2. What Is Cancer?
⢠Cancer â a large group of diseases characterized by
the uncontrolled growth and spread of abnormal
cells
⢠Neoplasm â new growth of tissue that serves no
physiological function
⢠Tumor â clumping of neoplasmic cells
⢠Malignant - cancerous
⢠Benign - noncancerous
⢠Biopsy â microscopic examination of cell
development
3. What Is Cancer? â cont.
â˘Metastasis â malignant tumors that are
not enclosed in a protective capsule
have the ability to spread to other
organs
â˘Mutant cells â disruption of RNA and
DNA within normal cells may produce
cells that differ in form, quality and
function from the normal cell
5. Characteristics of benign and malignant neoplasms
â¨
Benign
â˘Well
differentiated
cells that
resemble normal
cells of the
tissue
Malignant
â˘Cells are
undifferentiated
and often bear
little
resemblance to
the normal cells
Cell characteristic
6. Mode of growth
Benign
â˘Tumor grows by
expansion and
does not
infiltrate the
surrounding
tissues; usually
encapsulated
Malignant
â˘Grows at the
periphery and
sends out
processes that
infiltrate and
destroy the
surrounding
tissues
9. General effects
Benign
â˘Usually
localized that
does not cause
generalize
effects unless its
location
interferes with
vital functions
Malignant
â˘Causes
generalized
effect such as
anemia,
weakness, and
weight loss
10. Tissue destruction
Benign
â˘Does not usually
cause tissue
damage unless
its location
interferes with
blood flow
Malignant
â˘Often causes
extensive tissue
damage; may
also produce
substances that
cause cell
damage
11. Ability to cause death
Benign
â˘Does not cause
death unless its
location
interferes with
vital function
Malignant
â˘Usually cause
death unless
growth can be
controlled
12. Features of malignant cells
⢠The cell membrane are altered in cancer cells, which affects
the fluid movement in and out of the cell.
⢠The cell membrane of malignant cells also contains protein
called tumor specific antigens (eg: carcinoembryonic
antigen and prostate specific antigen)
⢠They may be useful in measuring the extent of disease and
in tracking the course of disease during treatment.
⢠Malignant cellular membranes also contain less amount of
fibronectin, a cellular cement
⢠They are therefore less cohesive and do not adhere to
adjacent cells readily.
⢠Mitosis occurs more frequently in malignant cells.
⢠As the cells grow and divide, more glucose and oxygen are
needed.
13. Mechanism of metastasis
Lymph and blood are key mechanisms by which
cancer cells spread.
1. Lymphatic spread
⢠Lymphatic spread (the transfer of tumor cells
through the lymphatic circulation) is the most
common mechanism of metastasis.
⢠After entering the lymphatic circulation,
malignant cells either lodge in the lymph
nodes, pass between the lymphatic and
venous circulation
14. 2. Hematogenous spread
⢠Hematogenous spread is the dissemination of
malignant cells via the blood stream.
⢠It is directly related to the vascularity of the tumor
3. Angiogenesis
⢠Angiogenesis is the growth of new capillaries from the
host tissue by the release of growth factors and
enzymes such as vascular endothelial growth factor
(VEGF).
⢠These protein stimulate the production of new blood
vessels.
⢠Through this vascular network the tumor emboli can
enter the systemic circulation and travel to distant
sites.
15. Carcinogenesis
Malignant transformation or carcinogenesis, is thought to
be at least a three- step cellular process.
1. Initiation : during initiation, initiators such as
chemicals, physical factors, and biological agents,
escape normal enzymatic mechanisms and alter the
genetic structure of the cellular DNA.
2. Promotion : during promotion repeated exposure to
promoting agents causes the expression of abnormal
or mutant genetics information.
3. Progression : during progression, the cellular changes
formed during initiation and promotion exhibit
increased malignant behavior. These cells have
propensity to invade adjacent tissues and to
metastasis.
16. TNM classification system of cancer
Tumors are staged depending on
size, lymph node involvement, and
metastasis. Staging also expressed in
TNM symbols:
T- primary tumors
N- lymph node involvement
M- metastasis
17. Stages of tumors
Stage I: tumor less than 2 cm, negative lymph node
involvement, no detectable metastasis
Stage II: tumor greater than 2 cm but less than 5 cm,
negative or positive unfixed lymph node
involvement, no detectable metastasis
Stage III: large tumor greater than 5 cm, or tumor of
any size with invasion of the skin or chest wall or
positive fixed lymph node involvement in the
clavicular area with or without evidence of
metastasis.
