IndexSr. no Content Page no. 1 Introduction to cancer 1 2 Causes of cancer 1 3 Treatment of cancer 2 4 Quality of life 3 5 Impact of cancer on quality of life 3 6 Physical aspects 4-11 7 Psychological aspects 12-15 8 Social aspects 16 9 Spiritual aspects 17 10 Conclusion 18 11 Key points 19 12 Assignment 19
Introduction Human body is composed of manymillions of tiny cells, each a self-contained livingunit. Normal cells in the body grow and dividefor a period of time and then stop growing anddividing. Cancer occurs when this cellularreproduction process goes out of control. Inother words, cancer is a disease that ischaracterized by uncontrolled, uncoordinatedand undesirable cell division. Cancer Cancer is a disease characterized abnormal anduncontrolled growth of cancer cells. Causes of cancer Ø Cancers are primarily an environmental disease with 90-95% ofcases due to lifestyle and environmental factors and 5-10% due togenetics. Ø Tobacco use. Cigarette smoking and regular exposure totobacco smoke greatly increase lung cancer. Ø Obesity. High-fat, high cholesterol diets are proven risk factorsfor several types of cancer Ø Ionizing radiation. Radiation comes from radioactive fallout,radon gas, x-rays, and other sources can cause cell damage thatleads to cancer. Ø Sexually transmitted HPV-infection. HPV increases your riskfactor for cervical, anal, vulvar and vaginal cancer. 01
Ø Exposure to harmful chemicals (carcinogens). People who have certain jobs (such as painters, construction workers, and those in the chemical industry) have an increased risk of cancer. Ø Heredity. Some gene changes that increase the risk of cancer are passed from parent to child. Treatment of cancer Ø At present, there exists a variety of acceptable treatments for cancer. Ø Surgery. It is effective in removing cancer that is limited to an organ or area of the body. Surgery is performed for treatment of cancer, p a l l i a t i o n , p a i n c o n t ro l a n d Surgery diagnosis. Ø Chemotherapy. Cancer drugs can kill or stop the growth of your tumor, as well as cancer cells that may have spread from the original tumor site. Ø Radiation therapy. It is the use of high- energy rays to kill cancer cells. It may be used alone to try to cure the cancer or to reduce Chemotherapy some of the discomfort created by your tumor. Ø Hormone therapy. Hormones can make tumour grow Radiation therapy02
Quality of life Ø Under normal circumstances,most of us would probably definequality of life as companionship withfamily and friends, rewarding work,the knowledge that we make adifference in the lives of others, thefreedom to pursue a multitude ofinterests, the joy of learningsomething new. The list is as variedas we are. Ø Under the abnormal circumstance of receiving a cancerdiagnosis and undergoing treatment, these sources of satisfaction andself-esteem can be severely compromised. Quality of life diminishes Impact of cancer on quality of life Ø Cancer affects the quality of life (QOL) of individuals with thedisease and also that of their family members and close friends. This issignificant throughout the trajectory of the illness. Patients progressthrough different phases and experience different reactions afterbeing given the diagnosis of cancer. Ø The initial phase is the pre treatment phase, the symptomsexperienced by the patients include anxiety, fatigue, and pain. Ø The second phase is the primary treatment phase, during thistime patients experience, in addition to the above mentionedsymptoms, other disease-specific symptoms. Ø The third Phase is the post treatment phase. In this phase,patients often experience treatment-related symptoms. Decreasedmovement, loss of strength, anxiety, and depression... Ø The fourth phase is the recurrence phase. Shock, disbelief,anxiety, fear, grief, and a feeling of betrayal and anger are common inthis phase along with loss of appetite and depression. Ø The fifth and final phase is the end-of-life phase. During thisphase there may be a feeling of alienation or isolation. Fear ofimpending death and concern over the events preceding death. 03
Aspects of quality of life Ø In general the quality of life can be categorized into following aspects. – Physical aspect – Psychological aspect – Social aspect – Spiritual aspect Physical Aspect Ø Physical aspect involves a variety of aspects that support physical well-being. Ø Physical health is important to your overall well being true to the old proverb “A sound mind in a sound body.” Ø By maintaining good physical health during your course of cancer treatment helps you better cope with your treatment, boost your immune system, better nourished and experience improved quality of life.04
