Global burden of lung cancer
Introduction
Around the world, lung disease is the most widely recognized harm and the most well-known reason for malignancy deaths in the previous couple of decades. An aggregate of 1.8 million new cases was evaluated in 2012, representing 12.9% of all new cancer cases. As indicated by the Global Burden of Disease contemplates 2020, the medicinal services weight and costs credited to lung tumor was considerable on a worldwide scale. The surviving rate in five years of lung cancer is 17.8% which is much lower than that of other major types of cancers. Attributable to the high casualty rate, its land mortality designs nearly take after those of frequency, and it stays to be a critical general medical problem.
A group approach is required for precise appraisal and treatment of a patient with lung growth. This group may comprise of doctors, specialists, oncologists, and the palliative care group. Satisfactory distinguishing proof and appraisal of prognostic variables are basic before choosing the sort of move to make for the treatment of the particular patient. Since just a couple of patients of lung cancer completely recoup, the primary issue to focus on is the side effect control and enhancing the personal value of life for the patient and their family.
Lung malignancy still remains a pestilence with a high predominance rate of 1.37 million deaths per year globally. The reason for this high rate of deaths can be because of a late finding of lung tumor, issues as co-horribleness in a populace consisting patients who have background marked by smoking, disappointment of momentum restorative methodologies to affect on the regular past occurrences of the ailment or the remedial skepticism of doctors involved and consequently patients are not alluded to fitting organizations (Jemal, et al, 2011)
Lung cancer is a major issue and a lot can be done notwithstanding that lone a couple of patients are totally restored and just a couple is practical to have medical procedures or radiotherapy treatment. Advances have been made on various strategies for treating growth and how unique techniques can be joined together to draw out an ideal answer for the patient, their family, and the treating oncologist. The primary risk factor associated with lung malignancy is tobacco smoking but other risk factors also can cause lung cancer. Below is a case study of a patient I examined who had been diagnosed with lung disease.
A case study of a patient with lung cancer
Patient status
The patient is a retired African American male from Australia and used to work in a production factory. We discovered that the patient had other chest complications caused by pleural effusion, also the patient’s family has a history of lung cancer, and the patient’s mother died of lung cancer. Since he worked in a production company, this may have exposed him to dangerous fumes that caused the growth of the cancerous tumor among other factors. The patient complained about chest pains, shortness of breath and sound hoarseness, although the symptoms were not severe, more tests X-ray and CT scan were required to identify the problem.the patient was placed on psychosocial care where he underwent counseling ,personal psychotherapy and psychoeducation
Case study of a patient with lung cancer
Nursing Assessment
After his visit to the clinic, we assessed the symptoms and identified a high likeliness of lung cancer and therefore. He came to the hospital complaining of an unending cough and increasing shortness of breath which had been going on for two and a half months. The coughing was accompanied by a wheezing sound and hoarseness. He also complained of chest pain which became even more powerful when in taking of breaths or laughing. However, he was physically fit and could run for at least one mile and he had a smoking history. The symptoms did not cease despite him completing a dosage of antibiotics from the respiratory physician he visited. He also explained a notable loss of appetite and weight by about 2 and half kilograms over the past 3 months.
The results of the scan demonstrated a mass (lump) below his right hilum. The mass had a maximum diameter of about 3.8 cm in but there were no extra abnormal observations were made in both the lung surface and the mediastinum. His airways were examined using a bronchoscope and he was identified to have a tumor at the aperture of his left lower lobe, stretching out into the left bronchus intermediate. A tissue sample of this indicated tolerably separated squamous cell carcinoma (Brown, 2010).he was provided with alectinib, aftinib and bevacuzumab to improve his condition and methadone and levo-droman to relieve pain.
Nursing Interventions, Treatment and care planning
After assessing the results of the X-ray scan, a CT scan was identified as helpful to further assess his condition and the symptoms. The CT scan showed that the diameter of the tumor on his left hilum was 4.4cm, with a sub-carinal node that had a 1.8 cm diameter. Also, several other nodes were noted but were quite smaller with a diameter of less than 1 cm. The rest of the lung was identified to be fine. He also registered a Forced Expiratory Volume in of 1.5 in I second and a forced vital capacity of 2.0.
These symptoms pushed for a need for him to be checked by the cardiothoracic surgeons who confirmed the results of the bronchoscope scan. He then proceeded with mediastinoscopy whereby biopsies were taken from sub-carinal, pre-tracheal and par-tracheal regions. The biopsies proved metastatic carcinoma which therefore had him staged him as having non-small lung cancer of T2 (Tumor greater than 3cm but not more than 7cm) and N2 (Metastasis in ipsilateral mediastinal and sub-carinal lymph nodes). He was deemed inoperable on the basis of the mediastinal lymphadenopathy and therefore an oncology opinion was required (Travis, Brambilla, Burke, 2015).
