAP) smear test, which utilizes cytological methods and the Bethesda reporting method to identify non-significant, low-grade, and high-grade lesions (Banerjee et al., 2022). Liquid-based cytology (LBC) is another screening test utilized when there is a need to lower the frequency of unsatisfactory PAP smears and shorten the time needed to interpret PAP smears. However, the LBC sensitivity to cancerous lesions is equal to that of PAP smears.

An additional screening test often used is the Human papillomavirus (HPV) DNA or mRNA testing. Chronic HPV infection has been associated with a higher risk of developing cervical cancer (Banerjee et al., 2022). The test is more sensitive than cytology and recommended for women above 30 years. Additionally, visual screening tests such as VIA VILLI have been utilized in screening for cervical cancer. A VIA VILLI test involves the application of dilute acetic acid to the cervix and visualizing the cervix for changes under a bright light.

Diagnosis and Staging of Cancer

Diagnosis of cervical cancer should be done following a positive screening test. Colposcopy is a common visual imaging procedure that utilizes a colposcope to visualize tissue changes and obtain biopsy samples from the cervix, vulva, and vagina (Bechmann et al., 2020). In addition, gynecologists should also perform their examination to assess the tumor and its infiltration to surrounding organs such as the rectum. However, tissue biopsy for pathological examination remains the goal standard for the final diagnosis of cervical cancer. Pathological and gynecological examinations need to be supplemented with imaging methods to stage the cancer. Common imaging methods include abdominopelvic ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) examination. Lastly, chest radiographs and CT are crucial in ruling out lung and mediastinal metastasis.

The recommended TNM cervical cancer staging system was developed by the American Joint Committee on Cancer (AJCC), which utilized cross-sectional imaging findings in the staging. TNM categories include the tumor (T), regional lymph nodes (N), and distant metastasis (M) (Boon et al., 2022). The Tcategory can be classified into TX, T0, T1, T2, T3, and T4. TX indicates that the primary tumor cannot be assessed, while T0 is when there is no evidence of a primary tumor. An increasing tumor size and degree of invasion are classified as either T1, T2, T3, or T4.The N category can either be N0, N1, or N2. N0 indicates no lymph node metastasis, N1 indicates pelvic lymph node involvement, and N2 indicates para-aortic lymph node involvement. The M category can be MX, M0, and M1, where MX occurs when a distant metastasis cannot be assessed, and M0 indicates no distant metastasis. Lastly, M1 indicates distant metastasis of cervical cancer to organs such as the liver, lungs, and bones.

Complications, Side Effects, and Methods to Lessen Effects

            Cervical cancer complications arise from tumor invasion and metastasis to various organs. For example, as the tumor enlarges, it invades the urinary bladder and ureter, causing obstruction to urinary flow and predisposing patients to urinary tract infections such as pyelonephritis and risk of urosepsis (Beckmann et al., 2020). In addition, tumor invasion of the rectum results in bowel obstruction. Metastasis to the bones predisposes the patients to pathologic fractures and anemia due to bone marrow suppression. Additionally, acute liver failure has been seen in patients resulting from deteriorating liver function due to metastasis.

            Radical hysterectomy, commonly used in the management of cervical cancer, has been associated with a higher risk of developing lymphedema. Lymphedema occurs due to obstruction of lymph flow in the pelvic lymph nodes, resulting in swelling in the lower limb and genitalia (Beckmann et al., 2020). In addition, the treatment is associated with loss of fertility resulting from uterus removal. Brachytherapy and radiation used during treatment predispose patients to risk of bowel and bladder changes such as obstruction, diarrhea, incontinence, and proctitis. Several methods, such as physiotherapy, nutritious diets, and medications, have been utilized to help manage pain, nausea, and fatigue. Lastly, patients have been using acupuncture, meditation, massage, and mind-relaxation techniques to help alleviate the side effects of the treatment.

Incidence Rates and Preventative Measures

            Cervical cancer is the fourth most common cancer in women, with 604,000 new cases in 2020. About342,000 cervical cancer-related deaths have been reported, with most deaths occurring in low- and middle-income countries (Zhang et al., 2020). The statistics translate to an incidence of 13·3 cases per 100 000 and a mortality rate of 7.2 deaths per 100 000 women, making the cancer a global burden. In addition, one in 70 women globally has a likelihood of developing cervical cancer throughout their life. HPV 16 and 18 have contributed to 70% of the total cases, and HIV has contributed to five percent of the total cases.

            The World Health Organization (WHO) has created several measures to reduce the global burden, morbidity, and mortality of the disease. One major step has been to advocate vaccination for girls between the ages of 9–14 years as a way to prevent HPV infection, cervical cancer, and other HPV-related cancers (Basoya et al., 2022). In addition, the organization has advocated for screening for cervical cancer every five to ten years for women starting at age 30 and three yearly starting at 25 years for women living with HIV. The organization also recommends a multidisciplinary team to ensure uniformity in diagnosis, staging, and treatment and that the treatment decisions align with national guidelines.