Pain Ø Cancer pain is a subjective sensation of tissue damage, whichhas an adverse influence on multiple domains in an individuals life. Ø Severe pain is associated with decreased function, increasedinterference with daily activities, depression, and anxiety.Causes of Cancer Pain:Ø People with cancer can experiencepain from different sources: the tumoritself can cause pain the treatment toocan cause pain. Ø Pain needs to be assessed to treatproperly it can be done with the help ofpain scale. PainPain management methods F Hot and cold packs, to relieve painful areas of the body. F Massage and physical therapy. F Hypnosis and diversional therapy. F Stretching and range-of-motion exercises, to maintain strength, flexibility, and mobility. F Acupuncture is a traditional Chinese medicine, which involves inserting very tiny needles into the body. 05
F Transcutaneous electric nerve stimulation (TENS). This uses a mild electrical current from a power pack to relieve pain. F Progressive muscle relaxation (PMR). It is based upon the simple practice tightening one muscle group at a time followed by a relaxation phase with release of the tension. F Guided imagery. It is a technique in which patients use their imagination to visualize improved health. Fatigue Ø Fatigue is a feeling of tiredness or not having enough energy after rest or a good sleep that can have a negative impact on quality of life. Ø Fatigue is most common, as well as one of the most debilitating, side effects experienced by cancer patients. Ø Fatigue is also a frequent side effect of surgery, radiation, chemotherapy, or immunotherapy. Ø Common signs of fatigue include: ™ Feeling tired even after a good nights sleep ™ Feeling sleepy throughout the day ™ Feeling too weak to stand ™ Finding it difficult to start routine activities ™ Needing to stop in the middle of activities to rest ™ Not being able to do activities for long ™ Difficulty in concentrating ™ Irritability Fatigue How to be free from fatigue? F Eat a balanced diet. A more nutritious diet may increase your energy level. F Delegate activities that someone can do for you. F Sit if you need to when doing tasks. F Rest in bed on a very bad day. But, lift your legs, circle your ankles, and stretch your arms and legs every 2 hours.06 F Use assistive devices to help you reach. But stretch and reach unassisted whenever you can.
F Remember that exercise and moving are ways to lessen fatigue, the more you move the better you will feel overall. F Sleep when you are tired. But dont stay in bed all day. Try to get up and walk a few steps or more. Sleep disorder Ø Sleep disorders such asinsomnia, multiple awakenings andearly waking can be attributed tomany side effects of cancer or itstreatments. These include depression,anxiety, stress, pain, and medicationside effects. Ø Lack of sleep can undermineyour healing process and your abilityto function. Sleep disorders can be reduced by following methods F Go to bed and get up at about the same time every day, even on the weekends. F Dont eat or drink large amounts before bedtime. F Avoid nicotine, caffeine and alcohol in the evening. F Exercise regularly. F Make your bedroom cool, dark, quiet and comfortable. F Sleep primarily at night avoid daytime naps. F Choose a comfortable mattress and pillow. F Make sure you have a bed thats comfortable. 07 F Go to bed when youre tired and turn out the lights.
Nutrition Ø Nausea, loss of appetite and changes in taste perception are common side effects of cancer and its treatment. These symptoms can reduce your enjoyment of food, and may result in decreased nutrition. Ø Diarrhea and constipation also negatively affect your ability to obtain adequate nutrition. Ø Good nutrition is an essential part of cancer treatment. A well- balanced diet also prevents the breakdown of body tissue, helps rebuild the tissue that cancer may harm, and helps maintain the bodys immune system. Balanced diet Healthy eating tips in cancer F Eat smaller meals more frequently. F Keep fat levels low. Fat contains a high amount of calories. F Increasing protein. Protein is important for growth, health and repair of your body. F Increasing calories. During illness, treatment or recovery, your need for calories may be greater than usual. F Eat all types of fruits and vegetables a day. F Drink lots of water.08 F Multivitamin tablets.