After a long discussion both with the team of professionals and the patients, the treatment options that were seen as optimal for him were a 21 day broken into three cycles of neoadjuvant chemotherapy with mitomycin-C, ifosfamide and an cisplatin with MIC given on the first day of the cycle. This mode of treatment took into consideration the histology of the patient where he has squamous cells, patient preference, co-morbidities, age, pathology, and PS (Ardizzon, et al, 2007). He was administered these treatments in three cycles and was tolerant of the treatment except for alopecia and generalized lethargy. He had neutropenia which was which had his third cycle delayed with 6 days. The patient was educated by the oncology nurse on the likely side effects of this treatment and how to cope with the side effects (Ung, Campbell, Duplan, Ball, David, 2016)
Nursing assessment
He received another CT scan after completing the cycle. The scan showed evident improvement and positive response to the treatment. The diameter of the tumor had reduced by 1.8 cm in diameter and the sub-carinal node had reduced substantially and now measure 1 cm in maximum diameter. With these improvements, he was further advised on the treatment options to continue with and he also received radical therapy of radiation which helped in controlling the symptoms of metastasis, SVCS, and neural invasion.
Three-dimensional contrast-enhanced Computed Tomography scan arranging with beam’s eye view facility was utilized to limit the total tumor volume and also, zones in danger which incorporated the left lobe and, lymph lobes inside the sub-carinal, pre-carinal, pre-tracheal and para-tracheal regions. An 80mm edge around the total tumor volume denned the clinical target volume and an extra 40mm in the sidelong surface and 80mm in the craniocaudal bearing to explain for varieties in everyday set up and chest movement amid treatment. Con-formal squares were utilized to separate ordinary tissue from the surface being treated. A 3-field procedure was utilized and the patient received cGy in 20 portions for 30 days.
An X-ray was performed a month after treatment was completed and no evident improvement was seen. However, three months later, after completion of radiotherapy, a CT scan was performed which showed no left traces of the tumor. He, however, had some scarring on the left lobe and fibroids due to radiation. The patient did not complain of any other symptoms.
8 months later, however, he returned to the hospital complaining of his neck swelling for 8 days and dyspnoea. The assessment showed he had indications of obstruction of SVC. An X-ray of the chest showed a big, left para-tracheal shade which was similar to upper mediastinal lymphadenopathy, which lay on the past surface of therapy of radiation. Re-growth of the mass on his left lobe was also identified. Venography was performed on him and it proved external firmness of the SVC. When being observed underneath fluoroscopic power, an expandable metal stent was inserted into the superior vena cava transversely the lessened area (Shaw, et al, 2009)
After this treatment procedure, a fast reprieve of his symptom and indications was evident but he sustained dyspnea on any physical effort or application of pressure. More palliative care which the patient readily accepted was provided. Two more cycles of MIC chemotherapy were administered to him. These further reduced the symptoms (Lee, et al. 2014)
However, these further treatments led him to have severe back pains and a scan of the bone indicated amplified intake of L3 and L4 and in numerous ribs constant with metastatic illness. One portion of supportive radiotherapy on the lumbar vertebrae was administered to him but he rejected any more chemotherapy. More supportive home-based care was arranged from the local hospital. Later on, he was discovered as having liver metastases and pneumonia of the bronchus (Chang, 2013).
During his treatment, the patient experienced hematological and non-hematological toxicity. Gastrointestinal toxicity was evident throughout the three cycles of the first chemotherapy where he experienced vomiting and nausea. Hematological toxicity was documented through the patient having anemia, alopecia and leucopenia. He also experienced a low level of depression which was a neurological toxicity. These toxicities were controlled through blood transfusion, use of growth supplements such as Filgrastim and antibiotics. Also, supportive care was eminent for management of the toxicities to ensure that the patient’s quality of life was high
Nursing interventions, treatment, and care planning
The administration of palliative care is guided and made easier and accessible to everyone through the certain policies that have been outlined by the World Health Organization. These guidelines are; a government policy to ensure that all healthcare centres have a palliative care plan, an education policy for training health professionals, public and volunteers, and a drug policy to ensure that drugs for pain relief and treatment were available in the cancer centres. The purpose of these policies was to ensure the quality of care and accessibility of supportive care thus improving the value of life of a cancer patient.
