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disease of aging, as multiple comorbidities affect cancer treatment and care

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cancer

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account for 60% of all new cancer diagnoses; account for 70% of all cancer deaths

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adults over 65

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number of new cases in a given time period, usually a year, in general population

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incidence

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prostate, lung, and colorectal

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leading types of cancer in men

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breast, lung, and colorectal

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leading types of cancer in women

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varies by stage of diseases and race

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cancer survival

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group age cohorts demonstrate different patterns of cancer incidence examination of patterns of cancer among racial or ethnic groups should include age and environmental considerations race and ethnicity are highly correlated with socioeconomic status

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racial and ethnic patterns

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considered the most important determinant of cancer risk -both biologically programmed life span and environmentally influenced life expectancy are important concepts when the relationship between aging and cancer are considered -aging cells have a tendency toward aberration or abnormalcy with replication -environmental factors contribute to decreased regulation of cell growth causing cell damage and promoting the replication of those damaged cells

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age and its relationship to cancer

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results from intense or prolonged exposure to an external agent that causes mutation of genetic material

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initiation

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when cancerous cell growth begins when an initiated cell encounters a promoting agent

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promotion

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may be subdivided into transformation, clonal progression, and metastasis

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progression

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involves conversion of initiated cells to cancer cells

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transformation

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involves further growth of the small cluster of transformed cancer cells

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clonal progression

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involves a change in location of the cancer cells from one organ or part of the body to another that is not directly connected

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metastasis

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within normal human DNA material are genes that code cell growth-regulating substances -genes that produce abnormal codes for growth-regulating substance -believed to play a role in the development of cancers because, once activated, they interfere with normal physiologic regulation of cell growth

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oncogenes

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evaluation of environmental risk factors can lead to specifically targeted education and screening programs among selected high-risk cohorts older adults should be encouraged to consume the recommended daily requirements of fruits and vegetables because dietary habits may be beneficial in halting the cancer process

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aging and cancer prevention

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common type of cancer and leading cause of cancer death in both men and women accounts for 14% of all cancer diagnoses and 32% of all cancer deaths

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lung cancer

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cigarette smoking: the greatest lifetime cumulative exposure to cigarette smoking occurs between ages 70 and 80; the risk of lung cancer decreases over time ex-smokers exposure to certain industrial substances long-term exposure to air pollution radiation exposure

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risk factors

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one quarter of individuals have no signs and symptoms, or vague symptoms classic clinical presentation is persistent cough, sputum streaked with blood, chest pain, and recurring respiratory infections

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signs and symptoms

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can grow for years before exhibiting clinical symptoms; early detection difficult American Cancer Society does not recommend routine screening in asymptomatic persons

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lung cancer early detection

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options for treatment include surgery, radiotherapy, and chemotherapy, depending on the type and stage of diseases -classified into two basic types: small cell cancer (also called oat cell cancer) and non-small-cell cancers -non-small-cell cancers further divided into three types: squamous cell cancers, adenocarcinomas, and large-cell cancers -each type has a different growth pattern and responds differently to therapy

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lung cancer treatment

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most common neoplasm in women, increasing in incidence with advancing age 79% of new cases occur in women over the age of 50, and 88% of deaths from breast cancer occur in women over the age of 50 the incidence of breast cancer decreases after the age of 80 leading cause of death in women ages 55 to 74

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breast cancer

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duration and intensity of exposure to hormonal influences, especially estrogen; early menarche, late menopause, lengthy exposure to postmenopausal estrogen, recent use of oral contraceptives, and never having given birth or having first given live birth at a late age personal or family history of breast cancer genetic basis: BRCA1 and BRCA2

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breast cancer risk factors

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malignant lumps are hard and fixed, with irregular borders, and are sometimes described as frozen peas nipple retraction or elevation skin dimpling may be present localized erythema and warmth may be present characteristically, edema appears an "orange peel" skin

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breast cancer signs and symptoms

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breast self-examination (BSE) should be performed monthly by all women older than age 20 mammography is able to detect breast tumors before they present physical findings the American Cancer Society recommends mammography screening every year for women after the age of 40, along with a clinical breast exam

