Coping With Uncertainty In Cancer: A Patient's Essay.

1. Review the knowledge and skills relating to the National Health Priorities of cancer control
2. Complete the online self-directed learning modules on the National Health Priority Areas of cancer control
3. Find and undertake further reading on this National Health Priority 

The Uncertainty of the Future

Two years ago, Michele was diagnosed with breast cancer, this news overwhelmed her and she felt her world had turned upside down. After treatment, cancer responded to chemotherapy and she was relieved and glad that her life was balanced again. She was happy with Pette her husband and her two kids. Two months later she started having coughs and feeling breathless. After a visit to the hospital, the oncologist told her that the cough was not a virus.  The CT scans showed cancer had spread to the lungs and the liver. The physician stated further that cancer was not curable.

The greatest challenge Michele faced was uncertainty about the future. In the first place, she was full of hope for the future, family and her job.  After the physician told her that   she might not survive cancer, she lost hope for the future. Causes for uncertainty include the following.

1. Having to put plans into a hold.

      Michele felt like she was unable to look into the future. Making plans was not easy. For instance, it was hard devoting to a lunch date not knowing how she will be feeling. She had difficulty planning for a family vacation since she couldn’t predict when she will be having therapy (Cheang, Vudok, Badjik, & Leung, 2013).

1. Fear about cancer treatment and its side effects.

     Mitchel was scared of the side effects of treatment such as nausea and vomiting, pain and fatigue. She felt like she was too dependent on Pette for cancer therapy. She was also not sure if the treatment will work since cancer had spread.        

1. Admitting the existence of the unknowns of cancer may make one feel afraid and anxious. For instance, it may interrupt sleep and make it harder to concentrate at work. Strategies that may help Michele cope with this particular challenge include the following.

1. Joining support groups

     Support groups help many individuals deal with the emotional issues of cancer by providing a peaceful environment to share and manage their feelings and challenges. Talking to the patient can reduce stress and it also creates a sense of belonging that helps an individual feel more understood and less alone (Delaney, Colvin, & Fleetwood, 2013).

1. Individual counseling

     Counseling helps the individual discover ways to cope with cancer. She is also able to manage anxiety and depression, cancer symptoms and treatment side effects. Counseling helps the individual talk about financial concerns and establish helpful resources and lastly one gets to learn how to assist the family to understand and adapt to changes in routine (Cheang, Vudok, Badjik, & Leung, 2013). 

1. Triple-negative breast cancer is a kind of breast cancer that tests negative for estrogen and progesterone receptors and excess HER2 protein. These results suggest that cancer is not caused by HER2 protein, estrogen, and progesterone. So, triple negative cancer does not show a response to hormonal therapy medicines that target HER2 protein receptors. This implied that Michele couldn't recover from cancer since there was no cure for it. The only thing that had remained for her was the management of symptoms which included neoadjuvant chemotherapy and adjuvant chemotherapy (Colvin & Fallon, 2017).  

1. signs and symptoms
2. Lump or thickening of the breast tissue. The lump may be firmly attached to the skin on top, chest wall or structures beneath it (Gotzsche & Jorgensen, 2014).
3. Breast pain, warmth, and irritation which is not related to periods

• A nipple that turns inwards

1. Formation of dimples on the skin of the breast particularly when the hands are raised. This is caused by attachment of the tumor to the skin overlying it. The dimples convey a pitted appearance and a skin color change called peae d’orange (Gotzsche & Jorgensen, 2014).
2. Pain experienced by cancer patient maybe disease or treatment related. The pathophysiology of cancer pain is as follows. A tumor may cause pain in the breast or spread of cancer to other parts of the body. Cancer cells in the breast secrets interleukins, growth factors, and prostaglandins which facilitate pain transmission. Tumor expansion can also inflict pressure on surrounding organs damaging the nerve tissues which may lead to neuropathic pain.

      Spread of cancer to other parts of the body may be the second cause of pain. For example, if cancer has spread to the lung the patient will start experiencing chest pain. If it spreads to the liver, an individual will experience pain in the upper right part of the abdomen (Gotzsche & Jorgensen, 2014).

Challenges and Side-effects of Cancer Treatment

Computerized tomography scan

A CT scan is an X-ray technique that shows a 2-dimensional of body’s internal organs. It’s often used to check if the breast cancer has spread to other internal organs. It helps decide if the breast cancer can be removed through a mastectomy. Before the test, a die is injected into the arm. A scan is conducted to check other parts of the body since cancer can spread to organs such as liver, lungs, lymph nodes and spine (Nelson, Cantor, & Griffin, 2012).