Foods to avoid in cancer û Foods containing acrylamide, such as french fries and potato chips. û Trans fats. û Soda. û Processed meats. û Fried foods. û Foods containing the preservatives BHT, BHA. û Smoked and pickled foods. Exercise Ø Many patients find that their level of physical activity diminishesdue to their disease, its treatment, or some combination of both.This is particularly true for patients who are hospitalized orbedridden. It can also be an issue for all patients suffering from pain,lethargy, or depression. Ø One of the best ways to combat these symptoms is to exercise. Nomatter how seemingly insignificant, move your body! Ø With the help of exercise you will be tolerate the side effects ofchemotherapy, radiation, and surgery in a better manner. Ø Cancer, as well as cancer treatments can increase the risk of bloodclots, exercise will help to prevent clot formation. Ø Weight-bearing exercises, such as walking and resistive exercisesusing weights, help keep your bones strong and healthy and will help toprevent osteoporosis which is a side effect of steroid therapy 09
Exercise for people living with cancer Ø Warm-up. It is important to warm-up at the start of each exercise session. Ø Warming up helps to get you going and reduces your chance of injury. Ø A warm-up should include 5-10 minutes of some light stretching activities. These are some of the exercise that can be done. Push ups Calf raise Chair raise Squat10 Shoulder press Shoulder press
Biceps curl Triceps extension Sexuality Ø Sexual problems may be the result of aphysical problem related to either the canceritself or its treatment. A decline in erectilefunction, common in men with prostate cancer,can be treated with external penile vacuumdevices, injections, prosthetic penile implantsor prescription medication such as Viagra. Ø In women, problems include increased ordecreased vaginal discharge caused by chemo-hormonal therapy drugs or a narrowing of thevagina due to radiation of the pelvis. Suchconditions can be treated using medical creams, lubricants,hormone replacement therapy, or vaginal dilations. ØIf you are experiencing emotional or physical problems with yoursexuality, you can take charge by discussing them with your partnerand/or consulting your physician or a sex therapist. 11
Psychological Aspect Ø A diagnosis of cancer often brings up one of people’s worst health fears. It affects the complete psychological status of the patient. Ø Psychological aspects includes the different aspects related to the mental status of the patient. Following are the psychological aspects of quality of life in cancer. Cognitive functioning Ø Cancer patients undergoing chemotherapy or brain radiation experience increased forgetfulness, a decreased attention span and problems concentrating. Ø In most cases, cognitive dysfunction is minimal and limited to simple forgetfulness or loss of coordination. Ø Mental exercises such as doing mind games, crossword puzzles, playing chess or other games of strategy can keep the mind sharp and focused. Stress Ø Stress is an inherent component of a cancer diagnosis for both the patient and the family and friends. The minds natural tendency is to run off in an infinite number of directions, each with its own stress and fear. Ø Stress reduction techniques, such as self- hypnosis, yoga, biofeedback, meditation, and acupuncture, acupressure, healing massage, or keeping a journal cultivate inner peace and may even benefit to reduce your stress.12
Anxiety Ø Anxiety is a normal reaction to cancer.Anxiety associated with cancer mayincrease feelings of pain, interfere withones ability to sleep, cause nausea andvomiting, and interfere with the patientsquality of life. Tips to reduce anxiety F Whenever possible, lower your risk (for example, avoid alcohol to relieve symptoms). F Find a technique that works for you to lower your anxiety & use it (like slow deep breathing, in & out, 15 times). F Follow your treatment plan & take your medications exactly as prescribed. F Take guidance from doctor or a counselor. F Keep a diary or journal of how you are feeling once treatment is started. Let your health care professional know if your symptoms are getting better or worse. Depression Ø Depression is a disabling illness that affects of cancer patients.It affects men and women with cancer equally. Ø People who face a diagnosis of cancer will experience differentlevels of stress and emotional upset. Issues in the life causing anxiety in cancer may are ™ Fear of death. ™ Interruption of life plans. ™ Changes in body image and self-esteem. ™ Changes in social role and lifestyle. ™ Money and legal concerns. 13
Positive thinking Ø A positive and optimistic outlook will not only improve your quality of life but also improve your chances of getting well. Ø When you have cancer, it can be difficult to maintain a positive attitude. Daily you are confronted with many obstacles, including the side effects of the illness and treatment. Ø One way you can help yourself maintain a positive attitude is by setting reasonable, achievable goals. Another helpful hint is to put your energy into activities that bring satisfaction to your life. Hope Ø Hope is a force that sustains and regenerates your will to live. Even if there is only a remote chance for a successful outcome, hope can still empower the spirit to fight for life. Ø Hope can be nourished in many ways, including accomplishing a goal, having control over your life, feeling appreciated and useful, experiencing religious faith, and spending quality time with family and friends. Ø Recent advances in cancer therapy are also a cause for hope. There are over two hundred new drugs, vaccines, and antigrowth factors currently being tested in clinical research. Because of these and other advances in cancer research, it is wise not to focus on the statistics concerning your illness. Statistics can give you a general idea of the odds for getting better or having a recurrence of disease, but they only represent averages. You are not 40 percent of anything!14