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breast cancer early detection

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surgery-either lumpectomy or modified radical mastectomy- is indicated for removal of primary tumor lymph nodes should be evaluated chemotherapy may include antineoplastic agents and hormonal therapies radiotherapy after breast-conserving surgery or following mastectomy for large (greater than 5 cm) tumors or when cancer has spread to the lymph nodes

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breast cancer treatment

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average age at diagnosis is 67 although prostate cancer is serious, most men do not die from it is usually adenocarcinoma that develops slowly in the gland cells of the prostate disease of aging risk of factors include a family history of prostate cancer and occupational exposure to carcinogens

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prostate cancer

question

asymptomatic in early stages signs and symptoms related to the increased growth of the prostate: weak or interrupted urine flow, difficulty or inability to begin urine flow, difficulty stopping urine flow, and urinary frequency, especially at night hematuria, pain or burning during urination, and pain in lower back, pelvis, and upper thighs

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prostate cancer signs and symptoms

question

annual digital rectal examination (DRE) and prostate-specific antigen (PSA) testing are the two primary screening tests American Cancer Society recommends men begin discussing the risks and benefits of screening for prostate cancer with their doctor at age 50 (age 45 for African American men and those with a family history) in order to make an informed decision

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prostate cancer early detection

question

surgery, radiotherapy, endocrine manipulation, and observation used, either alone or in combination choice of treatment determined by the age of the patient, comorbidities, stage and grade of the tumor, the likelihood of a cure, and the feelings of the patient hormone therapy is an adjunct to radiation therapy or used alone in patients who are not candidates for surgery or radiation

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prostate cancer treatment

question

primary surgery for prostate cancer is the radical prostatectomy -following surgery, men may develop incontinence and impotence when the cancer has not spread beyond the prostate, radiation therapy may be an effective treatment; it may also be used in conjunction with hormone therapy, following surgery, or with advanced cancer to relieve the symptoms

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prostate cancer surgery and radiation

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median age is diagnosis is 69; the median age at death is 74 early screening with polyp removal, early diagnosis and treatment leading to cure, and improvements in treatment are the sources for the declining rates risk factors: personal or family history of colorectal cancer, polyps, or inflammatory bowel disease

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colorectal cancer

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early states: may not have symptoms cancer of the right colon: pain, cramping, and appendicitis-like symptoms cancer of the transverse colon: bloody stool, changes in bowel habits, and obstruction cancer of the left side of the colon: constricting, progressively restricting the lumen of the bowel rectal cancer: change in bowel habits, increased frequency of evacuation and bright-red bleeding

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colorectal cancer signs and symptoms

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starting at age 50, both men and women should have yearly fecal occult blood tests flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years, or double contrast barium enema every 5 years, or computed tomography (CT) colography every 5 years

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colorectal cancer early detection

question

surgery is treatment of choice radiation therapy may take place prior to surgery to shrink the size of tumor, or after surgery to reduce the chance of recurrence chemotherapy after surgery is used with cancer that has spread to the lymph nodes or cancer that has penetrated the bowel wall surgery in combination with radiotherapy is the usual treatment for early stages of rectal cancer

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colorectal cancer treatment

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older adults have had a lifetime of exposure to risk factors; changing lifestyles is advantageous, but changes may not reverse effects of exposure screening asymptomatic persons at risk is feasible for many common malignancies, including breast, cervical, and colorectal uncertainty exists concerning cancer screening tests in older adults, as illustrated by the different age cutoffs recommended by various guideline panels

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screening and early detection

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screening should not be conducted if there is not intent or ability to pursue findings with more complete evaluation and treatment factors influencing decision: comorbidity, functional ability, and life expectancy

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decision-making processes that take into account the older adult's personal preferences and health should be used rather than relying only on age guidelines

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based on following factors: individualize the decision estimate the life expectancy assess risk for cancer screening ascertain patient preferences consult various cancer screening guidelines -US Preventive Services Task Force (USPSTF) -American Cancer Society and American Geriatric Society