Stage IV: tumor of any size, positive or negative lymph
node involvement, and distant metastasis.
18. What Causes Cancer?
â˘Viruses and bacteria
⢠Viruses are thought to incorporate themselves
in the genetic structure of cells, thus altering
future generation of that cell population-
perhaps leading to cancer.
Eg: Epstein-Barr virus is highly suspected as a
cause in Burkitt lymphoma, nasopharyngeal
cancers, and some type of non-Hodgkin
lymphoma and Hodgkin disease
20. â˘Genetic and familial Factors
â˘Some cancers such as breast, stomach,
colon, prostate, uterus, ovaries and lung
appear to run in families
â˘Hodgkinâs disease and certain leukemia's
show similar patterns
â˘A rare form of eye cancer appears to be
transmitted genetically from mother to child
21. â˘Reproductive And Hormonal Risks For Cancer
⢠Late menarche, early menopause, early
first childbirth, having many children
have been shown to reduce risk of
breast cancer
⢠Oral contraceptives and prolonged
estrogen therapy are associated with an
increased incidence of hepatocellular,
endometrial and breast cancers, but they
decreases the risk of ovarian cancer.
23. â˘Dietary factors
⢠It includes fats, alcohol, salt-cured or
smoked meats, and nitrate containing foods.
⢠A high caloric dietary intake is also
associated with an increased cancer risk.
⢠Consumption of high fiber foods and
vegetables appears to reduces the risk of
cancer.
⢠Obesity may also increase the risk for
cancers of the colon, kidney, and
gallbladder.
24. â˘Medical Factors
⢠Some medical treatments actually increase a
personâs risk for cancer
⢠Diethylstilbestrol (DES) used 1940 to 1960
to control bleeding during pregnancy, the
daughters of mothers that used DES were
found to have an increased risk for cancers of
the reproductive organs
⢠Chemotherapy used to treat one form of
cancer may increase risk for another type of
cancer
27. Diagnosis aids used to Detect Cancer
⢠Tumor marker identification
⢠MRI
⢠CT
⢠Fluoroscopy
⢠Ultrasonography
⢠Endoscopy
⢠PET
⢠Radioimmunoconjugates
29. New Hope In Cancer Treatments
â˘Surgery. Combine surgery with radiation or
chemotherapy
â˘Radiation therapy
â˘Chemotherapy
â˘Immunotherapy
â˘Cancer-fighting vaccines
â˘Gene therapy and Stem cell research
â˘Hospice
30. Surgery
Surgical removal of the entire cancer
remains the ideal and most frequently used
treatment method. Surgery may be the primary
method of treatment, or it may be prophylactic,
palliative, or reconstructive.
1. Diagnostic surgery
⢠Diagnostic surgery such as biopsy, is usually
performed to obtain a tissue sample for analysis of
cells suspected to be malignant.
⢠The three most common biopsy methods are:
a. Excisional biopsy: is most frequently used for
easily accessible tumors of the skin, breast, upper
and, lower GI tract, and upper respiratory tract.
31. ⢠In many cases, the surgeon can remove
the entire tumor and surrounding
marginal tissues as well
b. Incisional biopsy: is performed if the
tumor mass is too large to be removed.
⢠In this case, a wedge of tissue from the
tumor is removed for analysis
c. Needle biopsy: is performed to sample
suspicious masses that are easily
accessible, such as some growth inside
breasts, thyroid, lung, liver, and kidney
32. 2. Surgery as a primary treatment
⢠The goal is to remove the entire tumor or as
much as feasible (a procedure some times
called debulking) and any involved
surrounding tissue, including regional lymph
nodes.
⢠Two common surgical approaches are used, ie
local and wide excision.
⢠Local excision is warranted when the mass is
small. It includes removal of the mass and a
small margin of normal tissue that is easily
accessible.
33. ⢠Wide excision include the removal of the
primary tumor, lymph nodes, adjacent
involved structures, and surrounding tissues
that may be at high risk for tumor spread.
Other techniques
â˘Electrosurgery
â˘Cryosurgery
â˘Chemosurgery
â˘Laser surgery (photocoagulation or
photoablation)
34. 3. Prophylactic surgery: involves removing
nonvital tissues or organ that are likely to
develop cancer.