1. The test showed that cancer had spread to the lungs and the liver. Breast cancer can spread when the cell detaches from the tumor and travel to distant regions such as lungs and liver through the bloodstream or lymphatics. This process is called metastasis.
2. From the results, the cancer has advanced to stage four. It means that cancer has metastasized to other parts of the body. At this stage, the cancer is not curable and the only thing that can be done is the management of symptoms (Nelson, Cantor, & Griffin, 2012). 

1. Radiotherapy uses eminent x-rays to kill cancers cell that could not be removed through surgery. It is also used to shrink the tumor that has metastasized and is causing pain. Shrinking of the tumor helps reduce pain (Meek, 2013).
2. Side effects
3. Mild to moderate fatigue
4. Skin irritation
5. To minimize fatigue the patient is advised to take plenty of rest after the procedure. The individual should get a good and restful sleep at night. Eating a healthy balanced diet after treatment is also advised, it helps the patient feel better and stay stronger (Meek, 2013).

     skin irritation can be minimized by avoiding tight or stiff clothing over the treatment site, avoiding scratching or rubbing the treated site, avoiding showering with hot or cold water, protecting the treated site from sunlight and lastly avoid using body oils or lotions on the treatment area (Meek, 2013). 

1. Breathlessness
2. Cancer in the lungs is the major cause of difficulty in breathing. Lung cancer causes blockage of the airways, pneumonia due to increased bacteria in obstructed airways, and a collapse of the lungs. Inflammation of the lungs example fibrosis and lymphangitis which is mostly caused by cancer cells, can also contribute to dyspnoea (Banning, Sjgoren, & Henriksen, 2012). 

1. Resuscitation planning is vital to the care of patients in a hospital. It is a medical order signed by a physician and designed to give clinical direction in a situation in which the client is in acute deterioration. ARP entails diagnosis, proposed resuscitation plan in case the client deteriorates, alternative decision makers and lastly choices on life-sustaining measures example refusing cardiopulmonary resuscitation (Wanscher, Kober, & Lippert, 2012). 

1. Michelle’s problem
2. Acute pain
3. Breathlessness

• Persistent cough

1. Acute pain is an awful emotional and sensory experience arising from potential tissue damage. Pain may be related to nerve tissue compression caused by a tumor, side effects of cancer therapy or inflammation. Uncontrolled pain is a problem since it causes excess glucocorticoid and catecholamine’s production which may lead to hypertension and tachycardia (Caraceni, Martini, & Portenoy, 2014).

Lung cancer is the major cause of breathlessness due to blockage of airways by cancer cells. Difficulty in breathing can be a problem since it may increase the risk of getting a heart disease such as angina, pulmonary hypertension, and anxiety (Caraceni, Martini, & Portenoy, 2014).

Radiotherapy and chemotherapy are the major cause of cough. Cancer cells can cause lung collapse which is manifested by coughing. Persistent coughing is a problem since it facilitates lung damage, fractured ribs, syncope and dizziness (Caraceni, Martini, & Portenoy, 2014). 

1. Short term goals
2. The client will verbalize comfort and rate pain of one in a scale of one is to ten in not more than half an hour after pain assessment (Doyle, Rock, & Kushi, 2016).
3. The client will show effective breathing patterns within 24 hours which will be evidenced by respiration of 18 and 20 per minute and the skin color will be pink and warm (Doyle, Rock, & Kushi, 2016).

• Relief of cough in 48 hours after taking cough suppressants medication (Doyle, Rock, & Kushi, 2016).

1. Advanced health directive (AHD) also called living will is a formal style of giving consent about your future health care (William, Smith, & Geroge, 2012). AHD can only work if your cognitive health becomes worse and you are unable to make up your mind about your health. AHD includes information that health professional should be aware of an example health condition, religion and cultural beliefs that could affect clients care. It also allows the client to assign an attorney to be responsible for health and personal matters.  Lastly, it summarises the medical treatment the client wants in case she is not able to make by herself (Johnston, 2014).  

1. Experiencing distress for people still surviving with cancer is normal. But it is of great significance to seek help when the distress has occurred for a long time. Reaching for help is crucial when your emotions start to affect the ability to deal with your daily life. Other considerations include withdrawal from family and friends, talk of suicide, drug use and purging of food (Dorsey & Steven, 2013).