Coping Ø Coping refers to the attitudes youdevelop and the actions you take to maintainyour equilibrium and adjust to the stressescaused by cancer. Ø Different people cope in different ways.It is normal to feel frustrated at times, but howyou cope, and your attitude can make adifference. By externalizing your frustrations,you can improve your quality of life. Some ways of coping that you may find helpful are: F Relying on others for support and assistance. F Sharing your feelings with others. F Seeking professional counseling. F Setting realistic goals and readjusting them when necessary F Controlling fear and anxiety with stress reduction techniques F Adopting a mantra, or a reassuring phrase F Giving yourself time to adjust to and recover from bad news F Accepting your limitations F Recognizing that you still have control over many aspects of your life F Moving on from mistakes rather than letting them debilitate or destroy you F Alleviating day-to-day stress 15
Social Aspect Ø The society where a person live plays a important role in shaping the persons perception about the life. Ø Socializing allows you to share your ideas, believes, values and provides an equal opportunity to listen to what others have to say and have a positive attitude towards problems you may face in everyday life. Family/Friends Ø The support of family and friends is an essential part of maintaining your quality of life. Ø Family and friends provide you with emotional support, physical comfort, spiritual guidance, a welcome diversion and assistance. Ø Spending quality time with your friends and family will enrich your life. Share a meal, play a game, or look through an old photograph album together. Ø Writing an ethical will - or your philosophy of life - is another way to share important beliefs with your family. Support group Ø Support groups provide patients with an opportunity to see the problems they are confronting through the eyes of others. This can give patients a new perspective on their situation, reduce the inappropriate guilt felt by some, and help patients to recognize that their problems are the result of the cancer, rather than some personal failing. Questions such as "Why me?" take on a new meaning in a group of people wondering the same thing.16
Spiritual Aspect Ø Being spiritual helps in more than one way. It is good to keepyour faith on supreme being whom you trust. Ø Trust on spiritual being channels your energy to your creator. Nomatter what is your religion, faith in your creator can bring you peace,good health and all other blessing. Spirituality, Faith and Religion Ø At times of extreme vulnerability, we all tend to pay moreattention to our innate spirituality and seek to restore a feeling ofbeing connected with the universe or a spiritual idea beyondourselves. Ø We may seek this liaison throughprayer and a renewed devotion toGod. In the event of treatment failureand progressive disease, spiritualitycan help ease the pain of separationfrom loved ones and the things of thisworld. Ø Spirituality also plays a role inend-of-life care, helping patientsutilize their remaining time to achievea sense of peace and purpose, even intheir final weeks, days or hours. Spiritual practices can strengthenfeelings of hope or give meaning to life prior to death Some religions way to increase ones feeling of being in control ™ Collaborative religious coping- Seeking control in solvingproblems through a partnership with God. ™ Active religious surrender- Turning control over to God afterall else has failed. ™ Pleading for direct intercession- Seeking control indirectlyby praying for a miracle or divine intercession ™ Passive religious deferral- Waiting for God to control thesituation ™ Self-directing religious coping- Believing that God gives 17individuals the tools and resources to solve problems
Leaving instructions to loved ones Ø Therefore, this is the time to leave clear instructions as to whether you want to be resuscitated or treated, if you have no chance of regaining a reasonable quality of life. Ø You will also want to leave written instructions for your family and friends, if death occurs, telling them how you want your remains handled and type of funeral service. Ø If you dont have a will for the disposition of your estate, this is a good time to get that out of the way as well. You can always change it later. The act of leaving instructions on these matters is a gift to those you love. Conclusion Ø Health professionals today believe that a combination of medical therapy and supportive care offers the best chance to maintain a patients quality of life. Ø Satisfaction of these diverse needs demonstrates the powerful connection between mind and body and improves quality of life. Ø Cancer - because it can have an impact on every aspect of your life, from your faith and the quality of your relationships to your physical being and your career is an assault on your life. Yet, as we have seen with so many of our patients, it need not destroy the quality of your life.18
Steps for Improving Your Quality of Life F Conserve your energy for essential or pleasurable activities. F Work collaboratively with your medical team so that you can get the best possible medical and supportive care. F Set realistic, achievable goals. F Dont let mistakes debilitate or destroy you. Move on. F Avoid negative thinking and self-destructive behavior. F Make end-of-life decisions, including writing legal and medical wills, and an Advanced Directive. F Take control. Even when your prognosis is not good, you still have choices. F Try to maintain your hope, endurance, faith, and courage. Seek spiritual guidance from your faith, community, religious or inspirational readings, or other sources. F Acknowledge your need for psychological support and seek assistance from a professional counselor, pastor, social worker, or a wise friend or family member. F Learn new techniques to promote relaxation, such as yoga and meditation. F Engage in pleasurable diversions, such as art, music, hobbies, social events and physical activities. F Give of yourself to others. F Strengthen your relationships by spending more quality time with family members and friends. F Recognize the sources of your anger and use techniques of forgiveness and mindful meditation to move on. F Try not to let your illness dominate your life. Be willing to make the necessary compromises as you go through treatment. Assignment1. Cancer is the abnormal and uncontrolled __________ of cancer cells.2. Surgery removes___________tissues from the body.3. _________is the use of high-engergy rays to kill cancer cells.4. Cancer diagnosis and treatment diminishes the_________ of life.5.Quality of life can be categorized into_______,_______,_______&______ aspects 19