4. Palliative surgery: when cure is not possible,
the goal of treatment are to make the patient
as comfortable as possible and to promote a
satisfying and productive life for as long as
possible.
5. Reconstructive surgery: may follow curative
or radical surgery and is carried out in an
attempt to improve function or obtain a more
desirable cosmetic effect.
36. MEANING
Radiation therapy is a treatment
commonly applied to the cancer
because of its ability to control cell
growth. Ionising radiation works by
damaging the DNA of exposed tissue.
37. Mechanism of radiation therapy
⪠Radiation therapy is the use of high energy
ionizing radiation to treat a verity of cancers
⪠Ionizing radiation destroys a cells ability to
reproduce by damaging itâs DNA , delaying
mitosis to repair DNA
⪠Rapidly dividing cells are more vulnerable
to radiation than slowly dividing cells
⪠Normal cells have greater ability than
cancer cells to repair DNA damage from
radiation
38. Types of radiation therapy
There are verity of method , the RT may be
delivered as external beam therapy or internal
beam therapy
1. External beam therapy (teletherapy) :-
⪠It is the delivery of radiation from a source
placed at some distance from the target site. It
is administered in XRT department by high
energy X-rays or rays machines.
39. ⪠The major advantage of high energy
radiation is its â skin sparing effectâ
that is, the maximum effect of
radiation occurs at tumor depth in the
body and not on the skin surface
⪠The therapist do not remain in the
room with the client during the
treatment, rather they monitor the
client via closed circuit television and
remain in voice content via an
intercom.
40. 2. Internal radiation therapy:-
⪠Internal radiation therapy involves placement of
specifically prepared radioisotope directly into or
near the tumor itself (brachytherapy) or into the
systemic circulation. The two major type of internal
radiation therapy are
A. sealed source radiation therapy
B. unsealed source radiation therapy
41. A.sealed source of radiation therapy:-
⪠In which radioactive material is
enclosed in a sealed container. Sealed
source is used for both intra cavity and
interstitial therapy
⪠In intracavity therapy ( usually cancer
of uterus and cervix) radioisotope
usually cesium-137 or radium-226 is put
in an applicator, which is placed in a
body cavity for a carefully calculated
time, generally 24- 72 hours.
42. ⪠In interstitial therapy the radioisotope of
choice ( Eg:- iridium-192, iodine-125) is
placed in a needle or catheter which are then
implanted directly into the tumor . Client
with prostate or breast cancer may received
implanted therapy.
43. B.
Unsealed source of radiation therapy:-
⪠Unsealed source used for internal radiation
therapy are colloid suspension that come into
direct contact with body tissue. The
r a d i o i s o t o p e c a n b e a d m i n i s t e r e d
intravenously, orally or by instillation directly
into a body cavity.
Eg:- Iodine 131 is given orally in very low dose
to treat graveâs disease.
⪠With unsealed source of internal radiation,
radioisotope circulate through the clients body.
There for the clients urine, sweat, blood and
vomits contains the radio active isotope.
44. Radiation safety standards
⪠Three key principle you should follow to protect
yourself and others from excessive radiation
exposure are:
1. Distance:- Greater the distance from the
radiation source, less the exposure dose of
ionizing rays
Eg:- 1 meter â exposure
2 meter â Âź of exposure)
3 meter- 1/9 of exposure
45. 2. Time:- Aim to minimize the time of
exposure, although you must still meet the
clients care needs
3. Shielding:- Use of shielding devices when
ever possible reduces radiation exposure
of x-rays.
Others:-
⪠Client receiving internal radiation therapy
with sealed or unsealed source need to have
a private room and bathroom to reduces the
chance of exposure
46. ⪠Institution with high volume of radiation
implants must have specially designed rooms
with led shield walls
⪠In case of sealed source, a led container pig
and a pair of long handled forceps should
always be present in the clientâs room. If the
radiation source become dislodged, forceps
are used to pick it up and placed it
immediately in the pig.
47.
48. ⪠Visitors and staff contact are limited
⪠Staff members caring for clients with radio
active implant are rotated to limit the amount
of exposure of each employee.
