Nursing care of patients under chemotherapy and/or radiotherapy for CRC

1. Nursing care of patients under chemotherapy and/or radiotherapy for CRC SouliouKaterina RN, MSc

2. chemotherapy Side effects Source: Casciato et al. 2000 • Pain • Oral symptoms (stomatitis, xerostomia, abnormal taste) • Nausea and vomiting • Colorectal symptoms (constipation, diarrhea) • Urinary symptoms (bladder spasm) • Respiratory symptoms • Skin problems • Necrotic, malodorous tumor masses • Fever • Venous access problems • Nutritional support

3. radiation Side effects • Anorexia • Nausea • Lassitude • Diarrhea • Skin reactions (erythema, desquamation) • Mucosal reactions • Epilation • Hematopoietic suppression Source: Casciato et al. 2000

4. nursing care plan: • Assessment • Diagnosis • Expected outcomes • Interventions • Rationale • Evaluation

5. Nursing care plan • organizes, analyzes, compiles and summarizes the information they have collected • recognizes their problems, their characteristics and their rationale • prioritizing needs • determines nursing activities • continuous and repetitive • adjusted for each treatment • supports the patient physically, mentally and emotionally

6. Assessment tools

7. Fatigue assessment tool Multidimensional Assessment of Fatigue (MAF) Scale • Consists of 16 items • The MAF is a self‐administered questionnaire to measure 4 dimensions of self‐reported fatigue: • degree and severity • amount of distress • duration • degree to which fatigue interferes with activities of daily living. • Completed in 5 min and scored in 5 min • Respondents are asked to reflect on their experience of fatigue for the past week.

8. Pain assessment tool Memorial Pain Assessment Card • Valid & useful • Reliable for repeated assessments

9. Nausea & vomiting assessment tool MASCC Antiemesis Tool (MAT) • 8 items • Assesses acute and delayed nausea & vomiting • Completed in 5 mins • The MAT is a reliable, valid, clear, and easy-to-use clinical tool

10. Nutritional assessment tool Mini Nutritional Assessment Short Form (MNI-SF) • Simple and highly sensitive tool • 6 items grouped in 4 rubrics • anthropometry • general status • dietary habits • self-perceived health and nutrition states • Completed in 5 mins • Special training needed • In case of low score (malnutrition), do the full MNI

11. how patients are affected by radio-chemotherapy? Physically Mentally Psychologically

12. Evaluation of the side-effects of chemotherapy in patients with cancer • Polikandrioti et al • Published 2010 • Jan 2007- Jan 2008 • Private hospital • Sample 151 patients • 49% men/51% female • Attending on One Day Clinic

14. According to ‘Macmillan cancer support’: • 49% of patients were depressed • 75% of patients had anxiety • 19% of patients felt abandoness • 45% of patients suffered more emotional consequences than physical impairment • In general, cancer patients had high levels of depression, anxiety and problems in their relationships, including divorce and separation. Similar problems were also experienced by their environment, relatives or friends who had taken care of them

15. problems that arise in relationships • 32% cancer causes enormous pressure and tension in relationships   • 26% of patients have very serious difficulties with their partner or husband because of the cancer that challenged them   • 7% of patients’ relationship with their partner or husband was interrupted (divorce, separation) due to their cancer   • 43% of patients’ sex lives suffered from cancer Source: MacMillan Cancer Support

16. How cancer patients experience the support that they receive • 58% of cancer patients declare that they feel that their emotional needs do not have an equivalent level of care, such as physical health problems   • 24% of cancer patients feel they have none to talk   • 49% of cancer patients want or need more information. But 41% cannot find this information. • 75% of cancer patients say they have anxiety due to their cancer   • Fewer than 44% receive any information, advice, support or treatment for the psychological consequences of their condition. • Due to lack of support, the proportion of patients with depression increased from 49% to 60% Source: MacMillan Cancer Support

17. Patient needs • Physical, mental and psychological support • An holistic and individual care plan • Information • Acquaintance with cancer illness • Positive aspect for life Source: Polikandrioti et al,2010

19. Nursing care of patients under chemotherapy and/or radiotherapy for CRC • Chemotherapy administration – venous line insertion • Application of radiotherapy • Cope with side effects – nausea, vomiting, pain • Physical changes from cancer – anorexia, diarrhea • General health disorders due to treatment -diabetes deregulation • Psychological support - patient’s and his environment • Training - colostomy treatment,appropriate nutrition, doing Sc injections • Briefing of his therapy - resolving questions • Prepare of discharge plan - removing the portable pump and gripper

20. An oncology nurse… • Multidimensional response • Special knowledge and skills on oncology nursing • Effective communication and co-operation skills • Ability to adapt to the stressful oncological environment • Holistic assessment of patient and family • Patient and family training • Psychological support • Physical care • Management of symptoms and side effects • Management of cancer healthcare team

21. Nurse – patient relationship • Careful thinking • Sensitiveness • Energy • Time

22. Thank you!