Week 9

Question 1

When does cancer begin?

Answer 1

When a cell starts diving uncontrollably > the type of cancer is determined by the organ in which the cancer starts.

Question 2

What is the initial tumour?

Answer 2

The primary or first tumour discovered. When cells from this tumour break off, they can lodge elsewhere and grow into what are known as secondary cancers.

Question 3

What are the stages of cancer?

Answer 3

0: carcinoma in situ (early)
1: localised and curable
2: early, locally advanced
3: late, locally advanced, may involve lymph nodes
4: metastasised; inoperable or metastatic cancer

Question 4

Around one third of cancers are due to 5 leading behavioural and dietary risks. What are they?

Answer 4

High BMI
Low fruit/veg intake
Lack of physical activity
Tobacco use
Alcohol use

Question 5

What is the leading cause of cancer related death?

Answer 5

Lung cancer followed by colorectal cancer

Question 6

What is the leading cancer diagnosis?

Answer 6

Breast cancer, followed by prostate

Question 7

More people are dying from cancer in Australia since 1994. True or false?

Answer 7

False. Fewer people are dying from cancer in Australia, since 1994.

Question 8

By 2035, 24m people are expected to be diagnosed with cancer - up from 14m today. Why?

Answer 8

People are living longer
Population growth
Cost of treatment is spiralling out of control.

Question 9

What are the four main treatments for cancer?

Answer 9

Surgery
Radiation
Chemotherapy
Hormonal treatments

Question 10

What influences which treatment is used for cancer?

Answer 10

Site of the cancer
Stage; localised or metastasised
Lymph node involvement
Other prognostic factors such as oestrogen receptivity of breast cancer cells

Question 11

What are some of the side effects of radiation treatment?

Answer 11

Skin changes > blistering, peeling, dryness, itching, Swelling
Fatigue
Mouth problems
Urinary/bladder problems
Diarrhoea
Difficulty swallowing

Question 12

What are some of the side effects of chemotherapy?

Answer 12

Nausea
Vomiting
Loss of appetite
Loss of hair
Mouth sores/sore gums/sore throat
Diarrhoea/constipation
Low blood cell counts > increased chance of infection > bleeding and bruising after minor trauma > anaemia > shortness of breath
Infertility/female early menopause

Question 13

What are some of the side effects of hormonal therapy?

Answer 13

Women: Breast cancer
hot flushes/sweats
changes to periods
feeling sick
joint pain
mood changes
fatigue

Men: Prostate cancer
hot flushes
osteoporosis
fatigue
weight gain
decreased muscle mass
increased chance of diabetes/heart attack/stroke
memory loss

Question 14

What is MDT cancer care?

Answer 14

Gold standard
Multi-disciplinary approach - medical and allied healthcare professionals come together to determine best treatment plan, while taking into consideration the personal preferences of the patient.

Question 15

What are the stages of the Cancer Care Continuum?

Answer 15

Risk Assessment
Primary Prevention
Detection
Diagnosis
Cancer/Precursor Treatment
Recurrence/Surveillance
End of Life Care
Risk Status

Question 16

What are some of the reasons that people avoid diagnosis?

Answer 16

Fear of diagnostic procedure e.g. endoscopy/ mammogram/ biopsy
Embarrassment about seeking care
Feeling too young to have cancer
Symptoms not serious enough
Fear of pain from diagnostic procedure
Fear of screening outcome

Question 17

What are some of the challenges associated with decision making arounD cancer diagnosis?

Answer 17

Anxiety around making the “right” decision
Understanding the available options
Acknowledging patient preferences and values
Acknowledging the role of others e.g. medical care team, spouse, other family members, friends

The gold standard is shared decision making between all

Question 18

What are decision aids?

Answer 18

Objective and balanced information about options available

Deeper processing of information

Actively process pros and cons

Values-preference activities (self-assist)

Complement counselling from a healthcare provider

Facilitation of shared decision making

Paper/computer based information such as websites

Question 19

What is the BRECONDA program?

Answer 19

A 3yr study into decision making associated with breast cancer. Outcomes:
More satisfied with information received
Better informed
More easily able to discuss concerns with surgeons/doctors
Less conflicted about the decisions taken
Less regretful about decisions taken

Question 20

What did an evaluation into different types of group interventions for breast cancer reveal?

Answer 20

3 interventions
- Education only
- Peer discussion only
- Both

Education enhanced self-esteem and body image, sort term reduction of feelings of confusion, increased discussion with social network members

Peer discussion generated no positive effects > some negative effects.

Question 21

What are some of the side-effects of treatment?

Answer 21

Residual side effects
Fear of recurrence
Lymph-oedema (chronic)
Infertility
Disfigurement
Speech impairment
Need to re-enter previous life or ‘new normal’
Effect on caregivers/family

Question 22

What are three main findings from the Rolland Family Systems Illness Model?

Answer 22

1. Classify illnesses according to their psychosocial demand (onset, course, outcomes of illness)
2. Consider illnesses longitudinally, rather than as a snapshot (crisis, chronic, terminal)
3. Evaluate the strengths and weaknesses in family functioning in relation to the disease

Question 23

What does the FOCUS acronym mean?

Answer 23

F: family involvement
O: optimistic attitude
C: coping effectiveness
U: uncertainty reduction
S: symptom management

Question 24

What are some of the considerations in terminal phases of care?

Answer 24

Accepting cancer
Existential concerns
Palliative care
Keeping well
Planning for end-of-life
Reprioritising

Question 25

What is demoralisation in the context of end of life care?

Answer 25

Results from existential conflict
Symptoms of hopelessness caused by a loss of purpose/meaning in life
Associated with hastened desire for death
Clinically significant (13-18%)
Inadequately treated depression + anxiety
Reduced social functioning

Question 26

What are some of the caregiver concerns associated with end of life care?

Answer 26

Physical and emotional exhaustion
Financial burdens of care
Increased psychological distress
Decreased QOL/sense of coherence
Multiple demands