⪠Staff members must wear their own film
badges
⪠Before being discharged instruct the client
about any precaution that should be continued
at home
49. SIDE EFFECTS
Acute side effect:
⪠Damage to epithelial surface
⪠Throat sore
⪠Intestinal discomfort
⪠Swelling
⪠Infertility
51. Nursing management
â˘Provide education:-
⪠Client may experience fear of being burned or becoming
radioactive, because radiation therapy can not be seen or
felt during treatment client may feel that the treatment is
not effective, education can dispel such common fears
â˘Minimize side effect
⪠Skin reaction is the common side effect. The term
âburnâ should not be used to describe these skin
reaction.
52. Post operative care:
⪠Recommended progressive ambulation,
after any period of enforced bed rest
⪠Bacterial contamination should be
avoided
⪠Psychological support.
54. ⢠Chemotherapy is an effective
treatment modality for cancer.
⢠Chemotherapy is a systematic
intervention and is appropriate in the
following circumstances such as:
oThe disease is wide spread
oTumor cant be resected and is contra
indicated to radiation therapy
55. Goal of chemotherapy
⢠Cure
⢠Control
⢠Palliation
Mechanism of chemotherapy
⢠The effect of chemotherapy is at cellular level.
All cells (normal cells and cancer cells) enter
cell cycle for replication and differentiation.
⢠The effect of chemotherapeutic agent is
described in relating to the cell cycle.
56. ⢠The two major categories of chemotherapeutic
drugs are:
o Cell cycle nonspecific chemotherapeutic drug
o Cell cycle phase specific chemotherapeutic
drug
⢠Cell cycle nonspecific chemotherapeutic drug
will have their effect on the cell that are in the
process of cell division as well as on the cell that
are in the resting phase
⢠Cell cycle phase specific chemotherapeutic drug
will have their effect on the cells that in the
process of cell division.
57. Classification of chemotherapeutic agents
Drugs are classified according their structure and
mechanism of their action.
1. Alkylating agent
⢠It is cell cycle nonspecific agent
⢠It acts by damaging the DNA
Eg : cyclophosphamide, mechlorethamine
2. Antimetabolites
⢠Cell cycle phase specific agent
⢠It will interfere with synthesis of DNA
Eg : methotrexate
58. 3. Antitumor antibiotics
⢠Cell cycle nonspecific agent
⢠Modify the function of DNA
Eg: doxorubicin, dactinomycine
4. Plant alkaloids
⢠Cell cycle phase specific agent
⢠Interrupt cellular replication
Eg: vinblastin, vincristin
5. Nitrosources
⢠Cell cycle non specific agent
⢠It will damage DNA
Eg: Lumustine
59. 6. Corticosteroid
⢠Cell cycle nonspecific agent
⢠It will increases the feeling of well being
Eg: cortisone, hydrocortisone
7. Hormone therapy
⢠Cell cycle non specific agent
⢠Decreases the process of cellular proliferation
Eg: androgen, estrogen
8. Miscellaneous
⢠Destroys exogenous supply of L-asparagine
60. Treatment plan
⢠When chemotherapy used in the treatment
of cancer, several drugs are usually gives
in combination
⢠The drugs given are carefully selected
most effectively kill the cancer cells
⢠The dose of each drug is carefully
calculated according to the body weight or
body surface area of the patient being
treated.
61. Route of administration
⢠Oral
⢠IM
⢠IV
⢠Intracavitary
⢠Intrathecal
⢠Intra-arterial
⢠Continuous infusion
⢠Subcutaneous
⢠Topical
62. Other methods
Vascular access device
⢠Chemotherapy can also be administered
by means of central vascular access
device, these are placed in large vessels
(arterial or venous) and permit frequent,
continuous or intermittent administration
of chemotherapy thus avoid multiple
puncture for vascular access.
63. There are 3 major type of vascular access devices
1. Sliastic right atrial catheter
⢠These are single, double, triple lumen catheters
approximately 90 cm in length with internal
diameter ranging from 1-2mm.
⢠These catheters are inserted with the aid of local or
general anesthesia through a central vein with the
tip resting in the right atrium of the heart.
⢠Accurate placement must be verified by chest X-ray
before the catheter can be used.
64. 2. Peripherally inserted central venous catheter
( PICCs & MLCs)
⢠PICCs lines are inserted at or just above the
antecubital fossa and advanced to a position with
the tip ending in the distal one third of the superior
vena cava.
⢠These lines are up to 60 cm in length with gauges
ranging from 24-16.