American Cancer Society (ACS) Services

            Some of the ACS services a nurse would recommend to cervical cancer patients include educational services on their website, information about the diagnosis, treatment options, home-care management, and available social support services. ACS also provides a helpline that canconnect patients with trained cancer information specialists who will answer questions about the diagnosis and provide guidance to the patients remotely (ACS, n.d.). Additionally, the society has support groups where patients can receive psychological and emotional support as they navigate their diagnosis. Lastly, the society provides free lodging and transportation services, which help reduce the financial burden for the patients.

Interdisciplinary Research Approach

The interdisciplinary research approach has helped nurses evolve in research methods. For example, nurses have worked with molecular scientists and gained insight into the biological mechanisms that contribute to cancer. In addition, the nurses have worked with data and statistic specialists, learned more data collection, analysis, and interpretationskills, created statistical study designs and informative representations such as graphs, and helped improve research implementation into evidence-based practice (Smye et al., 2021). Social scientists and liberal artists have provided insight to nurses that can help them understand social and cultural views regarding prevention, diagnosis, treatment, and patient-centered care and help nurses create solutions to any problem through research. In addition, nurses may learn the contribution of the interventions used in complementary and alternative medicine from the physical scientists, research them, and advocate for their use if effective in cancer care. Lastly, the interdisciplinary research approach can include physicians and pharmacists who can contribute to the evolving trends in the care and treatment of cancer patients.

The Nursing Process

The initial phase in providing care for cancer patients is conducting a comprehensive assessment of all aspects of their health, including their physical, psychological, and spiritual health. During the assessment, the nurse should actively listen, show empathy, and address the patient’s concerns regarding their symptoms (Nashwan et al., 2023). The nurse should analyze the assessment data, identify any physical or psychological health problems, and establish a diagnosis to formulate a multi-disciplinary plan of care that can help address issues affecting the patients. The plan should include the patient’s decision and cater to their need. In addition, the nurse can involve other healthcare providers, psychologists, chaplaincy, and patients in implementing and executing the plan of care. Lastly, the nurse evaluates the effectiveness of the interventions while considering the patient’s satisfaction with the care given.

Conclusion

Cervical cancer is a common malignancy that has a high mortality rate. Frequent screening, early diagnosis, and prompt treatment can contribute to reducing the incidence, morbidity, and mortality rate of cervical cancer. While providing care to cancer patients, the nursing process can be utilized to ensure optimal patient and nursing care satisfaction. 

References

American Cancer Society (ACS). (n.d.). https://www.cancer.org/about-us/what-we-do/providing-support.html

Banerjee, D., Mittal, S., Mandal, R., &Basu, P. (2022). Screening technologies for cervical cancer: Overview. CytoJournal, 19, 23. https://doi.org/10.25259/CMAS_03_04_2021

Basoya, S., &Anjankar, A. (2022). Cervical Cancer: Early Detection and Prevention in Reproductive Age Group. Cureus, 14(11), e31312. https://doi.org/10.7759/cureus.31312

Beckmann, M. W., Stübs, F. A., Koch, M. C., Mallmann, P., Dannecker, C., Dietl, A., Sevnina, A., Mergel, F., Lotz, L., Hack, C. C., Ehret, A., Gantert, D., Martignoni, F., Cieslik, J. P., Menke, J., Ortmann, O., Stromberger, C., Oechsle, K., Hornemann, B., Mumm, F., … Fehm, T. (2022). Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) – Part 1 with Recommendations on Epidemiology, Screening, Diagnostics and Therapy. Geburtshilfe und Frauenheilkunde, 82(2), 139–180. https://doi.org/10.1055/a-1671-2158

Boon, S. S., Luk, H. Y., Xiao, C., Chen, Z., & Chan, P. K. S. (2022). Review of the Standard and Advanced Screening, Staging Systems and Treatment Modalities for Cervical Cancer. Cancers, 14(12), 2913. https://doi.org/10.3390/cancers14122913

Nashwan, A. J., &Bani Hani, S. (2023). Enhancing oncology nursing care planning for patients with cancer through Harnessing large language models. Asia-Pacific journal of oncology nursing, 10(9), 100277. https://doi.org/10.1016/j.apjon.2023.100277

Smye, S. W., &Frangi, A. F. (2021). Interdisciplinary research: shaping the healthcare of the future. Future healthcare journal, 8(2), e218–e223. https://doi.org/10.7861/fhj.2021-0025

Zhang, S., Xu, H., Zhang, L., &Qiao, Y. (2020). Cervical cancer: Epidemiology, risk factors and screening. Chinese journal of cancer research = Chung-kuo yen chengyen chiu, 32(6), 720–728. https://doi.org/10.21147/j.issn.1000-9604.2020.06.05