     Psychologist plays an important role in the management of Mitchel and family by educating on ways of coping with cancer. The other role is discussing the next step after finishing therapy and educating the family to understand and adjust to changes in Michel’s routine. The client is educated on the management of depression and anxiety, discussion on financial issue and find helpful resources, address workplace troubles and how to manage them, and lastly address on how to manage relationship issues with her husband Peter. 

1. Palliative team
2. A cancer specialist who can be surgeon, oncologist or radiation oncologist (Jennifer, Nicholas, & Dara, 2015).
3. Counselor or psychologist.

• Spiritual adviser.

2. An oncologist is a health professional that specializes in the treatment of all cancers. The oncologist must give information on breast cancer, stage, and type. He is also in charge of ordering further test such as biopsy and examine the pathology report so as know the stage of breast cancer (Jennifer, Nicholas, & Dara, 2015). Mitchel oncologist played an important role in breast cancer therapy. Also, he chooses, prescribes and administered medication. He had ordered a bone scan to check if the breast cancer had metastasized and set up a follow-up examination to monitor her progress. Last but not least he educated and counseled Mitchel about cancer and its side effects. He recommended her to the oncology social worker who was going to help her cope with cancer and face challenges cancer brought. 

1. Signs and symptoms
2. The client reports decreased pain.
3. Reduced dyspnoea.

• Fewer episodes of nausea and vomiting.

1. Reduced coughing (Anand, Sundaram, & Tharakan, 2014).
2. Mitchel is verbalizing less pain, she takes pain medication at the right time, she demonstrates reduced behavioral and physical signs of pain, recognizes the previous actions that provoked pain. The client shows relaxation skills and various activities as suggested for an individual situation (Anand, Sundaram, & Tharakan, 2014).  

1. The self-care strategy that I might use is maintaining good health and be stress-free (Brayzke, 2012).
2. It is good to put your own needs last, but it is also important to look after yourself when you feel tired or stressed. Poor health will affect an individual ability to take care of the person that needs you the most. A good physical and emotional well-being can be enhanced by taking regular breaks to avoid becoming worn out, sleeping well, exercising, and lastly eating a healthy balanced diet. Looking after your health enables the caregiver to have the energy and vitality she needs to take care of her patients (Brayzke, 2012).  

References

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Banning, A., Sjgoren, P., & Henriksen, H. (2012). Treatment outcome in a multidisciplinary cancer pain clinic. Pain, 47, 129-134.

Brayzke, L. (2012). Self-management priority setting and decision-making in adults with morbidity: A narrative review of the literature. International Journal of Nursing Studies, 52(3), 744-755.

Caraceni, A., Martini, C., & Portenoy, R. (2014). Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med, 18, 177-183.

Cheang, M., Vudok, D., Badjik, C., & Leung, S. (2013). Basal-Like Breast Cancer Defined by Five Biomarkers Has Superior Prognostic Value than Triple-Negative Phenotype. Clinical Cancer Research, 14(5), 1368-1376.

Colvin, L., & Fallon, M. (2017). Challenges in cancer pain management: bone pain. Eur J Cancer, 44, 1083-1090.

Delaney, A., Colvin, L., & Fleetwood, M. (2013). Translational medicine: cancer pain mechanisms and management. Br J Anaesth, 101, 87-89.

Dorsey, M., & Steven, T. (2013). Medical Conditions that mimic psychiatric disease: A systematic approach for evaluation of patients who present with psychiatric symptomatology. Emergency Medicine Report, 34(11), 86-88.

Doyle, C., Rock, L., & Kushi, H. (2016). American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin, 62(1), 30-67.

Gotzsche, P., & Jorgensen, J. (2014). Screening for breast cancer with mammography. The Cochrane Database of Systematic Review, 6(6), 1877.

Jennifer, Z., Nicholas, J., & Dara, Z. (2015). Association between palliative care and patient and caregiver outcomes. JAMA, 316(20), 2104-2114.

Johnston, S. (2014). The discussion about advance directives: patient and physician opinions regarding when and how it should be conducted. Archives of Internal Medicine, 155(10), 1025-1030.

Meek, A. (2013). Breast radiation therapy and lymphedema. Cancer, 83, 2788-2797.

Nelson, H., Cantor, A., & Griffin, J. (2012). Risk factors for breast cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Annals of Internal Medicine, 156(9), 635-648.

Wanscher, M., Kober, L., & Lippert, K. (2012). Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile. Resuscitation, 85(3), 369-375.

William, D., Smith, E., & Geroge, S. (2012). Triple-negative breast cancer. New England Journal of Medicine, 363(20), 1938-1948.