⢠MLCs that are placed between the antecubital fossa
and the head of the clavicle.
⢠These catheters are shorter than PICC line
(15-20cm)
65.
66. 3. Implanted infusion ports
⢠It consists of a central venous catheter
connected to an implanted subcutaneous
injection ports.
⢠These catheter is placed in to the desired
vein and other end is connected to the
port that is sutured to the chest wall
muscle and surgically implanted in the
subcutaneous pocket on the chest wall.
67. Adverse reaction
1. Hypersensitivity reaction
⢠H y p e r s e n s i t i v i t y r e a c t i o n t o
chemotherapy although uncommon, can
be serious and life threatening.
⢠M a n i f e s t a t i o n o f i m m e d i a t e
hypersensitivity reaction are dyspnea,
chest tightness or pain, tachycardia,
nausea, abdominal pain etc
68. 2. Extravasations
⢠B e f o r e a d m i n i s t e r i n g a
chemotherapeutic drug, note its
vesicant, potential and its antidote
(Dexrazoxane) if there is.
⢠If extravasations present stop
administration of drug and take a
necessary action
69. Management & precaution
⢠Chemotherapy agent should be administered
only by adequately prepared registered
professionals
⢠Nurses should have complete chemotherapy
administration classes
⢠Bed side nurse be aware of the potential adverse
effect of the agent being administered
⢠Careful monitoring of side effect and adverse
effect is required
70. ⢠Nurse should carefully assess the
severity and duration of previous side
effects.
⢠B e f o r e a d m i n i s t r a t i o n o f
chemotherapeutic drug consult with
physician about dose route and
administration guidelines
⢠If any adverse reaction during
administration stop the procedure
immediately and notify the physician
71. ⢠Safe administration and disposal of
chemotherapeutic agent decrease the risk of itâs
exposure to health care professionals.
⢠Most chemotherapy agent bind directly to
genetic material in the cell nucleus it will cause
genotoxicity
⢠Patient teaching is an extremely important part
of the nurses role related to chemotherapy
⢠Management of hair loss by psychological
support and health education.
73. Immunotherapy
⢠Immunotherapy (also called biologic therapy or biotherapy)
is a type of cancer treatment designed to boost the body's
natural defences to fight the cancer.
⢠It uses materials either made by the body or in a laboratory
to improve, or restore immune system function.
⢠Although it is not entirely clear how immunotherapy treats
cancer, it may work by stopping or slowing the growth of
cancer cells, stopping cancer from spreading to other parts
of the body, or helping the immune system increase its
effectiveness at eliminating cancer cells.
74. Types of immunotherapy
1. Monoclonal antibodies
⢠When the bodyâs immune system detects antigens (harmful
substances, such as bacteria, viruses, fungi, or parasites), it
produces antibodies (proteins that fight infection).
⢠Monoclonal antibodies are made in a laboratory, and when
they are given to patients, they act like the antibodies the body
produces naturally.
⢠Monoclonal antibodies are given intravenously (through a
vein) and work by targeting specific proteins on the surface of
cancer cells or cells that support the growth of cancer cells.
75. When monoclonal antibodies attach to a
cancer cell, they may accomplish the following
goals:
⢠Allow the immune system to destroy the cancer
cell.
⢠Prevent cancer cells from growing rapidly.
⢠Deliver radiation directly to cancer cells.
⢠Diagnose cancer.
⢠Carry powerful drugs directly to cancer cells.
76. 2.
Non-specific immunotherapies
Like monoclonal antibodies, non-specific
immunotherapies also help the immune system
destroy cancer cells.
Two common non-specific immunotherapies are:
⢠Interferons. Interferons help the immune system
fight cancer and may slow the growth of cancer cells.
⢠Interleukins. Interleukins help the immune system
produce cells that destroy cancer.
77. Cancer fighting vaccines
A vaccine is another method used to help the body fight disease.
There are two types of cancer vaccines:
⢠Prevention vaccine. A prevention vaccine is given to a person with no
symptoms of cancer to prevent the development of a specific type of
cancer or another cancer-related disease. For example, Gardasil is a
vaccine that prevents a person from being infected with the human
papillomavirus (HPV), a virus known to cause cervical cancer.
⢠Treatment vaccine. A treatment vaccine helps the body's immune
system to fight cancer by training it to recognize and destroy cancer
cells. It may prevent cancer from coming back, eliminate any remaining
cancer cells after other types of treatment, or stop cancer cell growth.