Throughout the treatment period, the patient and his family received palliative/ supportive care to ensure an optimal quality of life and good coping skills for the family in case of bereavement. This was done through several methods. One such method is the use of mobile phone applications. Mobile frameworks for patient-detailed result measures; these frameworks empower efficient evaluation, an ongoing account of side effects, and quick restorative reaction. An electronic side effect administration framework provides a guideline for patients through a progression of inquiries concerning their side effects and after that gives computerized evidence-based self-management exhortation because of the appropriate responses. The two apparatuses encourage patient-focused care and provide patients with access to despite their demographic remoteness.
The family and the patient was given palliative care which was done in a way that improved the patient’s mood thus enhancing the value of life, ensured that the patient spends his life after diagnosis as actively as possible and removing pain and other symptoms that may cause distress to the patient and his family. Also, the family was educated on the threat factors related with the lung tumor and how to avoid getting lung cancer themselves and how to deal with bereavement and regard dying as a normal process (Temel, et al 2010)
The Brown (2010) guideline expresses that an oncology nurse ought to be available at analysis. The mental impact of analysis on patients and givers frequently requires extraordinary consideration and it is imperative that patients are offered a comprehensive, coordinated way to deal with care. When patients have been educated that they have suspected lung growth, additional tests and examinations are required. The working analysis is typically conveyed by a respiratory doctor, however, can on events be given by an oncology nurse, who traces the extra examinations required and the administration plan. The oncology nurse has the duty of surveying patient and family’s insight with respect to the treatment process, encourage family about treatment plan and proper symptoms, survey for skin variations amid radiation and make certain patients know to screen skin changes and avert breakdown, Survey for esophagitis in patients who mediastinal radiotherapy is been done on, survey for pain administration and survey for eating habits and required changes and make certain patient is capable keep up admission of liquids and nutritious admission
Conclusion
Recognition, counteractive action, and administration are critical errands for oncology attendants to ace to enable patients to stay in treatment. When properly equipped with the necessary and up to date, nurses play an instrumental role in reducing the side effects and probable deaths related to lung cancer. Oncology nurses offer help for patients and givers at all phases of the pathway, evaluating physical, mental, social, profound and budgetary requirements. Research into complex treatment choices for patients with signs and manifestations of sickness, propelled lung growth demonstrated that nurses upheld basic leadership and were viewed as confided in sources of data. Nurses are engaged with complex action pre-conclusion by giving data, coordinating tests, speaking with other specialists and also, supporting side effect by recommending the measures to be taken. Nurses ought to be engaged with the pre-conclusion care of all presumed lung disease patients from the point of deeper examinations in optional care.
References
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Jemal, A., Bray, F., Center, M.M., Ferlay, J., Ward, E. and Forman, D., 2011. Global cancer statistics. CA: a cancer journal for clinicians, 61(2), pp.69-90.
Travis WD ,Brambilla E, Burke AP et al (eds). 2015 WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart , 4th edition. Lyon, France: IARC Press
Lee, J.K., Hahn, S., Kim, D.W., Suh, K.J., Keam, B., Kim, T.M., Lee, S.H. and Heo, D.S., 2014. Epidermal growth factor receptor tyrosine kinase inhibitors vs conventional chemotherapy in non–small cell lung cancer harboring wild-type epidermal growth factor receptor: a meta-analysis. Jama, 311(14), pp.1430-1437.
Shaw, A.T., Yeap, B.Y., Mino-Kenudson, M., Digumarthy, S.R., Costa, D.B., Heist, R.S., Solomon, B., Stubbs, H., Admane, S., McDermott, U. and Settleman, J., 2009. Clinical features and outcome of patients with non–small-cell lung cancer who harbor EML4-ALK. Journal of clinical oncology, 27(26), p.4247.
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Gridelli, C., Perrone, F., Gallo, C., Cigolari, S., Rossi, A., Piantedosi, F., Barbera, S., Ferraù, F., Piazza, E., Rosetti, F. and Clerici, M., 2003. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. Journal of the National Cancer Institute, 95(5), pp.362-372.
Temel, J.S., Greer, J.A., Muzikansky, A., Gallagher, E.R., Admane, S., Jackson, V.A., Dahlin, C.M., Blinderman, C.D., Jacobsen, J., Pirl, W.F. and Billings, J.A., 2010. Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363(8), pp.733-742.
Chang, J.Y., Liu, Y.H., Zhu, Z., Welsh, J.W., Gomez, D.R., Komaki, R., Roth, J.A. and Swisher, S.G., 2013. Stereotactic ablative radiotherapy: a potentially curable approach to early stage multiple primary lung cancer. Cancer, 119(18), pp.3402-3410.
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