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Walter and Covinsky's Framework for cancer screening

question

change in bowel or bladder habits a sore that does not heal unusual bleeding or discharge thickening or lump in breast or elsewhere indigestion or difficulty swallowing obvious change in wart or mole nagging cough or hoarseness

answer

early warning signs of cancer

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four classic forms of cancer treatment: surgery radiotherapy chemotherapy biotherapy treatment selection is determined by the type and stage of cancer, unique biophysiologic characteristics of cancer cells, and older patient's overall health status at the time of diagnosis

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major treatment modalities

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cure-elimination of disease control or minimization of disease palliation- relief of symptoms adjuvant therapies to standard therapies have been developed that include angiogenesis inhibition, gene therapy, hyperthermia, laser therapy, and photodynamic therapy

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cancer therapies

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functional status reported to be a more important pretreatment variable, influencing both the decision to treat and type of treatment number of comorbid conditions is a significant predictor of outcome of an older adult receiving cancer treatment nurse should be sure patients and families have accurate information and a clear understanding of treatment options offered

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patient considerations in therapy

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most distressing side effect not all chemotherapeutic agents cause nausea and vomiting monitor for dehydration and electrolyte imbalances treatment includes 5-HT3 receptor antagonists, NK1 receptor antagonists, corticosteriods, benzamide analogs, phenothiazine derivatives, butyrophenones, and benzodiazepines

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nausea and vomiting

question

general loss of appetite contributing factors: chemotherapeutic agents, radiotherapy, pain medications, and mucositis leads to decreased caloric intake and weight loss, which is linked to poor outcomes dietary consultation and frequent weight monitoring are necessary

answer

anorexia

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results from destruction of actively dividing epithelial cells of the GI tract absorption of nutrients is decreased, and patients are at risk for dehydration and malnutrition can aggravate perirectal problems such as hemorrhoids and can cause pain, bleeding, and infection assessment includes number of stools per day, consistency, and color patients should be instructed to eat small frequent meals and avoid coffee, tea, alcohol, and sweets eat low-fiber foods avoid fried, greasy, or spicy foods

answer

diarrhea

question

hair loss may range from thinning of scalp hair to total body hair loss, including eyelashes, eyebrows, and pubic hair occurs rapidly and becomes apparent over a 2 to 3 week period after initiation of treatment hair begins to grow back slowly when treatment is completed the emotional distress can be enormous

answer

alopecia

question

for an older adult experiencing cancer in the context of a life mostly lived, quality is very- if not the most- important consideration it is multidimensional concept that includes not only functional status and severity of symptoms but also the patient's ideas about psychologic development, sociocultural issues, ethical issues, and economic issues, and spirit evaluation is relevant to both curative and palliative care

answer

quality of life

question

information obtained from assessment can guide the selection of therapeutic strategies leading to a more normal life

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curative care

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assessment can provide insight into areas that may require intervention, such as family counseling, financial planning, and management of depression

answer

palliative care

question

depressive symptoms may result from side effects of medication used to control cancer understand how experience of cancer affects such things as feelings of well-being, interpersonal relationships, and self-fulfillment -older patients and family members should be encourage to discuss the effects of cancer on family functioning -individual evaluation of depressive symptoms is needed if the older person is suspected of experiencing depression

answer

depression

question

an older adult being treated for cancer may experience multiple losses: loss of energy, loss of a body part, loss of functional ability, loss of self-esteem, and loss of control intensity of grief is determined by the meaning an individual places on the loss nurses should support older patients and families by patiently repeating information when asked, validating what the family has heard, and determining what the information means to them as individuals and as a family unit nurse should not support unrealistic ideas about the seriousness of the illness or the benefits of treatment

answer

grief and loss

question

choosing to be alone can provide important time for personal reflection, psychologic rebuilding, and renewal can have negative consequences on psychologic health -risk factors: physical disability or illness, frailties associated with advanced age, psychologic or neurologic disorders, and environmental constraints voluntary isolation may result when an older adult with cancer no longer feels comfortable in social settings involuntary isolation may result from physical changes that prevent a person form continuing with social activities

answer

social isolation

question

important component to nursing care of older adults is awareness of resources and referrals to appropriate agencies or support groups nurses should have up-to-date listings for groups in their area

answer

resources and support

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