Eg: sipuleucel-T
79. Bone marrow
Bone marrow is the soft, sponge-like material found
inside bones. It contains immature cells known
as hematopoietic or blood-forming stem cells.
Hematopoietic stem cells divide to form more blood-
forming stem cells, or they mature into one of three
types of blood cells: white blood cells, red blood cells,
and platelets. Most hematopoietic stem cells are found
in the bone marrow, but some cells, called peripheral
blood stem cells (PBSCs), are found in the bloodstream
80. Definition
Bone marrow transplantation (BMT) and peripheral blood
stem cell transplantation (PBSCT) are procedures that restore
stem cells that have been destroyed by high doses of
chemotherapy and/or radiation therapy. There are three types of
transplants:
⢠In autologous transplants, patients receive their own stem cells.
⢠In syngeneic transplants, patients receive stem cells from their
identical twin.
⢠In allogeneic transplants, patients receive stem cells from their
brother, sister, or parent. A person who is not related to the patient
(an unrelated donor) also may be used.
81. How is bone marrow obtained for transplantation?
⢠The stem cells used in BMT come from the liquid center of the bone, called the
marrow.
⢠In general, the procedure for obtaining bone marrow, which is called âharvesting.â
⢠The donor is given either general anesthesia, or regional anesthesia.
⢠Needles are inserted through the skin over the pelvic (hip) bone or, in rare cases,
the sternum (breastbone), and into the bone marrow to draw the marrow out of the
bone. Harvesting the marrow takes about an hour.
⢠The harvested bone marrow is then processed to remove blood and bone
fragments.
⢠Harvested bone marrow can be combined with a preservative and frozen to keep
the stem cells alive until they are needed. This technique is known
as cryopreservation.
⢠Stem cells can be cryopreserved for many years.
82. How are PBSCs obtained for transplantation?
⢠A process called apheresis or leukapheresis is used to obtain PBSCs for
transplantation.
⢠For 4 or 5 days before apheresis, the donor may be given a medication
(Mozobil) to increase the number of stem cells released into the
bloodstream.
⢠In apheresis, blood is removed through a large vein in the arm or
a central venous catheter.
⢠The blood goes through a machine that removes the stem cells.
⢠The blood is then returned to the donor and the collected cells are stored.
⢠Apheresis typically takes 4 to 6 hours.
⢠The stem cells are then frozen until they are given to the recipient.
84. Gene therapy includes approaches that correct genetic defects
or manipulate genes to induce tumor cell destruction in the hope of
preventing.
Three general approaches have been used in the development of
gene therapy.
⢠Tumor-directed therapy: is an introduction of therapeutic gene into
tumor cells in an attempt to destroy them.
⢠Active immunotherapy: is the administration of genes that will
invoke the antitumor responses of the immune system
⢠Adoptive immunotherapy: is a treatment typically for cancer in
which genetically altered lymphocytes are removed from a patient
are cultured with interleukin-2 and are returned to the patientâs body.
85. Hospice care
⢠The word hospice comes from Latin hospitium meaning
guesthouse.
⢠Hospice programs generally use a multidisciplinary team approach,
including the service of a nurse, doctor, social worker.
⢠Additional services provided include drugs to control pain and
manage other symptoms; physical, occupational, speech therapy,
medical supplies and equipments, medical social services, dietary
and other counselling etc.
⢠Although hospice care does not aim for cure of the terminal illness,
it may treat potentially curable conditions such as pneumonia and
bladder infection
87. Nursing diagnosis
Based on the assessment data, nursing
diagnosis of the patient with cancer may
include the following
1. Impaired tissue integrity (oral mucus
membranes, alopecia, malignant skin lesions)
related to the effect of treatment and disease
2. Imbalanced nutrition less than the body
requirements related to anorexia or
malabsorption or increased demand.
3. Pain or chronic pain related to disease and
treatment effect.
4. Fatigue related to physical and psychological
stressors
88. 5. Disturbed body image related to changes in
appearance and role of function.
6. Anticipatory grieving related to expected loss and
altered role function
Nursing interventions
⢠Maintaining tissue integrity
⢠Addressing alopecia
⢠Managing malignant skin lesions
⢠Promoting nutrition
⢠Relieving pain
⢠Decreasing fatigue
⢠Improving body image and self esteem
